Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis

Strengthening the role of community pharmacy in HPV vaccination roll-out in Serbia at national and local levels: A pharmacy-based education approach

Cervical cancer is a significant public health concern in Serbia, with high morbidity and mortality rates (27 and 14.2 per 100,000 women, respectively in 2020). The primary cause of cervical cancer is human papillomavirus (HPV) infection, and HPV vaccination has proven to be an effective prevention strategy. This publication discusses the implementation of the first pharmacy-based education (PBE) program realized through the project of Pharmaceutical Chamber of Serbia - "Ask me about HPV" which aimed at raising awareness of the general population about the importance of HPV vaccination. The program aimed to strengthen the role of community pharmacists in the HPV vaccination roll-out. A total of 250 pharmacists were selected and trained to provide information on HPV infection and promote vaccination uptake. The program aimed to counsel and to educate young adults and parents/guardians. A total of 24,327 subjects were educated during the program's implementation from February to May 2023, young adults (N=11,313) and parents/guardians (N=13,014). Data showed that only 4.9% of young adults and 6.4% of children (of the parents/guardians surveyed) in Serbia are vaccinated against HPV. The questionaries of 1,387 subjects already vaccinated were excluded from the further analysis and final analysis was performed based on the counseling of 22,941 participants. A significantly higher percentage of parents/guardians stated that they would have their children vaccinated against HPV after counseling at the pharmacy than young adults (42.3% and 34.1% respectively). On the other hand, of those respondents who stated they would get vaccinated after consulting at the pharmacy, a significantly higher number of young adults (51%), compared to parents/guardians (48%), would receive the vaccine specifically at the pharmacy. The results of the project indicate that education of the general population on the benefits of HPV vaccination is highly needed. The expected outcomes of this educational program are increased awareness of the burden of illness, improved consumer education, the potential for higher vaccination rates, and consequently a reduction in cervical cancer incidence and mortality in Serbia.

Comparison of clinical pharmacist practitioners' headache care roles across clinical contexts within the Veterans Health Administration: Optimizing pharmacist integration

BACKGROUND

Studies show interdisciplinary treatment is highly effective for addressing chronic pain syndromes, including headache disorders. Increasingly, advanced practice pharmacists work collaboratively with physicians to apply their unique skills to enhance patient outcomes.

OBJECTIVE

This qualitative study aimed to elucidate the potential in the Veterans Health Administration (VHA) for increased roles of clinical pharmacist practitioners (CPPs)-advanced practice pharmacists with a scope of practice-in collaborative, interdisciplinary headache care teams. Our research question was: How do CPPs integrate with interdisciplinary headache care teams in Headache Centers of Excellence (HCoE) and non-HCoE VHA facilities, and how can their roles be configured to optimize headache specialty care services?

METHODS

This cross-sectional qualitative study used purposive sampling to recruit CPPs providing headache care within HCoEs and in non-HCoE VHA facilities for virtual, recorded, individual interviews. Multi-stage qualitative data analysis entailed: team discussions; immersion/crystallization for close reading of transcripts to identify emerging patterns of HCoE/non-HCoE comparison of CPPs' experiences; team data sorting using spreadsheets; and further immersion into sorted data for final identification of comparisons and interpretation of the data.

RESULTS

A total of 15 CPPs involved in headache care were interviewed, with about half working in HCoEs and half in non-HCoE VHA facilities across the United States. CPPs' roles within and outside HCoEs have considerable overlap as both groups co-manage patients with headache with physicians. CPPs have independent and collaborative responsibilities as they extend headache specialists' services by providing direct patient care and referring to additional providers for headache treatment. When their roles differ within and outside HCoEs it is largely due to level of integration on interdisciplinary headache or pain teams. CPPs in HCoEs collaborate with headache neurologists and interdisciplinary teams; some outside HCoEs do as well, while others work with primary care. CPPs' weekly time dedicated specifically to headache tends to be greater in HCoEs. Nevertheless, most interviewees in both groups stated patient need exceeds CPP availability at their facilities for conducting detailed chart reviews, initial visits to understand the context of patients' headache, and scheduled follow-ups over time to monitor and adjust treatment. CPPs also consult with and educate physicians on headache pharmacy, particularly regarding appropriate use of non-formulary medications.

CONCLUSION

Findings from this study suggest that CPPs' roles in headache care are valuable to clinical colleagues and their patients and should be leveraged and expanded within HCoEs and non-HCoE VHA facilities. When substantively integrated into interdisciplinary headache care teams, CPPs offer unique knowledge, headache management and patient behavior change skills, extend headache specialists' services, and provide both patient and physician education. These combined responsibilities contribute to enhancing patient outcomes and facilitating ongoing access to high quality, evidence-based headache care.

Key Findings and Recommendations from the American Association of College of Pharmacy Curriculum Quality Survey of US Pharmacy School Faculty

OBJECTIVE

To evaluate the faculty perspectives on how well pharmacy programs achieve key areas in the American Association of Colleges of Pharmacy faculty survey, including administration, governance, faculty development, infrastructure, curriculum, teaching, and student supervision.

METHODS

American Association of Colleges of Pharmacy Curriculum Quality Survey data from 2016 to 2023 were analyzed. The survey included 40 Likert-scale questions (rated from 1 to 5: Strongly Agree to Strongly Disagree). Questions were grouped into the following categories: organizational structure, administration, faculty support, curriculum, and resources. Responses for "Agree'' and "Strongly Agree'' were combined to report the overall agreement levels. An Independent Samples t-test was used to compare the mean agreement levels between private and public institutions, and trend analysis was conducted for each item.

RESULTS

Faculty agreements ranged from 49.8 ± 2.5% to 94.8 ± 0.7% in public and 56.2 ± 2.3% to 95.8 ± 0.7% in private institutions. Private institutions exhibited statistically significant higher agreement levels than public institutions in faculty development, while public institutions exhibited statistically significant higher agreement levels in resources, infrastructure, professionalism, and culture.

CONCLUSION

Faculty concerns include leadership, resource allocation, and professional development across public and private institutions. Recommendations include strengthening cultural competency training, leadership, governance, faculty recruitment, emerging technologies, and interprofessional education. Although based on the Accreditation Council for Pharmacy Education Standards 2016, these analyses remain relevant to Accreditation Council for Pharmacy Education Standards 2025, which incorporate the earlier standards in a reorganized format.

Study to evaluate awareness about medication errors and impact of an educational intervention among healthcare personnel in a cancer hospital

IntroductionMedication errors (MEs) are preventable incidents that can result in harm to patients. Therefore, it is essential for healthcare professionals (HCPs) to be well-informed about MEs. This study aims to assess the awareness levels of HCPs and the impact of educational intervention on their understanding of MEs.MethodsResponses to a 17-question structured, self-administered questionnaire assessing the awareness of HCPs regarding fundamental aspects of MEs, ME reporting systems, and their ability to make recommendations for improving the system for handling the MEs were collected both before and after two weeks of educational intervention administration.ResultsOf a total of 114 HCPs who initially participated in the study, six dropped following the intervention. The awareness regarding the Class A questionnaire was good in most physicians (60%), nurses (60%), and pharmacists (57%) before the intervention, which improved postintervention, with physicians (80%), nurses (32%), and pharmacists (78%) demonstrating excellent awareness. The awareness level in the Class B questionnaire was also improved to excellent in most physicians (70%), pharmacists (85%), and nurses (85%) following the intervention, while it was excellent only in 50%, 35%, and 1% of physicians, pharmacists, and nurses, respectively, preintervention. In the Class C questionnaire, most physicians (40%) and nurses (60%) had good awareness, while pharmacists (35%) demonstrated excellent awareness preintervention. Postintervention, most physicians (70%), nurses (77%), and pharmacists (64%) exhibited excellent awareness.ConclusionMost oncology practice HCPs demonstrate a good to average level of awareness regarding MEs. Clinical pharmacists' educational interventions can significantly enhance awareness among HCPs concerning MEs.

