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de Souza JFF, Fernandes BD, Rotta I, Visacri MB, de Mendonça Lima T. Key performance indicators for pharmaceutical services: A systematic review. Explor Res Clin Soc Pharm 2024; 14:100441. [PMID: 38665264 PMCID: PMC11044031 DOI: 10.1016/j.rcsop.2024.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Background Key performance indicators (KPIs) are a set of indicators that improve the quality of services provided by pharmacists. They enable the monitoring and evaluation of result progress and optimize decision-making for stakeholders. Currently, there is no systematic review regarding KPIs for pharmaceutical services. Objectives To identify and assess the quality of KPIs developed for pharmaceutical services. Methods A systematic review was conducted in PubMed, Scopus, EMBASE, and LILACS from the inception of the database until February 5th, 2024. Studies that developed a set of KPIs for pharmaceutical services were included. The indicators were evaluated using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. Two independent reviewers performed the study selection, data extraction, and quality assessment. Results Fifteen studies were included. The studies were conducted in different regions, most of which were developed for clinical services in hospitals or ambulatory settings, and used similar domains for the development of KPIs such as medication review, patient safety, and patient counseling. Literature review combined with the Delphi technique was the method most used by the studies, with content validity by inter-rater agreement. Regarding methodological quality, most studies described information on the purpose, definition, and stakeholders' involvement in the set of KPIs. However, little information was observed on the strategy for risk adjustment, instructions for presenting and interpreting the indicator results, the detailed description of the numerator and denominator, evidence scientific, and the feasibility of the set of KPIs. Only one study achieved a high methodological quality in all domains of the AIRE tool. Conclusion Our findings showed the potential of KPIs to monitor and assess pharmacy practice quality. Future studies should expand KPIs for other settings, explore validity evidence of the existing KPIs, provide detailed descriptions of evidence, formulation, and usage, and test their feasibility in daily practice.
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Affiliation(s)
| | | | - Inajara Rotta
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil
| | - Marília Berlofa Visacri
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Tácio de Mendonça Lima
- Department of Pharmacy and Pharmaceutical Administration, Faculty of Pharmacy, Fluminense Federal University, Niterói, Brazil
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Shrestha S, Iqbal A, Teoh SL, Khanal S, Gan SH, Lee SWH, Paudyal V. Impact of pharmacist-delivered interventions on pain-related outcomes: An umbrella review of systematic reviews and meta-analyses. Res Social Adm Pharm 2024:S1551-7411(24)00091-3. [PMID: 38514293 DOI: 10.1016/j.sapharm.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Pain is a significant healthcare challenge, impacting millions worldwide. Pharmacists have increasingly taken on expanded roles in managing pain, particularly in primary and ambulatory care contexts. This umbrella review aims to systematically evaluate evidence from published systematic reviews that explore the impact of pharmacist-delivered interventions on clinical, humanistic, and economic outcomes related to pain. METHODS A systematic search was conducted across six electronic databases, including Ovid Embase, MEDLINE, CINAHL, Scopus, CENTRAL, APA PsycINFO, and DARE, from inception until June 2023. Prior to inclusion, two independent reviewers assessed study titles and abstracts. Following inclusion, an assessment of the methodological quality of the included studies was conducted. AMSTAR 2 was used to evaluate the methodological quality of the included SRs. RESULTS From 2055 retrieved titles, 11 systematic reviews were included, with 5 out of 11 being meta-analyses. These SRs encompassed diverse pharmacist-led interventions such as education, medication reviews, and multi-component strategies targeting various facets of pain management. These findings showed favorable clinical outcomes, including reduced pain intensity, improved medication management, enhanced overall physical and mental well-being, and reduced hospitalization durations. Significant pain intensity reductions were found due to pharmacists' interventions, with standardized mean differences (SMDs) ranging from -0.76 to -0.22 across different studies and subgroups. Physical functioning improvements were observed, with SMDs ranging from -0.38 to 1.03. Positive humanistic outcomes were also reported, such as increased healthcare provider confidence, patient satisfaction, and quality of life (QoL). QoL improvements were reported, with SMDs ranging from 0.29 to 1.03. Three systematic reviews examined pharmacist interventions' impact on pain-related economic outcomes, highlighting varying cost implications and the need for robust research methodologies to capture costs and benefits. CONCLUSION This umbrella review highlights the effectiveness of pharmacist-delivered interventions in improving clinical, humanistic, and economic outcomes related to pain management. Existing evidence emphasises on the need to integrate pharamacists into multi-disciplinary pain management teams. Further research is needed to investigate innovative care models, such as pharmacist-independent prescribing initiatives within collaborative pain management clinics.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Ayesha Iqbal
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, T6G1C9, Edmonton, Canada.
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, UEA Research Park Rosalind Franklin Rd, NR4 7UQ, Norwich, United Kingdom.
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well Being Cluster, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, United Kingdom; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
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Farhat A, Voidey A, Sommer I, Carrez L, Sadeghipour F. Optimizing pharmaceutical management of clinical trials. Ann Pharm Fr 2024; 82:285-291. [PMID: 38157980 DOI: 10.1016/j.pharma.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The clinical trials pharmacists have an essential role in managing the pharmaceutical part of interventional studies. The primary objective of this article was to provide a template for improving trials management for the growing number of studies without increasing personnel resources. MATERIAL AND METHODS A retrospective study was conducted between 2016 and 2020 at the service of pharmacy at Lausanne University Hospital in Switzerland. RESULTS The number of clinical trials (in progress) managed at the pharmacy increased from 77 to 115 (+49%) between 2016 and 2020. The majority of these studies were in oncology and were sponsored by industry. Therefore, different changes in routine tasks were decided during the 5 years term to meet the above challenge. These modifications allowed to improve pharmaceutical and administrative management of clinical trials, without increasing personnel resources. The management template was accepted by the sponsors, and no issues were mentioned by national and international audit authorities. CONCLUSION Changes could be made in the routine practice of the clinical trials pharmacists to improve the management of studies, while the number of trials is increasing every year.
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Affiliation(s)
- Akram Farhat
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Aline Voidey
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Isabelle Sommer
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Laurent Carrez
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Farshid Sadeghipour
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
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Bogaerts C, Schoenmaekers N, Haems M, Storme M, De Loof H. A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting. Int J Clin Pharm 2024; 46:141-149. [PMID: 37962780 DOI: 10.1007/s11096-023-01648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A six year collaboration between academics, community pharmacists and informaticians, led to the development of nine guidelines for a clinical decision support system, enhancing community pharmacists' ability to address drug-related problems and improve care. AIM The objective of this study was to assess the effectiveness of clinical decision support system rules in enhancing medication management within the community pharmacy setting. This was achieved through retrospective monitoring of real-world usage and measuring the pharmacotherapeutic impact of the rules. METHOD In 2019, a retrospective observational evaluation appraised the acceptance rate of the clinical decision support system components in 490 Belgian pharmacies. Among these, 51 pharmacies underwent a longitudinal analysis involving (i) co-prescription of methotrexate and folic acid, (ii) gastroprotection with non-steroidal anti-inflammatory drugs, and (iii) drug combinations causing QT prolongation. The study period spanned one year pre-launch, one year post-launch, and two years post-launch. RESULTS Of the targeted pharmacies, 80% used 7 of the 9 rules. After four years, methotrexate-folic acid co-prescription increased 4%, reaching 79.8%. Gastroprotection improved by 3% among older patients and 7.47% in younger individuals (< 70 year) with multiple risk factors. The QT prolongation rules faced implementation difficulties. CONCLUSION Pharmacists' acceptance of the developed rules was high and coincided with a decline in drug-related problems, holding potential public health impact. This real-world data can inform the future implementation of such systems, as it demonstrated the need for more detailed data-gathering and more intensive training of pharmacists in the handling of more complex problems such as QT prolongation.
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Affiliation(s)
- Carolien Bogaerts
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Nele Schoenmaekers
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium.
| | - Marleen Haems
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Michael Storme
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Hachemi D, Leguelinel-Blache G, Bouvet S, Roux-Marson C, Plouvier N, Kinowski JM, Castelli C, Dubois F. Clinical impact of pharmaceutical consultations in patients treated for chronic obstructive pulmonary disease: Study protocol for a randomized controlled trial (BPCObs study). Contemp Clin Trials Commun 2024; 37:101249. [PMID: 38269046 PMCID: PMC10805915 DOI: 10.1016/j.conctc.2023.101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is an irreversible chronic respiratory disease which outcome depends on medication adherence. Pharmacists may increase this adherence by advising patients on inhaler devices proper use. This paper presents the protocol for a randomized controlled trial, which assesses impact of pharmaceutical consultations on COPD exacerbations, medical care, adherence to inhaler devices and quality of life. Methods This trial will include 226 COPD patients treated with inhaler devices: 94 in a control group, 66 receiving a pharmaceutical consultation at hospital and 66 receiving up to 12 pharmaceutical consultations corresponding to dispensing at their community pharmacy. The aim of these interventions is to inform patients about COPD medication, train them in the use of inhaler devices and improve adherence. Patients included by hospital pharmacist will be randomly assigned to the control and hospital experimental groups. Community pharmacists (CP) will include patients in the experimental community group. CPs will follow-up all study patients for 12 months. Primary outcome is the mean number of COPD exacerbations. Secondary outcomes include number of medical consultations, emergency visits and hospitalizations, patients' adherence devices and quality of life. Discussion This is the first French trial which assesses both hospital and community pharmaceutical interventions on COPD patients. Study limitations include recruitment and CP adherence to follow-up. Indeed, the success of this trial depends on the willingness of CPs to collect the data. This work is the first step towards building a network of CPs trained for clinical research. Trial registration Clinicaltrials.gov, NCT03704545. Registered on October 12th, 2018. https://clinicaltrials.gov/ct2/show/NCT03704545?cond=COPD&cntry=FR&city=nimes&draw=2&rank=1.
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Affiliation(s)
- Djamila Hachemi
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
- Department of Law and Health Economics, Univ Montpellier, Montpellier, France
| | - Sophie Bouvet
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
| | - Nathalie Plouvier
- Department of Pulmonology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
| | - Christel Castelli
- Department of Law and Health Economics, Univ Montpellier, Montpellier, France
- Department of Clinic Research, AESIO SANTE Méditerranée Beau Soleil Clinic, Montpellier, France
| | - Florent Dubois
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
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Zavaleta-Monestel E, Arguedas-Chacón S, Quirós-Romero A, Chaverri-Fernández JM, Serrano-Arias B, Díaz-Madriz JP, García-Montero J, Speranza-Sanchez MO. Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team. Int J Heart Fail 2024; 6:1-10. [PMID: 38303921 PMCID: PMC10827703 DOI: 10.36628/ijhf.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 02/03/2024]
Abstract
Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.
