Ten recommendations to improve pharmacy practice in low and middle-income countries (LMICs)

Building an effective medicines optimisation model: a health system approach

This commentary narrates on the building of an effective and innovative medicines optimisation model. It discusses the essential features, emphasizes the need, and considers the strong health and pharmacy system as a prerequisite before such a model could be built. The paper argues that it is important to strengthen the health system before the elements of pharmaceutical care and medicine optimisation can take shape. It discusses the discourse and interplay between medicine use and medicine access research. The other important elements to include are the "selection of medicines by health technology assessment", "economic evaluation of pharmacy services", "pharmacists' remuneration by the government", "Health system strengthening status", "quality use of generic medicines programmes", "rationale prescribing", "access to medicines and medicines pricing", "medicines advertising" and the "state of pharmacy practice and the development of the pharmacist's role". A set of different high-, middle- and low-income countries are used to provide examples of the status of the health system and the subsequent development of pharmacy practice and medicines optimisation. The countries include the UK, Australia, New Zealand, Pakistan, Türkiye, Malaysia, India, and Pakistan.

Pharmacy practice and policy research in Türkiye: a systematic review of literature

Background

In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far.

Objectives

This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research.

Methods

The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC.

Results

In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies.

Conclusions

The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.

An exploratory study to identify the factors influencing community pharmacist retention by using COM-B model

BACKGROUND

Due to multitude of gaps in Pakistan's healthcare system, community pharmacies serve as the" first port of call" for various illnesses. However, the present scarcity of pharmacists in these settings poses significant challenges to healthcare delivery in the country. This scarcity is primarily due to difficulties in retaining pharmacists for community practice. The aim of this study was to explore the factors that influence the retention of community pharmacists by using COM-B model.

METHODS

A qualitative methodology employing the COM-|B model was utilized to design this study. In-depth interviews were conducted with pharmacists experienced in community pharmacy practice, at time and place convenient to them. Data were transcribed, translated and analyzed by deductive thematic analysis in accordance with the constructs of COM-B model.

RESULTS

A diverse range of factors were identified that negatively influenced the retention of community pharmacists including working conditions and proprietor's demeanor, deficiency in training and intern experience, lack of career planning, low social acceptance, less salary and job satisfaction, less regulatory control and aptitude of renting out category. Conversely, the study also identified the factors that motivate community pharmacists to stay in their roles despite the challenges including strong educational background, abundant job opportunities, flexible schedules, direct patient engagement and positive impact on sales.

CONCLUSION

There was an observed discrepancy between the challenges faced by community pharmacists and the motivators that encourage them to continue their job. Due to a disparity and abundance of challenges rather than motivators, retention rates for community pharmacists are low. This imbalance shed light on areas where improvements are needed to enhance pharmacist retention. Various areas for change were highlighted including strict implementation of regulations, integration of practical experience of community pharmacy practice and internships into academic programs, career guidance, and raising patient awareness about the roles of community pharmacists.

Public Knowledge and Beliefs Regarding Pharmacy-Based Immunization in Poland-A Nationwide Cross-Sectional Study, 2024

Pharmacy vaccinations are a key public health intervention. This study aimed to assess society's knowledge about pharmacy vaccinations in Poland. A cross-sectional study was conducted from 10 to 13 May 2024 among 1126 adults; the survey questionnaire contained 13 closed questions. Men (OR: 1.32; [1.02-1.70]; p < 0.05), and people aged 50-64 (OR: 1.55; [1.05-2.28]; p < 0.05), people with higher education (OR:1.74; [1.35-2.26]; p < 0.001), and people declaring trust in the pharmacist's competencies (OR:3.95; [3.03-5.15]; p < 0.001) more often declared knowledge of vaccinations in pharmacies. Support for these services was declared by men (OR:1.74; [1.28-2.36]; p < 0.001) and people with higher education (OR:1.39; [1.02-1.89]; p < 0.05) and participants declaring trust in the pharmacist's competences (OR:20.30; [14.65-28.11]; p < 0.001). Trust in pharmacists was important. People declaring trust in pharmacists were much more willing to get vaccinated against influenza (40.2%) and zoster (38.0%) at a pharmacy and declared that they would vaccinate their children against HPV at a pharmacy (38.8%) compared to people who did not trust the competences of pharmacists (p < 0.001). There was a significant difference in the case of influenza. People who trusted pharmacists were five times more likely to declare their willingness to get vaccinated against influenza (p < 0.001).

Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries

Antimicrobial resistance (AMR) is a global public health crisis that impedes the therapeutic effectiveness of available antimicrobial agents. Due to the high burden of infectious diseases and limited resources, especially trained healthcare professionals, low- and middle-income countries (LMICs) are particularly susceptible to the detrimental effects of AMR. Sometimes, as the first and last point of contact for patients seeking treatment for infections, community pharmacists can play a pivotal role in the stewardship required for AMR. This review aims to highlight the contributions made by community pharmacists in LMICs as AMR stewards. The review considers the challenges from the perspectives of limited resources, inadequate training, a lack of policies and regulations, and issues related to patient behavior. Community pharmacists in LMICs could optimize their advocacy contributions by focusing on One Health AMR stewardship. Transformational and actionable patient and population-centric antimicrobial stewardship (AMS) is feasible with the synergy of policymakers and other healthcare providers in the implementation of AMS policies and programs that support community pharmacists in their efforts to promote rational antimicrobial use.

Advancing opioid stewardship in low-middle-income countries: challenges and opportunities

The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.

Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: A systematic review and meta-analysis of randomized control trials

BACKGROUND

Medication-related problems (MRPs) continue to impose a voluminous health impact, particularly among patients on anti-cancer therapy, due to the nature and complexity of the care. Pharmacists have a pivotal role in ensuring the safe, effective, and rational use of medicines in this group of patients.

OBJECTIVES

To examine the impact of pharmacist-led interventions in resolving MRPs among patients treated for cancer.

METHODS

This systematic review and meta-analysis was conducted and reported following the PRISMA protocol and registered in PROSPERO (Registration number: CRD42022311535). Four database searches, PubMed, EMBASE, Cochrane, and International Pharmaceuticals Abstracts, were systematically searched from August 2022 to January 2023. Only randomized control trials (RCTs) were included. The Cochrane risk of bias assessment tool was used to check the quality of the included studies. The outcome measures were overall MRPs, adherence, medication errors, and adverse drug events (ADEs). Data for meta-analysis were analyzed used using STATA version 17 and standardized mean difference effect sizes were calculated for continuous outcomes and odds ratio for categorical outcomes.

RESULTS

Out of the 90 studies screened for eligibility, 20 RCT studies were included for the systematic review and 15 for the meta-analysis. Close to two-thirds of the studies were from Europe (n = 7) and Asia (n = 6). A combination of educational and behavioral intervention strategies were used for a period ranged from 8 days to 12 months. The pharmacist-led intervention improved adherence to treatment by 4.79 times (AOR = 4.79; 95%CI = 2.64, 8.68; p-value<0.0001), reduced the occurrence of ADEs by 1.28 (SMD = -1.28; 95%CI = -0.04-2.52; p-value = 0.04) and decreased the overall MRPs by 0.53 (SMD = -0.53; 95%CI = -0.79, -0.28; p-value<0.0001) compared to control groups.

CONCLUSION

This study found out that pharmacist-led interventions can significantly lower MRPs among patients treated for cancer. Hence, a global concerted effort has to be made to integrate pharmacists in a multidisciplinary direct cancer care.

Antimicrobial Dispensing Practices during COVID-19 and the Implications for Pakistan

Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of 'Watch' and 'Reserve' antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19 in Pakistan. A cross-sectional study was undertaken, collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%), with pharmacists/pharmacy technicians present in 32.6% of outlets. In total, 11,092 prescriptions were analyzed; 67.1% of patients were supplied at least one antimicrobial, 74.3% antibiotics, 10.2% antifungals and 7.9% anthelmintics. A total of 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. In addition, 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). Overall, 59.2% antibiotics were 'Watch' antibiotics, followed by 'Access' (40.3%) and 'Reserve' (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were 'Watch' and 31.7% 'Access'. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic, including for patients with COVID-19, alongside generally extensive dispensing of 'Watch' antibiotics. This needs to be urgently addressed with appropriate programs among pharmacists/pharmacy technicians to reduce AMR.

Community pharmacist's preparedness to provide patient-centred care in Saudi Arabia

Background

Community pharmacy practice in Saudi Arabia is evolving and needs to be at par with the developed world. Community pharmacists can play a vital role in bridging gaps in the delivery of healthcare services by providing patient-centred care to patients and contributing toward the healthcare transformation plan of vision 2030 of Saudi Arabia. The present study is aimed at evaluating the knowledge, attitude, and practices of community pharmacists in delivering patient-centred care services.

