A logic model for pharmaceutical care

Determination of Factors Influencing Pharmacists While Recommending Immune-Enhancing Products via Analytic Hierarchy Process

Objectives

Immune enhancers are attracting attention day by day. Besides, during the coronavirus disease-2019 (COVID-19) pandemic, there has been an increasing demand for immune enhancers. Pharmacists are seen as trustable providers of complementary and alternative medicines, dietary and herbal supplements, immune-enhancers, and so on. This study aims to prioritization criteria that affect community pharmacists' recommending behavior regarding immune enhancers.

Materials and Methods

This paper adopts the analytic hierarchy process (AHP) to rank different criteria substantial for affecting community pharmacists' recommending behavior regarding immune enhancers. In this direction, firstly seven criteria were identified through literature review and views of pharmacists who have community pharmacy experiences. These are; (i) ease of access, (ii) selling price, (iii) package, (iv) content (appropriateness to patient health status), (v) expectation of patient, (vi) quality, and (vii) trust in the manufacturer. Then, a questionnaire including criteria was prepared and delivered to community pharmacists. The data obtained from 93 participants were transferred to the Super Decisions software. The hierarchical structure of the AHP was established and pair-wise comparisons were made.

Results

This study showed that the most important criterion was the ease of access (28%). Secondly, pharmacists give importance to the content of the product, while advising immune-enhancers (22%). Besides, it was determined that the least important criterion was the package of the product (4%).

Conclusion

This study will contribute to the literature by facilitating the process of assessing factors that pharmacists pay attention to while recommending immune-enhancing products. Additionally, the present study results will shed light on firms producing such products, to shape their supply chain management strategies, especially for marketing and sales.

Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services

OBJECTIVES

The study aimed to determine how eHealth was adopted in pharmaceutical care (PC), the outcome reported and the contextual factors.

DESIGN

Systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Literature was searched in six databases including PubMed, Scopus, Medline, Web of Science, Science Direct and China National Knowledge Infrastructure.

ELIGIBILITY CRITERIA

Studies which reported the usage experiences of eHealth in any aspects of PC by pharmacists during the COVID-19 pandemic, written in English or Chinese, and published in peer-reviewed journals between December 2019 and March 2022 were included. Opinion articles, conference abstracts, correspondence, letters and editorials were excluded.

DATA EXTRACTION AND SYNTHESIS

The literature search was completed on 15 April 2022. Two researchers independently conducted the literature search and extracted the data into an Excel table informed by the logic model with the key components of goals, input, activities, output and contextual factors.

RESULTS

Forty-three studies were included in this review. During the COVID-19 pandemic, hospital pharmacists, community pharmacists and specialist pharmacists in 17 countries continued to educate, consult, monitor and manage the patients and the general public via phone calls, videoconferences, mobile applications, social media, websites and/or enhanced interoperability of electronic medical records. Assuring the continuity of pharmacy care, reduced need for hospital visits, and improved work accuracy and efficiency were the benefits of eHealth mostly reported. Contextual factors affecting the adoption of eHealth were multifaceted, prompting supporting actions at the levels of government, hospital/pharmacy, pharmacists and patients.

CONCLUSION

This study revealed the wide adoption of eHealth in PC during the pandemic and the emerging evidence for its importance. Proper adoption of eHealth will help reshape the mode of pharmacy services to ensure continuity, quality and efficiency of care amid the challenges of the pandemic.

PROSPERO REGISTRATION NUMBER

CRD42022299812.

Poverty, Household Structure and Consumption of Foods Away from Home in Peru in 2019: A Cross-Sectional Study

The aim of this study was to evaluate the probability of buying food away from home according to the type of household using the logit model, as well as the sociodemographic characteristics of the heads of household, and how much income expenditure represents. A cross-sectional study was carried out using the National Household Survey (ENAHO) 2019 database. After joining the database, the household type variables were created. To calculate the probability with the “logit” model of purchase, the variables—family size, income, types of household, and total expenditure—were selected as a measure of the purchasing power of the family. A statistically significant association (p < 0.05) was found between the probability of consumption and the variables: age of household members, predominance, nuclear without children−married, nuclear with children−cohabitant, nuclear with children−widowed, nuclear with children−separated, extended, compounded, poor not extreme, and not poor. The bulk of families was represented by nuclear families (61.97%). The highest expenditure in the CFAH was for families defined as composite with a yearly average of USD 1652.89 (equivalent to PEN 5520.67). Observing the expenditure on food consumed outside the home through the composition of households can allow a better approach to offer educational measures. This information can be helpful to developers of educational issues.

