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Cheetham A, Grist E, Nielsen S. Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research. Curr Opin Psychiatry 2024; 37:251-257. [PMID: 38726819 DOI: 10.1097/yco.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. RECENT FINDINGS Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. SUMMARY Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Montero Pérez O, Salazar González F, Sánchez Gómez E, Pérez Guerrero C. Impact of pharmaceutical care for asthma patients on health-related outcomes: An umbrella review. Pharmacol Res Perspect 2024; 12:e1195. [PMID: 38644566 PMCID: PMC11033327 DOI: 10.1002/prp2.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/23/2024] Open
Abstract
Recent systematic reviews suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established, and the role of clinical pharmacists is poorly represented. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients. PubMed, Embase, Scopus, and Cochrane Library were searched from inception to December 2022. Systematic reviews of all study designs and settings were included. Methodological quality was assessed using AMSTAR 2. Two investigators performed study selection, quality assessment and data collection independently. Nine systematic reviews met the inclusion criteria. Methodological quality was rated as high in one, low in two, and critically low in six. Reviews included 51 primary studies reporting mainly quality of life, asthma control, lung capacity, and therapeutic adherence. Only four studies were carried out in a hospital setting and only two reviews stated the inclusion of severe asthma patients. The quality of the systematic reviews was generally low, and this was the major limitation of this overview of systematic reviews. However, solid evidence supports that pharmaceutical care improves health-related outcomes in asthma patients.
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Affiliation(s)
- Olalla Montero Pérez
- Servicio de Farmacia, Institut Catalá d'OncologíaAvinguda de la Gran Via de L'Hospitalet de LlobregatBarcelonaSpain
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Ulutas Deniz E, Gülakar AN, Eren R. A qualitative study on asthma management experiences of Turkish community pharmacists. J Asthma 2024; 61:632-642. [PMID: 38108630 DOI: 10.1080/02770903.2023.2297373] [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: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Asthma is seen in more than 4 million people in Turkey. Numerous studies have shown the beneficial effects of pharmacist interventions on medication adherence and therapeutic outcomes. The aim of this study was to gain insight into the current situation by examining the experiences of Turkish community pharmacists in relation to the counseling and referral of asthma patients, the responsibilities of pharmacists and the recommendations made by pharmacists to improve asthma management. METHODS In this qualitative study, the constructivist-interpretivist paradigm was adopted. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study. RESULTS A total of 14 pharmacists engaged in semi-structured interviews conducted between June and August 2023. The wealth of information gathered during these interviews facilitated a meticulous thematic analysis, yielding four overarching themes: 1) Patient-related difficulties, 2) Communication with physicians, 3) Desired traits and responsibilities of pharmacists, 4) Pharmacists' expectations. Pharmacists placed significant emphasis on their challenges in allocating time to patients, primarily due to high workloads and limited collaboration with physicians. CONCLUSION Considering the workload and time limitations faced by pharmacists, a collaborative model involving pharmacists and physicians is seen as essential. Enhancing the collaboration between pharmacists and physicians, especially for chronic diseases, holds the potential to enhance public health outcomes while alleviating the workload of pharmacists.
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Affiliation(s)
- Elif Ulutas Deniz
- Department of Pharmacy Management, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
| | | | - Rumeysa Eren
- Department of Pharmacy Management, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
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Lim AH, Ab Rahman N, Nasarudin SNS, Velvanathan T, Fong MCC, Mohamad Yahaya AH, Sivasampu S. A comparison between antibiotic utilisation in public and private community healthcare in Malaysia. BMC Public Health 2024; 24:79. [PMID: 38172715 PMCID: PMC10762925 DOI: 10.1186/s12889-023-17579-3] [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: 07/13/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018-2021. METHODS This study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors. RESULTS The overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and 'Not Recommended' antibiotics increased slightly over the years. CONCLUSION Antibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.
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Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia.
