The future role of pharmacists in primary care

Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations

Purpose

The current research aimed to illustrate a real case using the validated Alsayed_v1 tools as tutorial training to improve the knowledge and skills of healthcare practitioners in the clinical problem-solving process necessary to implement medical and pharmaceutical care.

Patients and Methods

The Alsayed_v1 instruments consist of principal components: data collection, assessment of treatments, the medical problem oriented plan (MPOP), as well as a care plan and patient education.

Results

This study illustrated a real case of asthma patient using the validated Alsayed_v1 tools. These validated and clinically tested tools provide a coding system for the MPOP that permits easy documentation with an open hierarchical structure where higher levels are broad and lower levels are particular, and the possibility to enter free text. The section dedicated to treatment assessments is intended to synthesize patient information to facilitate the identification of the MPOPs. Effective management requires the development of a partnership between the patient with asthma (or the patient's caregivers) and his healthcare professional(s). This partnership aims to allow the patient to control his condition with guidance from the healthcare professional(s), discuss and agree on therapy goals, and develop a personalized, written, self-management asthma care plan.

Conclusion

By implementing Alsayed_v1 tools, the clinical practitioner can actively give the best practice for optimal patient outcomes.

Pharmaceutical care and telemedicine during COVID-19: A cross-sectional study based on pharmacy students, pharmacists, and physicians in Jordan

Lack of access to the patient medical record (90.6%) was the major barrier for the integration of pharmaceutical care into practice. The majority of participants (93.0%) encouraged creating a website that provides pharmaceutical care. Furthermore, 45.1% would pay for such a service if present. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients’ data will help in decreasing medical errors. Among the four aspects of pharmaceutical care (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist’s, general weakness in all aspects was noticed. This study highlights that absence of proper documentation of patient medical information raises the risk of medical problems and is considered the most documented barrier for the integration of pharmaceutical care. This emphasizes the future role of telemedicine and the availability of a specialized website and database repository that stores patient’s information to ensure the continuity of care even during pandemics.

Bulgarian community pharmacists’ attitudes and barriers towards pharmaceutical care provision for pregnant women

The aim of this study was to assess the attitudes and perceived barriers towards pharmaceutical care provision for pregnant women in Bulgarian community pharmacies.

A cross-sectional web-based study was carried out among community pharmacists in Plovdiv region, Bulgaria. The survey instrument was a self-administered questionnaire including 18 statements based on a five-point Likert scale. Descriptive statistics were applied to respondents’ characteristics and opinion regarding attitudes and barriers towards pharmaceutical care provision for pregnant women. A total of 122 community pharmacists completed the survey. The majority of respondents (90%) agreed or strongly agreed with the statement that providing pharmaceutical care will improve health and awareness of pregnant women. The statement that providing pharmaceutical care brings professional satisfaction, obtained the highest mean score of 4.61. Half of the respondents (50.8%) were worried about taking risks associated with assuming responsibility for the treatment outcomes of pregnant women. One of the main barriers for providing pharmaceutical care was the lack of time (mean score = 4.10). Other major barriers were the lack of additional training (83.9%) and electronic medical record of the pregnant women (68.9%). Overall Bulgarian community pharmacists have positive attitudes towards providing pharmaceutical care to pregnant women. Conducting additional training courses and workshops will help for the active involvement of the pharmacist in the care of pregnant women.

Perceptions of the Value of Clinical Pharmacy Medication Review for Women During Early Pregnancy

BACKGROUND

The benefit of continuing medications to prevent or treat illness is often overlooked, since pregnant women tend to overestimate the teratogenic risk of medications. Pharmacists can serve as a resource to prescribers and pregnant women with their knowledge of the appropriate use and management of medications during pregnancy. Little information exists on the value women place on pharmacists' medication management during pregnancy.

OBJECTIVE

To assess pregnant women's perceptions of an ambulatory care clinical pharmacist (CP) medication review service during early pregnancy that provided education regarding the risks and benefits of medication use during pregnancy.

METHODS

This was a qualitative study of pregnant women using semistructured telephone interviews performed between December 12, 2018, and January 18, 2019, and conducted in an integrated health care delivery system. Potential participants were identified from CP encounter records. Consented English-speaking women aged ≥ 18 years participated in an up to 30-minute interview within 1 week of the CP encounter. Interviews were professionally transcribed and coded line by line using the constant comparison method with grounded theory used to gain insight into participants' perspectives.

