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Shariff A, Kumar TMP, Siddalingegowda SM, Wani SUD, Elsobky Y. PharmD students experiences on end year clerkship evaluation using objective structured clinical exam (OSCE) method at JSS College of Pharmacy, Mysuru, India. PEC Innov 2024; 4:100271. [PMID: 38495318 PMCID: PMC10940797 DOI: 10.1016/j.pecinn.2024.100271] [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: 08/28/2023] [Revised: 02/09/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
Objectives To assess the PharmD student's experiences about end year clerkship evaluation conducted using Objective Structured Clinical Exam (OSCE) format at JSS College of Pharmacy, Mysuru, India. Methods The student's experiences were captured using a newly developed, 14-item, 5-point Likert's scale feedback form. The results were analyzed and presented descriptively. The Mann-Whitney U test was used to compare the Likert's scale responses between the sex, entry level for PharmD and performance in the end year exam, whereas the Spearman's rank correlation coefficient test was used to measure the strength of association between the Likert's' scale responses and these variables. A p value of <0.05 was considered statistically significant. Results Thirty-seven students of fifth year PharmD attended the end year clerkship evaluation and provided their feedback. Out of the 14-items, the most frequent response in eleven items was strongly agree and in three items it was agree. The Mann-Whitney U test revealed statistically significant differences between regular and postbaccalaureate students with respect to Likert's scale responses in all the domains (p < 0.02). The Spearman's rank correlation test revealed no association between the students' performance and their experiences with OSCE as an assessment tool for the end year clerkship exam. Conclusions The study results demonstrate that OSCE is an alternative and preferred method of evaluating the clinical skills and competencies of fifth year PharmD students in their end year clerkship exam in India. Innovation For the first time in India, the JSS College of Pharmacy, Mysuru, had successfully implemented the OSCE method for evaluating PharmD students' clerkship in their end year exam and had assessed their experiences about OSCE as an assessment tool.
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Affiliation(s)
- Atiqulla Shariff
- Research Scholar, Department of Pharmacy Practice, JSS College of Pharmacy, Mysuru, JSS Academy of Higher Education and Research, Mysuru-570015, Karnataka, India
| | - Teggina Math Pramod Kumar
- Dean, Faculty of Pharmacy, JSS Academy of Higher Education and Research, Mysuru-570015, Karnataka, India
| | - Srikanth Malavalli Siddalingegowda
- Lecturer, Department of Pharmacy Practice, JSS College of Pharmacy, Mysuru, JSS Academy of Higher Education and Research, Mysuru-570015, Karnataka, India
| | - Shahid Ud Din Wani
- Department of Pharmaceutical Sciences, School of Applied Science and Technology, University of Kashmir, Srinagar 190006, India
| | - Yasmin Elsobky
- Senior Research Specialist, ALNAS Hospital, Shubra El Kheima, Egypt 6210120
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Schönenberger N, Blanc AL, Hug BL, Haschke M, Goetschi AN, Wernli U, Meyer-Massetti C. Developing indicators for medication-related readmissions based on a Delphi consensus study. Res Social Adm Pharm 2024; 20:92-101. [PMID: 38433064 DOI: 10.1016/j.sapharm.2024.02.012] [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: 12/11/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication-related readmissions challenge healthcare systems by burdening patients, increasing costs and straining resources. However, to date, there has been no consensus study on indicators for medication-related readmissions. OBJECTIVES This Delphi study aimed to develop a consensus-based set of indicators for detecting patients at risk of medication-related readmission. METHODS An expert panel of clinical pharmacists, physicians and nursing experts participated in a two-round Delphi study. In round 1, 31 indicators taken from the literature were rated for relevance on a scale from 1 to 9, with a median rating of 7 or higher suggesting relevance. The RAND/UCLA method was used to determine consensus. In round 2, indicators lacking consensus were re-rated together with a series of new indicators generated by the experts. Additional details were sought for some indicators. The main outcomes were the relevance of, consensus on, and completeness of the proposed indicators for identifying risks of 30-day medication-related readmission. RESULTS Thirty-eight experts participated in round 1. Consensus was found for all the indicators, with 25 included and 6 excluded. Thirty-four experts participated in round 2. Consensus was found for all 5 newly suggested indicators, and 4 were included. The expert panel prioritized the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (≥7 medications), (3) low rates of medication adherence (twice-weekly mistakes or missing administration), (4) complex medication regimens (≥3 doses, ≥2 dosage forms and ≥2 administration routes per day), and (5) multimorbidity (≥3 chronic conditions). The final set comprised 29 indicators. CONCLUSIONS The indicator set developed for flagging potential medication-related readmissions could guide priorities for clinical pharmacy services at hospital discharge, improving patient outcomes and resource use. A validation study of these indicators is planned.
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Affiliation(s)
- Nicole Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, 1847, Rennaz, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1205, Geneva, Switzerland
| | - Balthasar L Hug
- Department of Internal Medicine, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland; University of Lucerne, Faculty of Health Sciences and Medicine, 6005, Lucerne, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Aljoscha N Goetschi
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Ursina Wernli
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Institute of Primary Healthcare (BIHAM), University of Bern, 3012, Bern, Switzerland
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Bucknell L, Chambers B, Nott S, Webster E. Community pharmacists' perceptions of a hospital based virtual clinical pharmacy service: Findings from qualitative research. Explor Res Clin Soc Pharm 2024; 14:100437. [PMID: 38660625 PMCID: PMC11040165 DOI: 10.1016/j.rcsop.2024.100437] [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: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Background A Virtual Clinical Pharmacy Service (VCPS) was introduced in selected rural and remote NSW hospitals in 2020 to address a gap in onsite clinical pharmacy services. Follow-up research determined hospital staff and patients at these locations perceived the service as a safe, effective and efficient system for delivering clinical pharmacy services. Community pharmacists are key stakeholders in medication safety and continuity of management in these regions, however, their insight on the VCPS had not yet been sought. Objective To understand perspectives of community pharmacists on the implementation of VCPS in rural and remote hospitals and impacts on medication management at transitions of care. Methods Semi-structured interviews were conducted via videoconference with seven community pharmacists with at least three months exposure to VCPS following service implementation. Thematic analysis of transcribed interviews was conducted influenced by Appreciative Inquiry. Results Participants identified that the VCPS had supported and enhanced their community pharmacy practice and acknowledged its future potential. Identified themes were interaction with VCPS, acceptability of VCPS, community pharmacy workflow, and involvement in patient care. Suggested improvements included involving community pharmacists early in the implementation of the service and establishing clear expectations and procedures. Conclusions The experiences of community pharmacists with VCPS were positive and there was a consensus that the introduction of the service had assisted interviewees in providing medication management to patients at transition of care. The ease of communication and efficiency of the service were recognised as key factors in the success of VCPS for community pharmacists.
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Affiliation(s)
- Lucy Bucknell
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
| | - Brett Chambers
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
| | - Shannon Nott
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
| | - Emma Webster
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
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Mansour S, Mekaouche FZN, Rouabah H, Brahim S, Boudia F, Yafour N, Bereksi Reguig F, Toumi H. Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology. Ann Pharm Fr 2024:S0003-4509(24)00068-3. [PMID: 38729518 DOI: 10.1016/j.pharma.2024.05.001] [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: 07/12/2023] [Revised: 04/20/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.
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Affiliation(s)
- Sabah Mansour
- Faculty of Medicine of Oran, Oran, Algeria; Pharmacovigilance service, EHU Oran, Oran, Algeria.
| | | | - Halima Rouabah
- Faculty of Medicine of Oran, Oran, Algeria; Pharmacovigilance service, EHU Oran, Oran, Algeria.
| | | | - Fatima Boudia
- Faculty of Medicine of Oran, Oran, Algeria; Pharmacovigilance service, EHU Oran, Oran, Algeria.
| | - Nabil Yafour
- Faculty of Medicine of Oran, Oran, Algeria; Hematology department, EHU Oran, Oran, Algeria
| | - Faiza Bereksi Reguig
- Faculty of Medicine of Oran, Oran, Algeria; Oncology department, EHU Oran, Oran, Algeria
| | - Houari Toumi
- Faculty of Medicine of Oran, Oran, Algeria; Pharmacovigilance service, EHU Oran, Oran, Algeria.
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Ozturk N, Yakak I, Ağ MB, Aksoy N. Is ChatGPT reliable and accurate in answering pharmacotherapy-related inquiries in both Turkish and English? Curr Pharm Teach Learn 2024:S1877-1297(24)00120-5. [PMID: 38702261 DOI: 10.1016/j.cptl.2024.04.017] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Artificial intelligence (AI), particularly ChatGPT, is becoming more and more prevalent in the healthcare field for tasks such as disease diagnosis and medical record analysis. The objective of this study is to evaluate the proficiency and accuracy of ChatGPT in different domains of clinical pharmacy cases and queries. METHODS The study NAPLEX® Review Questions, 4th edition, pertaining to 10 different chronic conditions compared ChatGPT's responses to pharmacotherapy cases and questions obtained from McGraw Hill's, alongside the answers provided by the book's authors. The proportion of correct responses was collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 29. RESULTS When tested in English, ChatGPT had substantially higher mean scores than when tested in Turkish. The average accurate score for English and Turkish was 0.41 ± 0.49 and 0.32 ± 0.46, respectively, p = 0.18. Responses to queries beginning with "Which of the following is correct?" are considerably more precise than those beginning with "Mark all the incorrect answers?" 0.66 ± 0.47 as opposed to 0.16 ± 0.36; p = 0.01 in English language and 0.50 ± 0.50 as opposed to 0.14 ± 0.34; p < 0.05in Turkish language. CONCLUSION ChatGPT displayed a moderate level of accuracy while responding to English inquiries, but it displayed a slight level of accuracy when responding to Turkish inquiries, contingent upon the question format. Improving the accuracy of ChatGPT in languages other than English requires the incorporation of several components. The integration of the English version of ChatGPT into clinical practice has the potential to improve the effectiveness, precision, and standard of patient care provision by supplementing personal expertise and professional judgment. However, it is crucial to utilize technology as an adjunct and not a replacement for human decision-making and critical thinking.