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Siti Nur Su'aidah Nasarudin
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Tineshwaran Velvanathan
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Mary Chok Chiew Fong
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Abdul Haniff Mohamad Yahaya
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
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Shahid S, Alqahtani SS, Bajwa M, Rashid M, Sana A, Bajwa A, Ali AN, Ariffin AK, Mahmood M, Ahmed F, Mustafa MA. The Effect of Obesity on Severity of Asthma: An Observational Prospective Study from Pakistan. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:38-43. [PMID: 38694965 PMCID: PMC11060623 DOI: 10.4103/jpbs.jpbs_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/20/2023] [Indexed: 05/04/2024] Open
Abstract
Objective The current research study aimed to access the relationship between obesity and asthma exacerbations and severity among adult patients at the outpatient section of a federal hospital (PIMS) in Islamabad, Pakistan. Methods A cross-sectional research study was carried out on 207 asthma adult patients belonging to different areas and ethnic groups from the country. The study setting was the PIMS hospital, which attracts patients from all over the country due to its facilities and cost-effective treatments. The body mass index (BMI) of asthma patients was calculated using the heights and weights of the study subjects. However, the pulmonary functions were calculated using a computerized spirometer i-e Spirolab III S/N 303681 in line with Winspiro PRO 7.1.version software. It presents the patient's forced vital capacity that expires in the first second of expiration to full (FEV1) in comparison to forced vital capacity (FVC) ratio, that is, Tiffeneau-Pinelli index was also recorded to determine the asthma severity. Results According to recent surveys, the overall prevalence of patients with overweight and obesity was 29.0% and 23.7%, respectively. A Chi-square test was used, and a statistically significant relationship was observed between BMI and asthma severity (P < 0.001). The adult obese female patients presented poor pulmonary functions. The average FEV1/FVC ratio presented significant variance among four different categories of BMI with P < 0.05. This difference was due to the normal BMI category as the Tiffeneau-Pinelli index, that is, FEV1/FVC in the normal BMI group was significantly lower as compared to that in underweight and obese patients. Conclusion The study subjects presented raised asthma severity in accordance with the raised BMI. Obese patients presented comparatively raised asthma exacerbations. Moreover, a statistically significant association of gender difference was observed between obesity and asthma severity. It was concluded that adult asthmatic women with obesity presented raised asthma severity as compared to adult asthmatic males.
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Affiliation(s)
- Sara Shahid
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Mishal Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mahnoor Rashid
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Anosh Sana
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amna Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Abdul N. Ali
- Department of Pharmacy Practice, Geethanjali College of Pharmacy, Cheeryal (V), Keesara (M), Hyderabad, Telangana, India
| | - Ahmad K. Ariffin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, Malaysia
| | - Mahgull Mahmood
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Fahad Ahmed
- Faculty of Pharmacy, University of Sargodha, Sargodha, Punjab, Pakistan
| | - Muhammad Abid Mustafa
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Mahmoud MI, Maatoug MM, Jomaa AAAFA, Yousif M. Sudanese Medical Doctors' Perceptions, Expectations, Experiences and Perceived Barriers Towards the Roles of Clinical Pharmacists: A Cross-Sectional Study. Integr Pharm Res Pract 2022; 11:97-106. [PMID: 35879963 PMCID: PMC9307910 DOI: 10.2147/iprp.s354717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
Purpose Interprofessional collaboration between physicians and clinical pharmacists has been shown to improve patients’ outcome by reduce medical errors, costs and patient adherence. Thus, the purpose of this study was to investigate the medical doctors’ perceptions, expectations, experiences, and perceived barriers regarding clinical pharmacists in Wad Medani. Methods A cross-sectional study was conducted at five major hospitals in Wad Medani, between April and June 2021 using a self-administered questionnaire. The questionnaire was distributed among 178 physicians. The questionnaire consists of four sections, in addition to a demographic section. These four sections measure physicians’ perceptions, expectations, experience, and perceived barriers. Results A total of 178 physicians were enrolled in the study. Physicians were comfortable with clinical pharmacists detecting and preventing prescription errors (55.1%); providing patient education (56.3%). Generally, physicians had high expectations with agreement rate of all the items ranged from 51.7% to 85.4%. Most physicians (79.8%) agreed that clinical pharmacists were a reliable source of general and clinical drug information. 64.0% and 59.0% of physicians perceive the unclear responsibility of clinical pharmacists and the lack of physicians’ experience with clinical pharmacists were barriers that can hinder clinical pharmacists’ contributions, respectively. Conclusion Physicians had positive perceptions, expectations, and experiences with clinical pharmacists, and pointed out some barriers clinical pharmacists face. It was suggested that hospitals should recruit more clinical pharmacists to cover each unit within the hospital with clear job description and provide them CPD.