Method

A nationwide cross-sectional survey using a validated and pre-tested 27-item self-reported questionnaire was conducted amongst 301 (86.4% male, 13/6% female) community pharmacists from all regions of Saudi Arabia. Both descriptive and inferential analysis was employed using the SPSS version, with 0.05 as the level of significance.

Results

Community pharmacists from chain pharmacy groups, female gender and staff community pharmacists had statistically better overall practice standards, knowledge, and attitude to conduct patient-centred care services (p less than 0.01). The majority of community pharmacists would expect extra remuneration and participation in structured professional skills development programs to provide patient-centred care efficiently. Inaccessibility of patient data from healthcare facilities, the unavailability of informative literature, and administrative workload were among the barriers cited in delivering patient-centred care.

Conclusion

The study findings show that community pharmacists could play a significant role in providing patient-centred care and contribute to the achievement of the healthcare reform agenda of Saudi Arabia. However, some obstacles must be overcome before this practice can be shifted, including the introduction of a formalized continuing professional development program, financial incentives, and a decrease in the administrative burden on pharmacists. The results of this study may help policymakers in Saudi Arabia better comprehend the country's existing approach to community pharmacy practice.

Regulatory, safety and economic considerations of over-the-counter medicines in the Indian population

Background and purpose of review

Over-the-counter (OTC) medication has been an integral component of an established health care system but their easy accessibility might pose significant risks. This review has attempted to highlight the present scenario of OTC utilization in India, regarding standard practices followed globally. An attempt has also been made to highlight the lifecycle of a prescription and OTC medicine and the benefits and regulatory process involved in the prescription-to-OTC switch.

Findings

A paradigm shift has been observed in self-medication practice with OTC medicines in recent times and has become a widespread practice worldwide. Numerous key drivers, such as increasing consumer awareness, broader consumer access to essential medication, and socio-economic benefits to the public health care system, have advocated this practice. On the other hand, self-medication using OTC is also inextricably linked with inevitable risks such as excessive drug dosage, polypharmacy, drug abuse, and drug interactions. Nevertheless, these issues could be further regulated by employing a defined OTC framework. The government of India has recognized the utmost need to develop a robust policy framework for the effective utilization of OTC drugs. Also, various initiatives toward modifying existing laws or developing new OTC drug policies has been taken.

Conclusion

Prioritizing the utmost safety of the consumers and evident need of strong regulatory framework with respect to OTC drugs, the term "OTC" has been recommended as a distinct category of drugs by Government of India. This review has highlighted various factors that can play an essential role in OTC utilization and can be considered during policy reformation.

Patients' experience with a community pharmacy fall prevention service

Background

Pharmacists can contribute to fall prevention, by offering services such as fall risk screenings, counselling, and medication reviews. Patient acceptance of the role of pharmacists in fall prevention is crucial.

Objectives

The aim of this study was to explore patients' experience with a community pharmacy fall prevention service.

Methods

Interviews were conducted with patients one month after they participated in a pharmacy fall prevention service, in the Netherlands. Patient inclusion criteria for the service were: age ≥ 70 years, use of ≥5 drugs including ≥1 fall risk-increasing drug. The service included a fall risk screening followed by counselling and a medication review. The semi-structured interview guide was based on the consolidated framework for implementation research and included the following topics: outcomes, patient's motivation, and contact with the pharmacy technician.

Results

Of the 91 participants of the fall prevention service, 87 patients were interviewed with a median age of 78.0 years (first quartile [Q1] - third quartile [Q3]: 74.0-84.75) and 46.3% were female. Many patients expressed positive feedback about receiving a medication review. Most patients whose medication was deprescribed expressed to be positive about this. Others were reassured about the appropriateness of their medication use. Patients reported that the service enhanced their awareness about fall prevention. Only a few patients were motivated to adapt their lifestyle. Patients appreciated the attention and contact.

Conclusions

Patients see a potential benefit for a community pharmacy falls prevention service, including a medication review. Patient education appeared to enhance their fall risk awareness.