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Affiliation(s)
- Nur Ozturk
- Altinbas University, School of Pharmacy, Department of Clinical Pharmacy, Istanbul, Turkey; Istanbul Medipol University, Graduate School of Health Sciences, Clinical Pharmacy PhD Program, Istanbul, Turkey.
| | - Irem Yakak
- Istanbul Medipol University, Graduate School of Health Sciences, Clinical Pharmacy PhD Program, Istanbul, Turkey.
| | - Melih Buğra Ağ
- Istanbul Medipol University, Graduate School of Health Sciences, Clinical Pharmacy PhD Program, Istanbul, Turkey; Istanbul Medipol University, School of Pharmacy, Department of Clinical Pharmacy, Istanbul, Turkey.
| | - Nilay Aksoy
- Altinbas University, School of Pharmacy, Department of Clinical Pharmacy, Istanbul, Turkey.
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Fournier A, Fallet C, Sadeghipour F, Perrottet N. Assessing the applicability and appropriateness of ChatGPT in answering clinical pharmacy questions. Ann Pharm Fr 2024; 82:507-513. [PMID: 37992892 DOI: 10.1016/j.pharma.2023.11.001] [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: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Clinical pharmacists rely on different scientific references to ensure appropriate, safe, and cost-effective drug use. Tools based on artificial intelligence (AI) such as ChatGPT (Generative Pre-trained Transformer) could offer valuable support. The objective of this study was to assess ChatGPT's capacity to correctly respond to clinical pharmacy questions asked by healthcare professionals in our university hospital. MATERIAL AND METHODS ChatGPT's capacity to respond correctly to the last 100 consecutive questions recorded in our clinical pharmacy database was assessed. Questions were copied from our FileMaker Pro database and pasted into ChatGPT March 14 version online platform. The generated answers were then copied verbatim into an Excel file. Two blinded clinical pharmacists reviewed all the questions and the answers given by the software. In case of disagreements, a third blinded pharmacist intervened to decide. RESULTS Documentation-related issues (n=36) and drug administration mode (n=30) were preponderantly recorded. Among 69 applicable questions, the rate of correct answers varied from 30 to 57.1% depending on questions type with a global rate of 44.9%. Regarding inappropriate answers (n=38), 20 were incorrect, 18 gave no answers and 8 were incomplete with 8 answers belonging to 2 different categories. No better answers than the pharmacists were observed. CONCLUSIONS ChatGPT demonstrated a mitigated performance in answering clinical pharmacy questions. It should not replace human expertise as a high rate of inappropriate answers was highlighted. Future studies should focus on the optimization of ChatGPT for specific clinical pharmacy questions and explore the potential benefits and limitations of integrating this technology into clinical practice.
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Affiliation(s)
- A Fournier
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - C Fallet
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - F Sadeghipour
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - N Perrottet
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Babu D, Marotti S, Rowett D, Lim R, Wisdom A, Kalisch Ellett L. What is impacting clinical pharmacists' participation in an interprofessional ward round: a thematic analysis of a national survey. J Interprof Care 2024; 38:444-452. [PMID: 38151971 DOI: 10.1080/13561820.2023.2289506] [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: 05/10/2023] [Accepted: 11/25/2023] [Indexed: 12/29/2023]
Abstract
The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management.
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Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Novais T, Reallon E, Martin J, Barral M, Krolak-Salmon P, Coste MH, Zenagui H, Garnier-Crussard A, Hoegy D, Mouchoux C. Clinical impact of an individualised clinical pharmacy programme into the memory care pathway of older people: an observational study. Int J Clin Pharm 2024:10.1007/s11096-024-01723-z. [PMID: 38642248 DOI: 10.1007/s11096-024-01723-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia. AIM To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint. METHOD This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool. RESULTS Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12). CONCLUSION The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
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Affiliation(s)
- Teddy Novais
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France.
| | - Elsa Reallon
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
| | | | | | - Pierre Krolak-Salmon
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Marie-Hélène Coste
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
| | - Hanane Zenagui
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Antoine Garnier-Crussard
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Delphine Hoegy
- Pharmaceutical Unit, Groupement Hospitalier Est, University Hospital of Lyon, Lyon, France
- Health, Systemic, Process (P2S), Research Unit 4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Christelle Mouchoux
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
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Huon JF, Nizet P, Tollec S, Vene E, Fronteau C, Leichnam A, Tching-Sin M, Michelet-Barbotin V, Foucault-Fruchard L, Nativel F. A systematic review of the impact of simulation on students' confidence in performing clinical pharmacy activities. Int J Clin Pharm 2024:10.1007/s11096-024-01715-z. [PMID: 38632204 DOI: 10.1007/s11096-024-01715-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation. AIM To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities. METHOD Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool. RESULTS Among the 39 included articles, the majority were published in the last 5 years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16). CONCLUSION Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.
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Affiliation(s)
- Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France.
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France.
| | - Pierre Nizet
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Sophie Tollec
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Orléans, Orléans, France
| | - Elise Vene
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Rennes, Rennes, France
| | - Clémentine Fronteau
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Alison Leichnam
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Martine Tching-Sin
- Nantes Université, CHU Nantes, Pharmacie, 5 allée de l'île Gloriette, 44000, Nantes, France
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
| | - Vanessa Michelet-Barbotin
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Rennes, Rennes, France
| | - Laura Foucault-Fruchard
- Réseau HUGOPharm : réseau des pharmacies hospitalieres des Hopitaux Universitaires du grand ouest, Nantes, France
- CHU Tours, Service Pharmacie, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Fabien Nativel
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
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10
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Canning ML, Barras M, McDougall R, Yerkovich S, Coombes I, Sullivan C, Whitfield K. Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach. Int J Clin Pharm 2024; 46:451-462. [PMID: 38240963 DOI: 10.1007/s11096-023-01681-y] [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: 09/11/2023] [Accepted: 11/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. AIM To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. METHOD A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. RESULTS Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. CONCLUSION Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia.
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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Ashraf AR, Somogyi-Végh A, Merczel S, Gyimesi N, Fittler A. Leveraging code-free deep learning for pill recognition in clinical settings: A multicenter, real-world study of performance across multiple platforms. Artif Intell Med 2024; 150:102844. [PMID: 38553153 DOI: 10.1016/j.artmed.2024.102844] [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: 06/16/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Preventable patient harm, particularly medication errors, represent significant challenges in healthcare settings. Dispensing the wrong medication is often associated with mix-up of lookalike and soundalike drugs in high workload environments. Replacing manual dispensing with automated unit dose and medication dispensing systems to reduce medication errors is not always feasible in clinical facilities experiencing high patient turn-around or frequent dose changes. Artificial intelligence (AI) based pill recognition tools and smartphone applications could potentially aid healthcare workers in identifying pills in situations where more advanced dispensing systems are not implemented. OBJECTIVE Most of the published research on pill recognition focuses on theoretical aspects of model development using traditional coding and deep learning methods. The use of code-free deep learning (CFDL) as a practical alternative for accessible model development, and implementation of such models in tools intended to aid decision making in clinical settings, remains largely unexplored. In this study, we sought to address this gap in existing literature by investigating whether CFDL is a viable approach for developing pill recognition models using a custom dataset, followed by a thorough evaluation of the model across various deployment scenarios, and in multicenter clinical settings. Furthermore, we aimed to highlight challenges and propose solutions to achieve optimal performance and real-world applicability of pill recognition models, including when deployed on smartphone applications. METHODS A pill recognition model was developed utilizing Microsoft Azure Custom Vision platform and a large custom training dataset of 26,880 images captured from the top 30 most dispensed solid oral dosage forms (SODFs) at the three participating hospitals. A comprehensive internal and external testing strategy was devised, model's performance was investigated through the online API, and offline using exported TensorFlow Lite model running on a Windows PC and on Android, using a tailor-made testing smartphone application. Additionally, model's calibration, degree of reliance on color features and device dependency was thoroughly evaluated. Real-world performance was assessed using images captured by hospital pharmacists at three participating clinical centers. RESULTS The pill recognition model showed high performance in Microsoft Azure Custom Vision platform with 98.7 % precision, 95.1 % recall, and 98.2 % mean average precision (mAP), with thresholds set to 50 %. During internal testing utilizing the online API, the model reached 93.7 % precision, 88.96 % recall, 90.81 % F1-score and 87.35 % mAP. Testing the offline TensorFlow Lite model on Windows PC showed a slight performance reduction, with 91.16 % precision, 83.82 % recall, 86.18 % F1-score and 82.55 % mAP. Performance of the model running offline on the Android application was further reduced to 86.50 % precision, 75.00 % recall, 77.83 % F1-score and 69.24 % mAP. During external clinical testing through the online API an overall precision of 83.10 %, recall of 71.39 %, and F1-score of 75.76 % was achieved. CONCLUSION Our study demonstrates that using a CFDL approach is a feasible and cost-effective method for developing AI-based pill recognition systems. Despite the limitations encountered, our model performed well, particularly when accessed through the online API. The use of CFDL facilitates interdisciplinary collaboration, resulting in human-centered AI models with enhanced real-world applicability. We suggest that rather than striving to build a universally applicable pill recognition system, models should be tailored to the medications in a regional formulary or needs of a specific clinic, which can in turn lead to improved performance in real-world deployment in these locations. Parallel to focusing on model development, it is crucial to employ a human centered approach by training the end users on how to properly interact with the AI based system to maximize benefits. Future research is needed on refining pill recognition models for broader adaptability. This includes investigating image pre-processing and optimization techniques to enhance offline performance and operation on handheld devices. Moreover, future studies should explore methods to overcome limitations of CFDL development to enhance the robustness of models and reduce overfitting. Collaborative efforts between researchers in this domain and sharing of best practices are vital to improve pill recognition systems, ultimately enhancing patient safety and healthcare outcomes.
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Affiliation(s)
- Amir Reza Ashraf
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary.
| | - Anna Somogyi-Végh
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Sára Merczel
- Department of Pharmacy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Nóra Gyimesi
- Péterfy Hospital and Jenő Manninger Traumatology Center, Budapest, Hungary
| | - András Fittler
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
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12
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Wirth F, Cadogan CA, Fialová D, Hazen A, Lutters M, Paudyal V, Weidmann AE, Okuyan B, Henman MC. Writing a manuscript for publication in a peer-reviewed scientific journal: Guidance from the European Society of Clinical Pharmacy. Int J Clin Pharm 2024; 46:548-554. [PMID: 38332208 PMCID: PMC10960906 DOI: 10.1007/s11096-023-01695-6] [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: 11/07/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
Publishing in reputable peer-reviewed journals is an integral step of the clinical pharmacy research process, allowing for knowledge transfer and advancement in clinical pharmacy practice. Writing a manuscript for publication in a journal requires several careful considerations to ensure that research findings are communicated to the satisfaction of editors and reviewers, and effectively to the readers. This commentary provides a summary of the main points to consider, outlining how to: (1) select a suitable journal, (2) tailor the manuscript for the journal readership, (3) organise the content of the manuscript in line with the journal's guidelines, and (4) manage feedback from the peer review process. This commentary reviews the steps of the writing process, identifies common pitfalls, and proposes ways to overcome them. It aims to assist both novice and established researchers in the field of clinical pharmacy to enhance the quality of writing in a research paper to maximise impact.
