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Melo TAR, Bezerra CO, Fernandes BD, Rotta I, Reis WCT, Aguiar PM. Pharmacists' contribution to benzodiazepine deprescribing in older outpatients: a systematic review and meta-analysis. Int J Clin Pharm 2023; 45:1037-1049. [PMID: 37713028 DOI: 10.1007/s11096-023-01637-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking. AIM This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients. METHOD A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software. RESULTS A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence). CONCLUSION Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.
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Affiliation(s)
- Thiago Afonso Rodrigues Melo
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Conj. das Químicas, Bloco 13, Cidade Universitária Butantã, São Paulo, Brazil
| | - Cleyton Oliveira Bezerra
- Municipal Health Department, Multiprofessional Residency Program in Family and Community Health, João Pessoa, PB, Brazil
| | | | - Inajara Rotta
- Department of Pharmacy, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Patricia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Conj. das Químicas, Bloco 13, Cidade Universitária Butantã, São Paulo, Brazil.
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Ramos DC, Ferreira L, Santos Júnior GAD, Ayres LR, Esposti CDD. Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals. CIENCIA & SAUDE COLETIVA 2022; 27:3531-3546. [PMID: 36000642 DOI: 10.1590/1413-81232022279.19972021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: "understanding of the practice and perceived benefits", "acceptance and adherence to the practice, and "hindrances to the practice". The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.
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Affiliation(s)
- Diego Carneiro Ramos
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29047-105 Vitória ES Brasil. .,Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia. Barreiras BA Brasil
| | - Lorena Ferreira
- Instituto Capixaba de Ensino, Pesquisa e Inovação em Saúde, Secretaria Estadual de Saúde do Espírito Santo. Vitória ES Brasil
| | | | - Lorena Rocha Ayres
- Instituto de Biotecnologia, Universidade Federal de Catalão. Catalão GO Brasil
| | - Carolina Dutra Degli Esposti
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29047-105 Vitória ES Brasil.
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Ramos DC, Ferreira L, Santos Júnior GAD, Ayres LR, Esposti CDD. Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022279.19972021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: “understanding of the practice and perceived benefits”, “acceptance and adherence to the practice, and “hindrances to the practice”. The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.
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Affiliation(s)
- Diego Carneiro Ramos
- Universidade Federal do Espírito Santo, Brazil; Universidade Federal do Oeste da Bahia, Brasil
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Rodrigues CF. Communicative trust in therapeutic encounters: users' experiences in public healthcare facilities and community pharmacies in Maputo, Mozambique. Soc Sci Med 2021; 291:114512. [PMID: 34717287 DOI: 10.1016/j.socscimed.2021.114512] [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: 04/30/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022]
Abstract
Interactions between healthcare users and providers are an essential but often problematic element in therapeutic processes. In many settings worldwide, there has been a general recognition of the importance of adopting care approaches that understand patients as active agents, moving away from traditional paternalistic forms of interaction. Research shows that improving the quality of communication in therapeutic encounters fosters mutual understanding and cooperation in healthcare processes, helping to create the grounding conditions for building trusting relationships. But what are the communicative mechanisms through which trust in healthcare providers is cultivated? Going beyond the traditional 'doctor-patient' dyad analysis, and using data from a mixed-method study on medicine use in Maputo, Mozambique, this paper explores healthcare users' experiences and interpretations of their interactions with public healthcare professionals (medical doctors and prescribing nurses) and community pharmacy workers (pharmacists, technicians and other attendants). The analysis evolves around various communicative and relational aspects, emphasised by users as meaningful and underpinning different qualities of care, competence, integrity and trustworthiness. These attributes were assessed based on a combination of verbal conversation and information exchange, together with the use of other (non-verbal) situationally valued artefacts such as biomedical tools and communicative rituals performed by providers. This study shows that despite healthcare providers' different attributes of competence and authority, it is mainly their communicative performances during interactions that influence whether (symbolic) trust has the space to evolve or crystallise. Moreover, while performing certain rituals may be an effective form of communication, the lack of other (verbal and non-verbal) communicative elements during the interaction may compromise patient trust in what is being prescribed or advised. Efforts to improve the quality and responsiveness of healthcare services centred around citizens' needs should take users' perspectives into account and pay particular attention to these communicative and relational dimensions.
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Affiliation(s)
- Carla F Rodrigues
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands; Department of Sociology, Eduardo Mondlane University, Maputo, Mozambique.
