Assistive products in pharmacy practice to optimize medications use for visually impaired patients: Focus groups to explore community pharmacists' opinions and expectations

Background

Visual impairment can significantly affect a person's ability to take medications safely. Therefore, pharmacists need to ensure safe and effective access to medication information, particularly through the use of assistive products, which are devices that compensate for partial or total vision loss. Although assistive products are used by visually impaired patients for activities of daily living, their use in medication management needs to be more widespread.

Objective

The study aimed to investigate community pharmacists' opinions and excpectations on the use of assistive products in pharmacy practice to optimize and secure medications use for visually impaired patients. The goal is to transfer these assistive products to pharmacy practice.

Methods

Focus groups were conducted with 6 French-speaking community pharmacists via videoconference in Belgium, following the principle of participatory action-research. The participants were recruited voluntarily, and moderator's guides were developed to lead the discussion. The focus groups were recorded, transcribed verbatim, and analyzed in a double-blind fashion using thematic analysis. The data were organized by NVivo software.

Results

Four themes were identified: easy-to-use assistive products according to pharmacists, usefulness of assistive products in pharmacy practice, barriers to the use of assistive products, and potential solutions. According to community pharmacists, certain assistive products were deemed easy-to-use and transferable to pharmacy practice.

Conclusions

This qualitative study demonstrates the transferability of assistive products to pharmacy practice for visually impaired patients in medications use. The study taken into account the patient's profile and the multidisciplinary approach, which community pharmacists consider essential.

Designing Hospital and Pharmacy Services for Visually Impaired Persons in Bangkok, Thailand

This cross-sectional study aimed to develop a hospital and pharmacy services model from the patient's perspective, identifying the gap and domain for services improvement. The study was conducted on 140 persons aged ≥ 18 years with visual impairment or low vision in Bangkok, Thailand. The results demonstrated that patients' perceived services were not inclusively designed for visually impaired persons. The domains with the highest gap analysis score were navigation systems, followed by a detailed explanation, such as dose mismanagement, observed medication expiration dates, and pharmacy self-identification. The patient-centered service model empowered visually impaired persons to achieve medication outcomes and safety.

Pharmaceutical care for visually impaired patients: a qualitative study of community pharmacists' needs and professional experience

BACKGROUND

Visual impairment is a disability that can have a significant impact on the ability to take medication safely. As a result, pharmacists must adjust their practice to provide targeted and adapted support for this type of patient.

AIM

The aims of the present study were (1) to illustrate the usual clinical practice of community pharmacists to support the optimisation of medication use in visually impaired patients, and (2) to identify solutions to improve pharmaceutical care for visually impaired patients.

METHOD

Semi-structured interviews with 18 French-speaking community pharmacists were conducted via videoconference in Belgium. Participants were recruited on a voluntary basis and through a snowball method. An interview guide was developed based on literature review. Interviews were carried out until theoretical saturation of the data, recorded, transcribed verbatim and analysed using thematic analysis. Data were organised by NVivo Software.

RESULTS

Four themes were identified: community pharmacists' training, identification of visually impaired patients by the pharmacist, communication with visually impaired patients and their proxies, and provision of appropriate pharmaceutical care. Participants stated that they had not received any training regarding visual impairment. They described that they did not always know how to recognise visually impaired patients and that communication was often difficult.

CONCLUSION

This qualitative study has highlighted a lack of knowledge and skills among community pharmacists regarding visual impairment. One possible solution could be to develop recommendations and tools to improve the care of these patients.

Improving health equity: Evaluation of accessible written medication information for patients with visual impairment

BACKGROUND

Currently, there are limited options for patients with visual impairment or blindness to obtain accessible written medication information.

OBJECTIVES

The objectives of this study were to determine the availability of accessible medication guides provided by the manufacturer and identify common barriers reported by patients with visual impairment in obtaining accessible written medication information in health care settings.

DESIGN

Prospective, cross-sectional study.

SETTING AND PARTICIPANTS

Participants of the survey portion included individuals with visual impairment who were administered an online questionnaire.

OUTCOME MEASURES

Availability of accessible medication guides as verified by 39 manufacturers and accessibility assessed using a checklist based on revised Section 508 guidelines and testing with a screen reader for accessibility. To identify barriers in obtaining written medication information, respondents were recruited by Qualtrics to fill out an anonymous, online 13-question survey from September to October 2022.

RESULTS

All manufacturers did not provide an accessible medication guide or an alternative format. Common errors found by the screen reader were lack of a description for images (alternative text) and headings were not available to help with navigation. As for the survey, a total of 699 participants responded. The median age was 35 years and 49% of respondents were female. A paper copy was the most common format (38%) provided in the pharmacy and barriers identified included lack of Braille or electronic options and personnel not equipped to serve patients with visual impairment.

CONCLUSION

With the lack of accessible written medication information as a barrier to health equity, pharmacists and manufacturers need to provide alternative formats such as audio, electronic formats, or Braille to patients with visual impairment.

Regulation of Drug Prescribing Information in Latin America and the Caribbean

OBJECTIVE

To describe the status of drug regulations in Latin America and the Caribbean, in force as of May 2021, and assess through a comparative exercise the differences between the countries under scope on prescribing information of drugs for human use.