Factors Impacting Job Satisfaction among Pharmacists in the Arab World: A Qualitative Study

Purpose

This study was undertaken to investigate in-depth the factors impacting job satisfaction among pharmacists in the Arab world and the challenges they encounter in their career path. The outcome of this study should help the local policymakers to take corrective actions to improve pharmacist's satisfaction and therefore enhance quality of patient care.

Method

This qualitative study collected responses of pharmacists from 12 Arab countries, as part of a large quantitative survey. Participants added comments to an optional open-ended question regarding work satisfaction. The Qualtrics Survey Software was used to collect the responses. The survey was distributed from March to May 2021 through multiple online channels for filling. The responses collected were analysed to develop themes. An inductive constructivist approach was used for the conceptual thematic analysis as the methodological orientation.

Results

A total of 110 responses/comments were received from the study participants. The two largest practice settings of the participants were from hospitals (44.5%) and community pharmacies (28.2%). Almost 40% of responses came from pharmacists practising in Qatar (21.8%) and UAE (18.1%). The survey data demonstrated several reasons impacting job satisfaction among pharmacists practising in the Arab countries. Underestimation of the pharmacists' role, low salaries, lack of motivation and excessive workload were reported as major contributors to job dissatisfaction. On the other hand, professional commitment and the culture of the work setting were the major contributors to job satisfaction.

Conclusions

The study provides valuable insights into the aspects concerning pharmacists' satisfaction in the Arab world. Policymakers and other stakeholders need to act upon aspects of pharmacists' job satisfaction and dissatisfaction to ensure potentially better working environment and patient outcomes.

A comprehensive survey of cancer medicines prices, availability and affordability in Ghana

INTRODUCTION

In Ghana, prices for cancer medicines are characterized by high retail markups, forex fluctuations and high variation in prices of medicines. Most patients cannot afford the cancer medicines. There is a problem of unaffordability and limited availability of essential cancer medicines which suggests potential inequity in patient access to cancer medicines. The study objective was to assess the prices, availability, and affordability of cancer medicines in Ghana. Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost was assessed to determine the affordability.

METHOD

The methods developed and standardized by the World Health Organization (WHO) in collaboration with the Health Action International (HAI), was adapted and used to measure prices, availability, and affordability of cancer medicines in Ghana. The availability of cancer medicines was assessed as percentage of health facilities stocked with listed medicines. The price of cancer medicines (of different brands as well as the same medicine manufactured by different pharmaceutical industries) available in the public hospitals, private hospitals, and private pharmacies was assessed, and the percentage variation in prices was calculated. Medicine prices were compared with the Management Sciences Health's International Reference Prices to obtain a Median Price Ratio (MPR). The affordability of cancer medicines was determined using the treatment cost of a course of therapy for cancer conditions in comparison with the daily wage of the unskilled Lowest-Paid Government Worker.

RESULTS

Overall availability of cancer medicines was very low. The availability of Lowest Priced Generic (LPG) in public hospitals, private hospitals, and private pharmacies was 46%, 22%, and 74% respectively. The availability of Originator Brand (OB) in public hospitals, private hospitals, and private pharmacies was 14%, 11%, and 23% respectively. The lowest median price [United States Dollars (USD)] for the LPG was 0.25, and the highest median price was 227.98. For the OB, the lowest median price was 0.41 and the highest median price was 1321.60. The lowest and highest adjusted MPRs of OBs and LPGs was 0.01 and 10.15 respectively. Some prices were 20.60 times more expensive. Affordability calculations showed that patients with colorectal and multiple myeloma cancer would need 2554 days wages (5286.40 USD) and 1642 days wages (3399.82 USD) respectively to afford treatment.

CONCLUSION

The availability of cancer medicines was very low, and less than the WHO target of 80%. There were considerable variations in the prices of different brands of cancer medicines, and affordability remains suboptimal, as most patients cannot afford the cancer medicines. Comprehensive policies, regulations and multifaceted interventions that provides tax incentives, health insurance, and use of generics to improve cancer medicines availability, prices, and affordability, for the masses should be developed and implemented in Ghana.

A leap towards enforcing medicines prescribing by generic names in low- and middle-income countries (LMICs): pitfalls, limitations, and recommendations for local drug regulatory agencies

The Drug Regulatory Authority of Pakistan (DRAP) in response to the public outcry on increasing medicines prices in the country issued notifications to direct healthcare professionals to prescribe medicines with their generic names. Like DRAP, many regulators in the low- and middle-income countries (LMICs) are also inspiring from the west to legally enforce generic prescribing in a bid to reduce the out-of-pocket public expenditures. However, there are pitfalls in the LMICs drug regulatory framework, which if left unaddressed can severely jeopardise the foreseen benefits of medicines prescribing by generic names. This article critically appraises the impact of prescribing by generic names regulations in LMICs and highlights the key considerations that are vital to address before legally enforcing generic prescribing. The ethics, regulatory compliance, and good governance are the key to success; better generics for a better tomorrow.