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Rose AJ, Witt D, Azran C, Nissan R. Seven key parameters that facilitate clinical pharmacy practice: a comparison between Israel and the United States. Isr J Health Policy Res 2021; 10:37. [PMID: 34193277 PMCID: PMC8246679 DOI: 10.1186/s13584-021-00476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Clinical pharmacists have advanced training that enables them to manage medication therapy, including prescribing, titrating, and discontinuing medications, in order to achieve therapeutic goals. In some countries, such as the United States, advances in training, responsibility, legal frameworks, and public acceptance of new roles have proceeded in parallel to expand the scope and contribution of clinical pharmacists over several decades. In this manuscript, we detail seven discrete key parameters of professional advancement for clinical pharmacists, corresponding to the seven areas in which they must advance in order to contribute fully to delivering high-quality medical care. For each key parameter, we briefly summarize the progress made in the United States to date, as well as goals for future progress. We then compare this to the development of the analogous key parameter in Israel. We found that on some key parameters, the development of clinical pharmacy in Israel lags behind the United States. This manuscript can provide a roadmap for the future advancement of clinical pharmacy in Israel, toward its full realization as a profession that can contribute to delivering high-quality medical care.
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Affiliation(s)
- Adam J Rose
- Hebrew University School of Public Health, Jerusalem, Israel.
| | - Daniel Witt
- University of Utah College of Pharmacy, Department of Pharmacotherapy, Salt Lake City, UT, USA
| | - Carmil Azran
- Department of Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Ran Nissan
- Pharmacy Services, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Beit Rivka Geriatric Rehabilitation Center, Petah Tikva, Israel
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Mills T, Patel N, Ryan K. Pharmacist non-medical prescribing in primary care. A systematic review of views, opinions, and attitudes. Int J Clin Pract 2021; 75:e13827. [PMID: 33169464 DOI: 10.1111/ijcp.13827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/05/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Uptake of non-medical prescribing by pharmacists working in primary care has been slow. This is despite benefits such as quicker and more efficient access to medicines for patients, a reduction in doctor workload, and enhanced professional satisfaction. This systematic review explores the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing. METHODS Medline, ScienceDirect, Embase, and the University of Reading Summon Service were searched to identify qualitative and mixed methods papers that examined the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing. Papers published between January 2003 and September 2017 were included. Studies were quality assessed using the CASP checklist and then analysed using thematic synthesis. RESULTS After 85 full-text articles were assessed, a final 14 studies were eligible for inclusion. The included studies assessed pharmacists who currently prescribe, and other pharmacists and graduates with familiarity of non-medical prescribing. Thematic synthesis identified two themes: (1) practice environment, and (2) pharmacist's role. Non-medical prescribing was considered a natural extension to the role of a pharmacist despite difficulties in completing the required training. The ability to then prescribe was dependent on funding and access to medical records, time, and support staff. Pharmacists experienced professional rivalry with both support and resistance from members of the primary care team. The provision of training was frequently referred to as unsatisfactory. Pharmacists were motivated to prescribe, deriving increased job satisfaction and a sense of professionalism; however, they often felt underprepared for the reality of unsupervised practice. Furthermore, pharmacists reported a cautious approach with a fear of making errors frequently discussed. CONCLUSIONS This review has identified themes and subsequent barriers and facilitators to non-medical prescribing. Many of the barriers are more perceived than real and are diminishing. Consideration of these will assist and advance pharmacist prescribing in primary care, leading to positive outcomes for both patient care and the pharmacy profession.
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Affiliation(s)
- Timothy Mills
- Reading School of Pharmacy, University of Reading, Reading, UK
| | - Nilesh Patel
- Reading School of Pharmacy, University of Reading, Reading, UK
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Reading, UK
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Expanding Canadian Medicare to include a national pharmaceutical benefit while controlling expenditures: possible lessons from Israel. HEALTH ECONOMICS POLICY AND LAW 2018; 13:323-343. [DOI: 10.1017/s174413311700041x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn Canada, there is an ongoing debate about whether to expand Medicare to include a national pharmaceutical benefit on a universal basis. The potential health benefits are understood to be significant, but there are ongoing concerns about affordability. In Israel, the National Health Insurance benefits package includes a comprehensive pharmaceutical benefit. Nonetheless, per capita pharmaceutical spending is well below that of Canada and the Organization for Economic Co-operation and Development average. This paper highlights seven strategies that Israel has employed to constrain pharmaceutical spending: (1) prioritizing new technologies, subject to a global budget constraint; (2) using regulations and market power to secure fair and reasonable prices; (3) establishing an efficient pharmaceutical distribution system; (4) promoting effective prescribing behavior; (5) avoiding artificial inflation of consumer demand; (6) striking an appropriate balance between respect for IP rights, access and cost containment; and (7) developing a shared societal understanding about the value and limits of pharmaceutical spending. Some of these strategies are already in place in some parts of Canada. Others could be introduced into Canada, and might contribute to the affordability of a national pharmaceutical benefit, but substantial adaptation would be needed. For example, in Israel the health maintenance organizations (HMOs) play a central role in promoting effective prescribing behavior, whereas in HMO-free Canada other mechanisms are needed to advance this important goal.