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Affiliation(s)
- Mohammed Ibrahim Mahmoud
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
| | - Maha Mirghani Maatoug
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
| | | | - Mirghani Yousif
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
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Said ASA, Hussain N, Kharaba Z, Al Haddad AHI, Abdelaty LN, Roshdy RRS. Knowledge, attitude, and practice of pharmacists regarding asthma management: a cross-sectional study in Egypt. J Pharm Policy Pract 2022; 15:35. [PMID: 35505447 PMCID: PMC9062855 DOI: 10.1186/s40545-022-00432-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022] Open
Abstract
Background Asthma is a significant public health issue that poses a substantial health and economic burden. Despite the availability of effective asthma medications, its management remain suboptimal. Recent asthma guidelines have highlighted the importance of pharmacist unique position and its interventional strategies in positively impacting asthma treatment outcomes. Therefore, this study aimed to assess the degree of Egyptian pharmacists’ knowledge, attitudes, as well as their practices towards asthma management in line with the recent asthma guidelines. Methods This cross-sectional study was conducted among 800 pharmacists working in different private and governmental sectors. The data were collected using a 37-item pre-validated self-administered KAP questionnaire. The data were analyzed using Student’s t-test and analysis of variance to assess the association between each KAP level and the sociodemographic variables at the significance level of 0.05. Results Of the 800 distributed questionnaire, a total of 550 participants (316 Male, and 234 Female) responded, representing a 68.7% response rate. The mean ± SD score of knowledge, attitude, practice, and barrier was 5.49 ± 1.65 (min = 0; max = 8), 23.5 ± 2.84 (min = 15, max = 30), 43.12 ± 8.61 (min = 28, max = 62), and 27.76 ± 3.72 (min = 17, max = 39), respectively. The results showed that poor knowledge, attitude, and practice scores were achieved by 30.54, 0, and 38.72% of participants, respectively. Conclusion Our findings revealed the inconsistencies between poor pharmacists’ knowledge and practices with respect to their positive attitudes. The lack of pharmacists’ knowledge and compliance to recent GINA guidelines in this study highlight the crucial need for effective Educational strategies that should better equip pharmacists for their potential role in asthma care.
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Affiliation(s)
- Amira S A Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE. .,AAU Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, UAE. .,Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt.
| | - Nadia Hussain
- AAU Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, UAE.,Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE
| | - Zelal Kharaba
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE.,AAU Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, UAE
| | - Amal H I Al Haddad
- Chief Operations Office, Sheikh Shakbout Medical City (SSMC), Abu Dhabi, UAE
| | - Lamiaa N Abdelaty
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Cairo, Egypt
| | - Raghda R S Roshdy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt.,Department of Clinical Pharmacy, Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt
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Mahdavi H, Esmaily H. Impact of educational intervention by community pharmacists on asthma clinical outcomes, quality of life and medication adherence: A systematic review and meta-analysis. J Clin Pharm Ther 2021; 46:1254-1262. [PMID: 33817821 DOI: 10.1111/jcpt.13419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Community pharmacists can play an important role in controlling chronic diseases. This study aimed to evaluate the effects of pharmacists' educational interventions in the community pharmacy settings on asthma control and severity, quality of life (QOL) and medication adherence. METHODS Databases PubMed, Scopus and Web of Science were searched for evidence regarding asthma severity and control, QOL, and medication adherence after pharmacists' interventions in community pharmacy settings. Twenty-one studies were eligible for qualitative and quantitative analysis. Indices and questionnaires were used in the studies, such as Asthma-related quality of life (IAQLQ), Asthma Control Test (ACT), Perceived Control of Asthma Questionnaire (PCAQ), inhaler technique (IT), Asthma Control Questionnaire (ACQ), 36-Item Short Form survey (SF-36) and peak expiratory flow rate (PEFR). The outcomes were extracted, pooled and analysed as percentages, means, standard deviations and errors, and 95% confidence intervals (CIs). RESULTS AND DISCUSSION Community pharmacists in all studies educated and followed up the asthmatic patients, addressing the outcome measures. Pharmacists underwent training courses of at least a day. Standardized mean differences for the indices were pooled as follows: IAQLQ -0.241 (95% CI, -0.362 to -0.121), ACT 0.14 (95% CI, 0.02 to 0.27), PCAQ -0.15 (95% CI, -0.28 to 0.01), IT 0.79 (95% CI, 0.05 to 1.54), ACQ -0.50 (95% CI, -0.69 to -0.30), SF-36 0.39 (95% CI, 0.16 to 0.62), PEFR 0.13 (95% CI, 0.01 to 0.26) and asthma symptoms score -0.34 (95% CI, -0.49 to -0.18). WHAT IS NEW AND CONCLUSION Pharmacists' educational interventions in community pharmacy settings could significantly improve asthma severity and control, QOL and medication adherence.
