Differences and similarities in clinical pharmacy practice in China and the United States: a narrative review

Physicians and hospital pharmacists' knowledge, attitudes, and practices towards polypharmacy in older patients with chronic diseases

This web-based cross-sectional study aimed to evaluate the knowledge, attitudes, and practices of physicians and hospital pharmacists towards polypharmacy in older adult patients with chronic diseases in China. This study enrolled 374 physicians and pharmacists (270 females, 92 physicians) in 20 Chinese provinces between December 2022 and March 2023. The knowledge, attitude, and practice scores were 12.65 ± 2.05 (possible range, 0-18), 29.07 ± 2.68 (possible range, 7-35), and 26.16 ± 5.56 (possible range, 7-35), respectively. Working as a hospital pharmacist (vs. physician) was independently associated with adequate knowledge (OR = 2.190; 95% CI = 1.291-2.713; P = 0.004). Working in a tertiary hospital (OR = 4.296; 95% CI = 1.390-13.272; P = 0.011) was independently associated with a positive attitude. Knowledge score (OR = 1.176; 95%CI = 1.038-1.333; P = 0.011), hospital pharmacist (OR = 0.276; 95% CI = 0.137-0.557; P < 0.001), master's degree or higher (OR = 1.754; 95% CI  = 1.011-3.045; P = 0.046) and senior professional title (OR = 2.020; 95% CI = 1.032-3.952; P = 0.040) were independently associated with proactive practice toward polypharmacy in older adults. Physicians and hospital pharmacists had favorable knowledge, positive attitudes, and proactive practice toward polypharmacy. In conclusion, enhancing knowledge through continuous education, promoting interprofessional collaboration, educating patients, and conducting regular evaluations for quality improvement are necessary to improve the KAP of healthcare professionals toward polypharmacy in older adults.

Investigation on pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China

Objective

This study aimed to understand the current status of pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China, and to provide a reference for further improving the quality of pharmaceutical care and perfecting the construction of pharmaceutical care system in China.

Methods

The PCBS-CH scale (Pharmaceutical Care Barriers Scale in Chinese Hospitals) was used to measure the perceived pharmaceutical care barriers of clinical pharmacists, and descriptive statistical analysis was used to identify the main barriers faced by clinical pharmacists. The different barriers perceived by clinical pharmacists with various characteristics was investigated by subgroup analysis.

Results

A total of 1266 clinical pharmacists from 31 provinces were finally included. The results revealed that the main barriers faced by clinical pharmacists in the process of implementing pharmaceutical care included lack of additional staffing, lack of time for pharmaceutical care provision and continuing education, and lack of an electronic information system and prescription evaluation system for pharmaceutical care. Subgroup analysis found that clinical pharmacists who are without training (P < 0.001), worked in tertiary hospitals (P = 0.036), and had other training certificates (P < 0.001) perceived higher pharmaceutical care barriers.

Conclusion

Clinical pharmacists in secondary and tertiary hospitals in China have a low perception of overall pharmaceutical care barriers, but still face some important barriers. In order to promote the development of pharmaceutical care in China, the quality of clinical pharmacists should be improved, strict entry criteria should be established, clear responsibilities should be defined, the rights of female clinical pharmacists should be protected, and hospital facilities should be upgraded.

Qualitative study on the problems and potential solution strategies for part-time clinical pharmacists' clinical services work in a tertiary hospital in China

OBJECTIVE

To provide an initial understanding of problems and potential solution strategies for part-time clinical pharmacist work in China, and provide references for the training of part-time clinical pharmacists.

METHODS

The study was conducted in a tertiary teaching hospital in China, and the project lasted 6 months. Phenomenological methods were used to guide the research design. Research data were obtained by conducting one-to-one semistructured interviews with part-time clinical pharmacists, and interview data were coded and analysed through thematic analysis.

