The Impact of Pharmacist Medication Reviews on Geriatric Patients: A Scoping Review

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists' medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients' overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist's medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study

BACKGROUND

Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective.

METHODS

In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation.

DATA ANALYSIS

We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively.

RESULTS

Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population.

CONCLUSION

Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.

A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion

BACKGROUND

To determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy.

METHODS

We conducted a multicentre, prospective, comparative, non-inferiority study of participants aged ≥15 years seeking medical abortion from five clinics and five adjacent pharmacy clusters in three provinces of Cambodia. Participants were recruited in-person at the point of purchase (clinic or pharmacy). Follow-up for self-reported pill use, acceptability, and clinical outcomes occurred by telephone at days 10 and 30 after mifepristone administration.

RESULTS

Over 10 months, we enrolled 2083 women with 1847 providing outcome data: 937 from clinics and 910 from pharmacies. Most were early in their pregnancy (mean gestational age of 6.3 and 6.1 weeks, respectively) and almost all took the pills correctly (98% and 96%,). Additional treatment needed to complete the abortion was non-inferior for the pharmacy group (9.3%) compared with the clinic group (12.7%). More from the clinic group received additional care from a provider, such as antibiotics or diagnostics tests, than those from the pharmacy group (11.5% and 3.2%,), and one ectopic pregnancy (pharmacy group) was successfully treated. Most said they felt prepared for what happened after taking the pills (90.9% and 81.3%, respectively, p=0.273).

CONCLUSIONS

Self-use of a combined medical abortion product resulted in comparable clinical outcomes as use following a clinical visit, consistent with existing literature on its safety and efficacy. Registration and availability of medical abortion as an over-the-counter product would likely increase women's access to safe abortion.

Pharmacy dispensing of abortion pills in Ghana: experiences of pharmacy workers and users

BACKGROUND

Self-managed medical abortions are generally safe; however, pharmacy provision of abortion pills is against the Ghanaian abortion law. Nevertheless, evidence shows increasing numbers of women use it. An understanding of the influence of the law on pharmacies dispensing abortifacients and women who needed hospital care after using these pills is lacking. This study aimed to address this gap.

METHODS

We conducted 26 interviews with eight pharmacy workers and 18 women who sought hospital care after using abortion pills. Study participants were recruited from private pharmacies and hospitals within the Ashanti Region of Ghana between June 2017 and March 2018. We employed phenomenology in analysing the data.

RESULTS

Results show that criminalising medical abortion care from pharmacies does not stop abortions but rather drives it to be provided without oversight. It also denied pharmacy workers formal training in medical abortion care, resulting in situations where they failed to provide correct dosage information, used their discretion in determining the price of abortifacients and to whom they would dispense the pills. For women, it contributed to limited interaction with providers and an inability to insist on their rights even in instances where the pills were sold at exorbitant prices.

CONCLUSIONS

Due to the increasing numbers of Ghanaian women using medical abortion pills from pharmacies, although it is illegal, the ideal would be for medical abortion pills to be made legally available through pharmacies. Given that this may not occur in the short term, an immediate solution would be to upskill pharmacy workers.

Development of a Drug Management Performance Application: A Needs Assessment in Indonesia

OBJECTIVES

This study assessed the current state of pharmacy management information systems in Indonesia and systematically determined the improvements needed from the stakeholders' perspective.

METHODS

This descriptive study used focus group discussions and observations in 13 institutions, and 17 respondents were selected by purposive sampling. The PIECES (performance, information, economy, control, efficiency, service) framework was used to help identify needs. The research was conducted from September 2021 to November 2021 at primary health centers and health offices in Yogyakarta, Indonesia and involved pharmacists and information systems staff.

ESULTS

There was no standardized information system in place to support drug management and no format or rules for drug labeling (performance). Pharmacists were not able to provide non-prescription services outside the pharmacy warehouse (information). A new system needs to be developed, and budget availability needs to be determined (economy). System security decreases when users share accounts (control), and the existing systems have not been integrated as needed (efficiency). It is first necessary to plan and support regulations for system development (service). The authors formulated a recommended drug labeling format and a proposed system integration plan.

CONCLUSIONS

The development of an information system to support drug management is eagerly awaited by pharmacists in Indonesia to assist in their work. Further research on the development and implementation of an information system is needed to improve the quality of drug management at primary health centers.

Improving access to quality contraceptive counselling in community pharmacy: examining the knowledge, attitudes and practices of community pharmacists in Australia

BACKGROUND

Across most of Australia, the role of community pharmacists in contraceptive care has been unchanged since 2004. To understand their current scope of practice and potential for practice advancements, we examined community pharmacists' contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contraceptive counselling provision.

METHODS

A nationwide postal survey was conducted between September and December 2020. We contacted a state/territory-stratified sample of 2149 community pharmacies and limited eligibility to one pharmacist per pharmacy. Summary statistics of respondent characteristics and parametric (χ², linear regression) and non-parametric (Mann-Whitney, logistic regression) tests were computed for the outcomes: practices, knowledge (reported and tested), confidence, attitudes, barriers and benefits.

RESULTS

Eligible responses were received from 366 pharmacies (19%). Pharmacists' median age was 34. Most (85% of) pharmacists agreed that contraceptive counselling fits within their current professional activities and emphasised benefits to their patients, including improved access to contraceptive decision support (80%), as being key motivators of counselling. A lack of payment mechanisms (66%), training opportunities (55%) and technical assistance tools (54%) were the most important barriers. Self-rated knowledge and confidence were highest for combined oral contraceptive pills and lowest for the copper intrauterine device (IUD). When tested, pharmacists were very knowledgeable about method, dosage, frequencies and costs, and relatively less knowledgeable about side-effects and IUD suitability for adolescents.