Longitudinal study of Good Pharmacy Practice roles covered at the annual world pharmacy congresses 2003-2019

BACKGROUND

Globally accepted roles of pharmacists are described in the Good Pharmacy Practice (GPP) standards, published by the World Health Organization (WHO) and the International Pharmaceutical Federation (FIP) in 2011. These standards provide a wide-ranging description of four main roles pharmacists fulfil. The global platform, where pertinent discussions around excellence and innovation in various pharmacy roles take place, is the annual congress of the pharmacy organisation representing the profession globally, FIP.

OBJECTIVES

Given the world pharmacy congresses present and reflect on the most topical and contemporary matters, this longitudinal study aimed at creating a historical overview of the frequency of appearance of the different GPP roles in the programmes of the past 17 congresses (2003-2019). This is to distinguish the dominance of different roles over time and thus their relevance for the profession.

METHODS

The GPP standards served as a framework to create a set of keywords that were analysed for their frequencies of appearance in the programmes through text analysis. Trends in the four overarching GPP roles and at individual keyword level were analysed descriptively over time.

RESULTS

The study found that all four GPP roles appeared in the programme each year and none of them was significantly missing, neither in the decade preceding the publication of the GPP standards nor in the decade thereafter. Role 3 "Maintain and improve professional performance" was most frequently represented, also demonstrating an upward trend in appearance, together with Role 4: "Contribute to improve effectiveness of the health-care system and public health". Trends emerged towards patient-centred clinical focus and positioning pharmacy as an important player in the health-care system-observed also at individual keywords level in areas such as health promotion-away from the more traditional product-centred practice roles such as compounding.

CONCLUSIONS

GPP roles have been already covered by the FIP annual congresses (long) before 2011, when the GPP roles were formally adopted, and they stayed relevant in the decade after. The more pronounced dominance toward the roles related to improving professional performance and positioning pharmacy are in line with the trend that the rather technical topics in pharmacy are increasingly covered by specialised meetings and that the FIP annual congresses have moved toward more general, scholarly platforms for dialogue and conversation.

A pilot assessment of the career and job satisfaction of the pharmaceutical workforce in Lebanon

BACKGROUND

Lebanon has been recognized as a center for high-quality healthcare services in the Middle East because of its prestigious facilities certified by international bodies, competent health workers, and credible pharmaceutical sector. This study assessed the professional situation of the Lebanese pharmaceutical workforce upon graduation and entry to the job market. It also evaluated the satisfaction of pharmacists with the financial, physical, and psychological aspects of their job and the effect of the current socioeconomic crisis on their profession.

METHODS

A cross-sectional study was performed between January and May 2021 among 114 Lebanese pharmacists from all pharmaceutical sectors across Lebanon. A self-administered questionnaire was elaborated to assess the pharmaceutical workforce in Lebanon. The online questionnaire was built using Google Forms and disseminated via emails and social platforms.

RESULTS

Fresh graduates seemed more oriented toward community pharmacies, and 78.1% of the participants worked at least once in their lifetime in a community pharmacy. Pharmacists from the public university worked predominantly in the community pharmacy sector, while those who graduated from private universities worked mainly as medical representatives. Hospital pharmacy comprised significantly more PharmD graduates than other sectors; medical representatives had mainly a BS pharmacy, while those working as industrial pharmacists had a Master's degree. A low percentage (31.6%) of participants found it easy to get hold of a job across different pharmaceutical sectors while 64.0% considered the internships experience insufficient to get employed. Nearly half (48.2%) of the respondents were poorly satisfied with their job, and 54.0% of community pharmacists reported not working in their preferred field compared to 39.1% of pharmacists from other sectors. Also, 65.79% felt that the economic crisis and the consequent medication shortages affected their credibility and how society perceived them. About half (45.61%) of the participants reported that their employment status was not affected by the crisis; the rest got a second job to cover their expenses (15.79%) or changed jobs (14.91%).

