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Tessier S, Tsang V, Martin S. Assessing Hospital Pharmacists' Scope of Clinical Practice in Ontario. Can J Hosp Pharm 2024; 77:e3491. [PMID: 38601132 PMCID: PMC10984262 DOI: 10.4212/cjhp.3491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/16/2023] [Indexed: 04/12/2024]
Abstract
Background Expansion of the scope of pharmacists' activities in hospital is associated with reductions in adverse events and drug-related readmissions. However, the breadth of hospital pharmacists' clinical activities varies widely across Ontario due to provisions in the provincial Public Hospitals Act. Few data exist defining expanded scope in institutions across Ontario. Objectives The primary objective was to describe the scope of practice of hospital pharmacists in Ontario who were undertaking expanded clinical activities based on policies or medical directives. The secondary objectives included determining benefits, limitations, facilitators, and barriers associated with implementing these activities. Methods A survey was sent to the pharmacy leadership of Groups A and B public hospitals across Ontario. The survey contained quantitative and qualitative questions focused on 3 domains of expanded-scope activities: adaptation, discontinuation, and renewal of medication orders; prescriptive authority; and drug monitoring. Results Of 56 hospitals invited, 46 (82%) submitted a survey response, with 1 exclusion (due to no response on some mandatory questions). The most common expanded-scope activity was independent performance of therapeutic drug monitoring (71%, 32/45). Pharmacists had the authority to independently adapt, discontinue, or renew inpatient medication orders in 60% (27/45) of hospitals, and could independently initiate medication orders in 20% (9/45). Barriers to implementing expanded-scope activities included limited time and staffing. Facilitators included proactive leadership, demonstrated clinical value, and strong rapport with other health care providers. Conclusions Many institutions in Ontario have established polices to expand pharmacists' clinical activities, but there is a great deal of variability in scope of practice. Advocacy at the provincial level to unify scope of practice will help to optimize patient outcomes.
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Affiliation(s)
- Sarah Tessier
- , BSc, PharmD, ACPR, RPh, is with The Ottawa Hospital, Ottawa, Ontario
| | - Victor Tsang
- , BScPharm, PharmD, ACPR, RPh, is with St Joseph's Health Care London, London, Ontario
| | - Spencer Martin
- , BSc, PharmD, ACPR, RPh, is with the London Health Sciences Centre, London, Ontario
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Tharmalinga Sharma JJ, McMillan SS, Samaranayake NR, Waas DA, Coombes ID, Wheeler AJ. Multifaceted pharmacist-led interventions in secondary care settings between countries of various income levels: a scoping review protocol. BMJ Open 2024; 14:e083726. [PMID: 38594185 PMCID: PMC11015257 DOI: 10.1136/bmjopen-2023-083726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Clinical pharmacy services often involve multifaceted pharmacist-led interventions. However, current pharmacy practice models vary across different countries. Despite the documented benefits of clinical pharmacy services, the characteristics of pharmacist-led interventions in different countries have not yet been adequately explored and described. Therefore, this protocol outlines the methodology for a proposed scoping review aiming to investigate various types of multifaceted pharmacist-led interventions and the outcomes used to evaluate their effectiveness within secondary care settings. Additionally, the scoping review will map the current evidence surrounding the characteristics of interventions and outcomes reported across various countries of socioeconomic status. METHODS AND ANALYSIS The scoping review will be conducted according to the JBI Methodology for Scoping Reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews. We will systematically search the following electronic databases: MEDLINE (Ovid), CINAHL (EbscoHost), Embase (embase.com), Scopus (scopus.com), Cochrane Library (cochranelibrary.com) and APA PsycInfo (Ovid). Additionally, the reference lists of identified reviews and included full texts will be searched for relevant papers. Grey literature sources, such as International Pharmaceutical Abstracts and the International Pharmaceutical Federation (FIP) website, will be searched. We will include primary studies published in the English language from January 2013 to December 2023, involving secondary care multifaceted pharmacist-led interventions. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract relevant information. We will extract relevant data, complete a tabular summary from each included publication and analyse it. ETHICS AND DISSEMINATION Ethical approval is not required as we will be using data from publicly available literature sources. Findings will be disseminated in publications and presentations with relevant stakeholders. We aim to map available evidence across the breadth of studies that have reported multifaceted pharmacist-led interventions and their outcomes.
