Community pharmacists’ routine provision of drug-related problem-reduction services

Identification, classification, and documentation of drug related problems in community pharmacy practice in Europe: a scoping review

BACKGROUND

Drug-related problems (DRPs) are significant issues in healthcare contributing to adverse health outcomes and increased healthcare costs. While community pharmacists play a pivotal role in identifying, classifying, and documenting DRPs, there is a need to map approaches undertaken.

AIM

The aim of this scoping review was to examine the approaches to identifying, classifying, and documenting DRPs in community pharmacies in Europe, and their associated barriers and facilitators.

METHOD

The scoping review was conducted according to the Joanna Briggs Institute guidelines and reported according to the PRISMA-ScR guidelines. The search was conducted across 11 databases from inception until March 2023. Studies of all designs reporting DRPs in European community pharmacies were included. Titles, abstracts, and full texts were screened independently by two researchers, followed by data extraction and synthesis.

RESULTS

The search yielded 67 relevant studies. Forty-eight studies described approaches to DRP identification as predominantly relying on professional knowledge and computer software. The classification methods, described in 41 studies, varied with reports of predefined systems and computer-generated classifications. Documentation approaches were described in 53 studies and were primarily computer-based. Facilitators included electronic support systems, pharmacist experience, while barriers encompassed the complexity of classification as well as variations in training, IT solutions, operational structures, and implementation.

CONCLUSION

There is a lack of a standardized approach to identifying, classifying, and documenting DRPs in European community pharmacies. A framework for pharmacist education and a time-saving approach to documenting DRPs consistently could serve to overcome the barriers to their identification and documentation. Furthermore, the implementation of a standardised approach to classifying DRPs could facilitate comparison of the management of DRPs across Europe.

Costs saved and avoided from pharmacist interventions to address drug-related problems identified from outpatient clinics in Jordan

BACKGROUND

The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems.

RESEARCH DESIGN AND METHODS

Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective.

RESULTS

A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852).

CONCLUSIONS

The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.

Development and effectiveness of a BOPPPS teaching model-based workshop for community pharmacists training

BACKGROUND/AIM

With the pharmaceutical innovation and clinical knowledge updating, the continuing education and on-the-job training are extremely important for improving community pharmacists' professional competence. Previous training often adopted traditional lecture-based teaching, and the efficacy was limited. The aim of this study is to develop a new strategy for community pharmacist training.

METHODS

Based on the BOPPPS (Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment and Summary) teaching model and workshop method, a continuing on-the-job training program was constructed. Participates were randomly and evenly divided into two groups by random number table method. Twenty-four community pharmacists in total completed all training contents and evaluation components in this study. Twelve pharmacists in experimental group were trained via this new BOPPPS-based workshop, while others still adopted traditional didactic lecture-based approaches.

RESULTS

After training, quantitative examination combined with clinical pharmacy practice tests were carried out to evaluate the effectiveness and outcomes of two training groups. For written exam, the total scores from the BOPPPS-based workshop group (82.67 ± 4.70) was higher than that of traditional lectured-base group (73.75 ± 6.15) (P < 0.001). Encouragingly, compared with the results of practical ability assessment from traditional training group (71.75 ± 4.75), the pharmacists receiving BOPPPS-based workshop training presented more excellent performance (78.25 ± 5.03), which displayed statistically significant differences (P < 0.01). In addition, an anonymous questionnaire was used to survey trainees' feelings after completing this continuing education program. The results revealed that the BOPPPS-based workshop can bring a better learning experience than traditional lecture-based training, and the percentages of positive response to each item were more than 91.7%.

CONCLUSIONS

Through multi-dimensional evaluation, it was suggested that our BOPPPS-based workshop achieved desired training effects. Moreover, our research also demonstrated that this strategy had advantages of stimulating inspiration, autonomous learning, team-work spirit and pharmacy practice improvement. It may provide a reference of innovative training method for community pharmacists.

Patterns of drug-related problems and the services provided to optimize drug therapy in the community pharmacy setting

Introduction

Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes.

Objectives

To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services.

Methods

This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services.

Results

A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it.

Conclusions

Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes.

Public satisfaction with community pharmacists roles as healthcare providers: a cross-sectional study from Jordan

Objectives

In recent years, the responsibilities of community pharmacists have changed significantly. This study aimed to assess Jordanian public satisfaction with community pharmacists’ role as healthcare providers and to evaluate factors affecting their satisfaction level.

Methods

This cross-sectional questionnaire study was conducted among the Jordanian public using a convenience sampling approach between May 2022 and June 2022. A link to the self-administered questionnaire was distributed via different social media platforms to be filled by participants willing to participate to evaluate their views and satisfaction of community pharmacists’ role as healthcare providers.

Key findings

In this study, 710 participants agreed to participate in this study. The participants had a median age of 36.0 years and 62.3% of them were female. The most frequent reason for visiting any community pharmacy was purchasing prescription medications (83.1%). The location of the pharmacy was the most selected factor influencing the choice of a particular community pharmacy by the study participants (89.3%). Results showed that respondents had an acceptable satisfaction score about pharmacists’ behaviours and roles (median score of 32.0 out of 40.0). More than 80% of the participants were satisfied with the language used by the pharmacist in discussing drug-related matters (84.9%), with the privacy maintained by the pharmacist while dealing with them (83.1%), with pharmacists’ professionalism in dealing with patients (82.3%), and with the positive relationship between pharmacists and patients (81.0%). Respondents with a higher level of education showed more satisfaction towards pharmacists’ services compared to those with lower levels of education (Beta = 0.088, P = 0.031).

Conclusions

This study demonstrated an acceptable general satisfaction of community pharmacists while conducting their job, yet their role still mainly involves dispensing prescriptions.