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Affiliation(s)
- Esteban Zavaleta-Monestel
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Sebastián Arguedas-Chacón
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
| | - Alonso Quirós-Romero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, University of Costa Rica, San José, Costa Rica
| | | | | | | | - Jonathan García-Montero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
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Marqueyssat GS, Valton L, Civade E, Laborde C. [Evaluation of the relevance of the pharmaceutical educational interview on the knowledge and satisfaction of patients who received a vagus nerve neurostimulator implantation]. Ann Pharm Fr 2024; 82:163-173. [PMID: 37625530 DOI: 10.1016/j.pharma.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Vagal neurostimulation (VNS) medical devices (MDs) are used to treat drug-resistant epilepsy. Using a magnet, the patient can activate on the stimulations in order to stop a seizure or interrupt the adverse effects (AEs) of the device. The objective is to evaluate the improvement of the patients' knowledge about the VNS following a pharmaceutical educational interview (PEI) as well as their satisfaction. MATERIALS AND METHODS The pharmaceutical educational interview regarding drugs and DMs was performed by the clinical pharmacist at the patient's bed after VNS implantation. A questionnaire about VNS devices (operation, adverse effects, recommendations) and assessing knowledge was submitted to patients before and after the PEI. Satisfaction was assessed by the Likert scale. RESULTS From March 2020 to August 2021, 18 implanted patients were included in the study. In 78% of cases (14/18), the total number of good responses after PEI increased. The mean good response was significantly increased from 16.11/25 (64%) before PEI to 22.33/25 (89%) after PEI (P-value<0.01). The maximum satisfaction score (4/4) was given in 71% of the items. DISCUSSION-CONCLUSION The results support the relevance of PEI. Patients feel a need for information and consider the interview useful. An improvement in knowledge was observed, which allows us to hope for an optimization of the effectiveness of the device, in particular, a reduction in seizures and AE. This study shows the feasibility and the interest of the development of clinical pharmacy applied to medical devices in complementarity with the expertise on drugs.
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Affiliation(s)
- Gaël-Sean Marqueyssat
- Pôle pharmacie, équipe de pôle neurosciences et céphalique, CHU de Toulouse, Toulouse, France.
| | - Luc Valton
- Explorations neurophysiologiques, CHU de Purpan, Toulouse, France; Centre de recherche cerveau et cognition (CerCo), University of Toulouse, 31300 Toulouse, France
| | - Elodie Civade
- Pôle pharmacie, équipe de pôle neurosciences et céphalique, CHU de Toulouse, Toulouse, France
| | - Charlotte Laborde
- Pôle pharmacie, équipe de pôle neurosciences et céphalique, I2MC équipe Ceramic, UFR Santé service de Pharmacie clinique, CHU de Toulouse, Toulouse, France
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de Oliveira Duarte EC, Santiago NR, Visacri MB, de Mendonça Lima T. Role of pharmacist in the management of Hansen's Disease: A scoping review. Explor Res Clin Soc Pharm 2023; 12:100342. [PMID: 37823010 PMCID: PMC10563045 DOI: 10.1016/j.rcsop.2023.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Background Stakeholders and healthcare professionals have an essential role in the elimination of Hansen's Disease. Of these, pharmacists provide core services that assist the management of these patients with the supply of medicines and clinical actions. Objectives To summarize evidence on the role of pharmacist in the management of Hansen's Disease. Methods A literature search was performed in MEDLINE, Embase, Scopus, Web of Sciences, LILACS, and Google Scholar for studies published until September 29th, 2022 without language restriction. Studies that reported actions provided by pharmacists in the management of patients with Hansen's Disease were included. The pharmacist interventions identified in the studies were described based on key domains in DEPICT v.2. Two independent reviewers performed study selection and data extraction and any disagreements were resolved by third and fourth authors. Results A total of 751 records were identified, of which 8 studies fully met the eligibility criteria. Most of them were conducted in Brazil (n = 5), in an ambulatory setting (n = 8) and the most common study design was descriptive cross-sectional (n = 6). Different roles of pharmacists were identified, such as medication review, therapeutic drug monitoring, patient education, drug information, and dispensing. All studies described pharmacist interventions for patients through one-on-one contact and face-to-face. Pharmacists were responsible for patient counseling (n = 8), suggestions for change in therapy (n = 2), and monitoring results report (n = 2). The studies reported benefits associated with pharmacist interventions, despite the limited descriptions regarding these actions. Conclusions Few studies that described the activities of pharmacists in the management of Hansen's Disease were found. As the studies did not offer a satisfactory level of description and quality, further research should be conducted to strengthen this field.
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Affiliation(s)
| | | | - Marília Berlofa Visacri
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil
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National Cancer Center, Oncology Specialty Pharmacist Subcommittee, Chinese Pharmacists Association. [Guidelines for pharmaceutical care of endocrine therapeutics for breast cancer(2023 edition)]. Zhonghua Zhong Liu Za Zhi 2023; 45:834-62. [PMID: 37875421 DOI: 10.3760/cma.j.cn112152-20230823-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Endocrine therapy is one of the primary treatment methods for hormone receptor-positive breast cancer patients. As of June 1 2023, the National Medical Product Administration has approved 56 drugs related to endocrine therapy in patients with HR+ /HER-2- breast cancer (including generic drugs that have passed the consistency evaluation), including 44 endocrine drugs which can be categorized according to their mechanisms of action into selective estrogen receptor modulators, selective estrogen receptor down-regulators, aromatase inhibitors, luteinizing hormone-releasing hormone analogs, and progestogens and 12 targeted drugs for combined with endocrine therapy, including CDK4/6 inhibitors, mTOR inhibitors, and HDAC inhibitors. The different pharmacological characteristics, mechanisms of action, and long-term medication factors of breast cancer endocrine therapy-related drugs can directly affect patients' medication adherence and medication safety. To standardize the pharmaceutical care of endocrine therapy drugs for breast cancer and promote rational use in clinical settings, the Oncology Specialty Pharmacist Subcommittee, in conjunction with multidisciplinary experts nationwide, has developed the "Guidelines for pharmaceutical care of endocrine therapy drugs for breast cancer (2023 edition)". The guidelines is based on clinical evidence-based evidence, relevant regulations of pharmaceutical management, and pharmaceutical care practices. The Delphi method and expert interviews were used to formulate the guidelines. The GRADE approach was used for assessing the certainty of evidence. This guideline mainly focuses on endocrine therapy for HR+ /HER-2- breast cancer patients. Due to space constraints, HER-2 positive targeted drugs were not included in the guideline. It covers 6 dimensions and 22 key problems of pharmaceutical care in the whole process of drug therapy, providing a scientific basis for pharmacists to carry out pharmaceutical care of such drugs.
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Chew CC, Lim XJ, Letchumanan P, Narayanan MS, Rajan P, Chong CP. Development and validation of a pharmacist-led education model in allergic rhinitis management: a multi-phase study. J Pharm Policy Pract 2023; 16:116. [PMID: 37794504 PMCID: PMC10548631 DOI: 10.1186/s40545-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patient education is identified as one of the core and fundamental management strategies in the management of allergic rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed guidance for the management of allergic respiratory disease, and the guidelines are applicable to the international context. The ARIA guidelines for the pharmacy have specifically encouraged the creation of local pharmacist-led intervention in allergic rhinitis management. This study aims to develop a pharmacist-led educational model using a multi-phase study approach. METHOD In phase one, we conducted a literature review using four databases to extract relevant articles and clinical practice guidelines published between 2017 and 2022. The information was structured into a questionnaire consisting of patient education material (10 domains with 130 items) and pharmacist counseling scopes (15 domains with 43 items), with each item having a rating scale ranging from 1 (lowest) to 9 (highest) level of agreement. Fifty-two panellists, including otorhinolaryngologists and pharmacists, were invited to complete the questionnaire. A consensus agreement was considered when at least 70% of panellists scored 7 to 9 (critically important). A two-round survey was conducted, and descriptive analysis, inter-rater reliability (≥ 0.5-1 indicate moderate to excellent reliability), variation in the relative interquartile (VRIR < 0.3 indicate good stability), and variation in the coefficient of variation (VCV < 40% considered consensus achieved) were performed. In phase two, patient education material was developed into audio-visual format, and in phase three, patients rated its understandability and actionability using a validated Patient Education Materials Assessment Tool. RESULTS In the round one Delphi survey, 43 panellists responded, with 171 out of 173 items achieving "consensus agreement" (75.4-100%). In the second survey, 32 out of 43 panellists responded, with most items (171 out of 173 items) stable across rounds and all items had acceptable internal consistency (VCV: - 12.21-15.81). Two items did not achieve "consensus agreement" (64%) but improved in round two (92.9%), however, instability was observed (VRIR: 0.36). These two items were retained in the model due to achieving the minimum level of agreement and internal consistency (VCV = 15.81). Inter-rater reliability was 0.608 and 0.970 in the respective rounds. Patients rated the educational material as understandable (81.8-100%) and actionable (100%). CONCLUSION The validated pharmacist-led education model, with its educational materials tested on end-users, provides structured patient education and pharmaceutical care in assisting patients with allergic rhinitis. The educational material allows the delivery of standardized information by the healthcare providers to the patients. Further research on the effectiveness of this model in improving patients' symptom control and quality of life is warranted.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Maithrea Suresh Narayanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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11
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Melo TAR, Bezerra CO, Fernandes BD, Rotta I, Reis WCT, Aguiar PM. Pharmacists' contribution to benzodiazepine deprescribing in older outpatients: a systematic review and meta-analysis. Int J Clin Pharm 2023; 45:1037-1049. [PMID: 37713028 DOI: 10.1007/s11096-023-01637-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking. AIM This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients. METHOD A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software. RESULTS A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence). CONCLUSION Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.
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Affiliation(s)
- Thiago Afonso Rodrigues Melo
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Conj. das Químicas, Bloco 13, Cidade Universitária Butantã, São Paulo, Brazil
| | - Cleyton Oliveira Bezerra
- Municipal Health Department, Multiprofessional Residency Program in Family and Community Health, João Pessoa, PB, Brazil
| | | | - Inajara Rotta
- Department of Pharmacy, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Patricia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Conj. das Químicas, Bloco 13, Cidade Universitária Butantã, São Paulo, Brazil.