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Affiliation(s)
- Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Cathal A Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ankie Hazen
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Anita E Weidmann
- Department of Clinical Pharmacy, Innsbruck University, Innsbruck, Austria
| | - Betul Okuyan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Türkiye
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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13
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Jermini M, Fonzo-Christe C, Blondon K, Milaire C, Stirnemann J, Bonnabry P, Guignard B. Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis. Int J Clin Pharm 2024; 46:496-505. [PMID: 38315303 PMCID: PMC10960916 DOI: 10.1007/s11096-023-01683-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review. AIM To develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events. METHOD Two pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated. RESULTS The estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1-1.71. Sensitivity analyses showed that the economic model was robust. CONCLUSION This economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.
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Affiliation(s)
- Mégane Jermini
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Caroline Fonzo-Christe
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
| | - Katherine Blondon
- Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Bertrand Guignard
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
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14
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Weidmann AE. Artificial intelligence in academic writing and clinical pharmacy education: consequences and opportunities. Int J Clin Pharm 2024:10.1007/s11096-024-01705-1. [PMID: 38472596 DOI: 10.1007/s11096-024-01705-1] [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: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 03/14/2024]
Abstract
The current academic debate on the use of artificial intelligence (AI) in research and teaching has been ongoing since the launch of ChatGPT in November 2022. It mainly focuses on ethical considerations, academic integrity, authorship and the need for new legal frameworks. Time efficiencies may allow for more critical thinking, while ease of pattern recognition across large amounts of data may promote drug discovery, better clinical decision making and guideline development with resultant consequences for patient safety. AI is also prompting a re-evaluation of the nature of learning and the purpose of education worldwide. It challenges traditional pedagogies, forcing a shift from rote learning to more critical, analytical, and creative thinking skills. Despite this opportunity to re-think education concepts for pharmacy curricula several universities around the world have banned its use. This commentary summarizes the existing debate and identifies the consequences and opportunities for clinical pharmacy research and education.
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Affiliation(s)
- Anita Elaine Weidmann
- Department of Clinical Pharmacy, Institute of Pharmacy, Innsbruck University, Innrain 80, 6020, Innsbruck, Austria.
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15
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Klimentidis D. Effectiveness of clinical pharmacist interventions in optimizing pharmacotherapy for somatic comorbidities in serious mental illness: A clinical audit. Explor Res Clin Soc Pharm 2024; 13:100427. [PMID: 38455672 PMCID: PMC10918557 DOI: 10.1016/j.rcsop.2024.100427] [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: 12/10/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Background Clinical pharmacists significantly improve pharmacotherapy outcomes. Patients with serious mental illness (SMI) represent a group particularly vulnerable to medication mismanagement, potentially benefiting from pharmaceutical care targeting medication appropriateness. Objective This study aimed to assess the prevalence of inappropriate medication for somatic comorbidities in SMI patients and to evaluate the impact of clinical pharmacist-led interventions. Methods A pre-post intervention audit involving clinical pharmacist intervention was conducted on SMI patients with somatic comorbidities in a psychiatric clinic in Greece. A comprehensive medication review was undertaken by a clinical pharmacist. The Medicines Appropriateness Index (MAI) and Assessment of Underutilization of medication (AOU) instruments were used to gauge pharmacotherapy appropriateness before and after intervention. Physician acceptance rates and clinical significance were also noted. Statistical analysis employed descriptive and inferential methods, with a significance level set at α = 0.05. Results A total of 58 patients were reviewed. Most patients (75.86%) were being inappropriately treated at baseline, versus 15.52% post-intervention. The pharmacist proposed 107 interventions of which 104 (97.2%) were physician-accepted. Changes in MAI and AOU identified improved medication appropriateness post-intervention [χ2 = 33.029, p < 0.005]. Pharmacist interventions resulted in more (52.1%, n = 25), less (16.7%, n = 8) and no changes (31.2%, n = 15) in the total number of prescribed medicines [median difference:1, p < 0.005]. From 49 medication initiation recommendations, the most prescribed medicines were statins for primary or secondary prevention (n = 21, 42.8%), aspirin for primary or secondary prevention (n = 9, 18.36%) and metformin (n = 4, 8.2%). Conclusion SMI patients had a high prevalence of physical comorbidities, mainly cardiovascular disease, and a high ratio of inappropriate medication treatment. Intervention by a clinical pharmacist significantly improved medication appropriateness and led to the adoption of a new standard of care, to be checked with re-auditing.
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16
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Salgado-Garcia C, Moreno-Ballesteros A, Guardia-Jimena P, Sanchez-de-Mora E, Rebollo-Aguirre AC, Ramirez-Navarro A, Santos-Bueno A, Jimenez-Heffernan A. Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents. Rev Esp Med Nucl Imagen Mol 2024; 43:84-90. [PMID: 38184070 DOI: 10.1016/j.remnie.2023.12.005] [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: 08/08/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024]
Abstract
AIM To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. METHODS We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. RESULTS Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% - measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% - consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% - use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% - use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% - reassessment of patient's condition; acute exacerbation of COPD 0.8% - defer test until acute episode is over; severe asthma 0.4% - do not perform test; methylxanthine ingestion 0.3% - avoid consumption previously; other 6.1% - evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests. CONCLUSIONS Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.
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Affiliation(s)
- C Salgado-Garcia
- Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Juan Ramon Jimenez, Huelva, Spain.
| | | | - P Guardia-Jimena
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
| | - E Sanchez-de-Mora
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
| | | | - A Ramirez-Navarro
- Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Virgen de las Nieves, Granada, Spain
| | - A Santos-Bueno
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
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AlKhanbashi RO, AlNoamy Y, Ghandorah R, Awan RM, AlButi H. Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital. SAGE Open Med 2024; 12:20503121241233217. [PMID: 38410373 PMCID: PMC10896045 DOI: 10.1177/20503121241233217] [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: 07/01/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting. Methods A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process. Results A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%). Conclusions The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.
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Affiliation(s)
- Rana Omar AlKhanbashi
- Department of Pharmaceutical Services, Pharmacy Quality Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Yahya AlNoamy
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Reham Ghandorah
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Razan Mohammed Awan
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hala AlButi
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Verheyen S, Steurbaut S, Cortoos PJ, Wuyts SCM. Development and partial validation of Be-CLIPSS: a classification system for hospital clinical pharmacy activities. Int J Clin Pharm 2024; 46:80-89. [PMID: 37658157 DOI: 10.1007/s11096-023-01627-4] [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: 03/29/2023] [Accepted: 07/16/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Documentation of drug related problems (DRPs) and pharmaceutical interventions (PIs) is essential for an objective evaluation of the pharmacist's contribution to pharmacotherapy. However, in Belgium, a nationally used classification system is not available, prohibiting structured and uniform documentation of DRPs and PIs. AIM To develop and validate a national classification system for in-hospital clinical pharmacy activities, based on literature and field experience, specifically intended for routine registration. METHOD Based on a literature review, a survey among Belgian hospital pharmacists and a stakeholder focus group, a first version of Be-CLIPSS (Belgian CLInical Pharmacy claSsification System) was developed. Inter-rater reliability of the DRPs and PIs was assessed. Additionally, its usability was reviewed. The system was further refined, followed by a second validation. RESULTS Both the survey and focus group discussion revealed little use of validated DRP and PI classification systems in Belgium, although these were considered highly desirable if practical and minimally time-consuming. The final classification system encompassed seven clinical pharmacy activities, grouped into four activity classes. The inter-rater reliability for the second activity class was substantial for the DRPs (κ = 0.737) and almost perfect for the PIs (κ = 0.872). The interpretability (86.4%), user-friendliness (61.4%), user satisfaction (84.1%), interest for use in daily practice (68.2%) and difficulty in correctly classifying the DRP and PI (31.8%) were assessed. CONCLUSION Be-CLIPSS, a newly developed and partially validated classification system for DRPs and PIs, was found to be user-friendly, with a good interpretability and user satisfaction, resulting in a high interest for use in daily practice.
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Affiliation(s)
- Silke Verheyen
- Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - Stephane Steurbaut
- Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
- Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Pieter-Jan Cortoos
- Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
- Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Stephanie C M Wuyts
- Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
- Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
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Paudyal V, Okuyan B, Henman MC, Stewart D, Fialová D, Hazen A, Lutters M, Oleárová A, Weidmann AE, Wirth F, Cadogan CA, Nazar Z. Scope, content and quality of clinical pharmacy practice guidelines: a systematic review. Int J Clin Pharm 2024; 46:56-69. [PMID: 37991663 PMCID: PMC10830799 DOI: 10.1007/s11096-023-01658-x] [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: 08/18/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines. AIM To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument. METHOD Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument. RESULTS Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development. CONCLUSION Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.
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Affiliation(s)
- Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Betul Okuyan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Türkiye
| | | | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ankie Hazen
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Anna Oleárová
- Department of Clinical Pharmacology, Bratislava University Hospital, Bratislava, Slovakia
| | - Anita E Weidmann
- Department of Clinical Pharmacy, Innsbruck University, Innsbruck, Austria
| | | | - Cathal A Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Zachariah Nazar
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Alsowaida YS, Korayem GB, Thabit AK, Alshaya OA, Alsaif RS, Almangour TA. The impact of Saudi Arabia - United States clinical pharmacy post-graduate training programs agreements on clinical pharmacy faculty in Saudi universities: A retrospective descriptive study focused on history and future recommendations. Saudi Pharm J 2024; 32:101937. [PMID: 38261904 PMCID: PMC10797141 DOI: 10.1016/j.jsps.2023.101937] [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: 11/03/2023] [Accepted: 12/25/2023] [Indexed: 01/25/2024] Open
Abstract
Background There has been a growing demand for clinical pharmacy services in the Kingdom of Saudi Arabia (KSA) in the past 3 decades. The Ministry of Education has established agreements with several institutions in the United States to secure clinical pharmacy residency and research fellowship programs opportunities for Saudi scholars. The aims of this study were to describe the Saudi scholars' clinical pharmacy training pathways and their contribution to the pharmacy profession in KSA. Methods This is a retrospective, descriptive study conducted on clinical pharmacy faculty in governmental Saudi universities who graduated from the US until 2023. The study outcomes included the post-graduate year-1 (PGY-1) residency match rate, post-graduate year-2 (PGY-2) acceptance rate, the PGY-2 specialties of Saudi scholars, and the number of clinical pharmacy programs established in KSA. Results In total, 115 Saudi scholars have pursued clinical pharmacy pathway in the US. The PGY-1 residency match rate was 80 % (92/115). In contrast, the PGY-2 acceptance rate was 60.9 % (70/115). The most common PGY-2 specialty was in infectious diseases (N = 17; 24 %). Two pharmacy colleges had established residency programs and 1 pharmacy college had established a research fellowship. Conclusion The Ministry of Education's efforts for clinical pharmacy program agreements were fundamental for advancing clinical pharmacy in Saudi universities. A significant number of Saudi scholars returned to KSA with clinical pharmacy degrees. There are more opportunities for further development, including expanding the clinical pharmacy program collaboration in the US and increasing the number of residency and research fellowship positions in KSA.
