Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review

Patient counselling on opioids by pharmacy technicians: A mixed-method study to explore facilitators and barriers

Objectives

This study investigates community pharmacy technicians' (PTs) counselling practices for patients prescribed opioids and identifies facilitators and barriers influencing their counselling behaviour.

Methods

A sequential exploratory mixed-method study involving interviews and a questionnaire was conducted among PTs, working in Dutch community pharmacies. PTs were recruited via professional networks, panels and social media. Inductive thematic analysis was performed for interviews. Descriptive statistics of questionnaires was performed and associations between behaviour of discussing dependency and background characteristics (1), barriers (2) and beliefs (3) were tested.

Results

Nineteen topics emerged from 18 interviews. Out of 252 questionnaire-respondents, most PTs consistently discussed dosage and common side effects during the first opioid dispense. Although 92 % considered discussing opioid dependency important, only 62 % frequently performed it. Barriers included a lack of information about the indication (p = 0.012), lack of work agreements (p = 0.017), time (p = 0.022), feeling insecure (p = 0.041), less work experience (p = 0.025) and the belief that prescribers are responsible for discussing opioid dependency with patients (p = 0.018).

Conclusion

The high importance that PTs place on counselling patients on opioid dependency does not match their behaviour. To close this gap and optimize the role of PTs in promoting safe opioid use, organizational and competency-related barriers must be addressed. This includes clear work protocols, communication training and including the indication on opioid prescriptions.

Innovation

This research focuses on an underexplored group involved in patients' opioid management, crucial for designing effective interventions, as PTs frequently have direct patient contact.

Perceptions and experiences of community pharmacists with off-label prescribing in the pediatric population

OBJECTIVES

This study aimed to investigate and provide insight into the prevalence and patterns of off-label drug use in the pediatric population from the perspective of community pharmacists, addressing the existing data gap in a developing setting.

METHODS

A questionnaire-based cross-sectional study was conducted on Albanian community pharmacists in June 2021. The online administered survey explored the participants' demographic details, perceptions, and experiences with off-label prescriptions in pediatric patients. The statistical analysis conducted on the survey data comprised the construction of frequency tables and the application of the chi-square test for independence.

KEY FINDINGS

Three hundred and thirty-six community pharmacists nationwide completed the survey, out of which 186 (55.3%) were practiced in Tirana, the capital of Albania. Over 80% of surveyed pharmacists (n = 275) had encountered off-label drug prescriptions in pediatric patients, yet only 40% of participants reported dispensing medicines for off-label use. Community pharmacists reported that general pediatricians tended to prescribe off-label medications more frequently than pediatric subspecialists or general practitioners. It was found that off-label prescriptions were more frequently observed among children aged between 2 and 11 years. Antibiotics were the most reported medicines for off-label use in this study mentioned in almost all off-label categories.

CONCLUSIONS

Prescribing medicines for unapproved uses for the treatment of pediatric patients is present in community settings in Albania. This indicates the need for further data collection and analysis to understand off-label practices in our country's pediatric population comprehensively.

Documenting the indication for antimicrobial prescribing: a scoping review

BACKGROUND

Documenting an indication when prescribing antimicrobials is considered best practice; however, a better understanding of the evidence is needed to support broader implementation of this practice.

OBJECTIVES

We performed a scoping review to evaluate antimicrobial indication documentation as it pertains to its implementation, prevalence, accuracy and impact on clinical and utilisation outcomes in all patient populations.

ELIGIBILITY CRITERIA

Published and unpublished literature evaluating the documentation of an indication for antimicrobial prescribing.

SOURCES OF EVIDENCE

A search was conducted in MEDLINE, Embase, CINAHL and International Pharmaceutical Abstracts in addition to a review of the grey literature.

CHARTING AND ANALYSIS

Screening and extraction was performed by two independent reviewers. Studies were categorised inductively and results were presented descriptively.

RESULTS

We identified 123 peer-reviewed articles and grey literature documents for inclusion. Most studies took place in a hospital setting (109, 89%). The median prevalence of antimicrobial indication documentation was 75% (range 4%-100%). Studies evaluating the impact of indication documentation on prescribing and patient outcomes most commonly examined appropriateness and identified a benefit to prescribing or patient outcomes in 17 of 19 studies. Qualitative studies evaluating healthcare worker perspectives (n=10) noted the common barriers and facilitators to this practice.

CONCLUSION

There is growing interest in the importance of documenting an indication when prescribing antimicrobials. While antimicrobial indication documentation is not uniformly implemented, several studies have shown that multipronged approaches can be used to improve this practice. Emerging evidence demonstrates that antimicrobial indication documentation is associated with improved prescribing and patient outcomes both in community and hospital settings. But setting-specific and larger trials are needed to provide a more robust evidence base for this practice.

Incorporating 'reason for use' into the prescribing process of medication: a survey on the opinion of patients in Flanders, Belgium

Background

A longstanding debate exists about including a ‘reason for use’ on prescriptions for medication. Little is known, however, about patients’ opinions on this subject.

Methods

An internet-based questionnaire, consisting mainly of Likert scale questions, was distributed online to the general public in Belgium. Results from 1034 responses were analyzed using descriptive statistics.

Results

Opinions from patients toward including a ‘reason for use’ on medication prescriptions were generally positive. A clear majority of 62% increased to 74% after providing information about the possible link between indication and medication dose. A majority of the participants expressed a positive attitude regardless of the pathology involved, although sexually transmitted diseases were of greatest concern. Other important aspects differentiating the opinion positively was the transmission of this information in an electronic-only form and limiting it to the regular pharmacist excluding further use by third parties such as other pharmacies or insurance companies. Patients using multiple medicines and those frequenting the same pharmacy also had a more favorable opinion about including the reason for use. In addition, analysis of physician and pharmacist questionnaire responses, explicitly excluded from the main analysis, confirmed the known contrasting opinions in these subgroups.

Conclusions

Patients have strong support for transferring information on the ‘reason for use’ of their prescriptions to their regular pharmacy if this is done in a secure and privacy-conscious way enabling increased patient safety and improved pharmaceutical care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08596-w.