CONCLUSION

Our study findings revealed that most Lebanese fresh graduates worked as community pharmacists, which does not correspond to their preference, the available job market, and the modern pharmacy wingspan. Most pharmacists were also financially, physically, and emotionally dissatisfied due to the Lebanese economic crisis that added heavy workloads and responsibilities without any financial raise.

Perspectives of primary care providers on multidisciplinary collaboration to prevent medication-related falls

Background

The causes of falls are often multifactorial. The prevention of falls benefits from a multidisciplinary approach. As people who fall are generally older and users of polypharmacy who frequently visit pharmacies, pharmacists may contribute to fall prevention.

Objective(s)

This study aims to explore the perceptions of primary care providers on multidisciplinary collaboration in fall prevention especially with pharmacists.

Methods

Two focus groups were held with each of the following health disciplines: physiotherapists, home care nurses, and practice nurses. A topic list was developed based on the capability opportunity motivation – behaviour (COM-B) model and the theoretical domains framework (TDF). Focus groups were audiotaped and transcribed verbatim. Data were collected in the Netherlands between March and June 2021.

Results

Six online focus groups were held with 17 physiotherapists, 14 home care nurses, and 15 practice nurses. Participants reported to collaborate multidisciplinary to prevent falls, but they had very limited collaboration with community pharmacists regarding fall prevention. Participants had limited knowledge on drugs that increase the risk of falls. This contributed to their low awareness of the potential role of pharmacists in fall prevention. Other reasons for poor collaboration in fall prevention were lack of agreements with pharmacists, limited coordination and communication. Participants were open to more collaboration with pharmacists and believed this could potentially improve patient outcomes.

Conclusions

Multidisciplinary agreements among health care providers, including community pharmacists, about referral criteria, roles and responsibilities, communication and coordination, could stimulate further collaboration in fall prevention.

•

Fall prevention needs to receive more attention from primary care providers.

•

Primary care providers have low awareness of the potential role of pharmacists in fall prevention.

•

Primary care providers are positive about collaborating with community pharmacists to prevent falls.

•

Primary care providers need enhanced communication and coordination, clarification of roles, and agreements.

•

Primary care providers expect community pharmacists to focus on deprescribing of fall risk-increasing drugs (FRIDs).

Consumers’ access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review

Information about where medicines are in stock and how much they cost facilitates consumers’ timely access to affordable medicines by enabling price comparisons and the identification of stockists. Our aims were to: (1) Review how consumer access to price and availability information is engaged within the Medicine Access discourse and (2) identify factors associated with the existence of interventions that provide consumers with medicine availability and price information. We conducted two scoping reviews. We reviewed 26 medicine access and pharmaceutical system strengthening frameworks to assess how they conceptualise information access. We then reviewed four interventions that provide consumers with availability and price information to identify the factors associated with these interventions’ existence. We found that in the medical access discourse, information is mainly cast as helpful to entities that ensure medicine access for populations. Information as an enabler of medicine procurement for consumers/households is less emphasised. We then identified the following eight factors that facilitate consumer access to reliable medicine price and availability information: the recognition of a medicine access problem that can be mitigated by consumer access to information; cross-sectoral collaboration; the willingness of medicine sellers to disclose their inventory information; having information quality control measures; appropriate incentives for intervention adoption; enabling legal environments; systems of pooling information; and access to digital information technology infrastructure. We recommend that more theoretical and implementation attention ought to be directed at how medicine price and medicine availability information can empower individual consumers to make sound purchasing decisions.

National pharmacy associations in the commonwealth: current scenario and future needs to maximise effective contributions of the pharmacy profession towards universal health coverage

BACKGROUND

The Commonwealth Pharmacists Association (CPA) is a charity representing pharmacists across the Commonwealth, with the vision of empowering and collaboratively develop the profession and fully utilise the potential of pharmacists to strengthen health systems through supporting better access to, quality and use of medicines and related services. Commonwealth comprises predominantly of low- and middle-income countries, where limited data often exists in pharmacy practice. There is a recognised need across the Commonwealth to focus on developing, implementing and fully utilising pharmacy professional services to progress universal health coverage and achieve the sustainable development goals, particularly in low and middle-income countries; however, currently a knowledge gap exists in understanding the national priorities in Commonwealth nations. CPA is ideally positioned to access to these nations. The aim of this study was thus to explore the priorities and focus areas of NPAs across the Commonwealth and create evidence for a needs-based approach to inform the support that the Commonwealth pharmacists association can collaboratively and strategically provide to its members to progress towards shared goals.