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Affiliation(s)
- Yazed S. Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abrar K Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar A. Alshaya
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Thamer A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Corvaisier M, Annweiler C. The invaluable contributions of clinical pharmacy to geriatric medicine. Maturitas 2024; 180:107823. [PMID: 37659864 DOI: 10.1016/j.maturitas.2023.107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Mathieu Corvaisier
- UNIV ANGERS, UPRES EA 4638, University of Angers, France; Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; Department of Pharmacy, University Hospital, Angers, France
| | - Cédric Annweiler
- UNIV ANGERS, UPRES EA 4638, University of Angers, France; Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; Gérontopôle Autonomie Longévité des Pays de la Loire, France.
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22
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Rangchian M, Makhdoumi M, Zamanirafe M, Parvaneh E, Eshraghi A, Entezari-Maleki T, Mehrpooya M. Impact of Clinical Pharmacist-conducted Medication Reconciliation at Admission and Discharge on Medication Safety in Patients Hospitalized with Acute Decompensated Heart Failure. Curr Drug Saf 2024; 19:CDS-EPUB-137800. [PMID: 38299281 DOI: 10.2174/0115748863284257231212063959] [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: 10/16/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Most studies have focused on the impact of medication reconciliation on one of the points of hospital admission or discharge. In this study, we aimed to investigate the impact of medication reconciliation at both admission and discharge on medication safety in patients hospitalized with acute decompensated heart failure. METHODS This was a prospective, single-center, cohort study conducted in a tertiary care cardiovascular hospital from October 2022 to March 2023 on patients hospitalized with acute decompensated heart failure. Patients were considered eligible if they were taking at least five chronic medications prior to hospital admission. Medication reconciliation was carried out for the study patients by a clinical pharmacy team both at admission and discharge. Further, the study patients also received comprehensive discharge counseling as well as post-discharge follow-up and monitoring. RESULTS Medication reconciliation was applied for 129 patients at admission and 118 of them at discharge. The mean time needed for medication reconciliation presses was 32 min per patient on admission and 22min per patient on discharge. Unintentional medication discrepancies were relatively common both at admission and discharge in the study participants, but compared to admission, discrepancies were less frequent at discharge (178 versus 72). Based on the consensus review, about 30% of identified errors detected at both admission and discharge were judged to have the potential to cause moderate to severe harm to the patient, and most of the clinical pharmacists' recommendations on unintended discrepancies were accepted by physicians and resulted in changes in medication orders (more than 80%). Further, the majority of the participants were 'very satisfied' or 'satisfied' with the clinical pharmacy services provided to them during hospitalization and after hospital discharge (89.90%). CONCLUSIONS Our results demonstrated that heart failure patients are vulnerable to medication discrepancies both at admission and discharge and implementing a comprehensive medication reconciliation by clinical pharmacists could be helpful in improving medication safety in these patients.
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Affiliation(s)
- Maryam Rangchian
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mana Makhdoumi
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Department of Cardiology, Hamedan University of Medical Sciences, Iran
| | - Erfan Parvaneh
- Department of Cardiology, Hamedan University of Medical Sciences, Iran
| | - Azadeh Eshraghi
- Clinical Pharmacy, Iran University of Medical Sciences , Iran
| | | | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
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23
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Lee M, Kim SE, Jeong JH, Park YH, Han HW. Development of service standards and manpower calculation criteria for hospital clinical pharmacies in South Korea: a survey-based study. BMC Health Serv Res 2024; 24:118. [PMID: 38254141 PMCID: PMC10802065 DOI: 10.1186/s12913-023-10530-7] [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: 04/10/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND After the revision of the Korean Pharmaceutical Affairs Act, the certification of specialized pharmacists is scheduled to be legally recognized in 2023. Considering that the specialized pharmacist certification was developed based on the working model of hospital clinical pharmacists, it is necessary to establish standards for clinical pharmacists in hospitals and to calculate appropriate manpower. Through this study, we aim to establish practical standards for clinical pharmacists and propose a method for calculating staffing levels based on an investigation of actual workloads. METHODS This survey-based study consisted of two phases. In the first phase, a literature review was conducted to establish standards for clinical pharmacy services, and tasks in relevant literature were classified to identify clinical pharmacy service tasks that are applicable to the practice of Korean hospitals. Additionally, a preliminary survey was conducted to investigate the essential tasks. In the second phase of the investigation, a multicenter survey was conducted targeting pharmacists in facilities with more than 1,000 beds to explore their perceptions and actual workloads related to tasks. RESULTS According to the standards for clinical pharmacists in Korea, clinical pharmacy services consist of a total of 23 tasks, of which 16 have been identified as essential tasks. Essential tasks accounted for 93% of the total tasks in clinical pharmacy services. The average full-time equivalent (FTE) through workload calculation was 2.5 ± 1.9 for each field, while the FTE allocated to actual practice was 2.1 ± 1.6. The distribution of each type of clinical pharmacy service was as follows: 77% for medication therapy management, 13% for medication education, 8% for multidisciplinary team activities, and 3% for medication use evaluation. CONCLUSION This study identified essential tasks common to clinical pharmacy services across different healthcare institutions. However, the FTE of clinical pharmacists in actual practice was insufficient compared to the required amount. In order to establish and expand clinical pharmacy services in a hospital, it is necessary to ensure an adequate workforce for essential tasks.
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Affiliation(s)
- Mirinae Lee
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05535, Seoul, South Korea
| | - Seung-Eun Kim
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05535, Seoul, South Korea
| | - Jee-Hye Jeong
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05535, Seoul, South Korea
| | - Yoon-Hee Park
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05535, Seoul, South Korea
| | - Hye-Won Han
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05535, Seoul, South Korea.
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Nazar Z, Al Hail M, Al-Shaibi S, Hussain TA, Abdelkader NN, Pallivalapila A, Thomas B, Kassem WE, Hanssens Y, Mahfouz A, Ryan C, Stewart D. Investigating physicians' views on non-formulary prescribing: a qualitative study using the theoretical domains framework. Int J Clin Pharm 2023; 45:1424-1433. [PMID: 37454024 PMCID: PMC10682051 DOI: 10.1007/s11096-023-01616-7] [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: 04/03/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Well-designed and well-maintained drug formularies serve as a reliable resource to guide prescribing decisions; they are associated with improved medicine safety and increased efficiency, while also serving as a cost-effective tool to help manage and predict medicine expenditure. Multiple studies have investigated the inappropriate prescribing of non-formulary drugs (NFDs) with statistics indicating that up to 70% of NFD usage being inappropriate or not following the ascribed NFD policies. AIM To explore physicians' views and influences on their prescribing of non-formulary drugs. METHOD Data collection and analysis were underpinned using the Theoretical Domains Framework (TDF). Thirteen semi-structured interviews were conducted within Hamad Medical Corporation, the main provider of secondary and tertiary healthcare in Qatar, with physicians who had submitted a NFD request in the preceding 12 months. RESULTS Three overarching themes were identified: providing evidence-based care for individual patients; influences of others; and formulary management issues. Subthemes were mapped to specific TDF domains: environmental context and resources; social influences; professional role and identity; beliefs about consequences; goals; intentions. CONCLUSION The behavioral influences identified in this study can be mapped to behavior change strategies facilitating the development of an intervention to promote appropriate prescribing of NFDs with implications for medicine safety and healthcare efficiency.
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Affiliation(s)
- Zachariah Nazar
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Moza Al Hail
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Samaher Al-Shaibi
- Pharmacy department, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | | | | | | | - Binny Thomas
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El Kassem
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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25
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Tortolano L, Misandeau Q, Inouri T, Paul M, Dompnier M, Flouzat-Lachaniette CH, Archer V. Patient information pathway in orthopedic surgery: Roles of ERAS and pharmacists. Orthop Traumatol Surg Res 2023; 109:103576. [PMID: 36754166 DOI: 10.1016/j.otsr.2023.103576] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Enhanced Rehabilitation After Surgery (ERAS) pathways significantly improve the care of patients in orthopedic surgery. However, patient knowledge and memorization of the information provided are currently poorly documented. HYPOTHESIS The information provided by a postoperative pharmacist could have a positive impact on patient care, in particular by improving knowledge about their prosthesis. MATERIAL AND METHOD This prospective feasibility study included a cohort of 80 patients operated on for a hip or knee prosthesis and who received postoperative pharmacist interviews (POPI). These POPIs informed the patient about the prosthesis, the complications, positions to avoid, as well as the postoperative follow-up. The objective was to measure the patient's knowledge before and after the POPI. Qualitative and quantitative analyses, by indication and patient pathway, were performed. RESULTS The patient's knowledge before POPI was 70% correct. After POPI this rate rose to 91%. DISCUSSION Patients' knowledge was weak and heterogeneous, especially regarding the implanted prosthesis. The POPI led to significant improvement and standardization of knowledge which should contribute to the prevention of iatrogenic harm (positions to avoid, infection prevention, compliance with analgesics and anticoagulants). CONCLUSION A POPI with a pharmacist improves overall patient management during hip or knee arthroplasty. LEVEL OF EVIDENCE III; non-randomized prospective feasibility study.