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Affiliation(s)
| | - Sara S McMillan
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Mental Health and Menzies Health Institute, Griffith University, Brisbane and Gold Coast, QLD 4111 & 4222, Australia
| | - Nithushi R Samaranayake
- Department of Pharmacy and Pharmaceutical sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Dulshika A Waas
- Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
- Colombo South Teaching Hospital, Kalubowila-Dehiwela 10350, Sri Lanka
| | - Ian D Coombes
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD 4102, Australia
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
- Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER), woolloongabba, QLD 4102, Australia
| | - Amanda J Wheeler
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Mental Health and Menzies Health Institute, Griffith University, Brisbane and Gold Coast, QLD 4111 & 4222, Australia
- Faculty of Health and Behavioural Sciences, University of Auckland, Auckland 1142, New Zealand
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Amir M, Zehra A, Munawar R, Gul W, Fatima T, Khan Y, Jaffery R, Babar ZUD. Economic evaluation of clinical pharmacy service using integrated health system in tertiary care hospital. Expert Rev Pharmacoecon Outcomes Res 2024; 24:533-539. [PMID: 38362677 DOI: 10.1080/14737167.2024.2319593] [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: 05/06/2022] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. RESEARCH DESIGN AND METHODS A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. RESULTS Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. CONCLUSION Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention.
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Affiliation(s)
- Muhammad Amir
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Ale Zehra
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabya Munawar
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Wajiha Gul
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Fatima
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Younas Khan
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Razia Jaffery
- Department of Pharmacy Practice, Salim Habib University, Karachi, Pakistan
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Henman MC, Ravera S, Lery FX. Council of Europe Resolution on the Implementation of Pharmaceutical Care-A Step Forward in Enhancing the Appropriate Use of Medicines and Patient-Centred Care. Healthcare (Basel) 2024; 12:232. [PMID: 38255119 PMCID: PMC10815874 DOI: 10.3390/healthcare12020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Pharmaceutical care was proposed to address morbidity and mortality associated with medicine-related problems. It utilises the pharmacist's expertise in medicines, their relationship with the patient and cooperation with other healthcare professionals to optimise the use of medicines. The European Directorate for the Quality of Medicines & HealthCare (EDQM), part of the Council of Europe, found significant variation in the acceptance of pharmaceutical care and in the implementation of pharmaceutical care in Europe. A multidisciplinary group was established to draft a statement of principles and recommendations concerning pharmaceutical care. Through face-to-face meetings, circulation of draft texts and informal consultation with stakeholders, the group produced a resolution. On 11 March 2020, the resolution was adopted by the Committee of Ministers of the Council of Europe. It explains pharmaceutical care and illustrates pharmacists' contribution to medicine optimisation in different care settings. Pharmaceutical care's value to health services and its place in health policy were emphasised by addressing the risks and harms from suboptimal use of medicines. Pharmaceutical care can improve medicine use, promote rational use of healthcare resources and reduce inequalities in healthcare by realigning the roles and responsibilities of pharmacists and healthcare professionals. EDQM will promote and advocate for the implementation of pharmaceutical care by enacting practice Resolution CM/Res(2020)3.
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Affiliation(s)
- Martin C. Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40 Dublin, Ireland
| | - Silvia Ravera
- European Directorate for the Quality of Medicines and HealthCare (EDQM), Council of Europe, F-67081 Strasbourg, France; (S.R.); (F.-X.L.)
| | - Francois-Xavier Lery
- European Directorate for the Quality of Medicines and HealthCare (EDQM), Council of Europe, F-67081 Strasbourg, France; (S.R.); (F.-X.L.)
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d'Entremont-Harris M, MacNabb K, Wilby KJ, Ramsey TD. Pharmacy-based sexually transmitted infection service implementation considerations: A scoping review. J Am Pharm Assoc (2003) 2024; 64:186-196.e2. [PMID: 38453662 DOI: 10.1016/j.japh.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a gap in care. Pharmacy-based STI clinical services are a potential solution to improve care. OBJECTIVE To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences. METHODS A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported. RESULTS Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration. CONCLUSION Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.