METHODS

Data were collected virtually on Zoom by conducting interviews using a semi-structured interview guide developed for this study with CPA councillors representing NPAs or their equivalents if no official body existed. An inductive, reflexive, thematic analysis was performed for data analysis.

RESULTS

In total, 30 councillors were interviewed from 30 low- and medium-income countries. The three main overarching priority areas identified across respective Commonwealth nations developing extended pharmacy services, improving pharmacy education, and developing and redefining the role of NPAs.

CONCLUSIONS

This novel study highlights the collective priorities for the pharmacy profession across the low and middle-income countries of the Commonwealth and the urgent need for supporting NPAs around the three identified overarching priority areas. The mapped-out priorities will inform an evidence-based approach for the CPA to better support NPAs in their mission through advocacy and practitioner development, to fully harness pharmacists' unique skill set and maximise their contribution to progressing universal health coverage.

Identifying priority medicines policy issues for Qatar: exploring perspectives and experiences of healthcare professionals through a qualitative study

OBJECTIVES

To identify priority medicines policy issues, including the 'use' and 'access to medicines' in Qatar.

DESIGN

In this qualitative study, general inductive method was used and semi-structured exploratory interviews conducted.

SETTING

Stakeholders from a broad range of academic and healthcare practitioners in Qatar.

PARTICIPANTS

Exploratory, semi-structured interviews were conducted with 21 stakeholders throughout Qatar. The inclusion criteria include (a) participants working or involved in the Qatar's healthcare system, (b) participants having experience or working knowledge of medicine policy documents, different facets of it, use of medicines and access to medicines, (c) as well as participants well versed in the English language. It was intended to cover stakeholders from a broad range of healthcare and policy institutions in Qatar.

PRIMARY AND SECONDARY OUTCOME MEASURES

All participants were involved in semi-structured, audio-recorded interviews, which were then transcribed verbatim, coded into NVivo V.12 and followed by thematic analysis to identify the common themes. Perceptions, experiences and opinions regarding Qatar's medicines policy issues were recorded.

RESULTS

This study found challenges related to the availability of pharmaceuticals in Qatar, including medicines registration process. There is no comprehensive national medicines policy in Qatar, however, there are a number of rules, regulations, policies and procedures in place. The community pharmacy services provided are mostly 'traditional' with less emphasis on pharmacists' extended roles and/or cognitive services. The study identifies several areas for improvement including extending the role of the pharmacist, improve the prescribing of antibiotics, medicines compliance and counselling for consumers, pharmacovigilance, implementation of generic medicines policies, as well as the need for a national health record database.

CONCLUSIONS

The findings suggest that in the last 20 years, Qatar has moved towards advancing healthcare; however, there are gaps and opportunities. The strategies need to be developed to resolve access to medicines issues, the priority being medicines registration, import and so on. With the rise of chronic diseases and a growing population, there is also a need to work to improve medicines adherence among patients.A national medicines policy should be developed through a consultative broad-based process in which prescribers, physicians, pharmacists and healthcare professionals be given a chance to contribute.

Drug shops for stronger health systems: learning from initiatives in six LMICs

BACKGROUND

Private sector retail pharmacies, or drug shops, play an important role in access to essential medicines and services in low-and-middle-income countries. Recognising that they have the potential to contribute to health system strengthening efforts, many recent initiatives to engage with drug shops have been launched. These include initiatives that focus on changes in policy, regulation and training. However, the specific factors that influence their success remain poorly understood. Seven country case studies supported under the Alliance's programme of work 'Strengthening health systems: the role of drug shops' help to explore this issue.

METHODS

Country case studies from the above programme of research from Bangladesh, Indonesia, Myanmar, Nigeria, Tanzania and Zambia were used as the main sources of data for this paper. A modified version of Bigdeli et al.'s Access to Medicines framework was applied within a partially grounded approach to analyze each country case study and compare themes between countries.

RESULTS

Many factors may help initiatives targeting drug shops successfully achieve their intended outcomes. At the micro level, these include community demand for drug shops and a positive relationship between drug shops and their clients. At the meso level, facilitators of initiative success include training and positive attitudes from drug shops towards the initiative. Barriers include client pressure, procurement challenges and financial and administrative costs associated with initiatives. At the macro level, collaboration between stakeholders, high-level buy in and supervision, monitoring and regulation may influence initiative success. These factors are inter-dependent and interact with each other in a dynamic way.