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Affiliation(s)
- Lionel Tortolano
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France; Université Paris-Saclay, EA Matériaux et santé, 91400, Orsay, France.
| | - Quentin Misandeau
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Tinhinane Inouri
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Muriel Paul
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Mathilde Dompnier
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Créteil, France
| | - Valérie Archer
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
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Frestel J, Teoh SWK, Broderick C, Dao A, Sajogo M. A health integrated platform for pharmacy clinical intervention data management and intelligent visual analytics and reporting. Explor Res Clin Soc Pharm 2023; 12:100332. [PMID: 37810747 PMCID: PMC10556808 DOI: 10.1016/j.rcsop.2023.100332] [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: 05/04/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Our initiative aimed to improve the system used to capture pharmacist clinical interventions to better support staff to document, manage and identify trends in medication-related problems (MRPs). The aim of the study was to develop an electronic tool which is easily accessible by most electronic devices with secure data storage and access. Methods A REDCap® database was designed for documentation of pharmacy clinical interventions. Information documented can be retrieved in real-time and can be integrated to Microsoft Power BI® for real-time data visualisation. The dashboards were customised to display useful information including pharmacy clinical intervention details, common MRPs, common medications involved available to users at real time. Results A total of 4343 interventions were documented from July 2022 to March 2023. The most common MRPs were omission of regular medications 876 (20.17%), condition untreated 722(16.62%), and contraindications apparent 451 (10.38%). The most common medications involved include iron 244 (5.62%), enoxaparin 231 (5.32%), macrogol laxatives 208 (4.79%), multivitamin 206 (4.74%), colecalciferol 179(4.12%), tramadol 156 (3.59%). Conclusion This study demonstrated the significance of integration of health application tools of REDcap and Power BI in the data management and intelligent visual analytics and reporting.
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Affiliation(s)
- Jennifer Frestel
- Pharmacy Department, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, Australia
| | - Stephanie Wai Khuan Teoh
- Pharmacy Department, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, Australia
| | - Claire Broderick
- Pharmacy Department, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, Australia
- Patient Safety and Clinical Quality Directorate, Department of Health, Level 3 GPO Building, 3 Forrest Place, Perth, WA 6000, Australia
| | - Anna Dao
- Pharmacy Department, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, Australia
| | - Monica Sajogo
- Pharmacy Department, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, Australia
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Booth JP, Kennerly-Shah JM, Kelley LR, Capozzi D, Prescott HA, Soefje SA, Pace MB, Barbour SY, Tizon RF, DeVincenzo S, Carnes CA, Neidecker MV. Which hematology/oncology patients are high priority for ambulatory clinical pharmacist review? A three-round Delphi survey by the National Comprehensive Cancer Network. J Oncol Pharm Pract 2023; 29:1907-1914. [PMID: 36803319 DOI: 10.1177/10781552231157660] [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] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Prioritization and acuity tools have been leveraged to facilitate targeted and efficient clinical pharmacist interventions. However, there is a lack of established pharmacy-specific acuity factors in the ambulatory hematology/oncology setting. Therefore, National Comprehensive Cancer Network's Pharmacy Directors Forum conducted a survey to establish consensus on acuity factors associated with hematology/oncology patients that are high priority for ambulatory clinical pharmacist review. METHODS A three-round electronic Delphi survey was conducted. During the first round, respondents were asked an open-ended question to suggest acuity factors based on their expert opinion. Respondents were then asked in the second round to agree or disagree with the compiled acuity factors, in which those with ≥75% agreement were included in the third round. The final consensus was defined as a mean score ≥3.33 on a modified 4-point Likert scale (4 = strongly agree, 1 = strongly disagree) during the third round. RESULTS A total of 124 hematology/oncology clinical pharmacists completed the first round of the Delphi survey (invitation response rate, 36.7%), of which 103 completed the second round (response rate, 83.1%) and 84 the third round (response rate, 67.7%). A final consensus was achieved for 18 acuity factors. Acuity factors were identified in the following themes: antineoplastic regimen characteristics, drug interactions, organ dysfunction, pharmacogenomics, recent discharge, laboratory parameters, and treatment-related toxicities. CONCLUSIONS This Delphi panel of 124 clinical pharmacists achieved consensus on 18 acuity factors that would identify a hematology/oncology patient as a high priority for ambulatory clinical pharmacist review. The research team envisions incorporating these acuity factors into a pharmacy-specific electronic scoring tool.
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Affiliation(s)
- Jennifer P Booth
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- The Ohio State University-College of Pharmacy, Columbus, OH, USA
| | - Julie M Kennerly-Shah
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | | | - Donna Capozzi
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Makala B Pace
- Department of Pharmacy, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Sally Y Barbour
- Department of Pharmacy, Duke Cancer Institute, Durham, NC, USA
| | - Ricky F Tizon
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah DeVincenzo
- Department of Pharmacy, National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | - Cynthia A Carnes
- The Ohio State University-College of Pharmacy, Columbus, OH, USA
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Al-Dujaili Z, Omari S, Pillai J, Al Faraj A. Assessing the accuracy and consistency of ChatGPT in clinical pharmacy management: A preliminary analysis with clinical pharmacy experts worldwide. Res Social Adm Pharm 2023; 19:1590-1594. [PMID: 37696742 DOI: 10.1016/j.sapharm.2023.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/13/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND ChatGPT conversation system has ushered in a revolutionary new era of information retrieval and stands as one of the fastest-growing platforms. Clinical pharmacy, as a dynamic discipline, necessitates an advanced comprehension of drugs and diseases. The process of decision-making in clinical pharmacy demands accuracy and consistency in medical information, as it directly affects patient safety. OBJECTIVE The objective was to evaluate ChatGPT's accuracy and consistency in managing pharmacotherapy cases across multiple time points. Additionally, input was gathered from global clinical pharmacy experts, and the agreement between ChatGPT's responses and those of clinical pharmacy experts worldwide was assessed. METHODS A set of 20 cases of pharmacotherapy was entered into ChatGPT at three different time points. Reliability analysis was performed using inter-rater reliability to measure the accuracy of the output generated by ChatGPT at each time point. Test-retest reliability was performed to measure the consistency of the output generated by ChatGPT across the three time points. Pharmacy expert performance was evaluated, and the overall results were compared. RESULTS ChatGPT achieved a hit rate of 70.83% at week 1, 79.2% at week 3, and 75% at week 5. The percent agreement between weeks 1 and 3 was 79.2%, whereas it was 87.5% between weeks 3 and 5, and 83.3% between weeks 1 and 5. In contrast, accuracy rates among clinical pharmacy experts showed considerable variation according to their geographic location. The highest agreement between clinical pharmacist responses and ChatGPT responses was observed at the last time point examined. CONCLUSIONS Overall, the analysis suggested that ChatGPT is capable of generating clinically relevant pharmaceutical information, albeit with some variation in accuracy and consistency. It should be noted that clinical pharmacy experts worldwide may provide varying degrees of accuracy depending on their expertise. This study highlights the potential of AI chatbots in clinical pharmacy.
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Affiliation(s)
- Zahraa Al-Dujaili
- College of Pharmacy, American University of Iraq - Baghdad (AUIB), Baghdad, Iraq
| | - Sarah Omari
- Department of Epidemiology and Population Health, American University of Beirut (AUB), Beirut, Lebanon
| | - Jey Pillai
- College of Pharmacy, American University of Iraq - Baghdad (AUIB), Baghdad, Iraq
| | - Achraf Al Faraj
- College of Pharmacy, American University of Iraq - Baghdad (AUIB), Baghdad, Iraq.
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Díaz-Villamarín X, Fernández-Varón E, Rojas Romero MC, Callejas-Rubio JL, Cabeza-Barrera J, Rodríguez-Nogales A, Gálvez J, Morón R. Azathioprine dose tailoring based on pharmacogenetic information: Insights of clinical implementation. Biomed Pharmacother 2023; 168:115706. [PMID: 37857254 DOI: 10.1016/j.biopha.2023.115706] [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: 07/12/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
Azathioprine is commonly used as an immunosuppressive antimetabolite in the treatment of acute lymphoblastic leukemia, autoimmune disorders (such as Crohn's disease and rheumatoid arthritis), and in patients receiving organ transplants. Thiopurine-S-methyltransferase (TPMT) is a cytoplasmic trans-methylase catalyzing the S-methylation of thiopurines. The active metabolites obtained from thiopurines are hydrolyzed into inactive forms by the Nudix hydrolase 15 (NUDT15). The TPMT*2 (defined by rs1800462), *3A (defined by rs1800460 and rs1142345), *3B (defined by rs1800460), *3C (defined by rs1142345), *6 (defined by rs75543815), and NUDT15 rs116855232 genetic variant have been associated, with the highest level of evidence, with the response to azathioprine, and, the approved drug label for azathioprine and main pharmacogenetic dosing guidelines recommend starting with reduced initial doses in TPMT intermediate metabolizer (IM) patients and considering an alternative treatment in TPMT poor metabolizer (PM) patients. This study aims to assess the clinical impact of azathioprine dose tailoring based on TPMT genotyping studying the azathioprine toxicity and efficacy, treatment starts, and dose adjustments during follow-up, comparing TPMT IM/PM and normal metabolizer (NM) patients. It also studied the association of NUDT15 rs116855232 with response to azathioprine in patients receiving a tailored treatment based on TPMT and characterized the TMPT and NUDT15 studied variants in our population. Results show that azathioprine dose reduction in TPMT IM patients (TPMT*1/*2, *1/*3A, or *1/*3C genotypes) is related to lower toxicity events compared to TPMT NM (TPMT *1/*1 genotype), and lower azathioprine dose adjustments during follow-up without showing differences in the efficacy. The results support the hypothesis of existing other genetic variants affecting azathioprine toxicity.
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Affiliation(s)
| | - Emilio Fernández-Varón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
| | | | - José Luis Callejas-Rubio
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Internal Medicine Department, Hospital Universitario San Cecilio, Granada, Spain
| | - José Cabeza-Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Hospital Pharmacy Unit. Hospital Universitario San Cecilio, Granada, Spain
| | - Alba Rodríguez-Nogales
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
| | - Julio Gálvez
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain; Centro de Investigaciones Biomédicas en Red - Enfermedades Hepáticas y Digestivas (CIBER-ehd)
| | - Rocío Morón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Hospital Pharmacy Unit. Hospital Universitario San Cecilio, Granada, Spain
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Favez L, Zúñiga F, Meyer-Massetti C. Exploring medication safety structures and processes in nursing homes: a cross-sectional study. Int J Clin Pharm 2023; 45:1464-1471. [PMID: 37561370 PMCID: PMC10682270 DOI: 10.1007/s11096-023-01625-6] [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: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Medication safety is important to limit adverse events for nursing home residents. Several factors, such as interprofessional collaboration with pharmacists and medication reviews, have been shown in the literature to influence medication safety processes. AIM This study had three main objectives: (1) To assess how facility- and unit-level organization and infrastructure are related to medication use processes; (2) To determine the extent of medication safety-relevant processes; and (3) To explore pharmacies' and pharmacists' involvement in nursing homes' medication-related processes. METHOD Cross-sectional multicenter survey data (2018-2019) from a convenience sample of 118 Swiss nursing homes were used. Data were collected on facility and unit characteristics, pharmacy services, as well as medication safety-related structures and processes. Descriptive statistics were used. RESULTS Most of the participating nursing homes (93.2%) had electronic resident health record systems that supported medication safety in various ways (e.g., medication lists, interaction checks). Electronic data exchanges with outside partners such as pharmacies or physicians were available for fewer than half (10.2-46.3%, depending on the partner). Pharmacists collaborating with nursing homes were mainly involved in logistical support. Medication reviews were reportedly conducted regularly in two-thirds of facilities. CONCLUSION A high proportion of Swiss nursing homes have implemented diverse processes and structures that support medication use and safety for residents; however, their collaboration with pharmacists remains relatively limited.