RESULTS

A total of 21 pharmacists were interviewed in a semistructured manner, and the results showed that following problems exist in the work of part-time clinical pharmacists: the existing professional knowledge is not adequate to meet the demands of clinical service; the career orientation of part-time clinical pharmacists is not clear; lack of professional self-confidence in clinical pharmacy practice; there is no suitable entry point to carry out pharmacy service work; it is difficult to communicate effectively, and for in addition, 17 potential solution strategies are proposed for the current problems, which can provide reference for the development of part-time clinical pharmacists' work.

CONCLUSIONS

The work performed by part-time clinical pharmacists is currently immature and the strategies derived from this study may serve as potential solutions to resolve the part-time clinical pharmacy practice challenges.

Mental health symptoms and their associated factors among pharmacists in psychiatric hospitals during the early stage of the COVID-19 pandemic

As frontline workers, pharmacists often face significant work stress, especially in psychiatric settings. A multicenter cross-sectional design was conducted in 41 psychiatric hospitals. The Depression, Anxiety and Stress Scale-21 (DASS-21) was used to measure the mental health of 636 pharmacists. We also collected demographic data and work-related variables. The prevalence of depression, anxiety and stress was 20.60%, 22.96% and 8.96%, respectively. Multivariate logistic regression showed that several common factors were associated with depression, anxiety and stress, including professional identity (odds ratio [OR] = 0.132, 0.381 and 0.352) and verbal violence (OR = 2.068, 2.615 and 2.490). Those who were satisfied with their job were less likely to develop depression (OR = 0.234) or anxiety (OR = 0.328). We found specific factors associated with mental health. Older age (OR = 1.038) and perceived negative impact (OR = 2.398) of COVID-19 on medical work were associated with anxiety, and those with frontline experience with COVID-19 patients (OR = 2.306) were more likely to experience stress. More than one-fifth of pharmacists in psychiatric hospitals experienced symptoms of depression or anxiety during the pandemic, highlighting the need for policy change to improve workplace conditions and psychological well-being for this professional group.

Development and validation of pharmaceutical care barriers scale in Chinese hospitals: a cross-sectional survey

Introduction: Chinese hospitals still face various barriers to implementing pharmaceutical care. The quantitative instrument for measuring these barriers in China is scarce. This study aims to develop and validate a scale for measuring barriers to providing pharmaceutical care in Chinese hospitals from the perspective of clinical pharmacists. Methods: The scale was developed based on existing literature and qualitative interviews with 20 experts. The scale was included in a small-range pilot survey and then administered to a validation survey in 31 provinces in China. Exploratory factor analysis was used to identify the structure of the scale. Confirmatory factor analysis was applied to verify the structure of the scale and to validate the scale's convergent and discriminative validity. Known-group validity was also examined. Cronbach's alpha examined the internal consistency reliability of the scale. Results: 292 scales were completed and returned for a response rate of 85.6% in the pilot study. Exploratory factor analysis of the scale suggested a five-factor solution (Cognition and attitude, Knowledge and skills, Objective conditions, External cooperation, and Support from managers) accounting for 66.03% of the total variance. 443 scales were sent out in the validation study, with a response rate of 81.0%. Confirmatory factor analysis demonstrated a good fit of the structural model for pharmaceutical care barriers. It showed the scale's good convergent and discriminative validity (The average variance extracted >0.5 and composite reliability >0.7). The scale could also identify the differences in total score among the clinical pharmacists from different hospital grades (p < 0.05). Cronbach's alpha is between 0.658 and 0.896, indicating good internal consistency. Conclusion: From the perspective of clinical pharmacists, this study has developed a scale to assess obstacles to pharmaceutical care. The scale comprehensively encompasses barriers to clinical pharmacists' cognitive and ability-related aspects, hindrances encountered in collaborating with other health professionals and patients, and barriers to the working environment. The reliability and validity have been established through verification.