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Affiliation(s)
- Hossein Mahdavi
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Song X, Hallensleben C, Zhang W, Jiang Z, Shen H, Gobbens RJJ, Kleij RMJJVD, Chavannes NH, Versluis A. Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24602. [PMID: 33788700 PMCID: PMC8047793 DOI: 10.2196/24602] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Weihong Zhang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zongliang Jiang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Shetty KD, Chen AY, Rose AJ, Liu HH. Effect of the ExactCare medication care management model on adherence, health care utilization, and costs. J Manag Care Spec Pharm 2021; 27:574-585. [PMID: 33560167 PMCID: PMC10394188 DOI: 10.18553/jmcp.2021.20431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Multimorbidity and polypharmacy are common in the United States and are associated with greater risk of disease-related complications and higher health care costs. ExactCare has implemented a high-touch approach that includes home visits, comprehensive ongoing medication reviews, patient education, medication reconciliation, medication compliance packaging, and electronic reminders and trackers. OBJECTIVE: To test whether the ExactCare program improves medication adherence and reduces health care utilization and costs. METHODS: Using a national database from a large U.S. insurer, we identified Medicare Advantage plan members in 8 states from 2007 to 2018 who had both medical and prescription drug coverage. The index year for an ExactCare patient was identified using the date of the first prescription filled by ExactCare, with the previous year being the baseline. All patients without a prescription from an ExactCare pharmacy were considered potential comparison patients. To propensity match ExactCare and comparison patients, the probability of ExactCare participation was modeled using a logistic regression based on demographics, state, year, urban status, Medicaid eligibility, low-income subsidies, comorbidities, and baseline utilization and costs. Multivariate regression analysis was conducted to generate a difference-in-differences estimate of program effect for the matched pairs as well as patient-level fixed effects, while adjusting for additional time-varying characteristics. Adherence outcomes included the proportion of days covered for oral diabetic medications, antihypertensives, and hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins). Utilization outcomes included emergency department (ED) visits, hospitalizations, and skilled nursing facility (SNF) admissions, hospitalization days, and SNF days. Cost outcomes included total cost of care, prescription drug cost, hospital inpatient cost, and SNF cost. RESULTS: ExactCare patients (N = 701) were propensity-matched to comparison patients (N = 1,395) using the nearest 1:2 match approach, with an average follow-up period of 6.6 and 5.4 years for ExactCare and comparison patients, respectively. One year of ExactCare participation was associated with statistically significant increases in adherence to statins (8.4 percentage points; P < 0.001) and antihypertensive drugs (4.9 percentage points; P < 0.001), but the increase in adherence for diabetes drugs was not statistically significant. ExactCare participation was associated with statistically significant decreases in SNF admission rates (-67 SNF stays per 1,000 member-years; P = 0.011), inpatient days (-857 days per 1,000 member-years; P = 0.022), and SNF days (-1,801 days per 1,000 member-years; P = 0.002), but not with the rates of ED visits or hospital admissions. Each year of ExactCare participation was associated with increases in prescription drug costs ($30 per-member per month [PMPM]; P = 0.006) and decreases in total costs (-$196 PMPM; P = 0.023) and medical costs (-$226 PMPM; P = 0.008), largely attributable to decreases in hospital inpatient costs (-$119 PMPM; P = 0.001) and SNF costs (-$30 PMPM; P = 0.007). CONCLUSIONS: ExactCare's medication care management model was associated with improved medication adherence and an approximately $2,400 per member per year reduction in total cost of care, representing a 5% reduction in average costs. DISCLOSURES: This study was funded by ExactCare Pharmacy under a contract with RAND that grants the study authors sole responsibility for data management, study design, data analysis, manuscript drafting, and the decision to publish. The sponsor had no role in the study design and manuscript drafting. All data analysis was conducted by the study authors. A draft manuscript was reviewed by the sponsor, but the study authors made final decisions regarding the content and study conclusions. Shetty, Chen, and Liu are employed by RAND. Rose has nothing to disclose.