CONCLUSIONS

Community pharmacists provide contraceptive information and counselling but lack the necessary resources and support to be able to consistently provide quality, person-centred care. Remuneration mechanisms, training opportunities and pharmacy-specific professional resources need to be explored.

[Clinical pharmacy in four French-speaking university hospitals, integration and supervision of clinical pharmacists: An exploratory study]

BACKGROUND

Pharmacy practice continues to evolve worldwide. The clinical role of the pharmacists is increasingly recognized and their integration into the health care team is irreversible. Despite this progress, there are still a wide disparity in the scope of practice provided by hospital pharmacists around the world. This disparity can be attributed to a variety of factors.

OBJECTIVES

The primary objective is to describe the organization of clinical pharmacy in four university hospitals in four French-speaking countries. The secondary objective is to identify similarities and differences and to identify perspectives for the future.

METHODS

This is an exploratory cross-sectional descriptive study. The study targeted a university hospital (CHU) in France, Belgium, Switzerland and Canada (Quebec). A volunteer expert pharmacist involved in the management of clinical pharmacy at each hospital was approached at the initiative of a team member. A working group of five pharmacists was set up.

RESULTS

During the year 2021, the group met virtually on ten occasions. Although all institutions have an academic mission, they have very different numbers of beds and volumes of activity. The number of pharmacists is also very different (0.83 FTE pharmacist/1000 admissions in Belgium, 0.22 in France, 0.59 in Switzerland and 2.39 in Quebec). In all countries, pharmacists provide clinical pharmacy services to patients in a centralised or decentralised manner, including, to various extent, prescription analysis, medication reconciliation, pharmaceutical interviews and discharge plans.

CONCLUSIONS

Clinical pharmacy practice is very heterogeneous in a selection of four French-speaking teaching hospitals. Identification of similarities and differences may inspire improvements in the organization of clinical pharmacy activity. This work has contributed to the establishment of a community of practice on clinical pharmacy in the French-speaking world.

Validation of a computerized decision support system to review pharmacotherapy treatment: scheduling guidelines

BACKGROUND

The review of pharmacotherapy can be conceptualized as a service in which the drugs used by the patient are reviewed to control the risks as well as to improve the results of the drug therapy, detecting, solving, and preventing issues associated with the drug, readjusting the doses and times (schedule) so that the treatment is not incompatible or in duplicity.

METHODS

The aim of the study was to validate an intelligent information system, which was developed to assist the scheduling activity in the pharmacotherapy review. The system used the concept of Genetic Algorithms. To validate the system, hypothetical cases were elaborated considering various aspects of pharmacotherapy such as underdose, overdose, drug interactions and contraindications. These cases were tested in the system and were also analyzed by pharmaceutical experts with clinical and research experience in the pharmacotherapy review process. The degree of agreement between the assessments of the appointments carried out by the pharmaceutical specialists and by the system were measured using the Kappa index with a 95% confidence interval.

RESULTS

In detecting errors and make propositions, the system was able to identify 80% of errors, with pharmaceutical experts identifying between 20 and 70% of errors. In relation the results of kappa between the cases, the system had 87,3% of concordance, whereas the best pharmaceutical expert had 75,5% of concordance, considering the correct answer.

CONCLUSION

It can be concluded that with the methodology used, the investigation met the objectives and confirmed the system is effective for pharmaceutical review process. There are indications that the system can help in the Pharmacotherapy review process, being able to find prescription errors as well as to establish times for the use of medications according to the patient's routine.

Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students

Background

Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution.

Objective

To evaluate the number and type of medication discrepancies identified by pharmacy students.

Methods

Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies.

Results

There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system.

Conclusions

Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.

Implementation of pharmacist-led services in primary care: A mixed-methods exploration of pharmacists' perceptions of a national educational resource package

Background:

To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016.

Objective:

To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility.

Methods:

Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role.

Results:

Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available).

Conclusions:

The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources.

Pharmacists' roles in mental healthcare: Past, present and future

Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.

Self-reported vs RUCA rural-urban classification among North Carolina pharmacists

Background:

The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.

Objective:

The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.

Methods:

This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.

Results:

Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications – 94 (56.6%) of the 166 participants who reported working in “rural” areas were considered “urban” according to RUCA.

Conclusions:

A significant discordance between pharmacists’ self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as “rural” as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand

Background

Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.

Objective

This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.

Methods

A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.

Results

Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.

Conclusions

A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Home medicines reviews: a national survey of Australian accredited pharmacists' health service time investment

Background

In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment.

Objective

This study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time).

Methods

An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.

Results

There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).

Conclusions

Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.

Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

BACKGROUND

Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals.

OBJECTIVE

To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes.

METHODS

In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients' laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms.

RESULTS

All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95% CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes.

CONCLUSIONS

Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial

BACKGROUND

Successful diabetes treatment requires commitment and understanding of disease management by the patients.

OBJECTIVE

This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage.

METHODS

A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively.

RESULTS

No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted.

CONCLUSIONS

HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.

The role of primary care pharmacists in the response to the Zika epidemic

Background:

Zika virus (ZIKV) infection emerged in Brazil in 2015, leading to the declaration of a national public health emergency, mainly due to its consequences for pregnant women and newborn babies. The Zika epidemic demanded major efforts from the public health system to address the full range of disease consequences.

Objective:

The objective of this study was to investigate the role of Primary Health Care pharmacists working in the city of Campo Grande in the State of Mato Grosso do Sul.

Methods:

A qualitative cross-sectional interview-based study with pharmacists working in municipal Primary Health Care services was carried out to investigate knowledge about the disease and involvement in the response to the health emergency. Informed consent was obtained. After coding, the corpus underwent thematic analysis.