Pharmacist-led surgical medicines prescription optimization and prediction service improves patient outcomes - a machine learning based study

Background

Optimizing prescription practices for surgical patients is crucial due to the complexity and sensitivity of their medication regimens. To enhance medication safety and improve patient outcomes by introducing a machine learning (ML)-based warning model integrated into a pharmacist-led Surgical Medicines Prescription Optimization and Prediction (SMPOP) service.

Method

A retrospective cohort design with a prospective implementation phase was used in a tertiary hospital. The study was divided into three phases: (1) Data analysis and ML model development (1 April 2019 to 31 March 2022), (2) Establishment of a pharmacist-led management model (1 April 2022 to 31 March 2023), and (3) Outcome evaluation (1 April 2023 to 31 March 2024). Key variables, including gender, age, number of comorbidities, type of surgery, surgery complexity, days from hospitalization to surgery, type of prescription, type of medication, route of administration, and prescriber's seniority were collected. The data set was divided into training set and test set in the form of 8:2. The effectiveness of the SMPOP service was evaluated based on prescription appropriateness, adverse drug reactions (ADRs), length of hospital stay, total hospitalization costs, and medication expenses.

Results

In Phase 1, 6,983 prescriptions were identified as potential prescription errors (PPEs) for ML model development, with 43.9% of them accepted by prescribers. The Random Forest (RF) model performed the best (AUC = 0.893) and retained high accuracy with 12 features (AUC = 0.886). External validation showed an AUC of 0.786. In Phase 2, SMPOP services were implemented, which effectively promoted effective communication between pharmacists and physicians and ensured the successful implementation of intervention measures. The SMPOP service was fully implemented. In Phase 3, the acceptance rate of pharmacist recommendations rose to 71.3%, while the length of stay, total hospitalization costs, and medication costs significantly decreased (p < 0.05), indicating overall improvement compared to Phase 1.

Conclusion

SMPOP service enhances prescription appropriateness, reduces ADRs, shortens stays, and lowers costs, underscoring the need for continuous innovation in healthcare.

Older people, medication usage and long-term care pharmacists: a retrospective cohort study

OBJECTIVE

To investigate the impact of the presence of a pharmacist on medication usage in long-term care facilities.

METHODS

The study followed a retrospective cohort design, with a sample of patients aged ≥65 years admitted to three long-term care facilities over 30 months. Data on age, gender, type of stay, the presence or absence of a pharmacist and pharmacotherapeutic profile at admission and discharge were obtained for study patients. Variations in the number of medicines, anticholinergic burden and potentially inappropriate medications at admission and discharge were assessed as outcome variables. Anticholinergic burden and potentially inappropriate medications were assessed using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were used to compare the mean values of the outcome variables. A four-way ANOVA was used to test the association between background and outcome variables. Partial eta squared (η2) was used to measure the effect size.

RESULTS

A total of 1366 patients were studied. All outcome variables showed a statistically significant increase at discharge compared with admission. The presence of a pharmacist was statistically significant in improving the number of medicines (p<0.001) and the anticholinergic burden score (p<0.001), while no statistically significant value was reached on potentially inappropriate medications (p=0.642). Small effect size values were obtained for the impact of the pharmacist on the number of medicines and anticholinergic burden scores (η2=0.021 and η2=0.011, respectively).

CONCLUSION

These findings suggest that the presence of a long-term care pharmacist can positively impact the use of medication associated with poor health outcomes. An integrated interprofessional approach is needed to address potentially inappropriate medications, anticholinergic burden and polypharmacy in long-term care settings, particularly at the time of discharge.

A Biosocial Perspective to Understand Antimicrobial Prescription Practices: A Retrospective Cross-Sectional Study from a Public Community Health Center in North India

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a "biosocial" perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a "biosocial" perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings.

The role of pharmacists in mitigating medication errors in the perioperative setting: a systematic review

INTRODUCTION

Medication errors occur at any point of the medication management process and are a major cause of death and harm globally. The perioperative environment introduces challenges in identifying medication errors due to the frequent use of time-sensitive, high-alert medications in a dynamic and intricate setting. Pharmacists could potentially reduce the occurrence of these errors because of their training and expertise.

AIM

To provide the most up-to-date evidence on the roles and effects of pharmacist interventions on medication errors in perioperative settings.

METHODS

PubMed, CINAHL, and Embase were searched from inception to September 2023. Studies were included if they tested a pharmacist-led intervention aimed at reducing medication errors in adult perioperative settings. The included studies were assessed for quality using the Crowe Critical Appraisal Tool. Data were extracted and synthesized using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool). Screening, quality assessment, and data extraction were performed by two independent researchers.

RESULTS

Sixteen studies were eligible. All included studies incorporated multicomponent interventions, primarily medication reconciliation (n = 13), medicine-related recommendations (n = 12), staff education (n = 6), and patient counselling (n = 4). The development of implemented interventions was poorly reported across all papers. A diverse range of error reporting was observed, and none of the included studies provided definitions or basis for the categorization of errors. Although the studies showed that pharmacist interventions were associated with a reduction in overall medication errors rates, some studies showed inconsistent findings regarding error subtypes. The most common pharmacist intervention was medication optimization via holding or switching between agents.

CONCLUSION

While there is some evidence of positive impact of the pharmacist-led interventions on medication errors in perioperative setting, this evidence is generally of low quality and insufficient volume. Heterogeneity in study design, definitions, and case detection is common; hence, high-quality research that applies more stringent controls and uses clearer definitions is warranted.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023460812.

Improving ADR reporting in Jordan: a qualitative exploration of pharmacists' perspectives

Background

Community pharmacists are most accessible to patients. Hence, they have a crucial role in ensuring drug safety by detecting and reporting adverse drug reactions (ADRs). However, there may be gaps in their knowledge of ADR reporting systems and barriers they face in reporting.

Objective

This study aims to assess community pharmacists' knowledge of ADR reporting systems in the Kingdom of Jordan, identify the barriers they face in reporting ADRs, and explore the broader factors that influence their involvement in pharmacovigilance activities.

Methods

In-depth, semi-structured, face-to-face interviews were held with 20 community pharmacists from different regions of Jordan to evaluate their understanding of ADR reporting, the obstacles they encountered, and the elements that could motivate them to report ADRs. The interviews were transcribed and subjected to thematic analysis to find recurrent themes and insights. The thematic analysis highlighted opportunities for continuing education and an absence of formal training as the main barriers to ADR reporting.

Results

Pharmacists reported dissatisfaction with time limits in their hectic work situations and the complexity of reporting procedures, especially the length and information demanded by ADR reporting forms. Another factor influencing low reporting rates was a perceived lack of acknowledgment and feedback. Participants proposed that encouraging ADR reporting with professional recognition or compensation and improving and digitizing the reporting process would promote increased participation.

Conclusion

ADR reporting presents considerable difficulties for community pharmacists in Jordan, mostly because of administrative obstacles and an absence of official support and training. Enhancing pharmacovigilance efforts in Jordan could be achieved by providing incentives, simplifying the reporting procedure, and incorporating reporting into the current pharmacy management software.

