Effect of Evidence-Based Pharmacy Care on Satisfaction and Cognition in Patients with Non-Valvular Atrial Fibrillation Taking Rivaroxaban

Adoption of evidence-based medicine: A comparative study of hospital and community pharmacists in Saudi Arabia

OBJECTIVES

Evidence-based medicine (EBM) combines clinical expertise, patient values, and the best available evidence to guide healthcare decision-making. Despite its importance in pharmacy practice, EBM adoption in Saudi Arabian pharmacies remains under-researched. This study aimed to assess the knowledge, attitudes, and practices regarding EBM among hospital and community pharmacists in the Madinah Region, Saudi Arabia.

METHODS

A cross-sectional study was conducted with 206 pharmacists from September to November 2023. Data were collected through a validated online self-administered questionnaire to evaluate pharmacists' knowledge, attitude, and practice (KAP), as well as their understanding of EBM technical terms.

ETHICAL APPROVAL

The study was approved by the Scientific Ethics Committee of the College of Pharmacy at Taibah University, Madinah region, Saudi Arabia (reference number COPTU-REC-77-20230827). All participants received a consent form before participating.

RESULTS

Pharmacists demonstrated moderate knowledge (76.5%), neutral attitudes (76%), and fair practices (68%) toward EBM, with hospital pharmacists scoring higher than community pharmacists. Moreover, 83.3% believed that EBM could enhance patient health outcomes, 80.0% were willing to learn, and 35.9% believed that EBM focuses solely on research without considering clinical experience. Time constraints (34.0%) were a major barrier, and 46.1% of the participants lacked appropriate training. EBM education was correlated with higher knowledge and attitude scores; however, it had no significant impact on practice scores. Significant barriers identified were the difficulty in conveying technical terms (16%) and limited access to adequate training opportunities.

CONCLUSION

Despite positive attitudes toward EBM, many pharmacists perceive it as a potential threat to good clinical practice. This perception underscores the need for targeted educational initiatives that promote EBM benefits, address misconceptions, and provide practical support for its integration in both hospital and community pharmacy settings.

A novel shared decision-making (SDM) tool for anticoagulation management in atrial fibrillation: protocol for a prospective, cluster randomized controlled trial

BACKGROUND

Atrial fibrillation (AF) is a common arrhythmia that requires anticoagulation therapy to prevent stroke. However, there is still a significant under-/over-treatment in stroke prevention for patients with AF. The adherence and the risk of bleeding associated with oral anticoagulation therapy (OACs) are major concerns. Shared decision-making (SDM) is an approach that involves patients and healthcare providers in making decisions about treatment options. This study aims to assess the effectiveness of a novel SDM tool for anticoagulation management in AF.

METHODS

The study will be a prospective, cluster randomized controlled trial involving 440 patients with AF in 8 community health service centers (clusters) in Shanghai, China. The SDM group will receive anticoagulation management through the novel SDM tool, while the control group will receive standard care. The follow-up period will be at least 2 years. The primary outcome will be any bleeding event, while secondary outcomes include the accordance of stroke prophylaxis for AF according to the current guidelines, time in therapeutic range (TTR), the occurrences of major bleeding and thrombosis events, and patient knowledge, adherence, and satisfaction.

DISCUSSION

This study will provide evidence of the effectiveness of shared decision-making in improving the appropriateness of OAC use in Chinese AF patients. The findings may inform the development of guidelines and policies for the management of AF and anticoagulation therapy in China and other countries.

TRIAL REGISTRATION

ChiCTR ChiCTR2200062123. Registered on 23 July 2022.

Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist

Within Europe and the Asia-Pacific, the Atrial Fibrillation Better Care (ABC) pathway is the gold standard integrated care strategy for atrial fibrillation management. Atrial fibrillation diagnosis should be confirmed and characterized (CC) prior to implementation of ABC pathway components: 1) "A"- Anticoagulation/Avoid stroke; 2) "B"- Better symptom management; and 3) "C"- Cardiovascular and other comorbidity optimization. Pharmacists have the potential to expedite integrated care for atrial fibrillation across the health care continuum: hospital, community pharmacy, and general practice. This review summarizes the available evidence base for pharmacist-led implementation of the "CC to ABC" model.