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Peled O, Vitzrabin Y, Beit Ner E, Lazaryan M, Berlin M, Barchel D, Berkovitch M, Beer Y, Tamir E. Acceptance rate of clinical pharmacists' recommendations-an ongoing journey for integration. Front Pharmacol 2023; 14:1253990. [PMID: 37781706 PMCID: PMC10535001 DOI: 10.3389/fphar.2023.1253990] [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: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time. Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time. Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%. Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children’s Medical Center of Israel, Affiliated to School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Yael Vitzrabin
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Lazaryan
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Barchel
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Tamir
- Diabetic Foot Unit, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wylegała K, Religioni U, Czech M. The Impact of Hospital Pharmacy Operation on the Quality of Patient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4137. [PMID: 36901140 PMCID: PMC10002066 DOI: 10.3390/ijerph20054137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
This paper presents the role, tasks, and place of a hospital pharmacy in the structure of the entire facility. The role of hospital drug management and pharmacy seems to be extremely important in providing patients with high-quality care. Particular emphasis was placed on the distribution systems of medicinal products and medical devices in the hospital. The advantages and disadvantages of the classical distribution system and modern systems such as unit-dose and multi-dose-and the most important differences between them-are presented. Difficulties related to implementing modern distribution systems in hospitals were also discussed. The information provided is presented in the context of the legal regulations in Poland.
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Affiliation(s)
- Karolina Wylegała
- Chair and Department of Pharmacoeconomics and Social Pharmacy, Medical University of Poznan, 61-701 Poznan, Poland
- Independent Public Healthcare Center in Miedzychod, 64-400 Miedzychod, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, The Institute of Mother and Child, 01-211 Warsaw, Poland
- Business School, Warsaw University of Technology, 00-661 Warsaw, Poland
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Ahmed A, Tanveer M, Dujaili JA, Chuah LH, Hashmi FK, Awaisu A. Pharmacist-Involved Antiretroviral Stewardship Programs in People Living with HIV/AIDS: A Systematic Review. AIDS Patient Care STDS 2023; 37:31-52. [PMID: 36626156 DOI: 10.1089/apc.2022.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) frequently encounter antiretroviral (ARV) therapy-related problems. Clinical pharmacists with specialized training in ARV stewardship play an important role in managing these problems. However, there is a paucity of evidence to clarify the impact of clinical pharmacists' interventions on managing ARV therapy-related problems in PLWHA. Therefore, we aim to systematically review the literature to determine the nature and impact of pharmacists' interventions on managing medication-related problems in PLWHA. The review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42020173078). Relevant records were identified from six electronic bibliographic databases (PubMed, Embase, EBSCOhost, ProQuest, Scopus, and the Cochrane Central Register) from their inception until September 2022. We included all randomized and nonrandomized interventional studies that were published in English. After the abstract and full-text screening, data were extracted from the selected studies, and the quality of the studies was assessed. The electronic database search and citation tracking identified two thousand and three citations. The review included 21 of these studies, involving 2998 PLWHA, published between 2014 and 2022. Pharmacists' interventions, working alone or in a multi-disciplinary team, comprised ARV medication review, management of adverse drug reactions (ADRs), therapeutic drug monitoring, prevention of drug interactions, and provision of drug information to PLWHA or the health care team. The pharmacist-involved interventions significantly reduced incorrect/incomplete ARV regimens, drug interactions, incorrect dosages, duplicate therapy, polypharmacy, administration errors, missing medication, wrong formulation, ADRs, and prescribing errors. Most studies reported that physicians usually accept more than 90% of the pharmacists' recommendations. ARV medication-related problems remain highly prevalent in PLWHA. Pharmacist-led interventions and stewardship significantly reduce ARV therapy-related problems in PLWHA and are widely accepted by physicians. Dedicated pharmacists with specialized training and credentialing in infectious diseases or HIV/AIDS have a great potential to improve health outcomes in PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Maria Tanveer