Improving Clinical Pharmacist Performance in Oncology Care Through Education on Pharmaceutical Care Plans Documentation: A Pre-post Interventional Study

Clinical pharmacists are vital in oncology care as they are involved in optimizing pharmaceutical care plans (PCPs). Their involvement in medication management and accurate documentation assists in the care of cancer patients. This study aims to evaluate the impact of a targeted educational intervention for clinical pharmacists on both the quantity and quality of PCP documentation, providing insights into optimizing pharmaceutical care within an oncology setting. A descriptive pre-post study was done at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. Data on admitted patients' PCPs from November 2023 to March 2024 were collected from the Hospital Information System. PCP documentation was evaluated following the educational intervention on clinical pharmacy staff, and the improvement in the documentation among the specialties section was analyzed using a one-tailed t-test. The study assessed a total of 120 patients during the pre-intervention phase and 382 patients post-intervention. In the pre-intervention phase, the mean ± SD age of patients was 36.1 ± 20.1 years, with males constituting 57.5% and females 42.5%. Post-intervention, the mean ± SD age slightly increased to 37.3 ± 20.7 years, with a similar gender distribution of 58.9% males and 41.1% females. The intervention significantly increased the number of PCPs from 130 in the pre-intervention phase to 516 in the post-intervention phase, particularly in Adult Oncology (P = .0115) and Palliative Care (P = .0095). Post-intervention, a substantial enhancement in the documentation and management of PCPs was observed. The study demonstrates that structured educational interventions significantly enhance the clinical pharmacists' documentation of PCPs. By integrating targeted training with continuous reinforcement strategies, healthcare institutions can optimize pharmaceutical care processes, improve interdisciplinary collaboration, and ultimately enhance patient safety in oncology settings.

Effect of pharmacist care on clinical outcomes and therapy optimization in perioperative settings: A systematic review

PURPOSE

Integration of pharmacists into the perioperative practice has the potential to improve patients' clinical outcomes. The aim of this systematic review is to systematically investigate the evidence on the roles of pharmacists in perioperative settings and the effects of pharmacist interventions on clinical outcomes and therapy optimization.

METHODS

A protocol-led (CRD42023460812) systematic review was conducted using search of PubMed, Embase, CINAHL and Google Scholar databases. Studies that investigated the roles and impact of pharmacist-led interventions in the perioperative settings on clinical outcomes were included. Data were extracted and quality assessed independently by two reviewers using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and the Crowe Critical Appraisal Tool (CCAT), respectively. Studies were grouped according to the clinical area into 5 sections: (1) pain control and opioid consumption; (2) venous thromboembolism (VTE); (3) surgery-related gastrointestinal complications; (4) postoperative medication management; and (5) total parenteral nutritional.

RESULTS

Nineteen studies involving a total of 7,168 patients were included; most studies were conducted in gastrointestinal (n = 7) and orthopedics (n = 6) surgical units. Most included studies (n = 14) employed a multicomponent intervention including pharmaceutical care, education, guideline development, drug information services, and recommendations formulation. The processes of developing the implemented interventions and their structures were seldom reported. Positive impacts of pharmacist intervention on clinical outcomes included significant improvement in pain control and reductions in the incidence of VTE, surgery-related stress ulcer, nausea, and vomiting. There is inconsistency in the findings related to medication management (ie, achieving desired therapeutic ranges) and management of chronic conditions (hypertension and type 2 diabetes).

CONCLUSION

Whilst there is some evidence of positive impacts of pharmacist intervention on clinical outcomes and optimizing drug therapy, this evidence is generally of low quality and insufficient volume. While this review suggests that pharmacists have essential roles in improving the care of patients undergoing surgery, more research with rigorous designs is required.

The role and perception of the caregiver in a specialized pediatric palliative care center in medicine preparation and administration: a survey study

BACKGROUND

In pediatric palliative care, the main caregiver is primarily responsible for managing pharmaceutical therapies. Few data are available regarding the influence of this burden on quality of life in terms of time, concerns as well as a considerable risk of administration errors and adverse effects. This study aims to investigate how caregivers prepared and administrated medication, including errors and associated expectations, to identify improvement interventions.

METHODS

Between October 2022 and March 2023, a descriptive single-center survey study was carried out in the tertiary care pediatric palliative center of the Padova University Hospital. Participants were the caregivers of the patients followed by our center up to 23 years old, receiving at least one drug daily and who cannot self-administer their therapy. The questionnaire consisted of 18 multiple-choice and semi-closed questions, grouped into 4 main topics: therapy preparation, therapy administration, administration errors and therapy assessment.

RESULTS

A total of 100 caregivers responded to the survey. Mothers represented the main caregiver (91%). The prevalence of polypharmacy was 67% across the patients. 52% of caregivers handled prescriptions at least three times per day and for 32% it took to prepare them more than 5 min each time. Only 59% reported to have been trained for preparing and administrating drugs. 14% reported having made at least a drug administration error due to the tiredness or the complexity of therapeutic regimens in the preceding three months. Nearly one caregiver out of three felt their child was using too many drugs. 73% positively welcomed the possibility of having clinical pharmacist-led counseling.

CONCLUSIONS

Many caregivers of pediatric palliative care patients frequently have trouble planning, preparing and delivering pharmacological therapy to their children. Attempting to simplify medication regimens, choosing formulations that are simpler to administer and measure, investing in improved caregiver training, talking about therapies with carers, and involving clinical pharmacists to clarify their doubts could be all potential strategies to improve this condition and reduce their burden.

Effectiveness of pharmacist-led antimicrobial stewardship programs in perioperative settings: A systematic review and meta-analysis

OBJECTIVE

We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings.

METHODS

A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.

RESULTS

Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).

CONCLUSION

Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.

Development and reliability and validity testing of a medication literacy scale for medical college students

BACKGROUND

Irrational drug use has become a global problem threatening human health. As future health professionals, medical college students' medication literacy (ML) is critical. Their mastery of medication-related knowledge will directly affect public medication safety in the future.

METHODS

The initial scale was developed through a literature review and was modified through expert consultation and student interviews to form the initial scale with 14 items. In 2020, a questionnaire survey was conducted among students in a medical college for item analysis, reliability test, validity test and other analyses.

RESULTS

The total Cronbach's α coefficient was 0.826 and split-half reliability was 0.852. The Cronbach's α coefficients for functional medication literacy, communicative medication literacy, and critical medication literacy were 0.901, 0.858, and 0.851, respectively. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett's spherical test p < 0.001, indicating that the data are very suitable for factor analysis. Three principal axis factors were extracted by principal component analysis, and the total variance interpretation rate was 69.031% (> 40%). The confirmatory factor analysis identified a three-factor model and showed goodness of fit indices for the scale: The χ²/df = 2.623, The Goodness of Fit Index (GFI) = 0.905, The Comparative Fit Index (CFI) = 0.950, Normed Fit Index (NFI) = 0.922, Tucker-Lewis index (TLI) = 0.938, and The Root Mean Square Error of Approximation (RMSEA) = 0.078.

CONCLUSION

A new scale for evaluating the medication literacy of Chinese medical college students was preliminarily developed, demonstrating good reliability and validity. Itcan be used as a preliminary measurement tool for assessing medical students' medication literacy. However, due to the limitations of this study, the practical application of the scale needs to be further examined in a larger sample and should be refined in future studies.

Abdel-Qader D, Mohamed El Amin Ibrahim Hamid R, Menon V, Saeed AA, Fatehi Abdalla S, T. Alsulami F, Alqarni YS, Mohammed A. Randomized controlled trial parallel-group on optimizing community pharmacist's care for the elderly: The influence of WhatsApp-Email delivered clinical case scenarios

BACKGROUND

Drug-related problems (DRPs) significantly threaten the safety of the elderly. In order to improve pharmacists' ability to minimize these events, novel educational interventions that consider the current challenges in clinical practice are crucial.

OBJECTIVES

The primary objective is to assess the impact of two unique educational interventions on pharmacists' ability to identify DRPs.