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Affiliation(s)
- Lauriane Favez
- Pflegewissenschaft - Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts, Western Switzerland, Yverdon-les-Bains, Switzerland
| | - Franziska Zúñiga
- Pflegewissenschaft - Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
- Institute for Primary Healthcare BIHAM, University of Bern, Bern, Switzerland.
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Clinic for General Internal Medicine, Inselspital - University Hospital of Bern, Bern, Switzerland.
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Hias J, Hellemans L, Nuyts S, Vaes B, Rygaert X, Tournoy J, Van der Linden L. Predictors for unplanned hospital admissions in community dwelling adults: A dynamic cohort study. Res Social Adm Pharm 2023; 19:1432-1439. [PMID: 37573152 DOI: 10.1016/j.sapharm.2023.07.004] [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: 04/06/2023] [Revised: 06/20/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Polypharmacy and inappropriate medication use are associated with unplanned hospital admissions. Targeted interventions might reduce the hospitalization risk. Yet, it remains unclear which patient profiles derive the largest benefit from such interventions. OBJECTIVE The aim of this study was to determine independent risk factors, among which polypharmacy, for unplanned hospital admissions in a cohort of community dwelling adults. METHODS A retrospective study was performed using a large general practice registry and an insurance database in Flanders, Belgium. Community dwelling adults aged 40 years or older with data for 2013-2015 were included. The index date was the last general practitioner contact in 2014. Determinants were collected during the preceding year. Unplanned hospital admissions were determined during the year after the index date. Univariable logistic regression models were fitted on each risk factor for an unplanned hospital admission as the primary outcome. Two multivariable models were derived. RESULTS In total, 40411 patients were included and 2126 (5.26%) experienced an unplanned hospital admission. Mean age was 58.3 (±12.3) years. The two models identified the following determinants for an unplanned hospital admission: excessive polypharmacy, older age, male sex, number of comorbidities, atrial fibrillation, chronic obstructive pulmonary disease or stroke, low hemoglobin, use of hypnotics, antipsychotics, antidepressants or antiepileptics and prior hospital and general practitioner visits. Prior hospital visits was the largest determinant. CONCLUSIONS In our study we identified and confirmed the presence of known determinants for unplanned hospital admissions in community dwelling adults, most of which align with a geriatric phenotype. Our findings can inform the allocation of interventions aiming to reduce unplanned hospital admissions.
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Affiliation(s)
- Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Research Foundation Flanders - FWO, Brussels, Belgium
| | - Shauni Nuyts
- Department of Public Health and Primary Care KU Leuven - University of Leuven, Leuven, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium; Academic Centre of General Practice, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care KU Leuven - University of Leuven, Leuven, Belgium; Academic Centre of General Practice, Leuven, Belgium
| | | | - Jos Tournoy
- Department of Public Health and Primary Care KU Leuven - University of Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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Nguyen KT, Dao ML, Nguyen KN, Nguyen HN, Nguyen HT, Nguyen HQ. Perception of learners on the effectiveness and suitability of MyDispense: a virtual pharmacy simulation and its integration in the clinical pharmacy module in Viet Nam. BMC Med Educ 2023; 23:790. [PMID: 37875942 PMCID: PMC10599015 DOI: 10.1186/s12909-023-04773-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND My Dispense is a virtual pharmacy simulation developed for students to train and practice dispensing skills in a safe environment that causes no harm to patients. This study was aimed to investigate learners' perspectives on the effectiveness of MyDispense and its suitability to integrate into the clinical pharmacy module in Viet Nam. METHODS A mixed method approach was undertaken. Fourth- and fifth-year pharmacy students at University of Medicine and Pharmacy at Ho Chi Minh city and community pharmacists were invited to complete a survey questionnaire and to participate in semi-structured interviews. RESULTS A total of 92/99 participants agreed to take part, of which 75% of participants were students and 65.2% were female. About three-quarters of the participants agreed or strongly agreed that MyDispense improved their dispensing skills, such as patient counselling (70.6%) and collecting patient infomation (85.9%). The majority of the participants (84.8%) considered that MyDispense was suitable to integrate into the clinical pharmacy module. Qualitative analysis from the interviews highlighted the advantages of MyDispense, comprising high interactivity with users, safe environment for practicing medication dispensing, and diversity of common marketed medications. In addition, certain barriers of this programme were also reported, including the complicated process, inconsistent quality of product images, and mixed English-Vietnamese languages. CONCLUSIONS From learner's perspectives, MyDispense was an effective tool to enhance dispensing skills and was suitable to integrated into the clinical pharmacy module in Viet Nam.
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Affiliation(s)
- Kim Tt Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - My Lc Dao
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khoi N Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho N Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoang Tm Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoa Q Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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Meurant A, Lescure P, Lafont C, Pommier W, Delmas C, Descatoire P, Baudon M, Muzard A, Villain C, Jourdan JP. Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults. Eur J Clin Pharmacol 2023; 79:1391-1400. [PMID: 37597081 DOI: 10.1007/s00228-023-03551-y] [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: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients. METHODS A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores. RESULTS There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = - 0.13 [- 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = - 0.39 [- 0.72; - 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03). CONCLUSION Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.
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Affiliation(s)
- Alexandre Meurant
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France.
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France.
| | - Pascale Lescure
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Lafont
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Wilhelm Pommier
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Delmas
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Pablo Descatoire
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Marie Baudon
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Alexandra Muzard
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Cédric Villain
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Jean-Pierre Jourdan
- Department of Pharmacy, Vire Hospital, Vire, France
- Normandie University, UNICAEN, CERMN (Centre d'Etudes et de Recherche sur le Médicament de Normandie), F-14032, Caen, France
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Alcântara TDS, Carvalho GAC, Sanchez JM, Ramos SF, Cunha LC, Araújo-Neto FDC, Valença-Feitosa F, Silvestre CC, Lyra Junior DPD. Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review. Res Social Adm Pharm 2023; 19:1315-1330. [PMID: 37442709 DOI: 10.1016/j.sapharm.2023.07.003] [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: 10/28/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.
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Affiliation(s)
- Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Júlia Mirão Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Luiza Correia Cunha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Carina Carvalho Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
| | - Divaldo Pereira de Lyra Junior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Protzenko D, Nakache J, De la Brosse S, Honoré S, Hache G. Elderly patients whose hospitalization was medication-related were more likely to receive medication recommendations by clinical pharmacist than patients whose hospitalization was unlikely medication-related in non-geriatric units. Res Social Adm Pharm 2023; 19:1386-1390. [PMID: 37355436 DOI: 10.1016/j.sapharm.2023.06.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/30/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Elderly patients are often polymedicated, and drug-related hospitalizations are common in this population. In our hospital, pharmacists from the mobile geriatric team (MGT) coordinate medication reviews (MR) for elderly patients hospitalized in non-geriatric wards, to prevent iatrogenic. OBJECTIVE The aim of this work is to determine whether the drug-related origin of hospitalizations can be considered as a targeting criterion for performing MRs. MATERIAL AND METHOD We conducted a retrospective study of data from patients who received a MGT's MR between March 2021 and December 2022, from a single center of more than 1000 beds. The drug-related origin of the hospitalization was estimated as probable or unlikely by the AT-HARM10 tool. Between the two groups, we compared the number of potentially inappropriate prescriptions detected by the PIM-check and START/STOPP tools, drug-drug interactions (DI), unintended discrepancies (UDI) at entry reconciliation, the drug burden index (DBI), and the number of drug-related problems (DRP) i.e., START/STOPP score + DI + UDI. Linear regression of the number of DRP by AT-HARM10 score was computed. RESULTS 110 patients were included. 56 hospitalizations were estimated MRH and 54 non-MRH. Mean age (85.1 ± 7.0), ADL (3.8 ± 1.9), IADL (2.0 ± 1.6), and number of medications at entry (8.9 ± 3.8) were comparable in the 2 groups. Compared with non-MRH group, MRH group had a higher number of START/STOPP criteria (5.7 ± 3.5 vs 3.0 ± 2.6; p < 0.05), PIM-check overuses (2.1 ± 1.7 vs 1.4 ± 1.4; p < 0.05), DI (8.4 ± 9.0 vs 4.7 ± 4.7; p < 0.05), UDI at entry (4.0 ± 3.34 vs 2.2 ± 2.1; p < 0.05), and higher DBI score (0.9 ± 0.7 vs 0.3 ± 0.4; p < 0.05). The number of DRP was higher in group P (17.6 ± 10.8 vs 9.8 ± 6.3; p < 0.00.5). Linear regression showed a positive correlation between AT-HARM10 score and the number of DRP (r = 0.5, p < 0.05) with a coefficient of 7.7 (CI95% = [4.3; 11.1]) and an intercept of 9.8. DISCUSSION These results allow us to consider AT-HARM10 score as a targeting criterion for performing MR for elderly patients, as part of a curative approach to drug iatrogenic for these patients.