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12
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Soubolsky A, Halpape K, Jorgenson D, Remillard AJ, Necyk C. Between what is and what could be: a survey of pharmacists' practices, attitudes, and beliefs in the provision of mental health care. Int J Clin Pharm 2023; 45:1192-1202. [PMID: 37682399 DOI: 10.1007/s11096-023-01633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Pharmacists can have an essential role in providing care for patients with mental illness. There are gaps in the understanding of the current extent of pharmacists' involvement in caring for patients with mental illness and their readiness to effectively provide this care. AIM To describe the current practices, attitudes, and beliefs of pharmacists in providing care to individuals with mental illness, and to assess factors that may impact these practices. METHOD An electronic questionnaire was emailed to pharmacists in Saskatchewan, Canada. Likert scale questions were utilized, and data were analyzed using descriptive statistics and content analysis for free-text responses. RESULTS The response rate was 9.1% (n = 146/1596). Fewer than 20% of respondents reported they were providing the clinical services listed to most or all patients with mental illness, except for providing basic medication education (61%). Almost all agreed it is a pharmacist's role to provide all the services (61-98% for different services) and many were motivated to provide them (47-91%). The factors most frequently selected as having the greatest impact on service provision were insufficient knowledge (27%, n = 34) and competing priorities (19%, n = 24). CONCLUSION Consistent with international trends, Saskatchewan pharmacists reported low provision of clinical services for individuals with mental illness, despite a readiness to provide these services. There is an opportunity and a need to better utilize pharmacists internationally in the provision of mental health care.
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Affiliation(s)
- Amy Soubolsky
- Information Support Pharmacist RxFiles, College of Pharmacy and Nutrition, University of Saskatchewan, and Clinical Pharmacist, Saskatchewan Health Authority, Saskatoon, Canada.
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Derek Jorgenson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Alfred J Remillard
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Candace Necyk
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
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Rosenthal M, Miller L, Bateman M, Smith M, Nueva K, Ballou JM. The impact of pharmacy benefit managers on community pharmacy: A scoping review. Explor Res Clin Soc Pharm 2023; 10:100283. [PMID: 37333968 PMCID: PMC10276176 DOI: 10.1016/j.rcsop.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The introduction of pharmacy benefit managers (PBMs) within the United States healthcare system occurred with the aim to decrease costs and increase quality. News media and legislation have painted a picture of decreased pharmacy competition and potential negative impacts on patients and their access to affordable medications. Objective The objective of this scoping review was to evaluate the current research literature examining the impact of PBMs on the finances of community pharmacies. Methods Scientific journal articles published between 2010 and 2022 were included if they met the predefined objective. Results This scoping review identified four articles that met inclusion criteria. None of the identified articles independently quantified the financial impact of PBMs on community pharmacies. Conclusions Additional research should be completed to specifically understand the financial impact on community pharmacies to help ensure the viability of community pharmacy as an integral access point for patients.
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Affiliation(s)
- Meagen Rosenthal
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, United States of America
| | - Lindsey Miller
- Community-based Pharmacy Resident at Moose Pharmacy, The University of North Carolina Eshelman School of Pharmacy in Chapel Hill, NC, United States of America
| | - Mixson Bateman
- PGY-1 Resident, Baptist Memorial Hospital-Memphis, Memphis, TN, United States of America
| | - Megan Smith
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, United States of America
| | - Katrina Nueva
- University of Mississippi School of Pharmacy, Jackson, MS, United States of America
| | - Jordan M. Ballou
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, United States of America
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14
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O'Mahony E, Kenny J, Hayde J, Dalton K. Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge. Int J Clin Pharm 2023:10.1007/s11096-023-01558-0. [PMID: 37093415 PMCID: PMC10124684 DOI: 10.1007/s11096-023-01558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pharmacists can use teach-back to improve patients' understanding of medication; however, the evidence of its impact on patient outcomes is inconsistent. From the literature, there is no standardised way to provide pharmacist-delivered medication counselling at hospital discharge, with limited reporting on training. AIM To develop a standardised medication counselling procedure using teach-back at hospital discharge, and to evaluate feedback from patients and pharmacists on this initiative. METHOD A standardised intervention procedure was developed. Participating pharmacists (n = 9) were trained on teach-back via an online education module and watching a demonstration video created by the researchers. Pharmacists provided patients with discharge medication counselling utilising teach-back and a patient-friendly list of medication changes to take home. To obtain feedback, patients were surveyed within seven days of discharge via telephone and pharmacists answered an anonymous survey online. RESULTS Thirty-two patients (mean age: 57 years; range: 19-91) were counselled on a mean 2.94 medications/patient with the mean counselling time as 23.6 min/patient. All patients responded to the survey, whereby 93.7% had increased confidence regarding medication knowledge and were satisfied with the counselling and the information provided. All pharmacist survey respondents (n = 8) agreed they were given adequate training and that teach-back was feasible to apply in practice. CONCLUSION This is the first study to evaluate patients' views on pharmacist-provided teach-back medication counselling. With positive patient outcomes, a standardised procedure, and a comprehensive description of the training, this study can inform the development of discharge medication counselling utilising teach-back going forward.
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Affiliation(s)
- E O'Mahony
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Kenny
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Hayde
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - K Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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15
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Robberechts A, Van Loon L, Steurbaut S, De Meyer GRY, De Loof H. Patient experiences and opinions on medication review: a qualitative study. Int J Clin Pharm 2023:10.1007/s11096-023-01541-9. [PMID: 36862254 DOI: 10.1007/s11096-023-01541-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/11/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Medication reviews are a structured critical evaluation of a patient's pharmacotherapy, carried out by a healthcare professional, but are not yet a routine pharmaceutical service in Belgium. A pilot project to initiate an advanced medication review (= type 3 medication review) in community pharmacies was set up by the Royal Pharmacists' Association of Antwerp. AIM To investigate the experiences and opinions of patients who participated in this pilot project. METHOD Qualitative study through semi-structured interviews with participating patients. RESULTS Seventeen patients from six different pharmacies were interviewed. The medication review process with the pharmacist was perceived as positive and instructive by fifteen interviewees. The extra attention that the patient received was highly appreciated. However, the interviews revealed that patients did not fully understand the purpose and structure of this new service or were aware of the subsequent contact and feedback with the general practitioner. Medication reviews in the home setting put patients more at ease, were highly appreciated, and enabled also to address practical problems such as drug dosing or storage requirements. CONCLUSION This qualitative study analysed patients' experiences during a pilot project on the implementation of type 3 medication review. Although most patients were enthusiastic about this new service, a lack of patients' understanding of the whole process was also observed. Therefore, better communication to patients by pharmacists and general practitioners about the goals and components of this type of medication review is needed, with the added benefit of increased efficiency.
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Affiliation(s)
- Anneleen Robberechts
- Royal Pharmacists Association of Antwerp (KAVA), Consciencestraat 41, B-2018, Antwerp, Belgium. .,Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium. .,Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium.
| | - Laura Van Loon
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium.,Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
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Zanetti MOB, Rodrigues JPV, Varallo FR, Cunha RLG, Simões BP, Pereira LRL. Impact of the insertion of the clinical pharmacist in the Allogeneic Hematopoietic Stem Cells Transplantation team. J Oncol Pharm Pract 2023; 29:375-385. [PMID: 35037789 DOI: 10.1177/10781552211073797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. METHODS Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. RESULTS A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. CONCLUSIONS The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
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Affiliation(s)
| | - João Paulo Vilela Rodrigues
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Belinda Pinto Simões
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Lobo Borba HH, Woranovicz Carvalho DM. Impact of the Fourth Industrial Revolution on clinical pharmaceutical services: A scoping review. Res Social Adm Pharm 2023; 19:235-242. [PMID: 36175273 DOI: 10.1016/j.sapharm.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Digital technologies are becoming increasingly sophisticated and integrated, but the scope of the Fourth Industrial Revolution (4IR) is wider: technologies and innovations are diffusing faster and more widely. Despite the extensive use of telepharmacy technology by patients and pharmacists, there is an absence of research that examines the use of telepharmacy. OBJECTIVE To investigate the current evidence concerning the impact of the 4IR on the provision of pharmaceutical services. METHODS A scoping review based on the PCC (Population, Concept, and Context) mnemonic was conducted in Pubmed, Scopus and Web of Science. Population included pharmacist/clinical pharmaceutical services, the concept referred to the 4IR and the context was open. Electronic searches retrieved 8,694 articles that were screened by titles and abstracts. The search yielded 59 studies that were analyzed in terms of country of focus, publication year, type of publication, main technologies, types of pharmacy services, and the role of the Fourth Industrial Revolution. RESULTS Most of the included studies were conducted in the United States and were published between 2005 and 2021, with the highest number of publications in the year of 2021. The majority of included articles were observational studies. Technologies addressed in the studies were those within the scope of telepharmacy, and most of the articles discussed more than one pharmaceutical service, with medication therapy management as the most frequent. CONCLUSIONS The Covid-19 pandemic accelerated the use of technologies, identifying promising niches for pharmacists in the field of Pharmaceutical Care. This should encourage pharmacists to fortify their capacity to adopt new technologies in the provision of pharmaceutical services. The frequent use of various technologies has been demonstrated, which indicates the exigency for further health education actions by the pharmacist.
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Affiliation(s)
- Helena Hiemisch Lobo Borba
- Department of Pharmacy, Universidade Federal do Paraná, Curitiba, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, Zip code 80210-170, Brazil.
| | - Denise Maria Woranovicz Carvalho
- Department of General and Applied Administration, Universidade Federal do Paraná, Curitiba, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, Zip code 80210-170, Brazil.
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Torroba-Sanz B, de Lorenzo-Pinto A, Ribed-Sánchez A, Martin-Barbero ML, Giménez-Manzorro Á, García-González X, Ibáñez-García S, Herranz-Alonso A, Sanjurjo-Saez M. Achieving excellence in the pharmaceutical care of the surgical patient. Farm Hosp 2023; 47:26-30. [PMID: 36639263 DOI: 10.1016/j.farma.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 01/15/2023] Open
Abstract
The perioperative setting is one of the hospital areas with the highest prevalence of medication errors. Despite the wide experience of hospital pharmacists in developing medication safety programs and improvement initiatives, the surgical environment has remained one of the areas in which there is less experience. Clinical pharmacist should be integrated into the multidisciplinary care teams so that they can be involved in the different surgical phases of care, which include from the preoperative assessment to inpatient stay, and finally discharge from hospital. Their work will consist of coordinating and implementing strategies that have been demonstrated to reduce medication errors throughout the perioperative process. The aim of this paper is to introduce a specialized pharmaceutical care program to achieve excellence in the pharmaceutical care of surgical patients. This program is especially aimed at promoting the figure of the clinical pharmacist in the perioperative setting to guarantee the highest quality and safety in pharmacotherapeutic care throughout all the surgical phases of care.