RESULTS

62 women were invited to participate in semistructured telephone interviews of whom 24 (39%) completed the interview. Three main themes emerged from the qualitative analysis: satisfaction with the service, comfort with medication use during pregnancy, and connectedness to the health care team. Overall, the CP medication review and education service was perceived positively by the participants. Participants reported satisfaction in the quality, timeliness, and convenience of the service and found it beneficial to have their medications reviewed early during pregnancy to assist in medication use decisions before their first obstetric visit.

CONCLUSIONS

CP medication review provided a comforting, valuable service for women during early pregnancy when medication-taking decisions can feel exigent.

DISCLOSURES

This study was funded by Kaiser Permanente. The authors have nothing to disclose. Preliminary results were presented at the Mountain States Conference for Residents and Preceptors, May 2019, in Salt Lake City, UT.

Doctors' perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan

Background The inclusion of pharmacist in health care system is essential to ensure optimal patient care. However, with the passage of time, pharmacist's role has transcended from dispensing, compounding and counting of pills, to more sophisticated clinical duties. Objective To evaluate doctors' experience, perceptions and expectations regarding pharmacists' role in Pakistani healthcare settings. Setting All tertiary care hospitals across 26 cities of Pakistan. Method A cross-sectional study using a self-administered questionnaire was carried out targeting doctors practising in Pakistan. The survey was conducted from January to April 2018. Chi square (χ²) test was used to analyse responses of doctors regarding pharmacist's role in the healthcare system of Pakistan. The associations were considered significant at p value less than 0.05. The study was approved by concerned ethical committee. Main outcome measure Doctors' experience, perceptions and expectations regarding pharmacists' role. Results A total of 483 questionnaires were received and analysed (response rate; 87.9%). Most participants (67.5%) reported interaction with pharmacists at least once daily, and that was mostly related to drug availability inquiry (73.7%). 86.7% of doctors expected pharmacists to ensure safe and appropriate use of medicines to patients. 87.6% of doctors expected pharmacists to monitor patient's response to drug therapy (p < 0.05) and 66.5% expected pharmacists to review patient's medicines as well as discuss possible amendments to therapy (p < 0.05). Besides, most doctors (84.9%) disagreed with the notion of pharmacists prescribing medicine for patients (p < 0.05). Most participants (81.6%) did not want pharmacists to prescribe independently. Conclusion The study highlights that doctors considered pharmacists as drug information specialists, dispensers, educators and counsellors; however, their expectation of pharmacists performing the clinical role and being involved in direct patient care was limited. They negated the idea of prescription intervention and direct involvement of pharmacists in pharmacotherapy plan for patients. It is imparative  to increase doctors' awareness regarding the role pharmacists could play in Pakistan's healthcare system. Currently, the clinical role of pharmacists in Pakistan's healthcare system seems minimal and is seen with scepticism within the community of doctors.

Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar

Background Pharmacists in many developed countries have been granted prescribing authorities under what is known as "non-medical prescribing" or "pharmacist prescribing". However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists' perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.

Undergraduate pharmacy students' attitudes and perceived barriers toward provision of pharmaceutical care: a multi-institutional study in Nepal

Background: Pharmaceutical care (PC) has a significant impact on optimizing pharmacotherapy and improving patients’ quality of life. We aimed to determine the attitudes and perceived barriers of final year pharmacy undergraduates towards provision of PC services in Nepal.

Methods: A cross-sectional study was conducted among 232 students using a 13-item-standard PC attitude survey (PCAS) questionnaire and 12-itemed PC barrier questionnaires. Mann–Whitney U test and Kruskal–Wallis tests were used to measure the median difference between groups, at alpha=0.05, and Spearman’s rho test was used to measure the strength of the correlation.