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Affiliation(s)
- Dorian Protzenko
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service de Pharmacie, Marseille, France.
| | - Jérémie Nakache
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service de Pharmacie, Marseille, France
| | - Sonia De la Brosse
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service de Médecine d'urgence, Marseille, France
| | - Stéphane Honoré
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service de Pharmacie, Marseille, France; OMEDIT PACA-Corse, Marseille, France
| | - Guillaume Hache
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service de Pharmacie, Marseille, France
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Tecen-Yucel K, Ozdemir N, Kara E, Demirkan K, Sancar M, Okuyan B. Factors associated with intention of clinical pharmacists and candidates to provide pharmaceutical care: application of theory planned behaviour. BMC Med Educ 2023; 23:682. [PMID: 37730582 PMCID: PMC10512481 DOI: 10.1186/s12909-023-04658-7] [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: 03/21/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Postgraduate education programs in clinical pharmacy have become widespread in Türkiye. This study aimed to identify factors associated with the intention of Turkish clinical pharmacists and candidates (who were graduates and students of postgraduate clinical pharmacy programs) to provide pharmaceutical care. METHODS This prospective observational study was conducted between June 2021 and May 2022. After searching relevant studies, an expert panel discussion, translation, cultural adaptation, and a pilot study developed a 52-item Turkish scale based on the Theory of Planned Behavior (TBP). Cronbach alpha for each construct was calculated after an explanatory factor and test-retest reliability analysis. An online survey link was sent to all graduates or candidates of postgraduate clinical pharmacy programs in Türkiye. After univariate regression analysis, the multiple linear regression model was performed. RESULTS One hundred fifty-six participants completed the survey (response rate: 59.1%). The Cronbach's alpha for attitude (9 items), subjective norm (6 items), perceived behavioural control (5 items), self-efficacy (6 items), intention (11 items) and past behaviour (15 items) were 0.945, 0.720, 0.751, 0.864, 0.934 and 0.955 respectively. The multiple linear regression analysis found a higher score of the subjective norm (p = 0.016), a higher score of self-efficacy (p < 0.001), younger age (p < 0.001) and having PhD (p = 0.038) were associated with increased intention score. CONCLUSIONS It was shown that higher self efficacy and positive beliefs of their peers and other healthcare professionals were associated with their higher intention score for providing pharmaceutical care. Younger age and having a PhD were other factors associated with their intention to provide pharmaceutical care.
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Affiliation(s)
- Kamer Tecen-Yucel
- Department of Clinical Pharmacy, Anadolu University, Faculty of Pharmacy, 26210, Eskisehir, Türkiye.
| | - Nesligul Ozdemir
- Department of Clinical Pharmacy, Inönü University, Faculty of Pharmacy, Malatya, Türkiye
| | - Emre Kara
- Department of Clinical Pharmacy, Hacettepe University, Faculty of Pharmacy, Ankara, Türkiye
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University, Faculty of Pharmacy, Ankara, Türkiye
| | - Mesut Sancar
- Department of Clinical Pharmacy, Marmara University, Faculty of Pharmacy, Istanbul, Türkiye
| | - Betul Okuyan
- Department of Clinical Pharmacy, Marmara University, Faculty of Pharmacy, Istanbul, Türkiye
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Albayrak A, Düzenli T, Kayıkçıoğlu E. Potential drug-drug interactions in patients with non-small cell lung cancer at a university hospital in Turkey. J Cancer Res Clin Oncol 2023; 149:9621-9627. [PMID: 37222813 DOI: 10.1007/s00432-023-04890-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/20/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The aim of this study was to determine the drug profile of patients with non-small cell lung cancer (NSCLC) and to identify potential drug-drug interactions (PDDIs) during hospitalization. In particular, PDDIs in categories X and D were determined. METHODS This retrospective cross-sectional study was conducted in the oncology services of a university hospital between 2018 and 2021. PDDIs were evaluated using Lexicomp Drug Interactions® software included in UpToDate®. RESULTS A total of 199 patients were included in the study. Polypharmacy was present in 92.5% of the patients and the median (min-max) number of drugs used was 8 (2-16). 32% of the patients had D and X PDDIs. A total of 16 PDDIs at risk grade X were found in 15 (7.5%) patients. A total of 81 PDDIs of risk grade D were found in 54 (27.1%) patients and a total of 276 PDDIs of risk grade C were identified in 97 (48.7%) patients. Anticancer drugs (p = 0.008), opioids (p = 0.046), steroids (p = 0.003), 5-HT3 receptor antagonists (p = 0.012), aprepitant (p = 0.025) and antihistamines (p < 0.001) were statistically more frequent among patients with PDDIs than among those without. CONCLUSION The results of our study indicated that polypharmacy and PDDIs are common in hospitalized patients with NSCLC cancer. The monitoring of medications is critical for maximizing therapeutic effects and minimizing side effects related to PDDIs. As a part of multidisciplinary team, clinical pharmacists can contribute significantly to preventing, detecting and managing PDDIs.
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Affiliation(s)
- Aslınur Albayrak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey.
| | - Tuğdenur Düzenli
- Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey
| | - Erkan Kayıkçıoğlu
- Department of Medical Oncology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Correard F, Arcani R, Montaleytang M, Nakache J, Berard C, Couderc AL, Villani P, Daumas A. [Medication reconciliation: Interests and limits]. Rev Med Interne 2023; 44:479-486. [PMID: 36841717 DOI: 10.1016/j.revmed.2023.02.001] [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: 10/24/2022] [Revised: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.
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Affiliation(s)
- F Correard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Arcani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Montaleytang
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - J Nakache
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Berard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A L Couderc
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France; Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.
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Coiffard J, Aubry A, Bleibtreu A, Fourniols E, Junot H. Impact of clinical pharmacist interventions in a bone and joint infection orthoseptic surgery unit. Ann Pharm Fr 2023; 81:826-832. [PMID: 37075975 DOI: 10.1016/j.pharma.2023.04.004] [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: 08/02/2022] [Revised: 02/09/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the impact of interventions of a clinical pharmacist in a unit of orthopedic surgery specialized in bone and joint infections. METHODS Daily, in routine, a clinical pharmacist analyzed medication prescribed to inpatients via a computerized physician order entry (CPOE) (Phedra software). His attention was particularly focused on the impact of antibiotics on other medications. For this study, all of the pharmacist interventions (PI) have been retrospectively collected, then anonymized, and assessed over a two-month period. RESULTS Thirty-eight patients were hospitalized during the study period, with a mean age of 63 years old. Forty-five interventions were identified which represents a mean of 1.18 pharmaceutical interventions per patient. Most of them concerned lack of follow-up (24%) and drug-drug interactions (22%) and widely non-anti-infectious medication (35 interventions) with levothyroxine (10 interventions) as the most involved non-anti-infectious molecule. Among antibiotics, with respectively 9 and 8 interventions, rifampicin and fluoroquinolones (6 interventions for moxifloxacin) were the most concerned notably for drug-drug interactions with usual treatment. CONCLUSION In this observational retrospective study, 1.18 pharmacist interventions (PI) per patient were observed. Most of them are lack of follow-up and drug-drug interactions especially with usual treatment of patients. Moxifloxacin and rifampicin were the most antibiotics involved. Patients' characteristics (older, polypharmacy), long-term hospitalization and surgery are known to be predictive factors of medication errors and this study highlights the importance of the presence of clinical pharmacist in orthopedic surgery wards.
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Affiliation(s)
- Julie Coiffard
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France.
| | - Alexandra Aubry
- Laboratory of bacteriology, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Bleibtreu
- Infectious and tropical diseases ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Eric Fourniols
- Orthopaedic surgery ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Helga Junot
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France
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Baudouin A, Guillemin MD, Rioufol C, Ranchon F, Parat S. [SARS-COV-2 pandemic: Involvement of the hospital pharmacist in securing patient care]. Ann Pharm Fr 2023; 81:900-908. [PMID: 37086966 PMCID: PMC10118052 DOI: 10.1016/j.pharma.2023.04.005] [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: 09/15/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES In the context of the SARS-CoV-2 pandemic, hospital pharmacists supported the implementation of recommendations and ensured the safety of patient medication management. The aim of this study is to establish the interest of the involvement of the hospital pharmacist in this context by describing and comparing the activities carried out with patients with COVID-19 and those without. METHODS During the study period, data on clinical pharmacy activities with hospitalized patients were collected and analyzed: pharmaceutical analysis of prescriptions, participation in multi-professional consultation meetings (RCP) dedicated to COVID-19, and monitoring of adverse events. RESULTS The activities concerned 1483 patients, including 444 with COVID-19, resulting in 575 pharmaceutical interventions (PI). The main problems identified were overdoses, untreated indications, and drug-drug interactions (DDI). AMIs were significantly more common in patients with COVID-19, with 73.3% involving disease-specific therapies. Eleven PIs had a life-threatening impact, 189 a major impact. During the PCRs, 36 PIs were performed for 59% of the patients presented. A pharmacovigilance report was performed for a quarter of patients treated with hydroxychloroquine and 33% of patients treated with lopinavir/ritonavir. CONCLUSIONS This study demonstrates the value of involving hospital pharmacists in the drug management of patients with COVID-19, particularly with the evolution of available therapies and the implementation of vaccination, in order to reduce the spread of SARS-COV2 and limit the appearance of resistance.
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Affiliation(s)
- Amandine Baudouin
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - Marie-Delphine Guillemin
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Catherine Rioufol
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; EMR3738, université de Lyon, Lyon, France
| | - Florence Ranchon
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; EMR3738, université de Lyon, Lyon, France
| | - Stéphanie Parat
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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Lattard C, Baudouin A, Larbre V, Herledan C, Cerutti A, Cerfon MA, Kimbidima R, Caffin AG, Vantard N, Schwiertz V, Ranchon F, Rioufol C. Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review. J Cancer Res Clin Oncol 2023; 149:7905-7924. [PMID: 36853384 DOI: 10.1007/s00432-023-04630-4] [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: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs. METHODS A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact. RESULTS Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact. CONCLUSION Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France.
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Al Dali S, Al-Badriyeh D, Gulied A, Hamad A, Hail MA, Rouf PVA, El-Kassem W, Abushanab D. Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar. J Oncol Pharm Pract 2023:10781552231187305. [PMID: 37431260 DOI: 10.1177/10781552231187305] [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] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar. METHODS A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD). RESULTS A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%). CONCLUSIONS Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.
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Affiliation(s)
- Sara Al Dali
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | | | - Amaal Gulied
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Anas Hamad
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Wessam El-Kassem
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
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Maire A, Chapet N, Aguilhon S, Laugier ML, Laffont-Lozes P, Rigoni M, Mathieu B, Audurier Y, Breuker C, de Barry G, Jalabert A, Leclercq F, Pasquié JL, Roubille F, Castet-Nicolas A. Evaluation of vaccination coverage in heart failure patients in a tertiary center. Heliyon 2023; 9:e18080. [PMID: 37519644 PMCID: PMC10372228 DOI: 10.1016/j.heliyon.2023.e18080] [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: 02/10/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Background Despite current recommendation, vaccination coverage (VC) for patients with heart failure (HF) remains far too limited. Aims To evaluate the VC of HF patients followed in our hospital center and investigate the barriers to vaccination and the ways to address them. Methods This was a cross-sectional monocentric descriptive study conducted between December 2019 and January 2021 at the University Hospital of Montpellier, France. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status against influenza and pneumococcus. For non-vaccinated patients, opinion and willingness to be vaccinated were also obtained. Results Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years and the proportion of males was 72%. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p = 0.022) and 22% were up to date with pneumococcal vaccination (11% in CU, 35% in TP, p < 0.001). Among patients not vaccinated, 17% refused vaccination. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP). Conclusions The VC of HF patients remains insufficient. Patients in TP are more vaccinated than patients in CU, which could involve better management. The low rate of vaccinated patients is mainly explained by a lack of awareness. The medical team, including the clinical pharmacist by his dedicated time during medication reconciliation may play a major role in the management of hospitalized patients as well as GP's as local actors.