METHOD

A total of 127 community pharmacies in the United Arab Emirates (UAE) were recruited and randomly allocated to one of three arms using a 1:1:1 allocation ratio. While a series of clinical case scenarios (N = 24) related to elderly care were established and validated and sent to pharmacists in Active Group A over a 3-month period, lengthy research articles focused on medication safety in elderly were emailed to pharmacists in Active Group B. The control group pharmacist received no intervention. Then, pharmacists self-reported the number, categories, and severity of DRPs and pharmacist recommendations.

RESULTS

The incidence of DRPs identified by pharmacists was 10.8% in Active Group A, 2.0% in the Control Group (p = 0.011), and 3.8% in Active Group B (p = 0.014). A significant difference was observed in the proportion of DRP types between Active Group A and the Control Group. The most common DRPs in Active Group A were avoidable medication (14.7%) and untreated disease (9.2%). Pharmacists in Active Group A (37.2%) and Active Group B (32.3%) most commonly intervened by recommending the cessation of medication, while the most common intervention in the Control Group was recommending a decrease in dose (29.8%). The mean cost reduction per patient was highest in Active Group A (31.3 ±11.8 $), followed by Active Group B (20.8 ±8.6 $) and the Control Group (19.6 ±9.5 $). The mean time needed to resolve a DRP was shortest in Active Group A (7.3 ±3.5 minutes), followed by Active Group B (9.8 ±4.2 minutes) and the Control Group (9.8 ±5.7 minutes).

CONCLUSION

Using WhatsApp to deliver clinical scenarios was effective in improving pharmacists' ability to identify and address DRPs in elderly patients, resulting in faster resolution and higher cost savings.

The approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy

Objective

Norm Balance is an approach under the Theory of Planned Behavior (TPB) where subjective norm is weighted by the relative importance of others and self-identity is weighted by the relative importance of self. The relative importance was measured previously by a trade-off measure. In this study, we developed separate measures for the relative importance. The study objectives were to: 1) assess the construct validity of the separate measures; 2) examine the approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy; and 3) establish a modified TPB.

Methods

We selected a random sample of 750 Iowa pharmacists and conducted two surveys. The first survey was to examine intention prediction, and the second survey was to examine behavior prediction by measuring behavior among respondents to the first survey. The relative importance was measured by both the trade-off measure and the separate measures. Exploratory factor analyses were performed for the relative importance of others (separate measures) and subjective norm, and for the relative importance of self (separate measures) and self-identity. Regressions for intention prediction were conducted for TPB with self-identity and the approach of Norm Balance. The same regressions were also conducted for three subgroups according to the median of the relative importance of others (trade-off measure). Moreover, another regression was conducted for behavior prediction.

Results

239 practicing pharmacists responded to the first survey, and 188 responded to the second survey. The separate measures had cross factor loadings, whereas the trade-off measure had low correlations with other constructs. Both regressions for intention prediction explained 75% of the variance, with self-efficacy and attitude being strong predictors. Self-identity was not a predictor in the TPB with self-identify, but self-identity weighted by the relative importance of self was a significant predictor in the approach of Norm Balance. Regression coefficients of subjective norm and self-identify varied across subgroups. The regression for behavior prediction explained 30% of the variance, with intention and self-efficacy being two predictors.

Conclusion

The trade-off measure was better than separate measures. The approach of Norm Balance appears to be a better model than the TPB with self-identity to examine pharmacist-physician collaboration.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis

Background

The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings.

Objectives

To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings.

Design

A systematic review and meta-analysis.

Methods

We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs).

Results

Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality.

Conclusion

Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.

Whether Present Era Demand Change in Pharmaceutical Promotional Ways to be More Eco- and Doctor-Friendly? An Observational Study

Aim

Pharmaceutical promotion is the principal aspect of the healthcare system. In this study, we aimed to portray the opinion of doctors and medical representatives (MRs) on conventional pharmaceutical ways (usage of promotional or educational paper materials and physician drug samples) for pharmaceutical promotion.

Materials and Methods

In this cross-sectional observational study, data were collected from doctors and MRs across India using self-administered Google forms. Data were analyzed, and results were drawn.

Results

A total of 314 doctors and 272 MRs participated in the study. As per 95.5% of doctors, continuing medical education (CME)/books/online information is the most common and convenient method to update medical knowledge, whereas 67.9% of MRs also think the same. Only 5.5% of doctors prefer paper material provided by pharmaceutical companies to update their knowledge. Most doctors say paper materials provided by pharmaceutical companies contribute less than 25% to product information, rather CME, books, and online information contribute significantly. MRs also think similarly. 66.2% of MRs agree that more than 25% of paper material gets wasted due to non-distribution. 73.2% of doctors and 75.4% of MRs agree that the use of paper materials for product promotion is not cost-effective, even if it contributes to deforestation. Only 51% of doctors use more than 50% of medical samples in patient care and only half of doctors and MRs think expired medical samples are disposed of correctly. 56.1% of doctors and 71.4% of MRs think a significant amount of medical samples are wasted and are hazardous to the environment.

Conclusions

Both doctors and MRs are of the opinion that the conventional method of paper promotion, that is, paper material and drug samples, is not cost-effective and also not eco-friendly. Hence, need to rethink - is there a need to change with time?

Evaluation of nurses' attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study

BACKGROUND

By evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses' attitudes and behaviors regarding narcotic drug safety and addiction.

METHODS

The study was conducted in a descriptive cross-sectional design. It was carried out with 191 nurses in a public hospital between March 2023 and August 2023. Data were collected through face-to-face interviews, gathering socio-demographic information and utilizing the Addictive Substance Attitude Scale. The data were analyzed using independent sample t-tests, one-way ANOVA tests, and regression analysis (P < .001 and p < .05).

RESULTS

The average age of the participants was determined to be 36.58 ± 8.40. It was reported by 85.3% of nurses that narcotic drug follow-ups in their units were conducted according to procedures. In the study, it was found that 63.9% of nurses did not know the procedure to be followed towards a healthcare professional identified as a narcotic substance addict. The total mean score of the Addictive Substance Attitude Scale of nurses participating in the study was 74.27 ± 14.70. A significant difference was found between the total scores of the scale and the level of education of nurses, the follow-up status of the drugs in the unit where they work, their status of receiving narcotic drug addiction training, and their routine use of the half-dose drug disposal form (p < .05).

CONCLUSIONS

The findings of this study underscore the importance of evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction. These results indicate the need for nursing administrators, particularly in terms of patient and staff safety, to adopt more effective policies and strategies.

Knowledge, attitudes, and practices of primary healthcare practitioners regarding pharmacist clinics: a cross-sectional study in Shanghai

BACKGROUND

Pharmacist clinics offer professional pharmaceutical services that can improve public health outcomes. However, primary healthcare staff in China face various barriers and challenges in implementing such clinics. To identify existing problems and provide recommendations for the implementation of pharmacist clinics, this study aims to assess the knowledge, attitudes, and practices of pharmacist clinics among primary healthcare providers.

METHODS

A cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model, was conducted in community health centers (CHCs) and private hospitals in Shanghai, China in May, 2023. Descriptive analytics and the Pareto principle were used to multiple-answer questions. Chi-square test, Fisher's exact test, and binary logistic regression models were employed to identify factors associated with the knowledge, attitudes, and practices of pharmacist clinics.