Bioética clínica e ensino-aprendizagem de estudantes de Farmácia

De maneira geral, a atenção em saúde engloba atividades que demandam dos profissionais farmacêuticos a atuação clínica segura. Essa atuação considera a relação aperfeiçoada com os pacientes por meio de atributos para lidar com cenários conflitantes, os chamados “problemas ético-morais”. Nesse sentido, o método deliberativo de Diego Gracia atua na discussão democrática prudente de casos com base em fatos, valores e deveres, formando comitês multiprofissionais. O estudo em questão apresenta contribuições da aplicação do método deliberativo em sala de aula, com a abordagem de problemas relevantes para a atividade farmacêutica e humana sob o olhar da Bioética contemporânea trabalhado em conjunto com discentes do curso de Farmácia dos 6o e 10o períodos, respectivamente. A deliberação como estratégia de ensino possibilitou a reflexão dos alunos quanto às inúmeras perspectivas na tomada de decisão em saúde, considerando aspectos como cultura, religião e sociedade; além disso, exaltou a importância das disciplinas concernentes à Deontologia e à Bioética na matriz curricular.

Clinical practice and teaching of pharmaceutical care procedures for obstetric diseases

OBJECTIVES

Our goal was to explore the pharmaceutical service and teaching methods of obstetric clinical pharmacists to establish standardised pharmaceutical care procedures for obstetric diseases.

METHODS

According to the evidence-based medicine method, the "Standard of Pharmaceutical Care" was established to standardise the procedure and content of the pharmaceutical care procedure including preface, purpose, scope of application, responsibilities, procedures, references, and appendix, with seven parts in total. The object of the pharmaceutical care procedure was selected by the harmfulness of the disease and the drugs used. The clinical pharmacists in obstetrics formulated the pharmaceutical care procedure for each disease according to the standard and carried out clinical practice and teaching.A retrospective study was conducted to investigate the impact of the pharmaceutical care procedure before and after its implementation on both clinical practice and training. Obstetric pharmaceutical consultation and adverse reaction were the key indicators for clinical practice.The graduation assessment for students was strictly carried out in accordance with the regulations of the Chinese Hospital Association Pharmaceutical Affairs Professional Committee including communication and consultation capacity interview, case assessment, and training procedure assessment.

RESULTS

We established the standards for the pharmaceutical care procedures for three diseases: pregnancy with diabetes; pregnancy with thyroid disease; and pregnancy with hypertensive disorder. The clinical pharmacist conducted the pharmaceutical care procedure, participated in drug treatment management, and improved the recognition of the role of clinical pharmacists by the obstetric clinicians, often inviting the clinical pharmacists to participate in the consultations. The clinical pharmacists discovered and addressed any adverse reactions in a timely manner through patient drug education, subsequently reducing the underreporting of adverse reactions and improving the patient's medication compliance, which aimed to improve the medical quality of patients in our hospital. Second, the use of the pharmaceutical care procedure as a teaching tool helped to train students to grasp the key points of drug treatment and care of the disease and improve the students' scores in the graduation assessment (P<0.05).

CONCLUSIONS

As a pharmacy service and teaching method that can be promoted and implemented, the pharmaceutical care procedure is beneficial for clinical pharmacists to carry out in-depth pharmaceutical services and can also be used as a teaching tool for clinical pharmacist training.