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Affiliation(s)
| | | | - Adam J Rose
- Hebrew University School of Public Health, Jerusalem, Israel
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12
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Rolf von den Baumen T, Lake J, Everall AC, Dainty K, Rosenberg-Yunger Z, Guilcher SJT. "Clearly they are in the circle of care, but . . .": A qualitative study exploring perceptions of personal health information sharing with community pharmacists in an integrated care model. Can Pharm J (Ott) 2020; 153:378-398. [PMID: 33282029 DOI: 10.1177/1715163520956686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Ontario's Health Links approach to care is an integrated care model designed to optimize care for patients with complex needs. Currently, community pharmacists have no formalized role. This study aimed to explore stakeholders' perceptions about privacy and its impact on community pharmacists' involvement with integrated care models. Methods A qualitative study using semistructured telephone-based interviews was conducted. Participants worked in Ontario as pharmacists, providers in Health Links or team-based models or decision-makers in Health Links or health regions. Thematic analysis followed the Qualitative Analysis Guide of Leuven. Results Twenty-two participants were interviewed, and all but one commented on privacy or information sharing in integrating community pharmacists with integrated care models. The 4 themes identified were as follows: 1) what does the circle of care look like? 2) value of sharing information, 3) uncertainty of what information to share and 4) perceptions on how to share information. Interpretation The concerns surrounding privacy of personal health information and who is included in the circle of care represented an important barrier for integration. Enablers to mitigate privacy concerns included relationship building between community pharmacists, patients and other health care professionals and mutual access to information-sharing platforms such as electronic health records. Conclusion Providers' and decision-makers' perceptions about community pharmacists and privacy affect information sharing and are incongruent with Ontario's Personal Health Information Protection Act. Education is needed for health care professionals on legislation, especially as health systems move towards integrated care models to improve care. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Teagan Rolf von den Baumen
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
| | - Jennifer Lake
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
| | - Katie Dainty
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
| | - Zahava Rosenberg-Yunger
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy (Rolf von den Baumen, Lake, Everall, Guilcher), University of Toronto.,Institute of Health Policy, Management and Evaluation (Lake, Everall, Dainty, Guilcher), University of Toronto.,Faculty of Medicine (Lake), University of Toronto.,North York General Hospital (Dainty), Toronto, Ontario.,Ryerson University (Rosenberg-Yunger), Toronto, Ontario
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13
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Hadad R, Likhtenshtein D, Maimon N, Simon-Tuval T. Overuse of reliever inhalers and associated healthcare utilization of asthma patients. Sci Rep 2020; 10:19155. [PMID: 33154546 PMCID: PMC7645652 DOI: 10.1038/s41598-020-76280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022] Open
Abstract
Global Initiative for Asthma 2019 guidelines recommend to avoid strengthening patients’ reliance on relievers since they increase exacerbation risk. Our aim was to examine the association between reliever inhalers overuse and all-cause healthcare utilization (HCU). A retrospective study among Clalit Health Services (CHS) adult enrollees (n = 977) for 2012–2017. Reliever inhalers overuse was defined as consistent prescription refills of ≥ 3 canisters annually. Adherence to controllers was calculated using the proportion of days covered. HCU included: hospitalizations, diagnostic and surgical procedures, medications, emergency room (ER) visits, and clinic visits. 27% of the study population (n = 264) consistently refilled ≥ 3 relievers prescriptions annually, and had higher adherence to controllers (0.38 vs. 0.24, p < 0.001). Their total 6-year HCU costs were not higher than that of others ($5,550 vs. $5,562, p = 0.107). Most HCU components [including hospitalization (p = 0.405) and ER visits (p = 0.884)] were comparable; however, medication costs were higher ($1734 vs. $1504, p < 0.001). A multivariable ordered-logit model revealed that frequent and regular use of relievers was not associated with higher HCU costs (OR = 0.82, 95% CI 0.62–1.09, p = 0.175). Higher adherence to maintenance and reliever therapy (OR = 2.18, 95% CI 1.44–3.28, p < 0.001), other controllers (OR = 3.30, 95% CI 2.11–5.16, p < 0.001), and nebulized SABAs and SAMAs (OR = 1.08, 95% CI 1.02–1.14, p = 0.007) was associated with higher costs. Overuse of reliever inhalers was prevalent and associated with higher adherence to controllers, yet not associated with higher all-cause HCU. This highlights the need to examine the sources of elevated usage in order to develop intervention strategies to optimize pharmaceutical therapy of asthma patients.
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Affiliation(s)
- Ronit Hadad
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.,Clalit Health Services, Beer-Sheva, Israel
| | | | - Nimrod Maimon
- Division of Internal Medicine, Pulmonology Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tzahit Simon-Tuval
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.
