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Murry LT, Desselle SP. Barriers to person-centered service design in pharmacy practice: examples, lessons, and potential solutions. Int J Clin Pharm 2024; 46:542-547. [PMID: 38194008 DOI: 10.1007/s11096-023-01689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
Despite increased attention to, and frameworks conceptualizing person-centered care, systematic, organizational, and provider-level barriers continue to discourage the development and delivery of person-centered care (PCC) in pharmacy practice and beyond. This commentary describes existing pharmacy-specific literature related to PCC, barriers to PCC within the context of pharmacy practice, and potential solutions to increase person-centeredness in pharmacy services. Literature to substantiate and describe barriers and potential solutions was identified from 2008 to 2023, a period where the emphasis on PCC in pharmacy practice dramatically increased. Overall, pharmacy-specific literature was identified describing four key barriers to PCC. Several potential solutions were identified, including: using innovative and theory-informed approaches to collecting individual need and preference information, employing processes and equipping providers to facilitate trust, changing organizational culture, and aligning quality metrics and financial incentives with PCC. Identified solutions may be used to address individual, organizational, and systematic barriers to promote PCC.
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Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, 180 S Grand Ave, Iowa City, IA, 52242, USA.
- The Accreditation Council for Pharmacy Education, Chicago, IL, 60603, USA.
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Torres-Novellas B, Rius P, Figueiredo-Escribá C, Mariño EL, Modamio P. Drug-Related Problems Detected in Complex Chronic Patients by Community Pharmacists of Catalonia: Perception of the Person-Centred Approach Necessity. Healthcare (Basel) 2024; 12:240. [PMID: 38255127 PMCID: PMC10815887 DOI: 10.3390/healthcare12020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Community pharmacies are healthcare settings in which pharmacists are in an ideal position to carry out pharmaceutical care. The aim of this study was to analyse the number, type and groups of drugs that caused drug-related problems (DRPs) detected in complex chronic patients who are outpatients, the interventions and actions of community pharmacists and their impact on patient medication adherence. The study was designed as a secondary analysis of a multicentre study in the field of primary healthcare and community pharmacies in Catalonia (Spain). The patients who took part were divided into two groups by the primary care physician depending on whether or not they were considered likely to receive their medication through a monitored dosage system (MDS) based on pre-established criteria. Patients underwent 12 months of follow-up by community pharmacists. The prevalence of DRPs among the studied complex chronic patients was high (n = 689). The most identified DRP was nonadherence (31.20%). In the MDS group, results showed a statistically significant increase of 21% in the number of adherent patients with respect to the baseline visit (p-value = 0.0008). Community pharmacists can have an important role in addressing DRPs and optimizing the safety and effectiveness of medications for these patients and in involving them in their own health conditions.
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Affiliation(s)
- Berta Torres-Novellas
- Catalan Council of Pharmacists’ Associations (CCFC), 08009 Barcelona, Spain
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Pilar Rius
- Catalan Council of Pharmacists’ Associations (CCFC), 08009 Barcelona, Spain
| | - Carlos Figueiredo-Escribá
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Eduardo L. Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
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Malhotra R, Suppiah SD, Tan YW, Sung P, Tay SSC, Tan NC, Koh GCH, Chan A, Chew LST, Ozdemir S. Older adult patient preferences for the content and format of prescription medication labels - A best-worst scaling and discrete choice experiment study. Res Social Adm Pharm 2023; 19:1455-1464. [PMID: 37507340 DOI: 10.1016/j.sapharm.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Patient preferences for the content and format of prescription medication labels (PMLs, i.e., sticker labels placed on medication bottles/packets at dispensing) have been extensively studied. However, accommodating all preferences on PMLs is impractical due to space limitations. Understanding how patients prioritise the content and format attributes of PMLs can inform improvements while working within PML space constraints. OBJECTIVES We aimed to (1) identify a ranking of medication-related content attributes to be prioritised on PMLs using best-worst scaling (BWS), and (2) determine the relative importance of format attributes when incorporated onto PMLs using discrete choice experiment (DCE), from the perspective of older adult patients in Singapore. METHODS Attributes were informed by our prior qualitative study and PML best practice guidelines. For the BWS component, the assessed content attributes were indication, precautions, interaction or paired medicines, food instructions, side effects, expiry date, and missed dose action, all of which are currently not legally mandated on PMLs in Singapore. A BWS object case was used to rank the content attributes. For the DCE component, in a series of questions, participants were asked to choose between two PML options each time, that varied in the presentation of dosage-frequency instructions, font size, presentation of dosage, presentation of precautions, and font colour of precautions. A mixed logit model estimated the relative utilities of format attribute levels, enabling the calculation of importance scores of the format attributes. RESULTS The study recruited 280 participants (mean age: 68.8 ± 5.4 years). The three most-preferred content attributes were indication, precautions and interaction or paired medicines. The top three format preferences were tabular style presentation of dosage-frequency instructions, large font size and precautions in red colour. CONCLUSIONS Healthcare institutions should consider improving their PMLs based on the leading content and format preferences voiced by older adult patients. The methodology adopted in the study can also be used for aligning the content and format of other patient education materials with patient preferences.