MATERIALS AND METHODS

A narrative review allowed the identification of the regulations concerning the prescribing information of drugs in 25 countries in Latin America and the Caribbean for the registration of prescription medications. On this basis, terms and concepts regarding this topic, the general provisions by the regulatory authorities for these products, applications for health registration and further amendments were identified for each country.

RESULTS

The Latin American and the Caribbean countries included, manage and regulate drug prescribing information differently in terms of concepts, information publishing, structure for product information, among other criteria. Few health authorities publish product information on their website. Additionally, the patient information leaflet is not requested for prescription drugs in most of the studied countries. There is no standardized structure for drug product information within the region.

CONCLUSIONS

A poor level of harmonization among the regulations from these countries regarding the content and management (e.g. if physical package insert is required or not, if it is subject to notification or approval) of the prescribing information of human use drugs became evident. Also, there is a visible lack of standardization of concepts for referring to a specific document (e.g., package insert for healthcare professionals, patient information leaflet and technical information for the drug product) and in the content itself.

Development of a 3D-printed Medication Label for the Blind and Visually Impaired

This study explored the potential of three-dimensional printing (3DP) technology in producing a three-dimensional (3D) medication label for blind and visually impaired (BVI) patients to ease their drug administration. Different variations of label wordings, dosing instructions, and medication identifiers were designed with reference to guidelines by the American Foundation for the Blind. Shapes and symbols were used as dosing instructions and medication identifiers to the patient's medical conditions. Prototype designs were created with common graphics computer-assisted drafting software and 3D-printed using acrylonitrile butadiene styrene as the polymer filament. Feedback was then obtained from five people with normal vision and four BVI persons. The initial prototype comprised four components, namely, medication name and strength, patient's name, dosing instruction, and medication identifier. A revised label comprising the latter two components was developed after feedback by BVI persons. Words were in all uppercase and regular font type, with a 5-mm center-to-center letter spacing. Elevation heights of the letters alternated between 1 mm and 1.5 mm. A half sphere represented the medication dose unit, while vertical lines and a horizontal center line with alternating elevation of arrowheads represented the frequency of administration and the medication's consumption in relation to food, respectively. Symbols based on target organs were used as medication identifiers. With rapid advancements in 3DP technologies, there is tremendous potential for producing 3D labels in patients' medication management.

Evaluation of medication use and pharmacy services for visually impaired persons: Perspectives from both visually impaired and community pharmacists

BACKGROUND

Visual impairment poses various challenges to individuals in taking their medications, but there is a lack of studies on visually impaired population and their use of medications and pharmacy services.

OBJECTIVES

In this study, we aimed to examine (1) the usage pattern of medications and pharmacy services in visually impaired persons and (2) the status of medication counseling conducted to the visually impaired persons by the community pharmacists.

METHODS

This was a cross-sectional study conducted both to visually impaired and community pharmacists. After pilot testing, survey questionnaires were prepared for each group. Visually impaired participants were recruited from two institutions for visually impaired in South Korea. Pharmacists working at 47 community pharmacies that were selected for braille sticker distribution by the Seoul Metropolitan Government were recruited. SPSS Statistics 23 was used for statistical analysis.

RESULTS

One hundred and fourteen visually impaired and 36 pharmacies participated in this study. Majority of the visually impaired participants reported experiencing challenges in identifying medications at home but were using their own methods, such as the use of different storage containers or locations to distinguish medications. While the visually impaired preferred more detailed counseling and use of various tools for medication counseling, the majority of the pharmacists performed counseling to the patients' family members or caretakers.

CONCLUSIONS

For challenges in managing medications by the visually impaired persons, community pharmacists can play a role by putting efforts to understand their impairment and utilize tools available to guide them.

'Has she seen me?': a multiple methods study of the pharmaceutical care needs of older people with sensory impairment in Scotland

OBJECTIVES

To explore the pharmaceutical care needs of, and service provision to, older people with sensory impairment (visual, hearing and dual impairment) on prescribed polypharmacy (≥4 medicines) in Scotland.

DESIGN

Interviews were conducted with older people with sensory impairment and community pharmacy personnel, which informed the content of a subsequent national cross-sectional survey of community pharmacists.

SETTING

Scotland, 2015-2016.

PARTICIPANTS

Older people with sensory impairment and community pharmacy personnel.

RESULTS

Interviews were completed with 23 older people with sensory impairment (dual impairment n=13, visual or hearing impairment n=5 of each) and 30 community pharmacy personnel from eight of 14 Scottish Health Boards. A total of 171 survey responses were received.Older people reported that they did not always disclose their sensory impairment to pharmacy personnel. They also reported that medicines were difficult to identify particularly when their name, shape or colour changed. Pharmacy personnel relied on visible cues such as white canes or guide dogs to identify visual impairment and suggested that hearing loss was less visible and more difficult to identify. Many assistive aids in support of medicine management, such as dosette boxes, seemed inadequate for complex medication regimens. Few community pharmacy personnel reported receiving training in the care of people with sensory impairment.

CONCLUSIONS

This is the first comprehensive, multistakeholder, in-depth exploration of the pharmaceutical care needs of older people with sensory impairment. Strategies are needed to enable people with sensory impairment to disclose their impairment to pharmacy personnel (and other healthcare providers). Community pharmacy personnel require training to deliver person-centred pharmaceutical care for older people with sensory impairment particularly regarding communication with individuals in this vulnerable population.