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14
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Qazi A, Armour C, Saini B. Perspectives of general practitioners about a collaborative asthma care model in primary care. J Asthma 2020; 58:1648-1660. [PMID: 32921189 DOI: 10.1080/02770903.2020.1823408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma affects 2.7 million people in Australia and is predominantly managed by general practitioners (GPs) within primary care. Despite national focus on this condition, asthma control in the population is suboptimal, with many preventable hospitalizations. In the light of robust evidence supporting the role of pharmacists in the management of chronic diseases including asthma, the Australian Medical Association (AMA) proposed a General Practice Pharmacist (GPP) model in 2015. In this proposal, a non-dispensing pharmacist, co-located within the primary care setting and collaborating with GPs and allied health professionals, can make a positive impact on patients' health and minimize costs due to medication misadventure. The aim of this study was to obtain the views of GPs regarding the GPP model for better management of asthma in a qualitative study. METHODS Semi-structured interviews were conducted with 23 GPs, audio-recorded, transcribed verbatim, and later analyzed for emergent themes. The GPs support the idea of a GPP as time and task pressures restrict them in adhering to asthma management guidelines. RESULTS Support from another health professional in such a pressured environment can positively impact patient's health. Funding, clear role delineation within general practice, training of pharmacists working as GPPs, and effective communication systems were described as the potential catalysts for the success of the model. CONCLUSION Sustainable funding and the willingness of practice owners/managers were described as the barriers. The GPs agreed that pharmacists can make a positive difference in patient's asthma management once the barriers were effectively addressed.
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Affiliation(s)
- Anila Qazi
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Carol Armour
- The Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Bandana Saini
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Woolcock Institute of Medical Research, Glebe, NSW, Australia
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Al AdAwi RM, Stewart D, Ryan C, Tonna AP. A systematic review of pharmacist input to metabolic syndrome screening, management and prevention. Int J Clin Pharm 2020; 42:995-1015. [PMID: 32607719 PMCID: PMC7476979 DOI: 10.1007/s11096-020-01084-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high blood-pressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists’ input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the “Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)”. Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.
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Affiliation(s)
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Cristin Ryan
- College of Pharmacy, Trinity College Dublin, Dublin, Ireland
| | - Antonella Pia Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7AQ, Scotland, UK.
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Lake JD, Rosenberg-Yunger ZRS, Dainty KN, Rolf von den Baumen T, Everall AC, Guilcher SJT. Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study. BMC Health Serv Res 2020; 20:396. [PMID: 32393239 PMCID: PMC7212674 DOI: 10.1186/s12913-020-05237-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past several years, there has been more emphasis on integration within health care. Community pharmacy is often under-represented within integrated care models. This study explored stakeholder perceptions and enablers of including community pharmacy within an integrated care model. METHODS A qualitative study was undertaken. Participants were recruited through professional networks and social media, as well as snowball recruitment from other participants. They included community pharmacists, clinicians, and decision-makers working in Ontario, Canada. Data were collected using telephone interviews completed with a semi-structured interview guide based on Consolidated Framework for Implementation Research from June to September 2018. Data were analysed inductively and deductively following the Qualitative Analysis Guide of Leuven. An additional theoretical framework (Rainbow Model of Integrated Care) was used to categorize enablers. RESULTS Twenty-two participants were interviewed including nine pharmacists, seven clinicians, and six decision-makers. Three key themes were identified: 1) Positive value of including pharmacy in integrated care models; 2) One model does not fit all; and 3) Conflict of interest. Four key enablers were identified reflecting functional and normative factors: functional - 1) remuneration, 2) technology; normative - 3) engagement, and 4) relationships. While both functional and normative factors were discussed, the latter seemed to be more important to facilitate the inclusion of community pharmacy. Many participants characterized community pharmacists' lack of skills or confidence to provide patient care. CONCLUSIONS This study confirms previously known views about concerns with community pharmacy's conflict of interest. However, discordant perceptions of conflict of interest and negative perceptions about capabilities of community pharmacy need to be addressed for successful integration. Normative enablers, such as culture, are likely important for organizational integration and require additional inquiry.
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Affiliation(s)
- Jennifer D. Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Toronto, ON M5S 1A8 Canada
| | - Zahava R. S. Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, 350 Victoria Street, Toronto, ON M5B2K3 Canada
| | - Katie N. Dainty
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1 Canada
| | | | - Amanda C. Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
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