Results:

The data show that few professionals had received specific training in public health. Knowledge largely encompassed disease transmission by the mosquito and collective and individual preventive measures. Findings highlight knowledge gaps relating to signs and symptoms, diagnosis, consequences of infection, and the role of epidemiological surveillance. Most professionals mentioned at least one of the recommendations on the use of medicines in symptom management protocols. The practical implications surrounding knowledge gaps and misconceptions were reflected in pharmacists´ role in response, restricted to counselling on preventive measures. Few respondents participated in institutional groups and committees or in multiprofessional teams involving case management.

Conclusions:

The study identified important knowledge gaps and showed that the involvement of pharmacy professionals in the response to the Zika epidemic was timid or inadequate. The results also suggest that pharmacists failed to recognize their role in interventions related to the ZIKV epidemic. Findings highlight the need to increase the involvement of primary care pharmacists in community-based actions, for communication and reduction of health risks, and emergency preparedness and response.

Patient satisfaction with medication therapy adherence clinic services in a district hospital: a cross-sectional study

Background:

Patient satisfaction is one of the essential indicators for assessing the quality of healthcare services being delivered, including pharmacy ambulatory care service, as it determines the practicability and sustainability of the service provided. As such, pharmaceutical care services provided during medication therapy adherence clinic (MTAC) sessions need to be assessed to maximise its effectiveness and benefits to the patients.

Objective:

This study aimed to assess the association between patient satisfaction and socio-demographic characteristics, as well as the predictors for patient satisfaction.

Methods:

This was a cross-sectional study conducted at the medical outpatient department in Hospital Port Dickson from January until October 2019. Convenience sampling method was used to recruit potential study participants. Patient satisfaction was measured using Validated Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ2.0), consisted of quality of care and interpersonal relationship between pharmacist and patient domains. Descriptive data were presented as mean and standard deviation or numbers and percentages, while Independent Sample t-test, ANOVA and post-hoc analysis, and multiple linear regression were used for inferential data analysis.

Results:

There were 37 (25%) diabetes MTAC, 36 (24.3%) respiratory MTAC, and 75 (50.7%) warfarin MTAC patients recruited. On average, the mean overall satisfaction score was 3.30(SD=0.43). The mean satisfaction score in the interpersonal relationship domain [3.35(SD=0.44)] was higher than the quality of care domain [3.26(SD=0.45)]. There was a significant association between gender, education level, and patient satisfaction towards pharmaceutical care service (p<0.05). Gender and education level statistically predicted respondents’ satisfaction with MTAC services (p<0.001).

Conclusions:

The overall patient satisfaction towards MTAC services in this setting was high. Gender and education level were significant predictors for patient satisfaction. These findings could potentially contribute to the planning of MTAC services in the future.

Perspectives on the pharmacist's "product": a narrative review

Clarity about the pharmacist’s “product” is fundamental to developing and communicating the value of pharmacy offerings. It is clear within the profession that pharmacists use their scope of knowledge and technical skills to address medication-related needs of individuals and populations. However, confusion still remains in the professional and public literature about what a pharmacist precisely produces for society. Is it a drug, service, program, solution, or something else? As the profession evolves from one that focuses on dispensing drugs to a profession that seeks to achieve positive patient health outcomes, pharmacists need to better conceptualize and articulate what they produce. This narrative review explores ideas from the marketing, business strategy, and entrepreneurship literature to discuss diverse perspectives on the pharmacist’s product. The four perspectives are the product as (1) a tangible product, (2) an intangible service, (3) a “smart, connected” good or service, and (4) a solution to a customer problem in whatever form provided. Based upon these perspectives, the pharmacist’s product can be any combination of tangible or intangible, face-to-face or virtual offering produced by pharmacists that seeks to satisfy medication-related needs and wants of pharmacy patients and customers. Ideas discussed in this review include the total product concept, classification schemes from the services marketing literature, the theory of service-dominant logic, the concepts of “smart, connected” products and industrialized intimacy, and the jobs-to-be-done framework. These various perspectives offer lessons for pharmacists on how to innovate when serving patients and customers and to communicate the pharmacist’s value proposition to the people they serve.

Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas

Background

There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations.

Objective

To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas.

Methods

An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respondent characteristics were analyzed using descriptive statistics.

Results

Of the 111 completed surveys, a majority of respondents were White, non-Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were passion for caring for underserved populations, the presence of a faculty appointment, or the freedom and flexibility of advanced clinical roles.

Conclusions

With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical pharmacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in these areas. Thus, one potential long-term strategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patient populations as well as expand student and resident training opportunities in underserved settings.

Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

Background:

Pharmaceutical services in Brazil provide access, supply, and rational use of drugs for all population and an effort has been made to improve the quality of these services. Biological drugs are high-cost drugs supplied in Brazil that can inhibit disease progression and improve the quality of life of psoriatic arthritis (PsA) patients. However, some patients did not achieve therapeutic goals.

Objective:

To evaluate the medication adherence and persistence of PsA patients treated with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated factors.

Methods:

A prospective observational study was performed at a single-specialty pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and clinical outcomes were evaluated at 12 months of follow-up. Medication persistence was historically compared to overall PsA patients treated in Brazil. Associated factors were identified through log-binomial regression.

Results:

One hundred ninety-seven PsA patients were included in the study, of whom 147 (74.6%) and 142 (72.1%) had medication adherence and persistence, respectively. Patients treated with infliximab presented the highest adherence (90.5%) and persistence rate (95.2%) in comparison to patients treated with other drugs, except for adalimumab versus infliximab for adherence outcome. All clinical measures significantly improved in patients with medication adherence and persistence. Medication persistence was higher for patients attended by specialty pharmacy than other PsA patients in Brazil. The associated factors to higher medication adherence were lower disease activity by BASDAI, being non-white race, and intravenous drug use. The associated factors to higher medication persistence were lower disease activity by Bath Ankylosing Spondylitis Activity Index (BASDAI), intravenous drug use, non-use of corticoids and non-steroidal anti-inflammatory drugs, and comorbidity.