Clinical pharmacy undergraduate education in China: a comparative analysis based on ten universities' training programs

BACKGROUND

In recent years, the scale of personnel training for clinical pharmacy professionals in China has expanded increasingly, however, the shortage of clinical pharmacists is still prominent. In 2018, the Ministry of Education of China released national standards for the teaching quality of undergraduate majors at regular colleges and universities, which has developed a core policy for undergraduate clinical pharmacy training. To explore the training methods for clinical pharmacy professionals in China and to promote the healthy and sustainable development of the clinical pharmacy education system. This study comparatively analyzed the training programs for clinical pharmacy undergraduates in China's ten universities, discussed training programs suitable for clinical pharmacy professionals in China.

METHODS

The clinical pharmacy education programs in these ten universities were obtained through official school websites or by interviewing relevant people, and then compared and analyzed.

RESULTS

The school with the largest number of courses and the most class hours in general courses is University A1 (34 courses, 1316 class hours), and the school with the most credits is University B1 (75.5 credits). The schools with the largest number of courses and the most class hours in the basic courses are University A1 (50 courses, 1997 class hours), and the schools with the most credits are University B3 and University B1 (105.5 credits). The schools with the largest number of courses in the core courses are University C1 (23 courses), and the school with the most credits and class hours is University B2 (51 credits, 914 class hours). The school with the most class hours in practical teaching is University B6 (1406 class hours), and the schools with the longest internship time are University A1 and University B6 (52 weeks).

CONCLUSIONS

There was substantial variation in programs. There remains a gap between the existing educational model and clinical training in pharmacy in China and developed countries. China should explore the most appropriate method for undergraduate education in clinical pharmacy based on studying foreign excellent educational models and the experience of China.

Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study

Background

In China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS.

Methods

A qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews.

Results

Five broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS.

Conclusion

The attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.

Young hospital pharmacists' job stress and career prospects amidst the COVID-19 pandemic in China

Background

Coronavirus disease (COVID-19) pandemic posed a critical threat to public health in the past year and has not been fully controlled so far. The nature of front-line young hospital pharmacists’ occupation puts them at an increased risk of contracting any contagious disease, including COVID-19. Recent survey indicated that hospital pharmacists in China are depressive, hostile amid the pandemic.

Aim

The present investigation aims to understand the job stress among young hospital pharmacists during the outbreak of COVID-19 and to provide basic information for pharmacy managers to help young fellows to cope with job stress.

Method

This study is adopting pharmacist job stress questionnaire as the key instrument of data collection through WJX App in mobile phone. Demographic information, career prospects and stress management proposals were obtained synchronously. Quantitative data were processed with SPSS. Significant differences were examined using analysis of variance and Chi-square analysis.

Result

About 60% of 289 questionnaire respondents complained of job stress (178 respondents). According to the narrative description of the data, young pharmacists’ gender, education background, hospital grade, and specific work post had no significant effect on job stress difference. However, young pharmacists in different age-groups and professional titles showed different job stress. Pharmacists at the age of 31–35 complained more stress than the others. Pharmacists with high professional title (deputy chief pharmacist) complained more stress than the others. About 65% of 289 respondents had long-term plan for their practice, although 61% of young pharmacists felt troubled or worried with their future. As for stress management proposal, almost all young pharmacists hoped to improve their professional identity via raising their wages.

Conclusion

More than half of young pharmacists suffer from job stress amidst the COVID-19 pandemic in China, and various intervention measures should be taken to relieve the stress and finally improve their social identity.