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Affiliation(s)
- Beatriz Torroba-Sanz
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | | | | | - Sara Ibáñez-García
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Sanjurjo-Saez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
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Torroba-Sanz B, de Lorenzo-Pinto A, Ribed-Sánchez A, Martin-Barbero ML, Giménez-Manzorro Á, García-González X, Ibáñez-García S, Herranz-Alonso A, Sanjurjo-Saez M. [Translated article] Achieving excellence in the pharmaceutical care of the surgical patient. Farm Hosp 2023; 47:T26-30. [PMID: 36710222 DOI: 10.1016/j.farma.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 01/31/2023] Open
Abstract
The perioperative setting is one of the hospital areas with the highest prevalence of medication errors. Despite the wide experience of hospital pharmacists in developing medication safety programs and improvement initiatives, the perioperative setting has remained one of the areas in which there is less experience. Clinical pharmacist should be integrated into the multidisciplinary care team so that they can be involved in the different surgical phases of care, which include from the preoperative assessment to inpatient stay, and finally discharge from hospital. Their work will consist of coordinating and implementing strategies that have been demonstrated to reduce medication errors during the perioperative process. The aim of this paper is to introduce a specialized pharmaceutical care program to achieve excellence in the pharmaceutical care of surgical patients. This program is especially aimed at promoting the figure of the clinical pharmacist in the perioperative setting to guarantee the highest quality and safety in pharmacotherapeutic care throughout all the surgical phases of care.
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Schulz M, Griese-Mammen N, Müller U. Clinical pharmacy services are reimbursed in Germany: challenges of real world implementation remain. Int J Clin Pharm 2023; 45:245-9. [PMID: 36394784 DOI: 10.1007/s11096-022-01492-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
Over the last two decades, community pharmacy has experienced major changes as the role of pharmacists is evolving from a product to a service and a patient focus. As part of this change, new and innovative clinical pharmacy services aimed at improving medicines use and patient outcomes have been designed, both nationally and internationally. Since June 2022, five services are reimbursed by all statutory health insurance funds and private insurance companies in Germany: medication review for patients with polymedication; blood pressure control in hypertension; assuring proper inhalation techniques for patients receiving a new device or a device change; medication review including a follow-up for patients taking oral anticancer drugs or immunosuppressants post-transplantation. Beyond reimbursement, the upscaling and sustainable provision of these professional services are now the main challenges. Implementation research will provide important information for the further development of pharmaceutical care programs.
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Cooper JB, Scotti A, Carr ML. Implementing medicare education for medication access: A review of the literature using the RE-AIM framework. Res Social Adm Pharm 2023; 19:16-27. [PMID: 36085121 PMCID: PMC10187529 DOI: 10.1016/j.sapharm.2023.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/24/2022] [Accepted: 08/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND The rising cost of medications has a disproportionate effect on community-dwelling older adults despite policy changes designed to improve medication access. Medicare insurance counseling provided by pharmacists, including individualized plan comparison and enrollment assistance, improves medication adherence and health care utilization, yet only 15% of community dwelling older adults report using a pharmacy or pharmacist for Medicare information. To determine what information is available to inform expanding implementation of pharmacy as a resource for Medicare insurance counseling, a systematic review of published studies using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. METHODS Articles meeting inclusion criteria were identified through a literature search using PubMed and GoogleScholar; 27 pharmacy Medicare insurance counseling studies were identified representing 13 unique programs in clinical, community outreach, and community pharmacy settings. Each article was coded by two researchers using the RE-AIM Coding Sheet for Publications and the extent of RE-AIM dimension reporting was determined using descriptive statistics at the program level. Discussions were used to arrive at coding consensus and concordance was measured with Krippendorff's alpha. RESULTS Across all studies (15 quasi experimental, 10 analytical case reports, and 2 case reports) more than half of the programs reported framework component dimensions for Reach (69%), Adoption (58%), Implementation (54%), and Maintenance (54%), and fewer than half reported comprehensively on Effectiveness (44%). Ten studies in 7 of 13 programs reported estimated out-of-pocket cost savings. Two studies measured patient-centered outcomes: medication adherence by proportion of days covered (PDC) and health care utilization by hospital admissions and emergency department visits. Gaps in the external validity of pharmacy Medicare education programs were identified including staff participation rates, methods to identify participating settings and program costs. CONCLUSIONS Based on this review, current research on pharmacy Medicare education is insufficient to guide broad implementation. Additional studies are needed to determine how Medicare education integrating pharmacists and pharmacies can be implemented to address cost-related non-adherence for community dwelling older adults.
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Affiliation(s)
- Julie B Cooper
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
| | - Alice Scotti
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
| | - Megan L Carr
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
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National Cancer Center, Cancer Pharmacists Branch of Chinese Pharmacists Association. [China guideline for pharmaceutical care on anti-tumor antibody-based drugs]. Zhonghua Zhong Liu Za Zhi 2022; 44:1017-46. [PMID: 36319449 DOI: 10.3760/cma.j.cn112152-20220902-00593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Antibody-based drugs are prepared by cell and genetic engineering technology, which are widely used in the treatment of malignant tumors. According to the structural characteristics, antibody-based drugs currently on the market can be divided into several categories, including monoclonal antibody drugs, bispecific antibody drugs and antibody drug conjugates. Until June 1, 2022, 39 anti-tumor antibody drugs have been approved in China. Since the pharmaceutical characteristics, in vivo efficacy and pharmacokinetic characteristics of anti-tumor antibody drugs are different from those of traditional small molecule drugs, the pharmaceutical care of anti-tumor antibody drugs in clinical application has distinct features. To regulate pharmaceutical care of these drugs, promote the rational use of antibody drugs in China, this guideline has been made by Cancer Pharmacists Branch of Chinese Pharmacists Association, with the guidance of the National Cancer Center. We used the Delphi method and expert interview and discussion, to build the key problems. The contents in this guideline are based on clinical evidence, domestic pharmaceutical management regulations and pharmaceutical care practice. This guideline covers the whole process of pharmaceutical care system, includes the using of before, during and after drug administration. It provides a scientific basis for pharmacists to carry out pharmaceutical care for this kind of drugs.
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Chagas MO, de Mendonça Lima T, Rebustini F, Noll M, de Carvalho Queiroz DP, Hernandes JC, Chaveiro N, Barbosa MA, Porto CC. Instruments to assess the role of the clinical pharmacist: a systematic review. Syst Rev 2022; 11:175. [PMID: 35996155 DOI: 10.1186/s13643-022-02031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary. METHODS A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected. RESULTS A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments. CONCLUSIONS Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42018099912.
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Dos Santos RLB, Pepe VLE, Osorio-de-Castro CGS. Public procurement of antineoplastic agents used for treating breast cancer in Brazil between 2013 and 2019. BMC Cancer 2022; 22:769. [PMID: 35840933 PMCID: PMC9284867 DOI: 10.1186/s12885-022-09851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Breast cancer is the most common cancer among women in Brazil and the country’s public health care system is the main care provider. Timely treatment can increase the chance of cure, prevent metastasis and improve quality of life. Effective public procurement of antineoplastic agents can therefore improve access to drug therapy. This study investigates patterns in the procurement of selected antineoplastic agents used for treating breast cancer by public bodies and avoidable expenditure on these drugs between January 2013 and December 2019. Methods We selected antineoplastic agents used for adjuvant or preoperative chemotherapy listed in the 2018 Breast Cancer Diagnosis and Treatment Guidelines and included in category L of the WHO Anatomical Therapeutic Chemical classification system. We analyzed regular purchases of antineoplastic agents registered in the Integrated General Services Administration System (SIASG), considering purchased quantity, unit price, date of purchase and procuring entity. Prices were inflation-adjusted to July 2019 based on the National Consumer Price Index. Results A total of 10 antineoplastic agents were selected. Trastuzumab and tamoxifen accounted for the largest share of total spending and largest volume of purchases, respectively. The Ministry of Education was the largest purchaser in volume terms of all the drugs studied, except trastuzumab 440 mg, where the category “Other Institutions” accounted for most purchases, and vinorelbine 20 mg, where the Ministry of Health made most purchases. The category “Other Institutions” accounted for the largest share of total spending. Total avoidable expenditure was R$99,130,645. Prices paid for medicines and avoidable expenditure were highest in the Ministry of Defense. Conclusions The differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastic agents could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.
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Affiliation(s)
| | - Vera Lúcia Edais Pepe
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Claudia Garcia Serpa Osorio-de-Castro
- Department of Pharmaceutical Policies and Pharmaceutical Services, Sergio Arouca National School of Public Health/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Chen KL, Hunag CF, Sheng WH, Chen YK, Wang CC, Shen LJ. Impact of integrated medication management program on medication errors in a medical center: an interrupted time series study. BMC Health Serv Res 2022; 22:796. [PMID: 35725537 PMCID: PMC9210585 DOI: 10.1186/s12913-022-08178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Medication errors (MEs) are harmful to patients during hospitalization, especially elderly patients. To reduce MEs, an integrated medication management (IMM) model was developed in a 2500-bed medical center, allowing a clinical pharmacist to participate in the daily ward round and perform medication reconciliation and medication reviews. This study aimed to evaluate the impact of the IMM model on MEs and medication utilization using a quasi-experimental design. Methods We conducted an interrupted time-series study using the aggregated data of monthly admissions from two wards of a medical center, where one ward served as the intervention and the other served as the external control. The pre- and post-intervention phases comprised of 40 and 12 monthly observational units, respectively. The primary outcome was the mean number of ME reports, which were further investigated for different ME types. The mean number of daily inpatient prescriptions, mean number of daily self-prepared medications, and median daily medication costs were measured. All outcomes were measured per admission episode. Segmented regression was used to evaluate the level and slope changes in the outcomes after IMM model implementation, and subgroup analyses were performed to examine the effects on different groups. Results After IMM model implementation, the mean number of ME reports increased (level change: 1.02, 95% confidence interval [CI]: 0.68 to 1.35, P < 0.001). The number of reports has shown a dramatic increase in omissions or medication discrepancies, inappropriate drug choices, and inappropriate routes or formulations. Furthermore, the mean number of daily inpatient prescriptions was reduced for patients aged ≥75 years (level change: −1.78, 95% CI: −3.06 to −0.50, P = 0.009). No significant level or slope change was observed in the control ward during the post-intervention phase. Conclusions The IMM model improved patient safety and optimized medication utilization by increasing the reporting of MEs and decreasing the number of medications used. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08178-w.