Conclusions:

Patients with medication adherence and persistence had significant improvements in clinical measures, functionality, and quality of life. High medication adherence and persistence to biological therapy were observed and associated with lesser disease activity at baseline. Also, medication persistence to PsA patients attended in specialty pharmacy was higher than the overall PsA population in Brazil, which indicates the importance of pharmaceutical services to provide health care and promote the effectiveness and safety of biological therapies.

Pharmacy Electronic Records and Patient Clustering: Exploring New Ways to Increase the Provision of Tailored Pharmaceutical Services

Patients' electronic records in community pharmacy are an untapped resource to uncover new ways of providing healthcare services. In this paper, we present a preliminary work, where we explore this resource, aiming to identify patients' clusters that will help to define a future algorithm. This algorithm will then enable community pharmacists to provide tailored pharmaceutical interventions according to patient's risk assessment and needs. In this way, this work will provide a way to overcome known barriers for community pharmacists' provision of services and integration in the health system, while also contributing to support a better care for chronic patients.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies

Background:

Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.

Objective:

To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.

Methods:

A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.

Results:

Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.

Conclusions:

We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

Assessment of community pharmacists' communication and comfort levels when interacting with Deaf and hard of hearing patients

BACKGROUND

Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks.

OBJECTIVE

1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support.

METHODS

This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer's level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA.

RESULTS

A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6).

CONCLUSIONS

The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

Assessment of job satisfaction among community pharmacists in Baghdad, Iraq: a cross-sectional study

Background

Pharmacists have the unique position of providing safe and effective care. Hence, addressing their feelings about their working life is crucial to provide good pharmacy services.

Objective

this study aimed to assess job satisfaction among Iraqi community pharmacists and determine the effect of pharmacist characteristics on job satisfaction.

Methods

A cross-sectional study was conducted among community pharmacists in Baghdad, the capital of Iraq. A simple random sample technique was adopted to select community pharmacists. A survey questionnaire using Warr-Cook-Wall satisfaction scale (ranging from extremely dissatisfied to extremely satisfied) was used to assess job satisfaction.

Results

Community pharmacists experienced moderate satisfaction with their jobs. The mean satisfaction score for all pharmacists was 20.4 (SD 3.7). The lowest mean scores occurred for recognition (1.4; SD 0.7), public respect (1.8; SD 0.9), and pharmacy regulations (1.9; SD 0.9). Job satisfaction was significantly affected by pharmacist characteristics, including gender (p<0.001), age (p<0.001), degree level (p=0.003), years in practice (p<0.001), working patterns (p< 0.001), and working hours (p<0.001). Regression analysis indicated pharmacist gender and age had the highest effect on job satisfaction, while, years in practice, working hours, and working pattern had the lowest effect.

Conclusions

Community pharmacists expressed moderate satisfaction with their jobs with satisfaction levels being affected by gender, age, years in practice, working patterns, and working hours. New strategies will require support for Iraqi pharmacists by the Ministry of Health and Syndicate of Iraqi Pharmacists before being included in extended pharmacy services.

Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions

In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists

OBJECTIVE

To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status.

METHODS

Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis.

RESULTS

For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors.

CONCLUSIONS

North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.

Ensuring intervention success: Assessing fit as an overlooked step of the implementation process

Ensuring fit between a service and the implementing context is a critical but often overlooked precursor of implementation success. This commentary proposes five key considerations that should be evaluated when exploring fit: alignment with needs and metrics; alignment with organizational resources and capabilities; alignment with organizational priorities and culture; alignment with reimbursement mechanisms for long-term sustainability; and alignment with the regulatory environment. Successful uptake and implementation hinges on careful planning and, most importantly, appropriate fit between the service and the implementing environment.

Development of pharmacy competency framework for the changing demands of Thailand's pharmaceutical and health services

Background

In Thailand, pharmacists are responsible for all activities to ensure access to medicines throughout pharmaceutical supply chain. Competency framework (CF) is an important guidance for professional development and workforce planning.

Objective

This study aimed to explore needs for pharmacy services in pharmaceutical supply chain and competencies of pharmacists to serve those needs. It was the first step for developing evidence-based pharmacy CF within the context of Thailand in 2026.

Methods

A qualitative method using in-depth interviews to gain rich data from practitioners and leaders in all area of practices. 99 key informants from 56 workplaces in Thailand were interviewed during January and March 2016. Data was transcribed verbatim, and thematic analysis was used. Competencies were extracted, followed by several rounds of group discussion among team members to develop an initial framework. The competencies and CF were presented, and recommendations were gained from professional leaders for refining the findings.

Results

The key informants agreed that pharmacist's works and responsibilities have gradually been drifted to support changes in healthcare and pharmaceutical systems. The upcoming pharmaceutical services call for higher standards of practice, larger number of personnel, and skillful pharmacists who have strong foundation in pharmaceutical knowledge as well as an ability to integrate knowledge into practices. Two sets of CFs were established. The general CF comprises five core domains: product focus, patient focus, healthcare system focus, community focus, and personal focus for self-improvement. These general competencies allow practitioners to perform basic professional tasks, including providing information, dispensing, and compounding. The service-specific competency is the integration of general competencies tailored into specific area of practice.

Conclusions

Regarding the professional goal to evolve pharmacists from generalists to specialists for providing higher quality of professional services, the pharmacists are required to demonstrate general competencies and service-specific competencies. The findings serve as the need-based evidence for developing a national CF for pharmacists in Thailand.