RESULTS

A total of 223 primary practitioners participated in the survey. Our study revealed that most of them had limited knowledge (60.1%, n = 134) but a positive attitude (82.9%, n = 185) towards pharmacist clinics, with only 17.0% (n = 38) having implemented them. The primary goal of pharmacist clinics was to provide comprehensive medication guidance (31.5%, n = 200), with medication education (26.3%, n = 202) being the primary service, and special populations (24.5%, n = 153) identified as key recipients. Logistic regression analysis revealed that education, age, occupation, position, work seniority, and institution significantly influenced their perceptions. Practitioners with bachelor's degrees, for instance, were more likely than those with less education to recognize the importance of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809-28.099, p-value = 0.005) and prescription reviews (aOR: 4.675, 95% CI: 1.548-14.112, p-value = 0.006). Additionally, practitioners expressed positive attitudes but low confidence, with only 33.3% (n = 74) feeling confident in implementation. The confidence levels of male practitioners surpassed those of female practitioners (p-value = 0.037), and practitioners from community health centers (CHCs) exhibited higher confidence compared to their counterparts in private hospitals (p-value = 0.008). Joint physician-pharmacist clinics (36.8%, n = 82) through collaboration with medical institutions (52.0%, n = 116) emerged as the favored modality. Daily sessions were preferred (38.5%, n = 86), and both registration and pharmacy service fees were considered appropriate for payment (42.2%, n = 94). The primary challenge identified was high outpatient workload (30.9%, n = 69).

CONCLUSIONS

Although primary healthcare practitioners held positive attitudes towards pharmacist clinics, limited knowledge, low confidence, and high workload contributed to the scarcity of their implementation. Practitioners with diverse sociodemographic characteristics, such as education, age, and institution, showed varying perceptions and practices regarding pharmacist clinics.

Enhancing knowledge, attitude, and perceptions towards fall prevention among older adults: a pharmacist-led intervention in a primary healthcare clinic, Gemas, Malaysia

BACKGROUND

Falls and fall-related injuries are very common among older adults, and the risk of falls increases with the aging process. The lack of awareness of falls and fall-related injuries among older adults can contribute to an increasing risk of falls. Hence, a study was carried out to improve the knowledge, attitude, and perception of falls and fractures among older adults in a primary care setting in Gemas, a rural area of the Selangor state of Malaysia.

METHOD

A structured educational intervention was provided to older adults who visited the primary care setting in Gemas and provided written informed consent to participate in the study. A total of 310 older adult patients was included in the study using a convenience sampling technique.

RESULTS

Before the intervention, 74.84% of the respondents (n = 232) agreed that falls and related fractures are the leading causes of hospital admission among older adults. In post-intervention, the number of respondents who agreed with this statement increased to 257 (82.91%). At baseline, 28 respondents (9.03%) had poor knowledge, 160 respondents (51.61%) had average knowledge levels, and 122 respondents (39.35%) had good knowledge. In post-intervention, respondents with poor and average knowledge reduced to 1.93% (n = 6) and 29.35% (n = 91) respectively. A majority of respondents' knowledge levels improved significantly after the intervention (n = 213; 68.71%). About eight respondents (2.58%) had a negative perception of falls. In post-intervention, the percentage reduced to 0.65% as only two respondents had a negative perception. A total of 32 types of fall-risk-increasing drugs (FRIDs) have been prescribed to the respondents. A strong correlation (r = 0.89) between pre- and post-intervention knowledge was shown among the respondents. Paired t-test analysis showed a statistically significant difference.

CONCLUSION

The pharmacist-led educational intervention significantly improved the knowledge, attitude, and perception of falls among older adults. More structured and periodical intervention programmes are warranted to reduce the risk of falls and fractures among older adults.

Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis

BACKGROUND

Nurses may make medication errors during the implementation of therapeutic interventions, which initially threaten the patient's health and safety and prolong their hospital stay. These errors have always been a challenge for healthcare systems. Given that factors such as the timing, type, and causes of medication errors can serve as suitable predictors for their occurrence, we have decided to conduct a review study aiming to investigate the prevalence of medication errors and the associated factors among Iranian nurses.

METHODS

In this systematic review and meta-analysis, studies were searched on PubMed, Web of Science, Scopus, Google Scholar, IranMedex, Magiran, and SID databases using a combination of keywords and Boolean functions. The study that reported the prevalence of medication errors among nurses in Iran without time limitation up to May 2023 was included in this study.

RESULTS

A total of 36 studies were included in the analysis. The analysis indicates that 54% (95% CI: 43, 65; I2 = 99.3%) of Iranian nurses experienced medication errors. The most common types of medication errors by nurses were wrong timing 27.3% (95% CI: 19, 36; I2 = 95.8%), and wrong dosage 26.4% (95% CI: 20, 33; I2 = 91%). Additionally, the main causes of medication errors among nurses were workload 43%, fatigue 42.7%, and nursing shortage 38.8%. In this study, just 39% (95% CI: 27, 50; I2 = 97.1%) of nurses with medication errors did report their errors. Moreover, the prevalence of medication errors was more in the night shift at 41.1%. The results of the meta-regression showed that publication year and the female-to-male ratio are good predictors of medical errors, but they are not statistically significant(p > 0.05).

CONCLUSIONS

To reduce medication errors, nurses need to work in a calm environment that allows for proper nursing interventions and prevents overcrowding in departments. Additionally, considering the low reporting of medication errors to managers, support should be provided to nurses who report medication errors, in order to promote a culture of reporting these errors among Iranian nurses and ensure patient safety is not compromised.

Integrating Patient Safety Discussions with First-Year Doctor of Pharmacy Students in a Skills Lab Course

The patient safety problem has been well established for over 20 years in the United States (U.S.), and there is a recognized focus on ensuring that health professions' trainees receive explicit education in various patient safety principles and practices. While the literature provides examples of different approaches towards patient safety education for pharmacy students, there are few that focus on first-year pharmacy students. This educational observational study describes the implementation and evaluation of two 20 min patient safety learning activities integrated into a required pharmacy skills lab course. The first learning activity utilized a mock prescription and patient safety checklist that had students identify patient safety problems on the prescription, followed by a group discussion of implications for the patient. The second learning activity used images of common safety problems with a facilitated group discussion to have students identify systems-based solutions to those problems. Our study's findings revealed that students were able to identify basic patient safety problems and safety solutions, although some additional foundational information may be needed, particularly for students who may not have pharmacy work experience. Additional research is needed to continue building a literature base on patient safety education approaches, particularly for first-year pharmacy students.

Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

INTRODUCTION

Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.

METHODS

Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.

RESULTS

Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.

CONCLUSIONS

A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review

BACKGROUND

Medication errors are common events that compromise patient safety. Outpatient and ambulatory settings enhance access to healthcare which has been linked to favorable outcomes. While medication errors have been extensively researched in inpatient settings, there is dearth of literature from outpatient settings.

AIM

To synthesize the peer-reviewed literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings.

METHOD

A systematic review was conducted using Medline, Embase, CINAHL, and Google Scholar which were searched from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason's accident causation model.

RESULTS

Twenty-four articles were included in the review. Medication errors were common in outpatient and ambulatory settings (23-92% of prescribed drugs). Prescribing errors were the most common type of errors reported (up to 91% of the prescribed drugs, high variations in the data), with dosing errors being most prevalent (up to 41% of the prescribed drugs). Latent conditions, largely due to inadequate knowledge, were common contributory factors followed by active failures. The seven studies that discussed interventions were of poor quality and none used a randomized design.

CONCLUSION

Medication errors (particularly prescribing errors and dosing errors) in outpatient settings are prevalent, although reported prevalence range is wide. Future research should be informed by behavioral theories and should use high quality designs. These interventions should encompass system-level strategies, multidisciplinary collaborations, effective integration of pharmacists, health information technology, and educational programs.

Correction: Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis

[This corrects the article DOI: 10.1371/journal.pone.0253588.].

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

INTRODUCTION

Optimal pharmacological treatment of tuberculosis (TB) requires a multidisciplinary team, yet the hospital pharmacist's role is unclear. We aimed to analyse hospital pharmacist-provided clinical pharmacy services (CPS) implementation in TB care.

