The Impact of Pharmacist-Led Medication Management Services on the Quality of Life and Adverse Drug Reaction Occurrence

Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care: a proof-of-concept study

BACKGROUND

Prescribing cascades occur in clinical practice when a medication causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication.

AIM

The aim was to provide proof-of-concept for pharmacy-led interventions to reverse or prevent prescribing cascades.

METHOD

Two community pharmacies each tested two approaches. To reverse prescribing cascades, ten cascades were selected from literature. Dispensing records were screened to identify patients with these cascades. To prevent prescribing cascades, patients who started medications associated with five of these cascades were telephoned one month after their first dispensing to discuss ADRs. Pharmacists assessed the need to intervene together with prescribers. Primary outcome was the proportion of patients with a treatment change initiated. Secondary outcomes were time investment, potential cost-savings, and pharmacists' experiences.

RESULTS

To reverse prescribing cascades, 24 patients were included. For eight the prescriber was consulted, resulting in the reversal of three cascades. Forty-four patients were included to prevent prescribing cascades. Six of them experienced an ADR that could lead to a prescribing cascade. For two patients interventions were conducted to prevent this. The estimated time investment to identify patients possibly in need of intervention was 4.5 h for the reversing approach and 4.8 h for the preventing approach, while follow-up actions required 1.8 h and 0.5 h, respectively. Both approaches could be cost-saving. Pharmacists considered both approaches relevant but identified a knowledge gap on how to intervene for some cascades.

CONCLUSION

Pharmacy-led interventions may reverse and prevent prescribing cascades, but more efficient screening methods and tools are needed before further implementation.

Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil

Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.

How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review

BACKGROUND

Worldwide, minoritized populations experience inequitable health risks and outcomes. The importance of offering tailored services to meet the specific needs of target populations should be addressed during service development. Within healthcare systems, pharmacists play a crucial role in supporting patients to manage their medicines and health conditions.

OBJECTIVES

This scoping review aims to identify, collate and analyse literature describing pharmacist-led services tailored for minoritized populations in order to strengthen the knowledge base and support for achieving health equity.

METHODS

A scoping review was guided by the PRISMA-ScR checklist and the five-stage process outlined by Arksey and O'Malley. Medline, EMBASE, Scopus, CINAHL Plus, International Pharmaceutical Abstracts, and Google Scholar databases, plus grey literature were searched to identify relevant studies published up to October 2022. Texts were included if they reported on a pharmacist-led health service tailored to meet the needs of a minoritized population. The review protocol was registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/E8B7D).

RESULTS

Of the 566 records initially identified, 16 full-text articles were assessed for eligibility and 9 articles describing 6 unique services met the criteria and were included in the review. Three services were non-health-condition-specific, 2 targeted type two diabetes and 1 focussed on opioid dependency disorders. Service acceptability was consistently explored, and all services ensured that pharmacists' views were considered. However, only 4 consulted with the people from the group that the service targeted. Where reported, the effectiveness was not comprehensively evaluated.

CONCLUSION

There is limited literature in this area and a critical need for more evidence on the effectiveness of pharmacist-led services for minoritized populations. We need a better understanding of how pharmacists contribute to health equity pathways and how to expand this. Doing so will inform future services and contribute towards achieving equitable health outcomes.

Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.