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Schwartzberg E, Nathan JP, Rosen B, Marom E. Pharmacy in Israel. Am J Health Syst Pharm 2018; 75:e57-e61. [DOI: 10.2146/ajhp160986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eyal Schwartzberg
- Pharmaceutical Division Ministry of Health, State of Israel Jerusalem, Israel
- School of Pharmacy Ben-Gurion University Beer-Sheva, Israel
| | - Joseph P. Nathan
- International Drug Information Center Arnold & Marie Schwartz College of Pharmacy and Health Sciences Long Island University Brooklyn, NY
| | - Bruce Rosen
- Smokler Center for Health Policy Research Myers-JDC-Brookdale Institute Jerusalem, Israel
| | - Eli Marom
- Pharmaceutical Division Ministry of Health Jerusalem, Israel
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Khan MU, Arief M, Ahmad A, Malik S, Gogoi LJ, Kalita M, Saleem F, Hassali MAA. A cross-sectional survey on the attitudes and interests of rural population towards expanded pharmacist prescribing in India. Int J Clin Pharm 2017; 39:473-477. [PMID: 28260131 DOI: 10.1007/s11096-017-0443-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
Abstract
Background Shortage of qualified medical doctors and little or no access to basic medicines and medical facilities are the major rural health concerns in India. Expanding the role of pharmacists to provide prescribing services could improve rural health outcomes. Objective To assess the attitudes of rural population towards pharmacist prescribing and their interest in using expanded pharmacist prescribing services. Setting Rural population of Assam, India. Methods A descriptive, cross-sectional survey was conducted for a period of 2 months from March to April 2016 in the State of Assam, India. A multi-stage sampling was used to recruit (n = 410) eligible participants. Main outcome measure Rural population attitudes towards, and interests in using, pharmacist prescribing services. Results The attitudes of participants were generally positive towards pharmacist prescribing. A large proportion of participants (81.5%) agreed that pharmacists should have a prescribing role in rural India. Participants indicated their interest in using expanded pharmacist prescribing services, with greater interests in receiving medications in emergency situations (79.7%) and getting a treatment plan for their medical problem (75.6%). Participants with low income and tertiary education had better attitudes and showed more interest towards expanded pharmacist prescribing services (p < 0.05). Conclusions Most participants had positive attitudes towards pharmacist prescribing and were interested in using expanded pharmacist prescribing services.
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Affiliation(s)
- Muhammad Umair Khan
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Mohammad Arief
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Akram Ahmad
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Sadiqa Malik
- Department of Internal Medicine, Swan Neelu Angel's Hospital, New Delhi, 110017, India
| | - Lakhya Jyoti Gogoi
- Department of Medical Lab and Mocecular Diagnostic Technology, Mangaldai College, Mangaldai, Assam, 784125, India
| | - Manabendra Kalita
- Institutional Level Biotech Hub, Dakshin Kamrup College, Mirza, Assam, 781125, India
| | - Fahad Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, 87550, Pakistan
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Pinang, Malaysia
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Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study. Int J Clin Pharm 2016; 38:960-7. [PMID: 27194098 DOI: 10.1007/s11096-016-0321-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all stakeholders acknowledged the potential of pharmacist prescribing to increase patients' access to medicines in Nigeria.
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Coming of age: pharmacy practice in the 21st century. Isr J Health Policy Res 2015; 4:62. [PMID: 26673401 PMCID: PMC4678472 DOI: 10.1186/s13584-015-0058-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022] Open
Abstract
Individuals, families, health plans and governments are struggling with the growing importance of managing chronic, non-communicable diseases. People in many countries are living longer and thus are facing many years of managing hypertension, diabetes and hyperlipidemia – often complicated by obesity, declining physical activity and changing diets. The financial burden this places on governments, employers, and individuals purchasing health care services is growing and solutions are being sought on how to both finance this care and deliver the best care possible. New ideas are emerging that look to newfound resources, and one untapped resource increasingly being utilized is the clinical pharmacist. After many years being primarily involved in medication supply-chain management, the assistance that highly skilled pharmacists can provide medical providers and their patients is now being recognized. In order to realize fully the benefits of clinical pharmacists, governments, health plans and medical providers are taking a second look at the wisdom of maintaining the long-standing policy of compensating pharmacists only for filling prescriptions.
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