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Affiliation(s)
- Kuan-Lin Chen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fen Hunag
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kuei Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Jiuan Shen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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de Souza MFR, de Sena MPM, Oliveira CM, Sales CA, de Melo RBC, de Sena LWP. Analysis of the clinical practice of the pharmacist in a community pharmacy: A Cross-sectional Study from Brazil. Pharm Pract (Granada) 2022; 20:2658. [PMID: 35919800 PMCID: PMC9296079 DOI: 10.18549/pharmpract.2022.2.2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The pharmaceutical profession has experienced renewals over time. In community pharmacies, pharmaceutical services contribute to the public health system in Brazil. The development of these tasks, in collaboration with professionals from the multidisciplinary team, demonstrates the involvement with the well-being, health and improvement of the patient’s life. Objectives: This study aimed to identify the professional practice of pharmacists, their understandings and attitudes towards clinical practice in community pharmacies in northern Brazil. Methods: This is a cross-sectional descriptive study, based on a questionnaire carried out with pharmacists for seven months in the municipality of Belém, in the state of Pará. Data were expressed using descriptive statistics and the results were shown as a percentage. Results: 182 pharmacists participated. Females were predominant (80.2%) and the average age of participants was 34.2 years. 77.4% graduated from private institutions and 59.3% already have a specialization. 38.4% hold the position of technical director. 50.5% of respondents say that community pharmacies have a reserved place for service. The most used clinical services were pharmacotherapy review (89.5%), health education (60.9%), dispensing (34%), therapeutic monitoring (25.8%) and pharmacotherapeutic follow-up (4.9%). In the study, it was realized that community pharmacies should not be seen as a commercial place but rather as a health care facility. Conclusions: Therefore, these establishments must adapt at a structural and professional level, to meet an increasingly growing demand of a population in need of services offered with quality health care.
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Affiliation(s)
| | | | - Camila Martins Oliveira
- MSc. Research Assistant, Federal University of Para. Faculty of Pharmacy. Belem, Para, Brazil.
| | - Clarisse Andrade Sales
- MSc. Research Assistant, Federal University of Para. Faculty of Pharmacy. Belem, Para, Brazil.
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Luz TCB, Tavares NUL, de Castro AKS, Marques IC, Dos Santos EM, Cota BB. MedMinas project: design and use of mixed methods in the evaluation of pharmaceutical services in primary health care in Minas Gerais, Brazil. BMC Med Res Methodol 2022; 22:80. [PMID: 35346045 PMCID: PMC8962222 DOI: 10.1186/s12874-022-01568-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background The main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned. Methods This work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis. Results A total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants’ enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP. Conclusion We demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC).
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Affiliation(s)
- Tatiana Chama Borges Luz
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil. .,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), University of Strathclyde, Glasgow, G4 0RE, UK.
| | - Noemia Urruth Leão Tavares
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, Distrito Federal, 70910-90, Brazil
| | - Ana Karine Sarvel de Castro
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
| | - Isabela Cristina Marques
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
| | - Elizabeth Moreira Dos Santos
- LASER (Laboratório de Avaliação de Situações Endêmicas Regionais), National School of Public Health Sérgio Arouca (ENSP), Oswaldo Cruz Foundation (FIOCRUZ), 1480 Leopoldo Bulhões St, Manguinhos, Rio de Janeiro, 21041-210, Brazil
| | - Betania Barros Cota
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
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Ostrowska M, Drozd M, Patryn R, Zagaja A. Prescriptions as quality indicators of pharmaceutical services in Polish community pharmacies. BMC Health Serv Res 2022; 22:373. [PMID: 35317797 PMCID: PMC8939172 DOI: 10.1186/s12913-022-07772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Assessment of community pharmacies’ quality of service is a very difficult task, resulting from the multiplicity and variety of provided services as well as patient-related factors (i.e. their health condition, expectations, education level or cultural and social background). Although proceedings of pharmaceutical professionals are to a great extend legally determined and described in various acts and regulations, work diligence should be one of the most characteristic traits of a professional pharmacy employee. Many publications addressing the quality of services provided by pharmaceutical employees focus on patient satisfaction, here the authors focused on more objective methods i.e. prescription analysis. Objective The main aim of the study was to assess whether post-inspection National Health Fund reports would constitute a reliable source of quality assessment of pharmaceutical services provided by community pharmacies. Methods The study is an in-depth quality and quantity analysis of 28 post-inspection quarterly reports conducted by the National Health Fund between 2013 and 2019. Results Vast majority of inspections ended in stating a variety of irregularities. Conclusions The analysis of irregularities contained in the National Health Fund’s post-inspection reports does not seem an appropriate indicator of assessing the quality of pharmaceutical services provided in community pharmacies, because of its targeted character. Inappropriate performance of professional duties by staff members is the main source of irregularities in the implementation of prescriptions for reimbursable medications. There is a need to improve staffs’ professional competence and ultimately the quality of pharmaceutical services.
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Affiliation(s)
- Marlena Ostrowska
- Department of Humanities and Social Medicine, Medical University of Lublin, ul. Chodźki 7, 20-093, Lublin, Poland
| | - Mariola Drozd
- Department of Humanities and Social Medicine, Medical University of Lublin, ul. Chodźki 7, 20-093, Lublin, Poland
| | - Rafał Patryn
- Department of Humanities and Social Medicine, Medical University of Lublin, ul. Chodźki 7, 20-093, Lublin, Poland
| | - Anna Zagaja
- Department of Humanities and Social Medicine, Medical University of Lublin, ul. Chodźki 7, 20-093, Lublin, Poland.
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Santos SC, Rocha KSS, de Araújo DCSA, de Souza EV, Vieira LJSC, Dos Santos SNP, de Lyra Júnior DP. Perception of community pharmacists about the work process of drug dispensing: a cross-sectional survey study. BMC Health Serv Res 2022; 22:161. [PMID: 35135535 DOI: 10.1186/s12913-022-07528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Drug dispensing aims to promote rational medicine use. However, in many countries, the work processes are still not well defined. In this sense, the perception of pharmacists about dispensing practices presents an overview of how the service is being performed in the country and its main challenges. Thus, the purpose of this study was to determine the self-reported work process of Brazilian community pharmacists in relation to drug dispensing, challenges, and strategies for carrying out the service. Method A cross-sectional survey was conducted between May and July 2021, with community pharmacists from all regions of Brazil. Pharmacists were invited to answer a validated, self-administered questionnaire, implemented through Google Forms, containing 33 questions related to the steps of drug dispensing (questions and counseling) and the main challenges and strategies to perform the service. The data were exported to Microsoft Office Excel and SPSS®. Multiple linear regression analysis was used to assess the association between responses and demographic information, with a significance level of less than 5% (p < 0.05). This study was approved by the Research Ethics Committee (number: 4.295.171). Results A total of 625 community pharmacists responded to the survey. Most pharmacists reported always or frequently performing 17 (54%) of the 31 steps described in the instrument. The steps that pharmacists reported performing more frequently were forming the medication name (n = 569, 91.04%), verifying the completeness and adequacy of the prescription according to current legislation (n = 567, 90.72%) and providing counseling on dosage (n = 549, 87.84%). Documentation was the main step in which pharmacists reported never or rarely performing (n = 424, 67.84%). The results showed that there was a significant influence of the variables of public education institution, age, and postgraduate education on the frequency of dispensing steps (F(3, 621) = 14.884, p < 0.001; R2ajdusted = 0,063). Conclusion This study showed that most pharmacists reported always or frequently asking most of the questions and performing counseling contained in the instrument during drug dispensing. These results can contribute to an understanding of current dispensing practices and generate insights for developing strategies to qualify the service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07528-y.
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Fernandes BD, Foppa AA, Ayres LR, Chemello C. Implementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research. Res Social Adm Pharm 2022; 18:3631-3637. [PMID: 35123903 DOI: 10.1016/j.sapharm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medication reconciliation (MR) implementation in hospital care transitions has proved to be a challenge for health professionals and managers. It points to the need to conduct Implementation Research with a view to understanding the tasks of the real world and knowing how they impact this process. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aims to analyze the factors that influenced the MR implementation process conducted by pharmacists at a hospital setting. METHODS A qualitative case study was carried out in the cardiology and gastroenterology units of a teaching hospital in Brazil, involving participant observation and semi-structured interviews with physicians, pharmacists, nurses, nutritionists and a social worker. The CFIR was used to guide data collection and thematic analysis. The constructs were classified according to their influence and strength. RESULTS Sixteen health professionals involved directly or indirectly with MR implementation participated in the study. Based on the analysis of the participants' quotes and of the field diary, 18 constructs of the CFIR were identified as influencing MR implementation. The constructs that most strongly influenced MR implementation concerned "Inner Setting", "Characteristics of Individuals" and "Characteristics of Intervention". The participating professionals showed little knowledge of MR and had different points of view on its scope, weakly relating MR to patient safety. The tools used to conduct MR were adapted according to the hospital's needs, thus facilitating its implementation. However, MR proved to be complex and require clinical knowledge and aligned teamwork to identify and resolve undocumented medication discrepancies, being as well intertwined with culture and organizational communication. CONCLUSIONS The results point to implementation failures and highlight that MR is a complex intervention, requiring specific knowledge from the multidisciplinary team and alignment with other existing workflows. The barriers and facilitators identified may serve to design and test implementation improvement strategies.
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Affiliation(s)
- Brígida Dias Fernandes
- Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Aline Aparecida Foppa
- Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo, Avenida Marechal Campos, 1468, Maruípe, Vitória, Espirito Santo, 29043-900, Brazil
| | - Clarice Chemello
- Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
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Gorton HC, Riste L, Littlewood D, Pickering G, Armitage CJ, Ashcroft DM. Advancing Mental heaLth Provision In PHarmacY (AMPLIPHY): A feasibility study. Res Social Adm Pharm 2021; 18:3414-3424. [PMID: 34774424 DOI: 10.1016/j.sapharm.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specifically-designed community pharmacy-based services represent opportunities to support people with their mental health. As few such services exist worldwide, the Advancing Mental HeaLth Provision In PharmacY (AMPLIPHY) was designed with stakeholders. The purpose was to support people with their mental health when initiated on new prescription or change in drug, dose or quantity of antidepressant, through a series of consultations (up to 3 months). OBJECTIVE(S) The aim was to evaluate the feasibility of the AMPLIPHY service. The objectives were to: i) pilot the service; ii) examine anonymous consultation data to understand patients' characteristics, priorities and consultation focus and iii) Evaluate pharmacists' experiences. METHODS This service evaluation involved a concurrent mixed methods design. Patient characteristics were extracted from consultation notes and descriptive statistics applied. Content analysis was used to summarise consultation foci and comparisons between patients' priorities with consultation content were made. Pharmacists were interviewed at the start (n = 10) and end (n = 4) of the pilot with themes identified using thematic analysis. RESULTS Seventy-six patients participated (63% of recruitment target). The median age was 39 (IQR 28-47) and 62% were female. Seventy percent of patients had one consultation, 26% had two and 4% had three. Prescription for new antidepressant was the most common reason for entry (74%) and sertraline was most prescribed (46%). Consultations commonly focussed on life experience (n = 51), medication (n = 47), health (n = 42), support (n = 36) and patients' expression of their feelings (n = 31). The pharmacists' experiences were summarised in three themes: i) Motivation, ii) Practicalities and iii) Experience and Outcomes. CONCLUSIONS Pharmacists were motivated to deliver this novel service and some patients were willing to join the service. Analysis of patient demographics, consultation notes and interviews provide insight into the strengths and challenges of the service and provides a blueprint for future service developments.