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Affiliation(s)
- Adrien Maire
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Chapet
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Sylvain Aguilhon
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Lucie Laugier
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | | | - Mélinda Rigoni
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | - Betty Mathieu
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | | | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Gaëlle de Barry
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Luc Pasquié
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- Cancer Research Institute of Montpellier (IRCM), INSERM U1194, ICM, University of Montpellier, Montpellier, France
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Gutierrez Euceda B, Ferreri SP, Armistead LT. A descriptive analysis of primary care providers' interest in clinical pharmacy services. Explor Res Clin Soc Pharm 2023; 10:100267. [PMID: 37250620 PMCID: PMC10213089 DOI: 10.1016/j.rcsop.2023.100267] [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: 02/23/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Background Various clinical pharmacy services exist to improve the health outcomes of patients. However, there are numerous barriers to their implementation and execution, especially in outpatient settings. As pharmacists design and implement clinical pharmacy services in outpatient settings, they often do not consider the needs of providers until after service development. Objectives The purpose of this study was to assess primary care providers' (PCPs') perceptions of clinical pharmacy services and their clinical pharmacy support needs. Methods A web-based survey was distributed via email to PCPs across North Carolina (NC). Survey dissemination was completed in two phases. Data analysis consisted of mixed methods - quantitative and qualitative. Descriptive statistics were used to analyze demographic differences within each phase as well as the ranking of medication classes/disease states by providers. Qualitative data analysis through inductive coding was done to assess provider perceptions of clinical pharmacy services. Results The response rate of the survey was 19.7%. Providers with previous experience with a clinical pharmacist rated overall services as positive. 62.9% of PCPs (N = 80) provided their perception of the positive attributes (pros) of clinical pharmacy services. 53.5% of PCPs (N = 68) provided their perception of the negative attributes (cons) of clinical pharmacy services. The top three medication classes/disease states that providers indicated they would value clinical pharmacy services for were: comprehensive medication management (CMM), diabetes medication management, and anticoagulation medication management. Of the remaining areas assessed, statin and steroid management ranked the lowest. Conclusions The results from this study demonstrated that clinical pharmacy services are valued by PCPs. They also highlighted how pharmacists can best contribute to collaborative care in outpatient settings. As pharmacists, we should aim to implement the clinical pharmacy services that PCPs would value most.
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Sourisseau A, Fronteau C, Bonsergent M, Peyrilles E, Huon JF. Practicing and evaluating clinical pharmacy in oncology: Where are we now? A scoping review. Res Social Adm Pharm 2023; 19:699-706. [PMID: 36682897 DOI: 10.1016/j.sapharm.2023.01.006] [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: 05/06/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Clinical pharmacy is a discipline structured around multiple activities whose objective is to secure patient care. Among all the specialties where it can be applied, oncology is a field of choice. More and more studies are being conducted on the impact of this activity, but their methodology and results seem at first sight very heterogeneous. OBJECTIVE(S) The objective of this literature review was to describe the clinical oncology pharmacy activities found in the literature, and analyze the methodology used and the outcomes measured by the authors for their evaluation. METHODS This literature review was based on the PRISMA-ScR criteria. The Embase, CINAHL, Google Scholar, and PsycINFO databases were searched. All studies reporting the evaluation of hospital-based clinical pharmacy activity in cancer patients were included based on a previously validated search equation. The search was conducted until the end of 2020. The quality of all studies was assessed using the MMAT. RESULTS Of the 2521 results of the initial query, 93 were selected for complete review. The main interventions implemented were pharmaceutical analysis as well as pharmaceutical interviews. The indicators assessed most often were the number of pharmaceutical interventions as well as treatment-related problems. The overall quality assessment score was 55%. CONCLUSION Clinical pharmacy activity in oncology still lacks robust studies, whether methodologically or of the measured indicator. Patient-centered impact indicators are still too rare. This area of research should focus on the homogenization of indicators and their relevance.
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Affiliation(s)
| | | | | | | | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacy, F-44000, France; INSERM UMR 1246 SPHERE: Methods in Patient-centered Outcomes and Health Research, Nantes, France.
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Skalafouris C, Blanc AL, Grosgurin O, Marti C, Samer C, Lovis C, Bonnabry P, Guignard B. Development and retrospective evaluation of a clinical decision support system for the efficient detection of drug-related problems by clinical pharmacists. Int J Clin Pharm 2023; 45:406-413. [PMID: 36515779 PMCID: PMC10147748 DOI: 10.1007/s11096-022-01505-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical decision support systems (CDSS) can help identify drug-related problems (DRPs). However, the alert specificity remains variable. Defining more relevant alerts for detecting DRPs would improve CDSS. AIM Develop electronic queries that assist pharmacists in conducting medication reviews and an assessment of the performance of this model to detect DRPs. METHOD Electronic queries were set up in CDSS using "triggers" from electronic health records: drug prescriptions, laboratory values, medical problems, vital signs, demographics. They were based on a previous study where 315 patients admitted in internal medicine benefited from a multidisciplinary medication review (gold-standard) to highlight potential DRPs. Electronic queries were retrospectively tested to assess performance in detecting DRPs revealed with gold-standard. For each electronic query, sensitivity, specificity, positive and negative predictive value were computed. RESULTS Of 909 DRPs, 700 (77.8%) were used to create 366 electronic queries. Electronic queries correctly detected 77.1% of DRPs, median sensitivity and specificity reached 100.0% (IQRs, 100.0%-100.0%) and 99.7% (IQRs, 97.0%-100.0%); median positive predictive value and negative predictive value reached 50.0% (IQRs, 12.5%-100.0%) and 100.0% (IQRs, 100.0%-100.0%). Performances varied according to "triggers" (p < 0.001, best performance in terms of predictive positive value when exclusively involving drug prescriptions). CONCLUSION Electronic queries based on electronic heath records had high sensitivity and negative predictive value and acceptable specificity and positive predictive value and may contribute to facilitate medication review. Implementing some of these electronic queries (the most effective and clinically relevant) in current practice will allow a better assessment of their impact on the efficiency of the clinical pharmacist.
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Affiliation(s)
- Christian Skalafouris
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Bertrand Guignard
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Madden M, Stewart D, Mills T, McCambridge J. Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care. Addict Sci Clin Pract 2023; 18:22. [PMID: 36998099 PMCID: PMC10062268 DOI: 10.1186/s13722-023-00378-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. METHODS Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. RESULTS When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. CONCLUSIONS Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, University of York, York, UK.
| | - Duncan Stewart
- Centre for Primary Health and Social Care, School of Social Professions, London Metropolitan University, London, UK
| | - Thomas Mills
- PHIRST South Bank, London South Bank University, London, UK
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Crafford L, Kusurkar RA, Bronkhorst E, Gous A, Wouters A. Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa. BMC Health Serv Res 2023; 23:290. [PMID: 36978062 PMCID: PMC10044779 DOI: 10.1186/s12913-023-09222-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. METHODS An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. RESULTS The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. CONCLUSION The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.
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Affiliation(s)
- L Crafford
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands.
| | - R A Kusurkar
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - E Bronkhorst
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ags Gous
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - A Wouters
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Weidmann AE, Cadogan CA, Fialová D, Hazen A, Henman M, Lutters M, Okuyan B, Paudyal V, Wirth F. How to write a successful grant application: guidance provided by the European Society of Clinical Pharmacy. Int J Clin Pharm 2023. [PMID: 36877291 DOI: 10.1007/s11096-023-01543-7] [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: 09/25/2022] [Accepted: 01/12/2023] [Indexed: 03/07/2023]
Abstract
Considering a rejection rate of 80-90%, the preparation of a research grant is often considered a daunting task since it is resource intensive and there is no guarantee of success, even for seasoned researchers. This commentary provides a summary of the key points a researcher needs to consider when writing a research grant proposal, outlining: (1) how to conceptualise the research idea; (2) how to find the right funding call; (3) the importance of planning; (4) how to write; (5) what to write, and (6) key questions for reflection during preparation. It attempts to explain the difficulties associated with finding calls in clinical pharmacy and advanced pharmacy practice, and how to overcome them. The commentary aims to assist all pharmacy practice and health services research colleagues new to the grant application process, as well as experienced researchers striving to improve their grant review scores. The guidance in this paper is part of ESCP's commitment to stimulate "innovative and high-quality research in all areas of clinical pharmacy".
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Sajogo M, Teoh SWK, Lebedevs T. Pharmacist clinical interventions: Five years' experience of an efficient, low-cost, and future-proofed tool. Res Social Adm Pharm 2023; 19:541-546. [PMID: 36577571 DOI: 10.1016/j.sapharm.2022.12.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe the development of an efficient and future-proofed tool for the documentation and analysis of clinical interventions (CIs). A secondary objective was to describe CIs recorded over a 5-year period and describe implications of the tool. METHOD In 2016, a matrix guide and an advanced spreadsheet were implemented in the study hospital to document all CIs made by pharmacists. The data entry tabs are arranged by month. The summary report dashboard tab provides an automatically generated analysis of the real-time data following pharmacists entering the CI details. RESULTS A total of 10,855 CIs were documented over the 5 years period starting from March 2016 to February 2021. The real-time data were utilised for multiple quality improvement initiatives including medical and nursing education, development of business cases and progress monitoring of newly established services. The tool was able to adapt with changes in devices, business intelligence software and migration to cloud storage. CONCLUSION The study demonstrates the feasibility of developing a low-cost and low-resource CI documentation tool. This tool provides data with the capability to inform site-specific education strategies, monitor quality improvement services and inform management in business case preparation.
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Affiliation(s)
- Monica Sajogo
- Pharmacy Department, Perth, Western Australia, 6008, Australia.
| | | | - Tamara Lebedevs
- Pharmacy Department, Perth, Western Australia, 6008, Australia.
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