Educational intervention to improve pharmacist knowledge to provide care for transgender patients

Background:

Most pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap.

Objective:

The aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients.

Methods:

A quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention.

Results:

The majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p<0.001). The average total execution score was 52.15% in the pre-test and 72.89% (p< 0.001) in the post-test.

Conclusions:

Pharmacists benefited from a three-hour continuing education course with an increase in knowledge regarding transgender patient care and hormone therapy for gender affirmation. As this study only evaluated the effect in short term memory, further studies are needed to assess long term impact of the continuing education course on transgender care knowledge.

Pharmacy professionals' preparedness to use Mental Health First Aid (MHFA) behaviors

Background:

There is a need to train healthcare professionals to provide first aid to people experiencing a mental health crisis. Research testing the association between Mental Health First Aid (MHFA) training and the use of MHFA behaviors could provide evidence of program effectiveness in the pharmacy setting.

Objectives:

The objectives of this study were to measure the preparedness of pharmacy professionals to function in a MHFA role, and compare preparedness and the use of MHFA behaviors based on demographic characteristics.

Methods:

Pharmacists and student pharmacists attended MHFA training under a multi-state pharmacy initiative in 2018. An anonymous electronic survey was administered to 227 participants using 4 contacts in May to June, 2019. The survey evaluated if participants had recommended MHFA to others, their preparedness to engage in MHFA behaviors (13 items), and their frequency of performing a set of MHFA behaviors (7 items). Descriptive statistics, bivariate analysis, and ANOVA were used to describe the sample and compare these variables across groups.

Results:

The analysis was based on 96 responses (42.3%). Almost all respondents (96%) had recommended MHFA training to others. Respondents reported that the training program prepared them to provide a range of MHFA behaviors for multiple mental health conditions, particularly for depression and anxiety. Participants most often reported asking about a distressed mood and listening non-judgmentally. Almost half of participants had asked someone if they were considering suicide and a similar percent had referred someone considering suicide to resources. Those reporting the highest levels of preparedness engaged in significantly more MHFA behaviors than those with lower levels of preparedness (p=0.017). Preparedness and use of MHFA behaviors were not significantly associated with respondent demographic characteristics.

Conclusion:

These data suggest that pharmacy professionals who had MHFA training felt prepared to engage in MHFA and many used behaviors like asking about suicide and making referrals since being trained in MHFA. Research is warranted to better understand what makes someone feel maximally prepared to use MHFA behaviors compared to lower feelings of preparedness.

The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines

Background:

Only few studies have analyzed the pharmaceutical workforce in primary healthcare centers, and a global recommendation calls for better understanding of the trends that shape workforce development and capacity.

Objective:

To analyze the distribution of the pharmaceutical workforce in primary healthcare centers in the national health system [Sistema Único de Saúde (SUS)] in Brazil.

Methods:

The study was conducted using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil. Secondary data referring to the socioeconomic indicators of each municipality were obtained from national public databases. Data stratification in geographic regions was considered, and data on workers in the management of the municipal pharmaceutical services and medicines dispensing centers were analyzed. Crude and adjusted prevalence ratios were calculated by Poisson regression in the study investigating the factors associated with low and high-density pharmacists per 10,000 inhabitants.

Results:

The results showed that most Brazilian municipalities have a rate of 1 or more pharmacist per 10,000 inhabitants in primary healthcare public facilities, with a higher concentration of pharmacists in small municipalities. Even in Brazilian municipalities with lower economic capacity, the conditions of access to medicines and pertinent information on medicines were directly related to the number of pharmacists available in these centers.

Conclusions:

This study showed a high number of pharmacists in the public health system. The higher density of pharmacists in primary healthcare public facilities correlated to increased access to medicines information and better municipal social development.

Evaluation of simulated drug dispensing and patient counseling in the course of pharmaceutical improvement: 2009 to 2015

Background

Aiming to facilitate the drug dispensing process and patient counseling, specific professional skills are required. The knowledge, skills and attitudes involved in this process can be improved. From 2012 to 2015, a nationwide course was held, in partnership with the Ministry of Health and the Federal University of Rio Grande do Sul (UFRGS) - Brazil, to train pharmacists working in primary health care through the development of their clinical and communication skills. One of the steps in this process involved the simulation of the drug dispensing process and patient counseling.

Objective

To evaluate the performance of pharmacists in drug dispensing and counseling through patient simulation role-playing held in a face-to-face meeting at the end of a training course.

Methods

A cross-sectional and retrospective study with analysis of patient simulation recordings and data collection using an assessment instrument with scores ranging from 0 to 10 points to assess pharmacist's behavior, skills, and technical knowledge.

Results

Participants presented poor-to-regular performance, with median scores equal to or lower than six. The median time of the drug dispensing simulation was five minutes and the patient counseling was eight minutes. Pharmacists had better scores in the simulation of asthma cases. In drug dispensing, 99.5% of pharmacists had difficulty checking the patient's time availability, 98.5% did not know how to use the devices, and 94.7% did not advise the patient on what to do if they forgot to take a dose. In patient counseling simulation, 1.18% of pharmacists remembered to advise on what do with medication leftovers, and 50.6% asked questions that induced the patient's responses.

Conclusions

The low-to-regular performance showed that pharmacists had difficulties at improving their skills in the performance of complete and effective drug dispensing and patient counseling.

Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses

OBJECTIVE

To map the clinical pharmacy services conducted in Brazil, their characteristics, outcomes, and process measures in general population, as well as the assessment of the clinical impact on people with cardiometabolic diseases (cardiovascular diseases and metabolic diseases).