Evaluation of Antibiotic Use in Kazakhstan for the Period 2017-2019 Based on WHO Access, Watch and Reserve Classification (AWaRe 2019)

The purpose of this study is to conduct a comparative analysis of the consumption of antibiotics for systemic use reimbursed by the state in Kazakhstan for 2017–2019 with the Access, Watch, and Reserve classification (AWaRe 2019) of the World Health Organization (WHO). The evaluation of the consumption of antibiotics for systemic use in Kazakhstan for 2017–2019 was carried out using the ATC/DDD methodology in accordance with the WHO AWaRe classification. The study used data on all antibiotics that were centrally purchased by a single purchaser during the study period. To understand how often Access group antibiotics are taken in Kazakhstan, the top-10 most consumed antibiotics were additionally studied. The results of a comparative analysis of the antibiotics for systemic use consumption for 2017–2019 by the Access, Watch, and Reserve groups showed a negative trend of a decrease in the consumption of Access group drugs from 1.17 defined daily dose (DDDs) per 1000 inhabitants per day (DID) (39%) in 2017 to 0.59 DID (30%) in 2019. There is an increase in consumption of Watch group antibiotics from 1.84 DID (61%) in 2017 to 1.37 DID (68%) in 2019, as well as an increase in consumption of Reserve antibiotics from 0.001 DID (0.03%) to 0.4 DID (2.11%). In recent years in Kazakhstan, there has been a decrease in the consumption of Access group antibiotics. In addition, the Watch group antibiotics are widely consumed with a certain upward trend. In 2019, one Reserve antibiotic was included in the top-10 most commonly consumed antibiotics. There is a predominant consumption of parenteral forms of antibiotics for systemic use in the country.

Final-year pharmacy undergraduate students' career intention and its influencing factors: a questionnaire study in northwest China

BACKGROUND

Career intention is closely related to the distribution of university graduates across sectors in pharmacy-related field. The aim of the study was to describe career intention and identify its influencing factors among final-year pharmacy undergraduate students in China.

METHODS

A questionnaire study on demographic characteristics, educational situation, family background, occupational value and career intention was conducted among final-year pharmacy undergraduate students at three universities in northwest China. Exploratory factor analysis was used to identify the constructs of occupational value. Multinominal logistic regression was adopted to analyse the factors influencing career intention.

RESULTS

Among the 275 student participants, 62.6% intended to work in public medical institutions (rural: 44.4%; urban: 18.2%), 26.5% aimed to work in the pharmaceutical industry, 6.5% wanted to work in other sectors in the pharmacy-related field, and 4.4% planned to work in other fields. Their gender, father's education level, monthly household income per capita, whose opinions were considered most during job selection, the self-gratification factor of occupational value, and employment guidance had significant impacts on students' career intentions.

CONCLUSION

In the Chinese background, the career intention of more than half of the undergraduate pharmacy students was to work in public medical institutions. The career intentions of the overall participants were mainly determined by their gender, family background as well as psychological self-gratification, and they could also be influenced by employment guidance.

The effect of inpatient pharmaceutical care on nephrotic syndrome patients after discharge: a randomized controlled trial

Background Clinical pharmacists can play an important role in chronic diseases management, but limited attention has been given to the pharmaceutical care of nephrotic syndrome patients. Objective To evaluate the impact of inpatient pharmaceutical care on medication adherence and clinical outcomes in nephrotic syndrome patients. Setting A tertiary first-class hospital in Shanxi, China. Method We conducted a randomized controlled trial on 61 patients with nephrotic syndrome. The intervention consisted of medication reconciliation, pharmacist visits every day, discharge counseling and education by 2 certificated pharmacist, while the control group received usual care. Assessments were performed at baseline, month-1, month-3 and month-6 after hospital discharge. Main outcome measure medication adherence and patients' clinical outcomes. Results 61 patient completed the trial. Baseline variables were comparable between the two groups. The decline in medication adherence of patients in the intervention group after hospital discharge was restrained effectively at month-6 (p < 0.05). However, the groups did not differ in clinical outcomes, medication discrepancies, adverse drug events and readmission rate. The rate of return visits of the pharmaceutical care group was higher at month-1 and month-6 after discharge (p < 0.05). Conclusion Pharmaceutical inpatient care improved adherence in patients with nephrotic syndrome after hospital discharge, the effect of the intervention on clinical outcomes, medication discrepancies, adverse drug events or readmission was insignificant. These results are promising but should be tested in other settings prior to broader dissemination.

Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: a macro-level panel data model of fixed effects with individual and time

BACKGROUND

The rapid increase in pharmaceutical expenditure (PE) has been a main problem of global healthcare reform for decades. Previous studies demonstrated that pharmacists play an indispensable role in controlling PE, but macro-research evidence is scarce. Exploring the role of pharmacists from a macro-perspective is essential for pharmacy source allocation with an advantage of extensive applicability over regions. This study aimed to explore the relationship between the number of hospital pharmacists and hospital PE and to provide a macro-perspective evidence to curb the increasing PE and decline unnecessary medications.

METHODS

Data were extracted from China Health Statistics Yearbook from 2011 to 2018. A panel dataset with 31 provinces from 2010 to 2017 was constructed. Amongst them, 'Number of hospital pharmacists per 1 million of population' (HLPT) was selected as an independent variable, 'Per visit of hospital outpatient pharmaceutical expenditure' (OTPE) and 'Per capita of hospital inpatient pharmaceutical expenditure' (ITPE) were selected as dependent variables, and 'Number of hospital physicians per 1 million of population' (HLPN) and 'Drug price index' (DPI) were applied as control variables. Fixed-effect panel data analysis was performed to evaluate the relationship between the number of hospital pharmacists and hospital PE.

RESULTS

HLPT had a significant and negative relationships with OTPE (β₁ = - 0.0893, p = 0.0132) and ITPE (β₁ = - 4.924, p < 0.001). Considering the control variables, the significant and negative relationships with HLPT and OTPE remained unchanged (β₁ = - 0.141, p < 0.001; β₁ = - 4.771, p < 0.001, respectively), indicating that an increase in hospital pharmacist per 1 million of population led to a decrease of ¥474 million ($67.4 million) OTPE and ¥902 million ($128 million) ITPE in 2017. Overall, in 2017, an increase of 1 hospital pharmacist led to a decrease of approximately ¥1 million ($142 thousands) hospital PE nationwide.

CONCLUSION

This study confirmed the negative relationship between hospital pharmacists and hospital PE, indicating that hospital pharmacists might play a significant role in controlling PE. Pharmacists were encouraged to participate in more drug-therapy-related activities, such as medication reconciliation.

Impact of pharmaceutical care in the orthopaedic department

WHAT IS KNOWN AND OBJECTIVE

In the mid-1960s, clinical pharmacy developed in the USA, and as the demand for pharmaceutical services continued to grow, their impact began to be taken seriously. However, the participation of clinical pharmacists as members of the multidisciplinary team in the orthopaedic department is still in its infancy, although its role in orthopaedics has not been defined. The object of this study was to identify and discuss the impact of pharmaceutical care in the orthopaedic department.

METHODS

A literature search was conducted on MEDLINE, PubMed, Web of Science, the Cochrane Library and CNKI (China National Knowledge Infrastructure) for papers published between 1998 and 2019, using the keywords pharmacy, pharmacist, and medication or drug combined with orthopaedic. Other available resources were also used to identify relevant articles.

RESULTS AND DISCUSSION

Based on the available evidence in 74 articles, it was found that clinical pharmacists play an important role in all aspects of rational use of medications, medication review and reconciliation, monitoring adverse drug events, risk assessment, and medication education and counselling. In addition, clinical pharmacy services were developed to minimize medication errors, adverse drug events and medical costs, but clinical pharmacy is still in its early stages in orthopaedics.

WHAT IS NEW AND CONCLUSION

A multidisciplinary approach should be adopted in the orthopaedic department, as pharmacist interventions can be vital for promoting the safety, effectiveness and cost-effectiveness of pharmacotherapy. Although pharmacists' contributions to orthopaedics are not yet fully recognized, pharmaceutical services can undoubtedly contribute to both clinical and societal outcomes.