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Affiliation(s)
- Hayley C Gorton
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
| | - Lisa Riste
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PT, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK; NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
| | - Donna Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK.
| | | | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK; Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Darren M Ashcroft
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PT, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK; NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
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Cam H, Kempen TGH, Eriksson H, Abdulreda K, Franzon K, Gillespie U. Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review. BMC Geriatr 2021; 21:618. [PMID: 34724895 PMCID: PMC8561898 DOI: 10.1186/s12877-021-02564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. METHODS We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. RESULTS A total of 699 patients were included. The patients' mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). CONCLUSIONS The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Region Uppsala, Uppsala, Sweden
| | | | | | - Kristin Franzon
- Geriatric Department, Uppsala University Hospital, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.,Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Abstract
Health systems in many countries are currently undergoing an evolution towards more person-centred care. However, an overview of the literature shows that there is little or no guidance available on how to apply person-centred care to pharmaceutical care and clinical pharmacy practices. In this paper we apply a model for person-centred care created by a national multidisciplinary research centre in Gothenburg, Sweden, to the clinical work tasks of outpatient and inpatient pharmacists and describe how pharmaceutical care can become more person-centred.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.
| | - Joanne M Fuller
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
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Stuhec M. Clinical pharmacist consultant in primary care settings in Slovenia focused on elderly patients on polypharmacy: successful national program from development to reimbursement. Int J Clin Pharm 2021; 43:1722-1727. [PMID: 34228266 DOI: 10.1007/s11096-021-01306-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022]
Abstract
Clinical pharmacists in most primary care settings across Europe do not offer a reimbursed medication review service. This paper describes the development, implementation, and evaluation of a program in Slovenia that allows all general practitioners to refer patients to clinical pharmacists in primary care settings for a medication review. Between 2012 and 2015, the Health Insurance Institute of Slovenia proposed, funded and evaluated a pilot trial and recommended that the service be extended to all public health insurance beneficiaries in Slovenia. Following successful negotiations, the program (Pharmacist Consultant) has been available in all Slovenian primary care settings since 2018. It was evaluated internally with various questionnaires and externally with three studies that reported fewer medication-related problems, fewer drug-drug interactions, cost effectiveness, better treatment guidelines adherence and better humanistic clinical outcomes. The results demonstrate that including clinical pharmacists in primary care settings is particularly beneficial for patients with multiple diseases and medications, who are often elderly people. Future research should examine the service with improved methodologies (e.g., prospective studies with a larger sample size, measures of clinical outcomes and long-term follow-up). In the context of Slovenia, studies should also examine the effects of further integration of clinical pharmacists in patient care (e.g., through patient monitoring, dependent or independent prescribing and medication reviews in hospitals).
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Affiliation(s)
- Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia. .,Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ptujska Cesta 33, 2270, Ormoz, Slovenia. .,Faculty of Pharmacy, University of Ljubljana, Askerceva Cesta 7, 1000, Ljubljana, Slovenia.
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35
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Pirolli AV, Brusamarello T, Everton SS, Andrzejevski VMS. The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer. J Oncol Pharm Pract 2021; 28:1368-1374. [PMID: 34225523 DOI: 10.1177/10781552211029361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.
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Affiliation(s)
- Amanda V Pirolli
- Complexo Hospital de Clínicas from the Federal University of Paraná, Curitiba-Paraná, Brazil
| | - Tatiana Brusamarello
- Complexo Hospital de Clínicas from the Federal University of Paraná, Curitiba-Paraná, Brazil
| | - Stella S Everton
- Complexo Hospital de Clínicas from the Federal University of Paraná, Curitiba-Paraná, Brazil
| | - Vânia M S Andrzejevski
- Complexo Hospital de Clínicas from the Federal University of Paraná, Curitiba-Paraná, Brazil
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Ullah M, Wahab A, Saeed S, Khan SU, Ali H, Humayun S, Abbasi BA, Saud S, Naveed K, Khan SA, Fahad S. Coronavirus and its terrifying inning around the globe: The pharmaceutical cares at the main frontline. Chemosphere 2021; 275:129968. [PMID: 33652275 PMCID: PMC7884917 DOI: 10.1016/j.chemosphere.2021.129968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 05/06/2023]
Abstract
A novel coronavirus (2019-nCoV) is an acute life-threatening disease, emerged in China, which imposed a potentially immense toll in terms of public health emergency due to high infection rate and has a devastating economic impact that attracts the world's attention. After that, on January 30, 2020, it was officially declared as a global pandemic by World Health Organization (WHO). The International Committee on Taxonomy of Viruses (ICTV) recognized it as a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and the disease named Coronavirus Disease-19 (COVID-19). Several studies have been ameliorated the active role of COVID-19 transmission, etiology, pathogenicity, and mortality rate as serious impact on human life. The symptoms of this disease may include fever, fatigue, cough and some peoples are severely prone to gastrointestinal infection. The elderly and seriously affected peoples are likely concerned with serious outcomes. In this review, we mainly aimed to provide a benchmark summary of the silent characteristics and findings of some candidates for antiviral drugs and immunotherapies such as plasma therapy, cytokine therapy, antibodies, intravenous immunoglobulin, and pharmaceutical health concerns that are related to this disease.
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Affiliation(s)
- Muneeb Ullah
- Department of Pharmacy, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan.
| | - Sumbul Saeed
- College of Plant Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Shahid Ullah Khan
- College of Plant Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Haider Ali
- Department of Pharmacy, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Shah Humayun
- Pakistan Institute of Medical Sciences (pims), Pakistan
| | - Banzeer Ahsan Abbasi
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Shah Saud
- Department of Horticulture, Northeast Agricultural University, Harbin, China
| | - Khalid Naveed
- Department of Agronomy, University of Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Sher Aslam Khan
- Department of Plant Breeding & Genetics, University of Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Shah Fahad
- Department of Agronomy, University of Haripur, Khyber Pakhtunkhwa, Pakistan.
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Miranda VIA, Schäfer AA, Tomasi CD, Soratto J, de Oliveira Meller F, Silveira MPT. "Inequalities in access to medicines for diabetes and hypertension across the capitals in different regions of Brazil: a population-based study". BMC Public Health 2021; 21:1242. [PMID: 34182965 PMCID: PMC8240304 DOI: 10.1186/s12889-021-11279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To guarantee prevention and adequate treatment, as required for the population to have access to health services and technologies, including medicines. The purpose of this study is to analyse the economic and regional inequalities in access to medicines for diabetes and hypertension among the adult population in Brazil. METHODS This was a cross-sectional study with adults aged 18 and over from the VIGITEL study conducted in 2019 in all Brazilian regions. Non-access to antidiabetic and antihypertensive drugs was assessed according to formal education and housing macro-region. The slope index of inequality (SII) was used to analyse absolute inequalities. RESULTS The total number of individuals interviewed was 52,443. Approximately 10.0% of the people with diabetes and/or hypertension reported not having access to drug treatment. The major means for having access to antihypertensive drugs, in all regions, was private pharmacies; for antidiabetics, in the North region, people had greater access through private pharmacies, while in the Northeast, Southeast and South, they had greater access through the public sector. Inequalities were found in the lack of access to medicines according to the region of residence, especially in the North region. CONCLUSION The lack of access to medicines showed regional disparities, particularly in the most economically vulnerable regions.
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Affiliation(s)
- Vanessa Iribarrem Avena Miranda
- Postgraduate Program in Public Health, University of Southern Santa Catarina, Av. Universitária, 1105, Criciúma, Santa Catarina, CEP: 88806-000, Brazil.
| | - Antônio Augusto Schäfer
- Postgraduate Program in Public Health, University of Southern Santa Catarina, Av. Universitária, 1105, Criciúma, Santa Catarina, CEP: 88806-000, Brazil
| | - Cristiane Damiani Tomasi
- Postgraduate Program in Public Health, University of Southern Santa Catarina, Av. Universitária, 1105, Criciúma, Santa Catarina, CEP: 88806-000, Brazil
| | - Jacks Soratto
- Postgraduate Program in Public Health, University of Southern Santa Catarina, Criciúma, Santa Catarina, Brazil
| | - Fernanda de Oliveira Meller
- Postgraduate Program in Public Health, University of Southern Santa Catarina, Av. Universitária, 1105, Criciúma, Santa Catarina, CEP: 88806-000, Brazil
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Gregório J, Reis L, Peyroteo M, Maia M, Mira da Silva M, Lapão LV. The role of Design Science Research Methodology in developing pharmacy eHealth services. Res Social Adm Pharm 2021; 17:2089-2096. [PMID: 34119446 DOI: 10.1016/j.sapharm.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
The increasing focus on efficiency of care has prompted health systems to look for innovative solutions that yield maximum value for care. Integration of care and eHealth are seen as the most promising solutions in the high technological environment of the coming decades. Pharmacy services have been developed to a point where the face of community pharmacy has changed dramatically. Thus, service design and implementation has become an area of increased attention by Pharmacy practice researchers, and the arrival of eHealth concepts to Pharmacy is driving the need to find alternative ways to design new services. Moreover, known barriers and challenges remain when securing integration of pharmacy services with the health systems. In this paper, Design Science Research Methodology (DSRM), a user-centered alternative methodology to the design, development and implementation of health services, especially eHealth services, is presented. This alternative, originally from the Information Sciences field, has been adopted as a service design methodology in diverse settings, including health care. Here, case studies are used to explain how a DSRM process should be conducted in a health care setting, illustrating what methods to choose in each step of the process. Finally, the advantages of DSRM compared to other user-centered methodologies for service design are presented, hopefully prompting the discussion on the use of DSRM for the study of the implementation and sustainability of pharmacy services.