METHODS

A systematic scoping review and meta-analysis were conducted. The electronic searches were re-run in March 2020. To the clinical impact assessment, meta-analyses of cardiometabolic outcomes (i.e., change of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total cholesterol, glycated hemoglobin (HbA1c), fasting glycemia, LDL-, and HDL-cholesterol) were led. The risk of bias was assessed with the Cochrane Collaboration tools.

RESULTS

71 studies were identified (7,402 patients), being the majority quasi-experimental studies (n=41) and published by research groups of Southeast Brazil (n=33). Medication therapy management (n=62) was the most frequent clinical pharmacy service, performed on outpatient setting (n=45), with adults or elderly people (n=58) with hypertension (n=18) or diabetes (n=10). Process measures (n=58) (e.g. resolution of drug related-problem) were widely used as indicator, followed by clinical (n=44) (e.g. change in SBP), humanistic (n=12) (e.g. change in quality-of-life score assessed by Short-Form 36 Health Survey Questionnaire), and economic outcomes (n=3) (incremental cost-effectiveness ratio for reduction in HbA1c). Regarding the assessment of clinical impact of the services, 20 studies were included in meta-analyses, showing improvement in most cardiometabolic outcomes when considered individual studies. However, the evidence presents high risk of bias, high heterogeneity (median 67-90%) and imprecision, contributing to wide prediction intervals and low reliability.

CONCLUSIONS

A predominance of studies on cardiometabolic diseases, process measures, and clinical outcomes were identified. Considering the assessment of the clinical impact of clinical pharmacy services in cardiometabolic diseases, an improvement in most cardiometabolic outcomes was showed, however, with low confidence and wide prediction interval. Therefore, development of larger studies with low risk of bias and major homogeneity is necessary for a better comprehension of clinical pharmacy service characteristics, benefits, and the population groups most benefited.

The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines

BACKGROUND

Only few studies have analyzed the pharmaceutical workforce in primary healthcare centers, and a global recommendation calls for better understanding of the trends that shape workforce development and capacity.

OBJECTIVE

To analyze the distribution of the pharmaceutical workforce in primary healthcare centers in the national health system [Sistema Único de Saúde (SUS)] in Brazil.

METHODS

The study was conducted using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil. Secondary data referring to the socioeconomic indicators of each municipality were obtained from national public databases. Data stratification in geographic regions was considered, and data on workers in the management of the municipal pharmaceutical services and medicines dispensing centers were analyzed. Crude and adjusted prevalence ratios were calculated by Poisson regression in the study investigating the factors associated with low and high-density pharmacists per 10,000 inhabitants.

RESULTS

The results showed that most Brazilian municipalities have a rate of 1 or more pharmacist per 10,000 inhabitants in primary healthcare public facilities, with a higher concentration of pharmacists in small municipalities. Even in Brazilian municipalities with lower economic capacity, the conditions of access to medicines and pertinent information on medicines were directly related to the number of pharmacists available in these centers.

CONCLUSIONS

This study showed a high number of pharmacists in the public health system. The higher density of pharmacists in primary healthcare public facilities correlated to increased access to medicines information and better municipal social development.

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Background

Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements.

Objective

This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes.

Methods

PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities.

Results

This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m² to -1.94 kg/m²; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable.

Conclusions

These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.

A survey on feasibility of telehealth services among young Italian pharmacists

Background:

Telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status”. This relatively new concept of healthcare is based on the fusion between medical assistance and Information and Communication Technology (ICT) to provide support to people located in remote and underserved areas. It can be found not only in hospitals, but also in other healthcare facilities such as pharmacies. Starting from 2010, telemedicine or telehealth was formally introduced in the Italian pharmaceutical context with the “Pharmacy of Services Decree”. In spite of this regulatory framework, the implementation of this technology was very slow and there are no data about the spreading and use of these services in Italian pharmacies.

Objective:

The present study has therefore developed a survey to collect information on the diffusion of telemedicine/telehealth services within Italian pharmacies.

Methods:

A two-part questionnaire in Italian was developed using SurveyMonkey, setting a mechanism aimed to have different outcomes according to the answers given. Six hundred eighty-three respondents returned the questionnaire. The results were then analysed statistically.

Results:

The questionnaire results have shown a limited diffusion of telemedicine/telehealth services among Italian pharmacies and an apparently limited interest of health authorities in supporting the integration of this technology.

Conclusions:

More efforts should be spent by national public health stakeholders to better analyse the contribution of telemedicine services available in public pharmacies and to find the best solutions to implement this innovative technology as an established service.

Pharmacist's attitudes and knowledge of pharmacogenomics and the factors that may predict future engagement

BACKGROUND

While pharmacists are well positioned to implement pharmacogenomic testing in healthcare systems, uptake has been limited.

OBJECTIVE

The primary objective of this survey was to determine how post-graduate education and training influences pharmacist's knowledge and attitudes of pharmacogenomic testing.

METHODS

Survey questions were developed by the study team, and responses were collected electronically using REDCap™. The electronic survey was sent to all pharmacists (n=161) within a large, multi-state healthcare system by email.

RESULTS

A total of 75 (47%) respondents completed all aspects of the survey. The majority of respondents were female (60%), worked in acute care settings (57%), were full-time employees (80%), and worked in an urban area (85%), with many graduating in or after 2010 (43%). For post-graduate education, 36% of respondents completed a Post-Graduate Year One Residency (PGY-1), and 27% had a board certification. Those that completed a PGY-1 residency were significantly more likely to have received formal training or education on pharmacogenomics than those who had not. They also assessed their own knowledge of pharmacogenomic resources and guidelines higher than those without PGY-1 training. More recent graduates were also significantly more likely to have received formal training or education on pharmacogenomics. Additionally, pharmacists who completed a PGY-1 residency were more likely to respond favorably to pharmacogenomics being offered through pharmacy services. Pharmacists with board certification were more comfortable interpreting results of a pharmacogenomic test than those without board certification.