CONCLUSIONS

Using a framework approach, these country case studies demonstrate common factors that influence how drug shops can strengthen health systems. These learnings can help inform the design and implementation of successful strategies to engage drug shops towards sustainable systems change.

The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

BACKGROUND

The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.

RESULTS

The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.

CONCLUSIONS

The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

Recommendations to improve pharmacy practice research in the Middle Eastern Arab countries

The expansion of the pharmacist-led services has resulted in increased demand to have evidence in terms of necessity, efficacy, and cost. Evidence-based practice is crucial to provide the best patient health outcomes and pharmacy practice research can play a key role in this regard. This commentary provides a background of pharmacy practice research, and then, it highlights three key recommendations based on a systematic review of the literature. The systematic review of the literature on pharmacy practice research has been conducted in 12 Middle Eastern Arab Countries. The three key recommendations include (a) identification of research priorities by health authorities in each country; (b) pharmacy practice research culture to be nurtured and promoted with academic researchers and practitioners; and (c) shifting pharmacy practice research towards applied, interventional, and implementation studies

Drug Shortage: Causes, Impact, and Mitigation Strategies

Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.

Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa

BACKGROUND

Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost needs to be assessed.

OBJECTIVES

To assess the prices of cancer medicines for the three most common cancers ((breast, prostate and colorectal) in the private healthcare sector of South Africa.

METHODS

The methodology was adapted from the World Health Organization (WHO)/ Health Action International (HAI) methodology for measuring medicine prices. The Single Exit Price (SEP) variations between product types of the same medicine between the highest- and lowest-priced product and between Originator Brand (OB) and its Lowest Priced Generic (LPG) of the same medicine brand was compared, as of March 2020. The affordability of those medicines for cancer usage based on treatment affordability in relation to the daily wage of the unskilled Lowest-Paid Government Worker (LPGW) was also determined. Also, a comparison of the proportion of the population below the poverty line (PL) before (I_pre) and after (I_post) procurement of the cancer medicines was determined.

RESULTS

SEP Price differences ranged from 25.46 to 97.33% between highest- and lowest-priced products and a price variation of 72.09% more for the OB than the LPG medicine, except for one LPG that was more expensive than the OB. Affordability calculations showed that All OB treatments for all three cancers (breast, prostate and colorectal), except for paclitaxel 300 mg (0.2 days wage) and Fluorouracil (Fluroblastin) 500 mg (0.3 days wage) costs respectively were more than 1 day's wage, with patients diagnosed with colorectal cancer needing 32.5 days wages in order to afford a standard course of treatment for a month.

CONCLUSION

There was a considerable variation in the price of different brands of cancer medicines available in the South African private sector.

Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries

In low- and middle-income countries (LMICs), over 12 million people die yearly from chronic diseases and this number is expected to increase if concerted actions are not taken. The purpose of this paper is to highlight the roles and impact of community pharmacists in chronic disease management support and the need for policymakers in LMICs to reposition community pharmacists appropriately for this extended role. Recent findings have shown that community pharmacists are the most accessible healthcare providers to the members of the community. Published evidence have demonstrated that community pharmacists' interventions in chronic diseases significantly improve economic, clinical, and humanistic outcomes. However, they are not officially recognized as primary healthcare providers in LMICs. Therefore, there is need for policy reforms that will encourage strategic use of the clinical skills of community pharmacists as part of the primary healthcare team in LMICs.

Universal health coverage and COVID-19: recent developments and implications

Universal health coverage (UHC) is meant to access the key health services including disease prevention, treatment, rehabilitation, and health promotion. UHC varies according to demographics, epidemiology, and technology-based trends, as well as according to people’s expectations. Globally, the transition towards UHC has been associated with the intent of improving accessibility and affordability of healthcare. The COVID-19 pandemic has disrupted the health systems of even the most developed economies of the world in an unprecedented manner. The situation is also very challenging for the countries with the existing health inequities as well as the countries with the developing healthcare systems. This has amplified the need to accelerate efforts to build strong and resilient health systems to achieve progress towards UHC. This commentary discusses a global overview of UHC in the wake of COVID19. It also highlights the initiatives taken by Pakistan to promote the goals of UHC.