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Affiliation(s)
- João Gregório
- CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal.
| | - Lígia Reis
- CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal.
| | - Mariana Peyroteo
- Comprehensive Health Research Centre, NOVA Medical School, Lisbon, Portugal.
| | - Melanie Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Vargas López LC, Viso Gurovich F, Dreser Mansilla A, Wirtz VJ, Reich MR. The implementation of pharmaceutical services in public hospitals in Mexico: an analysis of the legal framework and organizational practice. J Pharm Policy Pract 2021; 14:41. [PMID: 33952350 PMCID: PMC8101239 DOI: 10.1186/s40545-021-00318-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. METHODS Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice. RESULTS The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider. CONCLUSIONS Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modification of the current legislation along with the development of an official minimum standard for activities and services in hospital pharmacies.
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Affiliation(s)
- Laura C Vargas López
- Faculty of Pharmacy, Instituto de Ciencias de la Salud, Autonomy University of Hidalgo State, Carretera Pachuca-Actopan camino a Tilcuautla s/n Pueblo San Juan Tilcuautla, 42160, Hgo, Mexico
| | | | - Anahí Dreser Mansilla
- Center of Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, México
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Michael R Reich
- Department of Global Health & Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Biddle MA, Hibbard A, O'Connor S, Wadsworth TG, Robinson R, Nguyen E. Implementation and assessment of a pilot module on billing for pharmacist-provided healthcare services in a doctor of pharmacy program. Curr Pharm Teach Learn 2021; 13:403-408. [PMID: 33715803 DOI: 10.1016/j.cptl.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE To describe the implementation and assessment of a pilot module on billing to inform future comprehensive curricular integration of billing for pharmacist-provided healthcare services. EDUCATIONAL ACTIVITY AND SETTING A module (two-hour didactic session and two-hour lab), developed by a faculty member and pharmacy billing specialist, was piloted to teach second-year pharmacy students how to bill the medical insurance benefit for provided services. Web-based pre- and post-surveys and performance on knowledge assessment questions were used to evaluate the pilot module. FINDINGS Students' perceptions of their abilities and knowledge to provide and bill for healthcare services improved as a result of participation in the pilot module. SUMMARY This pilot module on billing was successful in improving students' knowledge and perceptions of abilities to provide and bill for healthcare services. However, further efforts to integrate billing education within individual institutions and the entire pharmacy academy will help better prepare pharmacists to provide sustainable clinical services.
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Affiliation(s)
- Michael A Biddle
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, 1311 East Central Avenue, Meridian, ID 83642, United States.
| | - Andrew Hibbard
- Ambulatory Care Clinical Coordinator, 66612 Oriole Drive, North Bend, OR 97459, United States.
| | - Shanna O'Connor
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, 921 South 8(th) Avenue, Stop 8288, Pocatello, ID 83209, United States.
| | - Thomas G Wadsworth
- Department of Pharmacy Practice, University of Alaska Anchorage/Idaho State University College of Pharmacy, 3211 Providence Drive, PSB 113, Anchorage, AK 99508, United States.
| | - Renee Robinson
- Department of Pharmacy Practice, University of Alaska Anchorage/Idaho State University College of Pharmacy, 3211 Providence Drive, PSB 108B, Anchorage, AK 99508, United States.
| | - Elaine Nguyen
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, 1311 East Central Avenue, Meridian, ID 83642, United States.
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Meilianti S, Smith F, Ernawati DK, Pratita RN, Bates I. A country-level national needs assessment of the Indonesian pharmacy workforce. Res Social Adm Pharm 2021; 17:1989-1996. [PMID: 33766504 DOI: 10.1016/j.sapharm.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conducting a systematic country-level workforce needs-assessment is a way to develop coherent strategic and justifiable workforce planning. OBJECTIVE(S) This article describes a country-level needs-assessment process using a systematic approach (via the FIP Development Goals (FIP DGs) workforce element) as an analytical framework. The needs-assessment aimed to prioritise gaps toward transforming the pharmacy workforce as a prelude to practice and pharmaceutical services reform in Indonesia. METHODS The needs assessment consisted of three stages: needs identification, needs analysis, and needs prioritisation. The needs (workforce development gaps) were defined as the discrepancies between the perceived workforce challenges and the existing national workforce development projects. Interviews or group discussions were conducted to gather the workforce challenges of individual pharmacists. A structured workshop was conducted to identify workforce challenges and existing organisations' projects, with main stakeholders contributing to pharmacists' development in Indonesia. Perceived challenges findings and identified national workforce projects were mapped to the FIP DGs workforce element. The needs prioritisation was conducted by comparing the proportional mapping to the FIP DGs workforce element. RESULTS There were forty-three individual pharmacists and 7 principal stakeholder categories that provided information related to perceived workforce challenges; thirty national projects were identified from stakeholders. While this study identified perceived challenges with workforce "competency development" and "pharmacy workforce intelligence," there were no active ongoing national projects mapped to those goals. The framework mapping analysis showed there are workforce development gaps centred on "competency development" initiatives, "advanced and specialist development" initiatives, and strategic pharmacy workforce intelligence data gathering. Additionally, there were policy gaps with initiatives for strengthening "working with others" and a lack of clarity on infrastructure for early-career training strategies and workforce impact. CONCLUSIONS This study prioritises the gaps in developing pharmacists in Indonesia. This process could be used in conducting needs assessment of pharmacy workforce development in other Low and Middle-Income Countries (LMICs).
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Affiliation(s)
- Sherly Meilianti
- UCL School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London WC1N 1AX, UK.
| | - Felicity Smith
- UCL School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London WC1N 1AX, UK.
| | - Desak Ketut Ernawati
- Indonesian Pharmacists Association, Wijaya Kusuma No. 17, Jatipulo, West Jakarta, Jakarta, 11430, Indonesia; Department of Pharmacology and Therapy, Universitas Udayana, Denpasar, Bali, 80234, Indonesia.
| | - Rasta Naya Pratita
- Indonesian Pharmacists Association, Wijaya Kusuma No. 17, Jatipulo, West Jakarta, Jakarta, 11430, Indonesia.
| | - Ian Bates
- UCL School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London WC1N 1AX, UK.
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Robberechts A, De Petter C, Van Loon L, Rydant S, Steurbaut S, De Meyer G, De Loof H. Qualitative study of medication review in Flanders, Belgium among community pharmacists and general practitioners. Int J Clin Pharm 2021. [PMID: 33484398 DOI: 10.1007/s11096-020-01224-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
Objective Examining the implementation barriers and facilitators of this service as provided by Belgian community pharmacists in collaboration with general practitioners. Setting Community pharmacies in Flanders. Method Qualitative study through interviews of pharmacists and general practitioners. Main outcome measure Opinions and experiences of pharmacists and general practitioners about type 3 medication review. Results Sixteen community pharmacists and thirteen general practitioners were interviewed and generally gave a positive assessment of the project. The general practitioners saw the pharmaceutical and pharmacotherapeutic recommendations of the pharmacists as an added value for the patients. The pharmacists indicated that performing an medication review was time-consuming, but that it improved their professional relationship with general practitioners and patients. They reported obstacles in obtaining information: cumbersome access to individual patient data (laboratory values) and difficulties in finding and choosing adequate medical information sources. Moreover, pharmacists indicated that there is a need for adequate reimbursement and additional training to make the implementation sustainable. Conclusion Both pharmacists and general practitioners were enthusiastic about medication reviews. The implementation improved the interprofessional collaboration. However, important barriers remain, such as the considerable investment of time and the difficulty in gathering all the necessary information. The sustainable implementation of type 3 medication review in Belgium requires adequate reimbursement and additional training.
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Amariles P, Ledezma-Morales M, Salazar-Ospina A, Hincapié-García JA. Pharmacist's Role and Pharmaceutical Care During the COVID-19 Pandemic. Adv Exp Med Biol 2021; 1318:605-22. [PMID: 33973201 DOI: 10.1007/978-3-030-63761-3_33] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pharmacists play a vital role in public health during the COVID-19 pandemic. In this chapter, we present the most significant contributions that pharmacists could make to communitarian and hospital settings. It includes the provision of essential services, such as continuous access to medication and supplies, support to medical services, education and information to the population and the health team to reduce the misuse of medications, patient monitoring and follow-up, and the detection and referral of suspected cases of COVID-19. The chapter ends with a discussion over certain elements related to innovation needs, such as telepharmacy services.
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Visacri MB, Figueiredo IV, Lima TM. Role of pharmacist during the COVID-19 pandemic: A scoping review. Res Social Adm Pharm 2021; 17:1799-806. [PMID: 33317760 DOI: 10.1016/j.sapharm.2020.07.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since the start of the new Coronavirus (COVID-19) outbreak in December 2019, pharmacists worldwide are playing a key role adopting innovative strategies to minimize the adverse impact of the pandemic. OBJECTIVES To identify and describe core services provided by the pharmacist during the COVID-19 pandemic. METHODS A literature search was performed in MEDLINE, Embase, Scopus, and LILACS for studies published between December 1st, 2019 and May 20th, 2020 without language restriction. Studies that reported services provided by pharmacists during the COVID-19 pandemic were included. Two independent authors performed study selection and data extraction with a consensus process. The pharmacist's intervention identified in the included studies were described based on key domains in the DEPICT v.2. RESULTS A total of 1189 records were identified, of which 11 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 4) and China (n = 4). The most common type of publication were letters (n = 4) describing the workplace of the pharmacist in hospitals (n = 8). These findings showed the different roles of pharmacists during the COVID-19 pandemic, such as disease prevention and infection control, adequate storage and drug supply, patient care and support for healthcare professionals. Pharmacists' interventions were mostly conducted for healthcare professionals and patients (n = 7), through one-to-one contact (n = 11), telephone (n = 6) or video conference (n = 5). The pharmacists' main responsibility was to provide drug information for healthcare professionals (n = 7) as well as patient counseling (n = 8). CONCLUSIONS A reasonable number of studies that described the role of the pharmacists during the COVID-19 pandemic were found. All studies reported actions taken by pharmacists, although without providing a satisfactory description. Thus, future research with more detailed description as well as an evaluation of the impact of pharmacist intervention is needed in order to guide future actions in this and/or other pandemic.