CONCLUSIONS

Pharmacists who have completed a PGY-1 residency or received board certification appear more comfortable with interpretation and implementation of pharmacogenomic testing.

Pharmacists' perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan

OBJECTIVE

This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists' role during the coronavirus pandemic in Jordan.

METHODS

Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20th and April 3rd. A total of 184 posts and threads were identified for the purpose of the study.

RESULTS

Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public's awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time.

CONCLUSIONS

Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction.

Preparing for the next generation pharmacists

To address the changes in health care and the needs of society related to medicines, we must redefine the profession of pharmacy. We have defined the next generation pharmacists (NGP) as "a health care provider and change agent on the interprofessional health care team, personalizing medication use, managing safe and effective medication systems, and creating healthier communities." Schools and colleges of pharmacy should thoroughly examine their curriculum to ensure it is preparing pharmacists for this future. By creating a vision for the NGP and implementing the best curriculum, we ensure that pharmacists of the future will be up to the challenge of our society's health care needs..

Good pharmacy practice assessment among community pharmacies in Lebanon

Objective

This study aims to assess good pharmacy practice (GPP) aspects and compare GPP scores among community pharmacies in Lebanon, using a tool developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) to improve and maintain standards of pharmacy practice.

Methods

Data collection was carried out between July and October 2018 by a team of 10 licensed inspectors who work at the Lebanese Order of Pharmacists (OPL) and visited community pharmacies across Lebanon. The questionnaire was adapted to the Lebanese context and included 109 questions organized under five sections: socio-demographics, Indicator A (data management and data recording), Indicator B (services and health promotion), Indicator C (dispensing, preparation and administration of medicines), and Indicator D (storage and facilities). The value of 75% was considered as the cutoff point for adherence to indicators.

Results

Out of 276 pharmacies visited, a total of 250 (90.58%) pharmacists participated in the study with one pharmacist being interviewed in every pharmacy. Results showed that 18.8% of pharmacists were generally adherents to GPP guidelines (scores above the 75% cutoff): 23.3% were adherent to indicator A, 21.6% to indicator B, 14.8% to indicator C and 13.2% to indicator D. Moreover, comparison of GPP scores across geographical regions revealed a higher adherence among community pharmacists working in the Beirut region compared to the North region, the South region, Mount Lebanon, and the Bekaa.

Conclusions

Our study shows that community pharmacists in Lebanon do not fulfill GPP criteria set by FIP/WHO, and that this poor adherence is a trend across the country's geographical regions. Therefore, efforts should be made to raise awareness among pharmacists about the necessity to adhere to GPP guidelines and standards, and train them and support them appropriately to reach that goal. This is the first indicator-based comprehensive pilot assessment to evaluate GPP adherence in community pharmacies across Lebanon. Working on the optimization of this assessment tool is also warranted.

The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review

Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings.  Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion.  Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity.  PROSPERO Registration:  CRD42019139679 (28/08/19).

Medication follow-up in newborns with extremely low birth-weight

Objective:

The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.

Methods:

A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.

Results:

The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients’ pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were “untreated health problem” (40%, n=10) and “quantitative ineffectiveness” (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of “treatment day count correction” and “dose correction”, both with 21.6% (n=8), and “correction of dosage” (16.2%, n=6).

Conclusion:

The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.

A comparison of clinical pharmacist management of type 2 diabetes versus usual care in a federally qualified health center

Background:

Clinical pharmacists have demonstrated their ability to improve patient outcomes over usual care for patients with type 2 diabetes and glycemic levels above goal, though reasons for this are not well defined. Numerous medications exist for the management of patients with type 2 diabetes and different patterns of medication use by clinical pharmacists may explain these benefits.

Objective:

The objective of this study was to compare pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes receiving basal insulin by a clinical pharmacist versus usual care by a physician or advanced practice provider in a federally qualified health center.

Methods:

A retrospective cohort study of patients 18 to 85 years old with type 2 diabetes, A1C ≥9%, receiving basal insulin was conducted. Patients were grouped into two cohorts (1) those who received clinical pharmacist care and (2) those who received usual care from a physician or advanced practice provider. The primary outcome evaluated the proportion of patients treated with the addition of a non-basal insulin medication. Type of medication changes or additions as well as change in A1C and change in weight were also analyzed. Outcomes were evaluated at six months post-index A1C.

Results:

A total of 202 patients were identified (n=129 in the usual care group and n=73 in the clinical pharmacist group). A non-basal insulin medication was added in 29% of patients receiving usual care versus 41% of patients receiving clinical pharmacist care (adjusted p=0.040). Usual care providers more frequently added metformin, sulfonylureas and thiazolidinediones, while clinical pharmacists more frequently added prandial insulin, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors. A1C decreased 1.6% in the clinical pharmacist group versus 0.9% in the usual care group (adjusted p=0.055). No significant change in weight was observed between the clinical pharmacist and usual care group (0.2 kg versus -1.0 kg, respectively; adjusted p=0.175).

Conclusions:

Pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes varied between clinical pharmacists and other clinician providers. For patients already on basal insulin, clinical pharmacists were more likely to intensify therapy with the addition of non-basal insulin, including more frequent initiation of prandial insulin and by adding newer antihyperglycemic agents.

A nationwide web-based survey of a sample of Italian community pharmacists' perceptions and opinions about online sales of medicines and falsified drugs

Background

Throughout Europe, legal online pharmacies increasingly sell online drugs as well as other products such as dietary supplements. Online sale of pharmaceuticals however is closely connected to the phenomenon of drug falsification.

