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Milani GJ, Damasceno LT, Tiguman GMB, Aguiar PM. Assessment of the implementation of pharmacist prescribing: Challenges and pathways for ambulatory practice. Res Social Adm Pharm 2024; 20:870-879. [PMID: 38762366 DOI: 10.1016/j.sapharm.2024.05.002] [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: 11/21/2023] [Revised: 02/27/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic. OBJECTIVE We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications. METHODS A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines. RESULTS Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians. CONCLUSIONS This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.
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Karim L, McIntosh T, Jebara T, Pfleger D, Osprey A, Cunningham S. Investigating practice integration of independent prescribing by community pharmacists using normalization process theory: a cross-sectional survey. Int J Clin Pharm 2024; 46:966-976. [PMID: 38727778 PMCID: PMC11286670 DOI: 10.1007/s11096-024-01733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Independent prescribing (IP) has not been extensively investigated in community pharmacy (CP). Normalization process theory (NPT) constructs help explain how interventions are integrated into practice and include: 'coherence' (understanding), 'cognitive participation' (what promotes engagement), 'collective action' (integration with existing systems), and 'reflexive monitoring' (evaluation). AIM To use NPT to investigate the integration of pharmacist IP in CP. METHOD NHS Scotland Pharmacy First Plus (PFP) is a community pharmacy IP service. Questionnaire items were developed using the NPT derived Normalisation MeAsure Development (NoMAD) tool for an online survey of all PFP IP pharmacists. Demographic data were analysed descriptively and scale scores (calculated from item scores for the 4 NPT constructs) were used for inferential analysis. RESULTS There was a 73% (88/120) response rate. Greater than 90% 'strongly agreed'/'agreed' to NoMAD items relating to most NPT constructs. However, responses to 'collective action' items were diverse with more participants answering 'neither agree nor disagree' or 'disagree'. A statistically significant difference in NPT construct scale scores with significant p-values (ranging from p < 0.001 to p = 0.033) was shown on all the NPT constructs for the variable 'On average, how often do you consult with patients under the PFP service?'. CONCLUSION This theory-based work offers perspectives on IP integration within CP. Despite its geographic focus this work offers insights relevant to wider contexts on IP integration. It shows 'collective action' focused 'organisation' and 'group process' challenges with a need for further work on staff training, resource availability and utilisation, working relationships, communication and management.
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Affiliation(s)
- L Karim
- School of Pharmacy and Life Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
| | - T McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
| | - T Jebara
- Health Services and Population Science Department, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, King's College London, London, SE5 8AF, UK
| | - D Pfleger
- Pharmacy and Medicines Directorate, Westholme, Woodend Hospital, Queens Road, Aberdeen, AB15 6LS, UK
| | - A Osprey
- Community Pharmacy Scotland, 42 Queen Street, Edinburgh, EH2 3NH, UK
| | - S Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK.
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Cassidy CE, Boulos L, McConnell E, Barber B, Delahunty-Pike A, Bishop A, Fatima N, Higgins A, Churchill M, Lively A, MacPhee SP, Misener RM, Sarty R, Wells R, Curran JA. E-prescribing and medication safety in community settings: A rapid scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100365. [PMID: 38023632 PMCID: PMC10679534 DOI: 10.1016/j.rcsop.2023.100365] [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: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.
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Affiliation(s)
- Christine E. Cassidy
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, Halifax, Nova Scotia, Canada
| | - Nawal Fatima
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Rowan Sarty
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | - Janet A. Curran
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
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Piraux A, Angibaud M, Nizet P, Navas D, Sallenave-Namont C, Prot-Labarthe S, Huon JF. Factors influencing French community pharmacists' willingness to participate in research projects: a mixed method study. BMC PRIMARY CARE 2023; 24:229. [PMID: 37919662 PMCID: PMC10623853 DOI: 10.1186/s12875-023-02163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND French community pharmacists are facing an increasing demand to provide a wider range of services to meet the needs of the population. These new missions must be evaluated by primary care research studies. This study aims to explore the factors that influence French community pharmacists' willingness to participate in research projects. METHODS A mixed-method design was adopted for this study, comprising an initial quantitative online survey followed by semi-directed interviews. The investigation was conducted at two French faculties of pharmacy, Angers and Nantes, involving students in their 6th and final year of pharmacy education, and their community pharmacist tutors. The survey items were based on a study by Saini et al. and participants responded using five-point Likert scales. The semi-directed interviews were conducted after the quantitative analysis, only with volunteer and already graduated community pharmacists. RESULTS A total of 131 people participated in the quantitative analysis, comprising 75 students and 56 pharmacists. Pharmacists and students agreed on the significance of two key aspects: the research must possess a clear and meaningful purpose, and researchers must keep the pharmacists informed about the study's results. Among the 27 proposed items, only three showed significantly different results between students and pharmacists. Moreover, 11 semi-structured interviews were conducted. Research in the community pharmacy domain is relatively new for many pharmacists. Despite limited training, their willingness to participate is contingent on being actively involved from the outset, receiving appropriate support and training. However, the research should be seamlessly integrated into their daily practice, without being too time-consuming and administratively burdensome. Time constraints emerged as the main obstacle, along with concerns about the availability of human resources. Pharmacists expressed strong motivation driven by the research topic's relevance, and its potential impact on patients or the profession. While financial compensation is desirable, it did not appear to be the main criterion for participation in a study. CONCLUSIONS French pharmacists are willing to participate in research projects to improve patient care and develop the profession. Research teams must guide and involve from the project's inception.