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Bonetti AF, Tonin FS, Della Rocca AM, Lucchetta RC, Fernandez-Llimos F, Pontarolo R. Methodological quality and risk of bias of meta-analyses of pharmacy services: A systematic review. Res Social Adm Pharm 2020:S1551-7411(20)31236-5. [PMID: 33358399 DOI: 10.1016/j.sapharm.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND A suboptimal meta-analysis with misleading conclusions, frequently published in the healthcare journals, can compromise decision making in clinical practice. OBJECTIVE To evaluate the reporting quality, methodological quality, and risk of bias of meta-analyses of pharmacy services. METHODS Systematic searches to identify all the meta-analyses reporting the effect of pharmacy services were performed in PubMed, Scopus, and Web of Science. The reporting quality, the methodological quality, and the risk of bias of the included meta-analyses were evaluated using PRISMA checklist, R-AMSTAR, and ROBIS, respectively. RESULTS A total of 109 meta-analyses were eligible for the study. The heterogeneity, the quality of evidence, and the quality analyses were poorly reported on authors' conclusions (14.3%, 14.7%, and 17.4%, respectively). The median scores of PRISMA and R-AMSTAR tolls were 24 (IQR 21.75-25), and 30 (IQR 27-32.5), respectively. Additionally, most of the studies were considered as high risk of bias (n = 83, 76.1%). No association between the date of publication and guideline compliance exists. PRISMA score was higher in studies published in high impact factor journals (rho = 0.313; p = 0.002), in articles that reported the quality of evidence obtained (p = 0.018), and in those that stated the need for future studies in their conclusions (p = 0.011). R-AMSTAR score was higher in studies published in high impact factor journals (rho = 0.338; p = 0.001), in those which reported the quality of evidence (p = 0.002), and in articles that described the quality analyses in their conclusions (p = 0.046). An association between the risk of bias and the recognition of the need for further studies in their conclusions (p = 0.041) was also found. CONCLUSION The rapid increase of the meta-analyses of pharmacy services was not associated with higher quality. Mechanistic meta-analyses with poor conclusions are commonly published. Quality of the analyses, strength of evidence, heterogeneity, and absence of confrontation with current guidelines are rarely considered when synthetizing evidence and making recommendations.
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Molinero A, Carbajal de Lara JA, Cantalapiedra Fernández F, Eguilleor Villena A, Gutiérrez Ríos P, Amador-Fernández N. [Oral antibiotic request without prescription in community pharmacies. Description of pharmacists' intervention]. Semergen 2020; 46:545-52. [PMID: 33069568 DOI: 10.1016/j.semerg.2020.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To quantify the proportion of oral antibiotics requests without prescription in Community Pharmacy (CP) and to analyse it causes. METHOD Cross-sectional multicentre study carried out in Spanish community pharmacies during 4 weeks, one in each season of the year. Oral J01 antibiotics (Anatomical Therapeutic Chemical classification, ATC) requested for self-medication were analysed. RESULTS 247 pharmacies and 365 pharmacists participated in the study, 1172 antibiotic requests were recorded. More frequent requests for antibiotic self-medication were: previous treatment for the same symptoms (63.1%), insufficient time for a general practitioner (GP) consultation (12.1%) and patient belief that GP is going to prescribe the antibiotic (4.9%). Higher number of generic medication were requested compared to brand medication (41.1 versus 34.9%). Active ingredients commonly requested were amoxicillin (28.2%), amoxicillin-clavulanic (14.9%) and phosphomycin (21.8%) to treat upper respiratory related infections (35.1%), urinary infections (28.1%) and teeth infections (20.2%). 2406 pharmacists' interventions were carried out: referring to the GP (40.8%), information for correct use of medication (31.3%), non-pharmacological treatment (15.7%), and recommendation of a different medication (6.9%) or a different product (5.3%). CONCLUSIONS Nowadays higher number of active ingredients than brands are requested when selecting a treatment for an infection, mainly β-lactams and macrolides. Majority of self-medication tried to treat upper respiratory infections, urinary and teeth infections. Most frequent pharmacists' intervention was referring to the GP to obtain a correct diagnosis and treatment.
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Hikaka J, Hughes C, Jones R, Connolly MJ, Martini N. A pharmacist-led medicines review intervention in community-dwelling Māori older adults- a feasibility study protocol. Res Social Adm Pharm 2020; 16:1264-1271. [PMID: 31813763 DOI: 10.1016/j.sapharm.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacists have a role to play in supporting the optimal use of medicines to ensure older adults receive therapeutic benefit whilst minimising medicines-related harm. In Aotearoa New Zealand (NZ), Māori (Indigenous people of NZ) experience inequities in the determinants of health, including access to medicines, resulting in increased morbidity, earlier onset of chronic conditions and reduced life expectancy. This study aims to test the feasibility of a pharmacist-led medicines review intervention in community-dwelling Māori older adults. METHOD This is a non-randomised, non-controlled feasibility study undertaken within a kaupapa Māori methodological framework which supports the right of Māori to be included throughout the research process and seeks to potentiate transformational, positive change for Māori. The research pharmacist will recruit 30 participants (Māori; 55 years or older; community-dwelling). Participants will undergo a medicines education session with the pharmacist (medicines reconciliation, medicines information, well-being goal setting), with the option to proceed to a medicines optimisation session that includes the participant, pharmacist and primary prescriber (review of potentially inappropriate prescribing (PIP); medicines management plan development). Primary outcomes: participant and prescriber acceptability of intervention. Secondary outcomes include baseline and post-intervention medicines knowledge, PIP and quality of life scores, and number of changes made to the medicines regimen. ETHICS AND DISSEMINATION Ethical approval was granted by the Northern B Health and Disability Committee (9/NTB/106). Study results will be disseminated to various stakeholders including Māori communities, health practitioners and providers, and researchers through meetings and conference presentations, lay summaries and peer-reviewed journals. This study is an example of health service design, delivery and evaluation, informed by Indigenous knowledge and methodology, developed explicitly to address inequities in health outcomes for, and with, Māori and will inform the decision to proceed to a randomised controlled trial to test the effect of this intervention. TRIAL REGISTRATION NUMBER ACTRN12619001070123.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, New Zealand; Waitematā District Health Board, Auckland, New Zealand.
| | | | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, New Zealand
| | - Martin J Connolly
- Waitematā District Health Board, Auckland, New Zealand; Freemasons Department of Geriatric Medicine, University of Auckland, New Zealand
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Becker MW, Lunardelli MJM, Tovo CV, Blatt CR. Drug and herb-induced liver injury: A critical review of Brazilian cases with proposals for the improvement of causality assessment using RUCAM. Ann Hepatol 2020; 18:742-750. [PMID: 31130470 DOI: 10.1016/j.aohep.2019.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 03/06/2019] [Accepted: 02/08/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Although hepatotoxicity accounts for 10% of adverse drug reactions, it remains poorly understood and underreported. This study aimed to summarize case reports of herb- and drug-induced liver injury in Brazil. METHODOLOGY Systematic review in the following databases: PubMed, SciELO, Science Direct, CAPES, and gray literature. RESULTS Twenty-seven studies reporting 32 cases were identified. Brazilian cases were primarily detected in hospitals, and occurred mainly in young males suffering from chronic diseases. Drugs (n=29) were a more frequent cause of liver injury than herbs (n=3). Almost a third of these drugs were anticonvulsants, and 15 appear in the Brazilian List of Essential Medicines. In 50% of the cases, clinical manifestations started within 30 days of drug ingestion. Regarding the decline of liver enzymes, 50% of the cases reached normality after drug withdrawal. However, 7 deaths and 2 liver transplantations were reported. Only one study assessed causality using RUCAM. CONCLUSION Given the severe outcomes of DILI and HILI, early detection and management of hepatotoxicity to increase drug safety are necessary, as well as pharmacotherapeutic monitoring of patients with chronic diseases. Moreover, the application of the RUCAM algorithm in clinical practice has to be further disseminated.
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Affiliation(s)
- Matheus William Becker
- Graduate Program in Medicine - Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Michele John Muller Lunardelli
- Pharmaceutical Services, Hospital Divina Providência, Graduate Program in Medicine - Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristiane Valle Tovo
- Internal Medicine Department, Graduate Program in Medicine - Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carine Raquel Blatt
- Pharmacoscience Department, Graduate Program in Medicine - Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract
The latest outbreak of Covid-19 pandemic has placed a significant effect on health care system around the world. This article discusses the role of pharmacists in Saudi Arabia during the current Covid-19 pandemic. Pharmacists are an important part of everyday healthcare in Saudi Arabia. Pharmacists helped to protect the public from Covid-19 pandemic disease by participating in various initiatives including health education and promotion, medication dispensing, medication reconciliation, medication and patient counselling, training for self-management in current outbreak and emergency preparedness. Full utilization of skills of pharmacists boosted the safety response of Saudi Arabia to Covid-19 pandemic.
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Affiliation(s)
- Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
| | - Khalid M Alkharfy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
| | - Ziyad Alrabiah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
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Gernant SA, Bacci JL, Upton C, Ferreri SP, McGrath S, Chui MA, Rickles NM, Smith M. Three opportunities for standardization: A literature review of the variation among pharmacists' patient care services terminology. Res Social Adm Pharm 2020; 16:766-775. [PMID: 31836468 PMCID: PMC7784038 DOI: 10.1016/j.sapharm.2019.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Variation describing pharmacists' patient care services exist, and this variation contributes to the prevalent misunderstanding of pharmacists' roles. In contrast, standard phraseology is a critical practice among highly reliable organizations and a way to reduce variation and confusion. OBJECTIVE This work aims to identify and define pharmacists' patient care service terms to identify redundancies and opportunities for standardization. METHODS Between May to August 2018, terms and definitions were searched via PubMed, Google Scholar and statements/policies of professional pharmacy organizations. Two references per term were sought to provide an "early definition" and a "contemporary definition." Only literature published in English was included, and data gathered from each citation included the date published, the term's definition, and characterization of the reference's source as either a regulatory or professional body. A five-person expert panel used an iterative technique to revise and verify the list of included terms and subsequent literature review results. Terms were then searched in the National Library of Medicine's Medical Subject Heading Database (MeSH) in July, 2019. RESULTS There are fifteen commonly misunderstood terms that refer to the patient care services provided by pharmacists. The appearance of these terms in the literature spanned nearly five decades. Nearly half of terms appeared first in regulatory, law or policy documents; of these, two terms had contemporary definitions appearing in the professional literature that differed from their early regulatory definition. Three opportunities to improve standardization include: (1) Implementation of standardized phraseology systems similar to nursing's Clinical Care Classification System; (2) Academics' adherence to standardized MeSH terms; and (3) Clarification of pharmacy education accreditation standards. CONCLUSION Numerous terms are used to describe pharmacists' patient care services, with many definitions of terms overlapping in several key components. The profession has made concerted efforts to consolidate and standardize terminology in the past, but more opportunities exist.
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Affiliation(s)
- Stephanie A Gernant
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Jennifer L Bacci
- University of Washington School of Pharmacy, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Charlie Upton
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Stefanie P Ferreri
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, CB 7475, Chapel Hill, NC, USA.
| | - Stephanie McGrath
- Pennsylvania Pharmacists Care Network, 5587 Baum Blvd, Floor 3, Pittsburgh, PA, 15206, USA.
| | - Michelle A Chui
- Sonderegger Research Center for Improved Medication Outcomes, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53713, USA.
| | - Nathaniel M Rickles
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Marie Smith
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
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