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Affiliation(s)
- Rahul Malhotra
- Centre for Ageing Research & Education, Duke-NUS Medical School, Singapore; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | | | - Yi Wen Tan
- Centre for Ageing Research & Education, Duke-NUS Medical School, Singapore
| | - Pildoo Sung
- Centre for Ageing Research & Education, Duke-NUS Medical School, Singapore
| | | | | | | | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California, USA
| | - Lita Sui Tjien Chew
- Department of Pharmacy, National Cancer Centre Singapore, Singapore; Department of Pharmacy, National University of Singapore, Singapore
| | - Semra Ozdemir
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Kaae S, Hedegaard U, Andersen A, Loon EV, Crutzen S, Taxis K, Jacobsen R. What Are the Drug-Related Problems Still Faced by Patients in Daily Life?-A Qualitative Analysis at the Pharmacy Counter. PHARMACY 2023; 11:124. [PMID: 37624079 PMCID: PMC10459759 DOI: 10.3390/pharmacy11040124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Drug-related problems (DRPs) affect many patients. Many activities in general practice, hospitals, and community pharmacies have been initiated to tackle DRPs. However, recent studies exploring what DRP patients are still facing in their daily lives are scarce. METHODS Danish pharmacy staff registered DRPs in prescription encounters to understand what DRPs patients are still experiencing in daily life. They noted short descriptions of what happened in the encounter that qualified the incident as a DRP. The descriptions were subjected to an inductive content analysis. RESULTS A wide range of DRPs that impacted patients' daily lives practically and healthwise were identified. In total, eighteen percent of patients with prescriptions had a DRP. Three overall stages of DRPs were identified: challenges in receiving the medications, not knowing how or why to take the medications, and not experiencing satisfactory effects. Patients were emotionally affected by these problems. CONCLUSIONS DRPs are still widespread in patients' daily lives and influence their well-being. The identified DRPs illustrated the complexity of obtaining medications to work as intended and demonstrate that health professionals must take even the basics of medication intake much more seriously.
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Affiliation(s)
- Susanne Kaae
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark; (A.A.); (R.J.)
| | - Ulla Hedegaard
- Department of Health Research, Faculty of Health, University of Southern Denmark, 5230 Odense, Denmark;
| | - Armin Andersen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark; (A.A.); (R.J.)
| | - Ellen Van Loon
- Unit of Pharmacotherapy, Epidemiology and Economy, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, 9712 Groningen, The Netherlands; (E.V.L.); (S.C.); (K.T.)
| | - Stijn Crutzen
- Unit of Pharmacotherapy, Epidemiology and Economy, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, 9712 Groningen, The Netherlands; (E.V.L.); (S.C.); (K.T.)
| | - Katka Taxis
- Unit of Pharmacotherapy, Epidemiology and Economy, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, 9712 Groningen, The Netherlands; (E.V.L.); (S.C.); (K.T.)
| | - Ramune Jacobsen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark; (A.A.); (R.J.)
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Kaplan WA, Cellini CM, Eghan K, Pilz K, Harrison D, Wirtz VJ. Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities. J Pharm Policy Pract 2023; 16:60. [PMID: 37131256 PMCID: PMC10153779 DOI: 10.1186/s40545-023-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. METHODS A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including 'patient-centered' pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. RESULTS From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public-private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. CONCLUSION Public-private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.
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Affiliation(s)
- Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Carlotta M Cellini
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Kwesi Eghan
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA
| | - Kevin Pilz
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Denise Harrison
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
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Svensberg K, Khashi M, Dobric S, Guirguis M, Ljungberg Persson C. Making medication communication visible in community pharmacies-pharmacists' experience using a question prompt list in the patient meeting. Res Social Adm Pharm 2022; 18:4072-4082. [DOI: 10.1016/j.sapharm.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 11/28/2022]
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