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Affiliation(s)
- Arthur Piraux
- Department of Pharmacy, Univ Angers, CHU Angers, Angers, F-49000, France.
| | - Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, F-44000, France
| | - Pierre Nizet
- UMR INSERM 1246 SPHERE "methodS in Patient-centered Outcomes and HEalth ResEarch, Nantes Université, Université de Tours, Nantes, France
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - Dominique Navas
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - Claire Sallenave-Namont
- UR2160 ISOMer - UFR de Sciences Pharmaceutiques et biologiques, Université de Nantes, Nantes, F- 44035, France
| | - Sonia Prot-Labarthe
- Nantes Université, CHU Nantes, Université Paris Cité, Inserm, ECEVE, F- 75010, Pharmacie, Paris, France
| | - Jean-François Huon
- UMR INSERM 1246 SPHERE "methodS in Patient-centered Outcomes and HEalth ResEarch, Nantes Université, Université de Tours, Nantes, France
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Dores AR, Peixoto M, Carvalho IP, Jesus Â, Moreira F, Marques A. The Pharmacy of the Future: Pharmacy Professionals' Perceptions and Contributions Regarding New Services in Community Pharmacies. Healthcare (Basel) 2023; 11:2580. [PMID: 37761777 PMCID: PMC10531482 DOI: 10.3390/healthcare11182580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The use of information and communication technologies (ICTs) has revolutionized the provision of health services, often referred to as eHealth, benefiting community pharmacies that can offer new services in innovative formats, namely through telepharmacy. This study aimed to explore the perceptions of pharmacy professionals (i.e., pharmacists and pharmacy technicians) on the provision of new services. The study consisted of administering an online questionnaire to pharmacy professionals nationwide. The questionnaire was developed by the research team, based on focus group methodology, from which an inductive analysis led to the categories that made up the dimensions of the survey. Participants were 95 pharmacy professionals with a mean age of 33.69 years old (SD = 10.75). Almost 79% were women. The results show overall receptivity to the development of new services in community pharmacies. Suggestions for the development of the new services, conditions necessary for their implementation, potential obstacles, and strategies to promote adherence to the new services, among others, are identified. The knowledge thus acquired will help community pharmacies to develop innovative solutions in counselling, pharmacotherapy monitoring, and pharmacovigilance, for example, of herb/dietary supplement-drug adverse reactions and interactions. Based on this information, new services can become more accessible, namely through the use of ICTs.
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Affiliation(s)
- Artemisa R. Dores
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
| | - Miguel Peixoto
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
| | - Irene P. Carvalho
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Ângelo Jesus
- CISA, Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (Â.J.); (F.M.)
| | - Fernando Moreira
- CISA, Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (Â.J.); (F.M.)
| | - António Marques
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
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Holland R, Bond C, Alldred DP, Arthur A, Barton G, Birt L, Blacklock J, Blyth A, Cheilari S, Daffu-O'Reilly A, Dalgarno L, Desborough J, Ford J, Grant K, Harry B, Hill H, Hughes C, Inch J, Maskrey V, Myint P, Norris N, Poland F, Shepstone L, Spargo M, Turner D, Watts L, Zermansky A, Wright D. Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial. BMJ 2023; 380:e071883. [PMID: 36787910 PMCID: PMC9926330 DOI: 10.1136/bmj-2022-071883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes. DESIGN Cluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes. SETTING Care homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads. PARTICIPANTS 49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad. INTERVENTION Each pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. MAIN OUTCOMES MEASURES The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition. RESULTS The average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified. CONCLUSIONS Change in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received. TRIAL REGISTRATION ISRCTN 17847169.
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Affiliation(s)
- Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Linda Birt
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Joanna Ford
- Geriatric Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Bronwen Harry
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Helen Hill
- Stow Healthcare Ltd, Bury St. Edmunds, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Jacqueline Inch
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Phyo Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nigel Norris
- School of Education and Lifelong Learning, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Maureen Spargo
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
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General practice pharmacists' implementation of advanced clinical assessment skills: a qualitative study of behavioural determinants. Int J Clin Pharm 2022; 44:1417-1424. [PMID: 36214937 PMCID: PMC9718702 DOI: 10.1007/s11096-022-01484-7] [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: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The role of General Practice Clinical Pharmacists is becoming more clinically complex. Some are undertaking courses to develop their skillsets. AIM To explore potential behavioural determinants influencing the implementation of skills gained from Advanced Clinical Examination and Assessment courses by General Practice Clinical Pharmacists. METHOD This study used a qualitative methodology with theoretical underpinning. General Practice Clinical Pharmacists in the Scottish National Health Service, having completed an Advanced Clinical Examination and Assessment course, were invited for online dyadic (paired) interviews. Informed written consent was obtained. The interview schedule was developed using the Theoretical Domains Framework and piloted. Interviews were recorded, transcribed verbatim and analysed using a framework analysis. Ethics approval was obtained. RESULTS Seven dyadic interviews were conducted. These included fourteen pharmacist participants from eight Health Boards. Three main themes were identified: 1. Factors influencing implementation of advanced clinical skills by pharmacists; 2. Social and environmental influences affecting opportunities for pharmacists in advanced clinical roles; 3. Perceptions of pharmacist professional identity for advanced practice roles. Nine sub-themes provided a depth of insight including; participants reporting courses allowed clinically autonomous practice; participants shared frustration around social and environmental factors limiting implementation opportunities; participants expressed a need for clarification of professional identify/roles within current contractual mechanisms to allow them to fully implement the skills gained. CONCLUSION This work identified numerous behavioural determinants related to implementation of advanced clinical skills by pharmacists in general practice. Policy, and review of implementation strategies are urgently required to best utilise pharmacists with these skills.
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