METHOD

A nationwide survey-based online cross-sectional study was conducted on hospital pharmacists in Indonesia from 1 November 2022 to 22 November 2022. Outcomes were the extent of pharmacists' involvement in multidisciplinary TB care, TB-related CPS provided and views on TB-related CPS. The probability of pharmacists' involvement in multidisciplinary TB teams was assessed using logistic regression.

RESULTS

In total, 439 pharmacists (mean age 31.2±6.22 years, 78% female) completed the survey. Thirty-six per cent were part of multidisciplinary TB care, and 23% had TB-related tasks. Adherence monitoring (90%) and drug use evaluation (86%) were the most conducted TB-related CPS. Pharmacists' views on TB-related CPS implementation were generally positive, except for financial incentives. Work experience (OR 1.99, 95% CI 1.09 to 3.61), ever received TB-related training (OR 3.51, 95% CI 2.03 to 6.14) and specific assignments to provide TB-related CPS (OR 8.42, 95% CI 4.99 to 14.59) significantly increased pharmacist involvement in multidisciplinary TB care.

CONCLUSION

Around one-third of hospital pharmacists are part of multidisciplinary TB care, with medication adherence and drug use monitoring as primary tasks. Pharmacists' experience, training, assignment to provide TB-related CPS and financial incentives are key elements for further implementation in multidisciplinary TB care. Pharmacists should proactively support current TB care and conduct operational research, sharing data with healthcare peers and fostering a collaborative multidisciplinary TB care team.

Unveiling medication errors in liver transplant patients towards enhancing the imperative patient safety

Background

Medication errors (MEs) are a significant healthcare problem that can harm patients and increase healthcare expenses. Being immunocompromised, liver-transplant patients are at high risk for complications if MEs inflict harmful or damaging effects. The present study reviewed and analyzed all MEs reported in Liver Transplant Patients.

Methods

All MEs in the Liver Transplant Patients admitted between January 2016 to August 2022 were retrieved through the computerized physician order entry system, which two expert pharmacists classified according to the type and severity risk index.

Results

A total of 314 records containing 407 MEs were committed by at least 71 physicians. Most of these errors involved drugs unrelated to managing liver-transplant-related issues. Antibiotic prescriptions had the highest mistake rate (17.0%), whereas immunosuppressants, routinely used in liver transplant patients, rank second with fewer than 14% of the identified MEs. The most often reported MEs (43.2%) are type-C errors, which, despite reaching patients, did not cause patient harm. Subgroup analysis revealed several factors associated with a statistically significant great incidence of MEs among physicians treating liver transplant patients.

Conclusion

Although a substantial number of MEs occurred with liver transplant patients, the majority are not related to liver-transplant medications, which mainly belonged to type-C errors. This could be attributed to polypharmacy of transplant patients or the heavy workload on health care practitioners. Improving patient safety requires adopting regulations and strategies to promptly identify MEs and address potential errors.

Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients

OBJECTIVES

The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU).

METHODS

A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8,072 in the study period.

CONCLUSIONS

This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

[Translated article] Implementation of the standardized process of drug therapy evaluation in inpatients and outpatients

OBJECTIVES

The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU).

METHODS

A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1781 patients was evaluated before and 2129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5209 and 2246. In the after-SPEP period were 6105 and 2641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8072 in the study period.

CONCLUSIONS

This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Characteristics of the clinical pharmacists' interventions at the main general tertiary care hospital in Qatar

Medication-related problems (MRPs) are prevalent throughout healthcare systems, whereby pharmacy-based interventions are pivotal to reducing occurrence. In the Middle East, including Qatar, the professional roles of pharmacists have been expanding to improve patient safety. This study aimed to characterize and analyze pharmacist-led interventions among hospitalized patients in the leading general hospital in Qatar. A retrospective analysis of pharmacist interventions in the internal medicine ward, critical care unit, and emergency department (ED) was conducted. Data were extracted from three periods of 1 month (March 1-31, 2018, July 15-August 15, 2018, and January 1-31, 2019). A descriptive type of analysis was undertaken. A total of 340 patients with 858 interventions were analyzed. The average age of the study participants was 51 years (SD ± 17.7). The study population was predominantly male (65%). The prevailing pharmacist intervention was adding drug therapy (27%), followed by medication discontinuation (18%) and dosage adjustments (16%). This pattern was maintained across all subpopulations, e.g., gender, age, and ward, except for the ED, where cessation of medication was the most frequent intervention (4%). The two pharmacological classes associated with most interventions were anti-infective and cardiovascular agents. Pharmacist interventions effectively identify, prevent, and resolve MRPs in general inpatient settings in Qatar.

Challenges experienced during pharmacy automation and robotics implementation in JCI accredited hospital in the Arabian Gulf area: FMEA analysis-qualitative approach

Background

Pharmacy automation and robotics implementation are essential aspects of healthcare facilities. It streamlines the medication dispensing process and significantly reduces medication errors. However, implementing automation and robotics in pharmacies comes with its challenges. We aim to detect and rectify potential dangers in the pharmacy workflow by utilizing the Failure Mode and Effects Analysis (FMEA) methodology; this is expected to augment performance and increase profitability.

Materials and methods

In this study, we conducted an FMEA analysis using a qualitative approach to identify the challenges experienced during pharmacy automation and robotics implementation in a Joint Commission International (JCI) accredited hospital in the Arabian Gulf area. The pharmacy processes and procedures were mapped in a Flow chart to visualize the pharmacy workflow, including highlighting the risks that were found. Then these risks were arranged as Potential failure modes and added to the table as 9 main points for each RPNs were calculated, and then the 9 points were prioritized for the action plans.

Results

Via applying traditional Risk Priority Number (RPN) FMEA, the Pharmacy board identified the process stages marked risky failure modes through several FMEAs, calculating the total RPNs at the implementation phase. It revealed several challenges, including staff training, technical issues, and inadequate communication. Furthermore, the study resulted in corrective and intervention steps.

Conclusion

Pharmacy automation and robotics implementation is a complex process that requires proper planning, preparation, and execution. The FMEA approach effectively identifies potential problems and evaluates their impact on the pharmacy system. Nine major failure modes appeared to be risky stages with high RPN scores. Therefore, multiple interventions were done during the implementation to enhance the knowledge of challenges faced during the implementation of the automation process and solve it. Future studies should address the identified challenges and develop strategies to mitigate them.

Minimizing prescribing errors: A phenomenological exploration of the views and experiences of independent prescribing pharmacists

AIMS

This study aims to explore the views and experiences of independent prescribing (IP) pharmacists regarding prescribing errors and strategies to mitigate errors in practice.

METHODS

One-to-one online semi-structured interviews were conducted with IP pharmacists across the United Kingdom. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et al. RESULTS: A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctors' prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organizational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors.

CONCLUSIONS

Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organizational and system-related factors linked to prescribing errors can minimize errors and promote patient safety.

The Pharmacist's role in dermatology: Patient medication adherence

Medication non-adherence is currently estimated to have caused at least 100 000 preventable deaths and over $100 billion in preventable medical costs. Adherence is particularly poor in dermatological conditions, with more than 50% of patients discontinuing topical treatments within the first year. Pharmacists are among the most accessible health-care professionals with the potential to greatly impact medication non-adherence through patient education, medication therapy management, and improved access to care. This review aimed to determine how pharmacists have improved medication adherence in dermatology and discuss strategies for further involvement. An extensive medical literature search using the PubMed database was conducted to evaluate clinical studies, published in the last 20 years, that have evaluated the pharmacist's role and impact on adherence of to dermatological products. PubMed search terms include: "pharmacists' role in dermatologic medication adherence", "pharmacist-led interventions in dermatology", "pharmacist medication adherence dermatology" and "pharmacist intervention dermatology". A total of 18 relevant studies were identified. Pharmacists improved dermatological medication adherence by increasing access to medications, providing medication counseling programs, and performing treatment monitoring services. However, corticophobia may contribute to pharmacists' hesitancy in making corticosteroid over-the-counter recommendations. Pharmacists are accessible health-care providers with the potential to improve dermatological medication adherence. Future advanced training in dermatology medications may refine pharmacists' knowledge of dermatological products.