Immune checkpoint inhibitor combined with anti-angiogenesis agent inhibits metastasis of advanced adenoid cystic carcinoma of the tongue base to the lung: a case report

Patients diagnosed with advanced adenoid cystic carcinoma (ACC) with metastasis to the lung generally have poor prognosis when they exhibit resistance to conventional therapies. Programmed cell-death protein 1 (PD-1) inhibitors, a type of Immune checkpoint inhibitors (ICI), have shown good response in the treatment of various types of malignant tumors; however, objective response rates of monotherapy for advanced ACC are low. Anlotinib, a novel, orally managed tyrosine kinase inhibitor, that targets vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor receptor (FGFR), platelet-derived growth factor receptor (PDGFR), and c-kit, has appeared great adequacy in treating numerous sorts of malignant tumors, particularly tumors with lung metastases. Here, we have presented a case of refractory ACC with lung metastases that was reduced after combinatorial treatment using the immune checkpoint inhibitor (ICI) toripalimab and anti-angiogenesis agent anlotinib. The patient achieved a reduction in lung metastases by chest computed tomography (CT) examination, with an outcome of stable disease (SD) of 5 months, a significant decrease in the levels of peripheral blood cytokines interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α), as well as good tolerance without noteworthy unfavorable reactions, indicating that the combined therapy of toripalimab and anlotinib may be utilized in the management of advanced ACC.

Impact and acceptance of pharmacist-led interventions during HIV care in a third-level hospital in Spain using the Capacity-Motivation-Opportunity pharmaceutical care model: the IRAFE study

INTRODUCTION

In recent decades, HIV has become a chronic disease with which the HIV specialist pharmacist plays a fundamental role. The traditional pharmaceutical care model followed to date relied excessively on the medication, obviating the uniqueness of each patient. The purpose of this study was to determine the influence and acceptance of a Capacity-Motivation-Opportunity (CMO)-based structured pharmaceutical care (PC) intervention in a multidisciplinary team for improving healthcare results.

METHODS

Prospective single-centre study of a structured health intervention with patients living with HIV who attended hospital between January 2017 and June 2018 for any cause. Pharmacotherapeutic follow-up was applied according to the CMO PC model based on three key elements, namely stratification, motivational interview and new technologies. To assess differences in the variables collected before and after the intervention, Student's t-test or Wilcoxon test, and McNemar's test were used for quantitative and dichotomous variables, respectively.

RESULTS

A total of 349 patients were included, 76.1% of which were men. The acceptance of pharmacist intervention by both doctors and patients was high [336 (97.7%) and 321 (93.3%)] and the adherence rate to antiretroviral therapy before intervention was lower than that observed afterwards (85.6%±33.7% vs 96.4%±17.7%; p<0.001). No differences were found between median viral load pre- versus post-intervention [1175 (62.75-26 050) copies/mL vs 274 (76.75-5542) copies/mL], although the undetectability rate was recorded as higher after intervention compared with the previous period [294 (85.5%) vs 274 (79.7%); p<0.001].

CONCLUSIONS

Our results could help HIV pharmacy clinic specialists to recognise high-risk patients and to develop personalised follow-up care, thereby ensuring good adherence and response to treatments.

Community and hospital pharmacists in Europe: encroaching on medicine?

Pharmacy has been historically regarded as a discipline between health and chemistry devoted to drug development, production, and compounding. These tasks have been almost lost with the industrial manufacturing, and dispensing remains the main activity of pharmacists. Hospital pharmacists are usually employees in their workplace, while the professional framework of community pharmacists is very different, being pharmacies predominantly private shops in almost all European countries. In the last years pharmacists have strongly advocated that the focus of their services should switch from 'product' to 'patient'. Clinical pharmacy and pharmaceutical care are the two most cited concepts to support this shift. Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes. The practice of clinical pharmacy should embrace the philosophy of pharmaceutical care. The new wave of pharmacists' patient-centered care in Europe still seems to be a reaction against the loss of their traditional professional role after the drug manufacturing revolution. To depict a realistic scenario for progress, it is worth differentiating between hospital and community. Hospital pharmacists should strengthen their pivotal role of medication gatekeepers to improve among clinicians the appropriateness of drug prescriptions and generate savings in expenditures. Any proposal for clinical services provided by community pharmacists is inevitably affected by the issue of their potential remuneration, especially in countries where the remuneration for reimbursable drugs is still a proportion of the retail price.