Objective

The aim of this study was to assess the opinions of a sample of Italian community pharmacists towards the sale of pharmaceuticals on the web, as well as their knowledge and experience with falsified drugs.

Methods

A self-administered questionnaire was distributed by means of an online platform between October 2016 and January 2017. Collected information included: demographics, workplace and role, opinions towards the online sale of pharmaceuticals, whether the pharmacy has a website, knowledge and opinions about falsified drugs.

Results

A total of 668 community pharmacists completed the questionnaire (mean age: 48.5, SD 12.4 years, 52.3% women). Favourable opinions about online sale of pharmaceuticals were expressed by 4.9% of participants for prescription drugs, 25.4% for nonprescription drugs, and 51.6% for other products. Favourable opinions occurred more often among males and owners/directors of pharmacies in comparison to females and employees, and among pharmacists working in pharmacies with websites doing e-commerce. Knowledge about falsified drugs was limited, with 24.5% of respondents failing to indicate that falsified drugs may contain less or different ingredients, 46.4% less and/or different excipients, and 72.3% ignoring that falsified drugs may be lethal. One in 3 respondents didn't know about falsified drugs in Italy, however 51 participants had previous experience with falsified drugs and 21 provided specific information.

Conclusions

Italian community pharmacists have low confidence in the online sale of pharmaceuticals, as well as alarmingly limited knowledge about falsified drugs, even if many of them reported previous experiences. Results may support targeted interventions to increase pharmacists' knowledge about pharmaceuticals and the web, as well as concerning falsified drugs, and suggest community pharmacies as key components of integrated systems aimed at monitoring falsified drugs.

A naturalistic observation study of medication counseling practices at retail chain pharmacies

OBJECTIVE

This study evaluated medication counseling procedures and trends at retail pharmacies in the Houston metropolitan area through a naturalistic observational study.

METHODS

A blinded cross-sectional observational study was conducted at retail pharmacies in the Houston metropolitan area. Data were collected by trained observers utilizing an observational log, to record various parameters that could have an impact on the duration of patient-pharmacist interaction in a naturalistic pharmacy practice setting. Additionally, indicators of counseling such as utilization of the counseling window and performance of show-and-tell were recorded. Statistical analyses included descriptive statistics, t-tests, Pearson correlations, ANOVAs, and multiple linear regressions.

RESULTS

One hundred and sixty-five interactions between patients and pharmacy staff were recorded at 45 retail pharmacies from 7 retail pharmacy chains. The counseling window was utilized in only 3 (1.81%) out of 165 observations and the show-and-tell process was observed in just 1(0.61%) interaction during this study. Mean (SD) interaction time between patient and pharmacists [159.50 (84.50)] was not statistically different (p>0.05) from the mean interaction time between patients and pharmacy technicians [139.30 (74.19)], irrespective of type of the retail chain observed. However, it was influenced by the number of patients waiting in queue. Patient wait time significantly differed by the time of the day the interaction was observed, weekends and weekdays had significantly different wait times and patient interaction times Multiple linear regression analyses indicated that, patient interaction time, pharmacy chain type, initial contact (pharmacist/technician), and time of the day, were significantly associated with patient wait time whereas patient wait time, pharmacy chain type, number of patients in queue, and number of pharmacy technician were significantly associated with interaction time.

CONCLUSIONS

Our study found that the key indicators of counseling including the use of the counseling window and the show-and-tell process were absent, suggesting lack of adequate pharmacists counseling. Further studies are needed to evaluate the validity of this conclusion and the role of pharmacy services and its value towards medication use and safety.

The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review

Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings.  Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion.  Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity.  PROSPERO Registration:  CRD42019139679 (28/08/19).

Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit

Background:

There is limited information describing pharmacist participation in prophylactic enoxaparin monitoring in the surgical intensive care unit (SICU).

Objective:

Our study sought to: 1) characterize pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, 2) describe the frequency that medical providers accept pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, and 3) illustrate the frequency that trauma patients admitted to our SICU service achieve anti-factor Xa trough concentrations (AFXa-TRs) of 0.11 - 0.20 IU/mL following pharmacist recommendation to adjust prophylactic enoxaparin dosing.

Methods:

Adult patients who had an AFXa-TR drawn after at least three consecutive prophylactic enoxaparin doses between June 1, 2017 and March 1, 2018 were identified through chart review and included in this study. Patients were excluded based on the following criteria: 1) age less than 18 years, 2) anti-factor Xa (AFXa) level not representative of a trough concentration, 3) AFXa-TR not representative of steady state concentration, and 4) non-trauma based prophylactic enoxaparin dosing. This study was exempt from IRB review.

Results:

The final analysis consisted of 42 patients. A pharmacist provided at least one recommendation in 97.6% (41/42) of trauma patients with enoxaparin monitoring during their SICU stay. In total, a pharmacist made 170 recommendations, mean of 4.2 (SD 1.8) recommendations per patient. Recommendations were: 1) obtain an AFXa-TR, n=90; 2) adjust enoxaparin dose based on AFXa-TR, n=58; and 3) maintain enoxaparin dose based on AFXa-TR, n=22. Medical providers accepted 89.4% (152/170) of pharmacist recommendations for enoxaparin monitoring. Dose adjustments were made in 33 patients following pharmacist recommendation; of these, 27 had a repeat AFXa-TR following at least one dose adjustment. Target AFXa-TRs were achieved in 19/27 patients, indicating 70.4% had recommended AFXa concentrations.

Conclusions:

Pharmacists provided recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to the SICU. Medical providers regularly accepted pharmacist recommendations and trauma patients commonly achieved target AFXa-TR following pharmacist recommendation for dose adjustment. Further research is required to identify the optimal enoxaparin dose for VTE prophylaxis in trauma patients.