Results: Majority of students were self-motivated in undertaking the current pharmacy education (178, 76.7%) and had no previous incomplete grades that could delay their graduation (177, 76.3%). Over 80% of students had a positive attitude toward all items of PCAS (agreed and strongly agreed) except for two items. Whereas, 61 (26.3%) disagreed and strongly disagreed that providing PC takes too much time and effort. The major barriers perceived were inadequate PC training (176, 75.9%), inadequate drug information resources in the pharmacy (170, 73.3%), and lack of access to patient medical records in the pharmacy (165, 71.1%). A significant relationship was noticed between positive attitude towards PC and three factors; source of motivation, current employment in pharmacy job, and incomplete grades delaying graduation. Age factor was significant but negatively correlated with the scores of positive attitudes namely “I would like to perform PC as a pharmacist practitioner”, “Providing PC is professionally rewarding” and “I feel that the PC is the right direction for the provision to be headed”.

Conclusion: Nepalese undergraduate pharmacy students had positive attitudes toward PC. Exercising proper pharmacy practice regulations and educational efforts to overcome the perceived barriers may lead to better delivery of PC.

General practice pharmacists in England: Integration, mediation and professional dynamics

BACKGROUND

A number of key publications in recent years have advocated a more integrated vision of UK primary care involving increased multi-professional communication and understanding. This has resulted in a marked change in the roles being undertaken by pharmacists. Community pharmacists have traditionally provided a medicine supply function and treated minor ailments in addition to delivering a suite of locally commissioned services; however these functions have not necessarily been part of a programme of care involving the other clinicians associated with the patient. An integrated model of care would see much closer working between pharmacy and general practice but also with pharmacists not only working with, but in the practice, in an enhanced patient-facing role, trained as independent prescribers. This has implications for the dynamics amongst professionals in this environment.

OBJECTIVES

This exploratory multiple case study attempts to explore these changing dynamics across ten GP surgeries throughout the South-East of England.

METHODS

Semi-structured, in-depth interviews were conducted with one nurse, one pharmacist and one physician from each clinic, and survey data was collected from 38 patients who had appointments with a pharmacist.

RESULTS

The data suggested that the pharmacists who had enhanced roles perceived some uncertainty about their professional role and identity, which resulted in instability and insecurity and that this uncertainty led to both professional and interprofessional tension with their primary care colleagues. The survey data revealed that n = 35 (92%) patients stated they were 'very satisfied' or 'satisfied' with their appointment. And n = 37 (97%) were 'very comfortable' or 'comfortable' discussing their medications with the pharmacist. In addition, 36 patients (95%) reported that they strongly agreed or agreed with the clinical recommendations made by the pharmacist.

CONCLUSIONS

These findings are discussed in relation to role expansion and professional/interprofessional relations before key practical suggestions are offered.

Atypical alliances: the potential for social work and pharmacy collaborations in primary health care delivery

The growing prevalence of chronic conditions is a cause for concern globally, both in terms of its impact on the health of populations and also the strain it is predicted to place on health resources. There is a push to adopt more holistic and collaborative approaches to health care, and for the education of health care professionals to be reformed if these efforts are to be successful. A research project was undertaken in New Zealand in 2010-2011 aimed at exploring the perceptions of health care professionals on competencies in the field of chronic care. This article aims to highlight learning from the project regarding the "atypical alliance" between social work and pharmacy. Based on this, the authors argue that, with the growing expectations for interprofessional collaboration, effective primary and community health care delivery is increasingly dependent on relationships between educators in different health disciplines, between health professionals-in-training, and between education providers and health organizations.

Medication management during pregnancy: role of the pharmacist

A community pharmacist is frequently the first healthcare professional who is asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this action. Following a review of the literature, of which there is a paucity on this topic, we found that pharmacists often do not feel equipped to dispense teratology information and frequently refer the woman to her attending physician, without giving any information. In addition, it was clear that even when they did give information, it was not necessarily evidence-based and at times, inaccurate and based on their own opinions. In this article, we have attempted to make pharmacists aware of all the sources that are available, to enable them to perform this important role as a member of the health care team. These include websites, texts, evidence-based literature, teratogen information services and more. With the knowledge extracted from various resources, following critical appraisal of the data, they should be more comfortable and feel better equipped to transfer this information to a pregnant woman. In conclusion, while there may be a lack of adequate information regarding use of certain medications during pregnancy, pharmacists should be able to integrate available information with their medication expertise, to make appropriate individual risk/benefit decisions. This requires active engagement with pregnant women, rather than automatically referring them to their physician, thus establishing the pharmacist role as an essential member of the health care team.