Using a systematic review to uncover theory and outcomes for a complex intervention in health and social care: a worked example using life story work for people with dementia

OBJECTIVES

Life story work involves gathering information about a person, their history and interests, and producing a tangible output, usually a book. It is used increasingly in dementia care. However, theory about if, how, and why it affects outcomes is poorly developed, making the choice of evaluation methods and appropriate outcomes difficult. This article uses a systematic review to uncover theories of change and outcomes for life story work in dementia care. We describe the methods and their use in identifying appropriate outcomes for evaluative research, and their potential for improving evaluation of 'theory poor' interventions.

METHODS

A systematic review, carried out using Centre for Reviews and Dissemination guidelines, searched for evidence on underlying theory, good practice, and effectiveness of life story work to inform a feasibility study for the formal evaluation of life story work in dementia care. For the theory element, a 'landscaping review' analysed the extracted text, using qualitative techniques and mind maps to uncover both explicit and implicit causal links between life story work and outcomes. We triangulated the review findings with qualitative research, which used focus groups with people with dementia, caregivers, and professionals that explored the outcomes that they would like to see from life story work.

RESULTS

Of the 56 publications reviewed, only 16 were useful for the theory analysis. Six overarching outcomes were identified: the self-worth and empowerment of people with dementia, individual psychological outcomes, improved relationships between care staff and the individual with dementia, better care, more effective engagement of family members/carers within the care setting, and helping carers to cope. Twelve final theories linking these outcomes to life story work via a causal pathway were elicited. There was substantial overlap in the outcomes identified by the review and by carers, people with dementia, and professionals. Together, the results informed our choice of outcome measures for the pilot evaluation.

CONCLUSIONS

This approach may enable researchers to identify and develop the theory necessary before evaluation of a complex intervention in other under- or un-theorized areas. It has the potential both to shorten development stages (and thereby costs) in intervention research and improve the intervention itself.

Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model

Purpose

This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management.

Methods

A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized.

Results

Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socio-economic aspects were also identified.

Conclusion

Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management.

Self-assessment of Polish pharmacy staff's readiness to promote health

Background Nowadays, pharmacists are expected to focus not only on dispensing medicines but also on the wellness of the patient. In some developed countries a pharmacist is clearly defined as a health care professional that can make a contribution to improving the general health of the population. Objective To assess the readiness of Polish pharmacy staff to engage in health promotion and educational activities. Setting Community pharmacies in Poland. Method The study group consisted of 308 pharmacy staff (248 pharmacists and 60 pharmacy technicians) employed in Polish pharmacies. The survey questionnaire referred to three domains: systemic solutions for health promotion, readiness of pharmacy staff as a professional group to promote health, personal readiness to promote health. Responses about pharmacy staff’s readiness to promote health were scored using a 10-point scale. Scale reliability for all items (overall readiness), and for items within the three domains separately, were tested using Cronbach’s α and average inter-correlation coefficient among the items. Main outcome measure Pharmacy staff’s readiness to promote health (the questionnaire containing 32 items). Results The overall readiness of pharmacy staff to promote health was rather low (average of 4.6 ± 1.5 in 1–10 scale). The highest scores were obtained for pharmacy staff’s personal readiness to promote health (average of 5.5 ± 1.8) which was neutral on the scale. The lowest scores were obtained for systemic solutions for health promotion (average of 3.6 ± 1.4). Readiness of pharmacy staff as a professional group was ranked in the middle (average 4.8 ± 1.8). Surveyed pharmacy staff rated their readiness to promote health in the work environment significantly higher than promoting health in the local community. Female and younger pharmacy staff as well as those with job seniority of less than 5 years, or pharmacy technicians assessed their readiness to promote health significantly higher than others. Readiness to promote health was higher among pharmacy staff working in pharmacies employing up to 3 staff members and at pharmacies with over 200 customers daily. Conclusions The overall readiness of pharmacy staff to promote health was low, especially in the domain of systemic solutions in health promotion.