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Current affiliation: Swansea University Medical School, Singleton Campus, Swansea University, Wales, United Kingdom
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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The Development, Implementation, and Evaluation of a Pharmacist-Managed Therapeutic Drug Monitoring (TDM) Service for Vancomycin-A Pilot Study. PHARMACY 2022; 10:pharmacy10060173. [PMID: 36548329 PMCID: PMC9785066 DOI: 10.3390/pharmacy10060173] [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: 10/25/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In recent years, pharmacists in Australia have been able to expand their scope to include the provision of a range of services. Although evidence has demonstrated the benefits of pharmacist-managed TDM services, recent studies have shown that these services are not prominent within Australia and that the current TDM workflow may not be optimal. METHODS An interventional pilot study was conducted of a pharmacist-managed TDM program for vancomycin at a tertiary hospital in Australia. RESULTS In total, 15 pharmacists participated in the program. They performed 50.5% of the medication-related pathology over the intervention period. Pharmacist involvement in the TDM process was more likely to lead to appropriate TDM sample collection (OR 87.1; 95% CI = 11.5, 661.1) and to an appropriate dose adjustment (OR 19.1; 95% CI = 1.7, 213.5). Pharmacists demonstrated increased confidence after the education and credentialling package was provided. CONCLUSIONS This study demonstrated that a credentialling package for pharmacists can improve knowledge, skills, and confidence around the provision of pharmacist-managed TDM services for vancomycin. This may lead to the evolution of different roles and workflows enabling pharmacists to contribute more efficiently to improving medication safety and use.
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Kriegel J, Weigl A, Rissbacher C, Dieck M, Tuttle-Weidinger L. Characteristics and levers in the business model of hospital pharmacies in German-speaking countries. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2130639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Johannes Kriegel
- Institute for Management and Economics in Healthcare, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall i.T., Austria
| | - Alexander Weigl
- Hospital Pharmacy, Kepler University Hospital, Linz, Austria
| | | | - Marcel Dieck
- Hellmann Worldwide Logistics SE & Co. KG, Hospital Logistics, Bremen, Germany
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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Abousheishaa AA, Sulaiman AH, Huri HZ, Kamis SFB, Hamidi H, Ang WC, Zainal ZAB, Shamsuddin N, Guan NC. Psychiatric pharmaceutical care service across Malaysian hospitals: results from a cross-sectional study. BMC Health Serv Res 2022; 22:321. [PMID: 35264175 PMCID: PMC8905759 DOI: 10.1186/s12913-022-07681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Psychiatric pharmaceutical care is the provision of pharmaceutical care services to patients with psychiatric related illnesses or disorders. Several studies have demonstrated the positive influence psychiatric pharmaceutical care on patients’ clinical, humanistic and economic outcomes. This study aimed to examine the extent of psychiatric pharmaceutical care practice in a convenience sample of Malaysian government hospitals and the barriers to the provision of these services. Methods An anonymous cross-sectional survey of registered pharmacists working at a convenience sample of government hospitals in Malaysia was undertaken from September 2019 to June 2020. Results Pharmacists frequently ensured the appropriateness of the dose (55%), dosage form (47%) and dosing schedule (48%) of the dispensed medications. Most pharmacists infrequently worked with patients and healthcare professionals to develop a pharmacotherapeutic regimen and a corresponding monitoring plan (28%). There was no statistically significant difference in the provision of pharmaceutical care services with respect to gender, age, years of practice, and professional board certification. However, the services offered were influenced by the respondent’s education and pharmacy setting. The obstacles perceived by pharmacists included lack of time (89%), shortage of pharmacy staff (87%), the patients’ inability to comprehend medical information (85%), insufficient demand and acceptance by patients (82%), the lack of official policies and standardised practice protocols (78%), inaccessibility to the patients’ medical records (77%) and the lack of structured communication channels between pharmacists and physicians (75%), the pharmacists lack of knowledge/skills and confidence (78%) and insufficient recognition from physicians to the pharmacists’ skills (76%). Conclusions This is the first study to explore the extent and barriers of psychiatric pharmaceutical care in Malaysian hospitals; it highlighted the need for mobilising pharmacists to expand these services.