Patterns of adverse drug reactions in Jordan: a retrospective analysis of the National Pharmacovigilance Data Registry (2015-2021)

BACKGROUND

Post-marketing surveillance of drugs is a cornerstone of pharmacovigilance. This study was conducted to characterize patterns of adverse drug reactions (ADRs) reported in Jordan.

RESEARCH DESIGN AND METHODS

ADR reports submitted to the pharmacovigilance database of the Jordan Food and Drug Administration during 2015-2021 were retrospectively analyzed. The most commonly reported drugs, drug classes, ADRs, and ADRs consequences were explored. Logistic regression identified possible predictors of reporting serious ADRs.

RESULTS

A total of 2744 ADR reports were included, among which 28.4% were classified as serious. An annual increase in ADR reporting was observed. The most commonly implicated drug classes were antineoplastic and immunomodulating agents (24.0%), anti-infectives for systemic use (14.2%), and alimentary tract and metabolism (12.1%). Covid-19 vaccination was the most reported drug (22.8%). Fatigue (6.3%), injection site pain (6.1%), and headache (6.0%) were the top three common ADRs. Among ADRs with outcome information, 4.7% were fatal. Patient's age and intravenous medication use largely predicted reporting serious ADRs.

CONCLUSIONS

This study provides contemporary insights into the post-marketing surveillance of drugs in Jordan. The findings are foundational for future studies exploring drug-ADRs causality relationships. Efforts that promote pharmacovigilance concepts should be sustained and enhanced at the national level.

Medication-Related Problems Identified and Addressed by Pharmacists Dispensing COVID-19 Antivirals at a Community Pharmacy

Safe dispensing of coronavirus disease 2019 (COVID-19) oral antivirals requires comprehensive patient assessment to identify and address significant medication-related problems (MRPs). Given the fast-paced environment of community pharmacies and limited access to outside patient records, there are challenges with pharmacists ensuring the safe and appropriate dispensing of these medications. An independent community pharmacy in Pennsylvania developed and implemented a COVID-19 oral antiviral assessment protocol to systematically review all prescriptions dispensed for nirmatrelvir/ritonavir (Paxlovid™) and molnupiravir (Lagevrio™) to identify and address MRPs. A retrospective review was conducted to assess documented MRPs, including significant drug-drug interactions and inappropriate dosing requiring intervention, for prescriptions dispensed from 9 February 2022 to 29 April 2022. Pharmacists identified one or more significant MRPs requiring intervention on 42 of the 54 nirmatrelvir/ritonavir prescriptions (78%) and 0 of the 7 molnupiravir prescriptions. Most pharmacist interventions involved drug-drug interactions between nirmatrelvir/ritonavir and HMG-CoA reductase inhibitors and calcium channel blockers, along with four renal dose adjustments for nirmatrelvir/ritonavir. This study highlights the ability of community pharmacists to identify and address MRPs and promotes the use of a protocol to encourage safe dispensing practices for medications prone to MRPs.

Medical Residents' Informal Learning from Pharmacists in the Clinical Workplace

Workplace-based interactions between residents and pharmacists, though relatively underexplored, might contribute substantially to learning. This international study sought to investigate the affordances residents use for informal learning about medications, their interactions with pharmacists and patterns of resident-pharmacist engagement, as well as residents' perceived impact of these interactions on their learning. Contextual differences between US and Dutch residency training and electronic health record (EHR) may impact informal learning about medications. We conducted a cross-sectional, online, 25-item survey study, including closed-format and open-response questions among current resident physicians (post-graduate years 1-6, from a variety of residency programs n = 803) from the University of California San Francisco, the University of Minnesota, and the University Medical Center Utrecht. Responses from 173 residents in both countries revealed that these physician trainees were afforded opportunities to engage in a wide variety of pharmacotherapy-related activities but engaged differently with social and environmental resources for support. Residents from the United States (US) utilized pharmacists and Up-To-Date, whereas Dutch residents preferentially utilized the online Dutch medication information site and EHR-embedded medication resources. US residents interacted with pharmacists significantly more frequently than Dutch residents. Pharmacists provided residents with a wide range of useful information, much of which is integrated into the medication resources in the Dutch EHR-based decision-support system. While US residents reported overwhelmingly that informal interactions with pharmacists contribute to their learning about medications, Dutch residents' responses did not confirm this. Intentionally designing residents' training to include opportunities for interactions with pharmacists could potentially positively impact residents' informal workplace learning.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01784-1.

Clinical decision support systems to improve drug prescription and therapy optimisation in clinical practice: a scoping review

OBJECTIVE

Clinical decision support systems (CDSSs) can reduce medical errors increasing drug prescription appropriateness. Deepening knowledge of existing CDSSs could increase their use by healthcare professionals in different settings (ie, hospitals, pharmacies, health research centres) of clinical practice. This review aims to identify the characteristics common to effective studies conducted with CDSSs.

MATERIALS AND METHODS

The article sources were Scopus, PubMed, Ovid MEDLINE and Web of Science, queried between January 2017 and January 2022. Inclusion criteria were prospective and retrospective studies that reported original research on CDSSs for clinical practice support; studies should describe a measurable comparison of the intervention or observation conducted with and without the CDSS; article language Italian or English. Reviews and studies with CDSSs used exclusively by patients were excluded. A Microsoft Excel spreadsheet was prepared to extract and summarise data from the included articles.

RESULTS

The search resulted in the identification of 2424 articles. After title and abstract screening, 136 studies remained, 42 of which were included for final evaluation. Most of the studies included rule-based CDSSs that are integrated into existing databases with the main purpose of managing disease-related problems. The majority of the selected studies (25 studies; 59.5%) were successful in supporting clinical practice, with most being pre-post intervention studies and involving the presence of a pharmacist.

DISCUSSION AND CONCLUSION

A number of characteristics have been identified that may help the design of studies feasible to demonstrate the effectiveness of CDSSs. Further studies are needed to encourage CDSS use.

Disaster Preparedness Amongst Emergency Pharmacists for the FIFA World Cup Qatar 2022™: A Cross-Sectional Survey

Purpose

The aim of this study is to assess the level of preparedness of pharmacists working in the emergency department at Hamad Medical Corporation (HMC) for any emergency disasters that may take place during the FIFA World Cup Qatar 2022™ by evaluating their awareness (A), attitude (A), and readiness (R).

Methods

A cross-sectional quantitative observational study was conducted through a web-based survey. The survey was distributed among emergency pharmacists working in general hospitals under HMC. The questionnaire was composed of three major domains assessing awareness, attitude, readiness, as well as an additional domain to collect the participants' demographics. Student's t-test, analysis of variance, Pearson's correlation, and linear regression were used with an alpha level of 0.05.

Results

Most pharmacists working in the emergency departments at HMC had high levels of awareness (76.9%), attitude (92%), and readiness (53.8%) for any emergency disasters that may occur during the FIFA World Cup 2022. Nonetheless, almost half of the respondents reported moderate level of readiness for emergency events. Pharmacists with >10 years' practice experience had significantly higher AAR score compared to those with <5 years' experience (P = 0.002). Significant direct positive correlations were found among the 3 AAR parameters (P < 0.05). Attitude was found to be a significant predictor of readiness (P < 0.05). A model composed of attitude and awareness could predict 12% of readiness score.