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Affiliation(s)
- Aya Ahmed Abousheishaa
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasniza Zaman Huri
- Faculty of Pharmacy, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | | | - Wei Chern Ang
- Hospital Tuanku Fauziah, 01000, Kangar, Perlis, Malaysia
| | | | | | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Tan YZ, Chong JJ, Chew LST, Tan KH, Wang A. Burnout and resilience among pharmacists: A Singapore study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yan Zhi Tan
- Health Economics and Outcomes Research Monitor Deloitte Brussels Belgium
| | - Jin Jian Chong
- Department of Pharmacy Singapore General Hospital Singapore Singapore
| | - Lita Sui Tjien Chew
- Department of Pharmacy National University of Singapore Singapore Singapore
- Department of Pharmacy National Cancer Centre Singapore Singapore Singapore
| | - Kok Hian Tan
- SingHealth Duke‐NUS Institute for Patient Safety & Quality (IPSQ) Singapore Health Services Singapore Singapore
- Department of Maternal Fetal Medicine KK Women's and Children's Hospital Singapore Singapore
| | - Aiwen Wang
- Department of Pharmacy Singapore General Hospital Singapore Singapore
- Department of Pharmacy National University of Singapore Singapore Singapore
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13
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Al-Jedai AH, Khurshid F, Mayet AY, Al-Omar HA, Alghanem SS, Alsultan MS. Pharmacy practice in hospital settings in GCC countries: Prescribing and transcribing. Saudi Pharm J 2021; 29:1021-1028. [PMID: 34588848 PMCID: PMC8463471 DOI: 10.1016/j.jsps.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries' hospitals. Methods A modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. Results Sixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy services in their hospitals. Conclusion In GCC countries' hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.
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Key Words
- ASHP, American Society of Health-System Pharmacist
- ASP, Antimicrobial stewardship program
- Ambulatory care
- Anticoagulation
- CPOE, Computerized prescriber order entry
- DOACs, Direct oral anticoagulants
- FMEA, Failure mode and effects analysis
- Formulary
- GCC, Gulf Cooperation Councils
- HER, Electronic health record
- LMWHs, Low molecular- weight heparins
- MTM, Medication Therapy Management
- Medication therapy
- P&T, Pharmacy and therapeutics committee
- SPS, Saudi Pharmaceutical Society
- Stewardship
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Affiliation(s)
- Ahmed H Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia.,Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - Fowad Khurshid
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Ahmed Y Mayet
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Hussain A Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Sarah S Alghanem
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Mohammed S Alsultan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
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14
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Joshi G, Kabra A, Goutam N, Sharma A. An Overview on Patient-Centered Clinical Services. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.
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Affiliation(s)
- Gaurav Joshi
- University Institute of Pharma Sciences, Chandigarh University
| | - Atul Kabra
- University Institute of Pharma Sciences, Chandigarh University
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15
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Validation of a Questionnaire for Patient Awareness and the Need for a Community-Based Outpatient Antimicrobial Stewardship Program (O-ASP): A Pilot Study. Antibiotics (Basel) 2021; 10:antibiotics10040441. [PMID: 33920828 PMCID: PMC8071141 DOI: 10.3390/antibiotics10040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
An outpatient antimicrobial stewardship program (O-ASP) was developed and implemented to promote appropriate antibiotic therapy in outpatient settings. As active patient involvement is a critical component of an effective O-ASP, this study aimed to develop and validate a questionnaire addressing patient awareness for appropriate antibiotic therapy and the need for pharmaceutical care services (PCS) in the O-ASP in Korea. The questionnaire was drafted based on ASPs and PCS guidelines and validated for content and construct validity using the item-content validity index (I-CVI) and Cronbach’s alpha, respectively. The estimated I-CVI and Cronbach’s alpha were considered excellent or adequate (≥0.8 and 0.70–0.90, respectively) for most of the survey items (17 out of 23 items). The validated questionnaire was utilized in a pilot survey study, including 112 individuals (37% male) with the mean ± SD age of 37 ± 13 years. Among the survey participants, 68% responded that antibiotics had been prescribed appropriately; however, ≥50% showed a lack of knowledge regarding their antibiotic therapy. The participants expressed the need for PCS as part of an O-ASP in the questionnaire (average Likert score ≥3.4/5). In conclusion, our newly validated questionnaire successfully measured patient awareness and knowledge of antimicrobial use and the need for PCS in the O-ASP.
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