Conclusion

Emergency pharmacists at HMC have high level of preparedness for any emergency disaster event during the World Cup. Future research should focus on the development of theory-based action framework for pharmacy departments during mass gathering events.

Impact of pharmacist-initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam

WHAT IS KNOWN AND OBJECTIVE

Unintentional medication discrepancies (UMDs) are common in geriatric patients during care transitions, resulting in frequent undesirable consequences. Medication reconciliation could be a useful practice to prevent or ameliorate UMD. However, this practice in Vietnamese hospitals has not been well established or standardized. This study aims to determine the effect of pharmacist-initiated educational interventions on improving medication reconciliation practice.

METHODS

This prospective 6-month pre-and post-study was conducted in two internal medicine wards in a Vietnamese 800-bed public hospital. Pharmacists provided training and short-term support to physicians on medication reconciliation. Primary outcome measures were the proportions of patients with at least one UMD at admission. Secondary outcome measures were the proportions of patients with preventable adverse drug events (pADEs) score ≥0.1 due to these UMDs. Odds ratio and 95% confidence intervals were assessed based on a multivariate logistic regression model.

RESULTS AND DISCUSSION

One hundred fifty-two patients were recruited in the pre-intervention phase, and 146 in the post-intervention phase. Following the intervention, the proportion of geriatric patients with ≥1 UMD at admission significantly decreased from 55.3 to 25.3 % (ORadj 0.255, 95% CI: 0.151-0.431). Similarly, the proportion of patients with a pADE ≥0.1 at admission reduced from 44.1 to 11.6% [ORadj 0.188, 95% CI: 0.105-0.340] post-intervention.

WHAT IS NEW AND CONCLUSION

Our pharmacist-initiated educational interventions have demonstrated the ability to produce substantial improvement in medication reconciliation practice, reducing UMDs and potential harm. Our approach may provide an alternate option to implement medication reconciliation for jurisdictions with limited healthcare resources.

An umbrella review of systematic reviews on contributory factors to medication errors in health-care settings

INTRODUCTION

Medication errors are common events that compromise patient safety and are prevalent in all health-care settings. This umbrella review aims to systematically evaluate the evidence on contributory factors to medication errors in health-care settings in terms of the nature of these factors, methodologies and theories used to identify and classify them, and the terminologies and definitions used to describe them.

AREAS COVERED

Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google Scholar were searched from inception to March 2022. The data extraction form was derived from the Joanna Briggs Institute (JBI) Reviewers' Manual, and critical appraisal was conducted using the JBI quality assessment tool. A narrative approach to data synthesis was adopted.

EXPERT OPINION

Twenty-seven systematic reviews were included, most of which focused on a specific health-care setting or clinical area. Decision-making mistakes such as non-consideration of patient risk factors most commonly led to error, followed by organizational and environmental factors (e.g. understaffing and distractions). Only 10 studies had a pre-specified methodology to classify contributory factors, among which the use of theory, specifically Reason's theory was commonly used. None of the reviews evaluated the effectiveness of interventions in preventing errors. The collated contributory factors identified in this umbrella review can inform holistic theory-based intervention development.

Analogous comparison of registered brand name drugs of tablets and capsules commercially available in Thailand: A retrospective study

Drug name confusion or similar product packaging and labeling, also known as "look-alike, sound-alike" (LASA) medication error, is one of the most problematic causes of prescribing and dispensing errors. Therefore, this study aimed to compare the similarity of registered brand name drugs of tablets and capsules that are commercially available in Thailand to estimate the magnitude of LASA medication errors. Analogous comparisons of brand names using similarity in orthography (written forms with identical letters) were analyzed retrospectively. Tablets and capsules commercially available in Thailand and registered with the Bureau of Drug Administration, Food and Drug Administration (FDA) in 2012 as "dangerous drugs" and "specially controlled drugs" for humans and animals were included in this study. Descriptive statistics, including frequencies and percentages, were used in this study. The analogous comparison of brand name orthography was scrutinized, and the results revealed 1,668 brand names, which were categorized into three genres as follows: 1) Single brand names from a single manufacturer having the same active pharmaceutical ingredient (API) with numerous registration numbers (1,049 names, 62.89% of the total similarity results) 2) Single brand names from different manufacturers having the same API and possessing several registration numbers (615 names, 36.87% of the total similarity results) 3) Single brand names from different manufacturers with diverse APIs (four brand names, 0.24% of the total similarity results). Analogous results revealed that numerous identical brand names could be derived from the same manufacturers, APIs, dosage strengths, or otherwise. The results of this study recommend improvement on product registration to better ensure patient safety in the future.

Pharmacist Intervention in Portuguese Older Adult Care

Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

Pharmacists are essential members of the healthcare team. The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has led pharmacists to undertake additional clinical roles. We aim to conduct a systematic review on the interventions and impact of pharmacist-delivered services in managing COVID-19 patients. We searched PubMed, Embase, Scopus, CINAHL plus, International Pharmaceutical Abstracts, and Web of Science from 1 December 2019 (the first case of COVID-19 emerged) to 13 January 2022 to retrieve the articles. Cochrane handbook and PRISMA guidelines were followed respectively to perform and report the review. The pharmacist-led interventions were reported following the Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2. The protocol of systematic review was registered on PROSPERO (CRD42021277128). Studies quality was assessed with the modified NOS scale. In total, 7 observational studies were identified from 10,838 studies. Identification of dosage errors (n = 6 studies), regimen modifications (n = 5), removal of obsolete/duplicate medications (n = 5), identification and management of adverse drug reactions (n = 4), drug interactions prevention (n = 2), and physicians acceptance rate (n = 3) of therapy-related services delivered in-person or via tele-pharmacy were among the pharmacist-delivered services. Common interventions delivered by pharmacists also included optimizing the use of antibacterial, antivirals, and anticoagulants in COVID-19 infected patients. The acceptance of pharmacist-delivered services by physicians was high (88.5-95.5%). Included studies have described pharmacists' beneficial role in managing patients with COVID-19 including detection, resolution, and prevention of medication-related problems, with physicians demonstrating high trust in pharmacists' advice. Future research should assess the feasibility and scalability of such roles in real-world settings.

Medication reconciliation on discharge in a tertiary care Riyadh Hospital: An observational study

The purpose of this study was to assess the frequency and characteristics of discharge medication discrepancies as identified by pharmacists during discharge medication reconciliation. We also attempted to identify the factors that influence the occurrence of drug discrepancies during medication reconciliation. From June to December 2019, a prospective study was performed at the cardiac center of King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh. The information from discharge prescriptions as compared to the medication administration record (MAR), medication history in the cortex system, and the patient home medication list collected from the medication reconciliation form on admission. The study included all adult patients discharged from KFMC’s cardiac center. These participants comprised 776 patients, 64.6 percent of whom were men and 35.4 percent of whom were women. Medication discrepancies were encountered in 180 patients (23.2%) out of 776 patients. In regards to the number of discharged medications, 651(83.9%) patients had ≥ 5 medications. Around, 174 (73.4%) discrepancies were intentional, and 63 (26.6%) were unintentional discrepancies. The risk of unintentional medication discrepancy was increased with an increasing number of medications (P-value = 0.008). One out of every four cardiac patients discharged from our hospital had at least one medication discrepancy. The number of drugs taken and the number of discrepancies was found to be related. Necessary steps should be taken to reduce these discrepancies and improve the standard of care.

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

BACKGROUND

Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults.

AIMS

This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions.

METHODS

We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults.

RESULTS

We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect.

CONCLUSION

This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.

The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

BACKGROUND

The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.

RESULTS

The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.

CONCLUSIONS

The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.