Iranian Pharmacist's Experiences of COVID-19 Pandemic: A qualitative study

BACKGROUND

Since the 2019 COVID-19 pandemic is not the first and will not be the last, pharmacists' experiences during this period can be used to establish a more efficient healthcare system to face future pandemics.

OBJECTIVE

This study aims to explore Iranian pharmacists' experiences in pharmacies using the content analysis method.

METHODS

In this qualitative study, a conventional content analysis approach was applied. Ten male and female pharmacists working in community pharmacies in Birjand, Iran participated using a purposeful sampling method. Semi-structured interviews were carried out for data collection. The data were analyzed using Graneheim and Lundman's method.

RESULTS

Four categories and ten subcategories were extracted as follows: Multifaceted concerns of pharmacists (familial, economical, professional, and personal concerns), Non-compliance with protocols from occurrence to cause (facing non-compliance with protocols by clients, obstacles to complying with protocols in the pharmacy), Prevention from COVID-19 (protective equipment usage, designing protection rules), and Double reactions to COVID-19 (emotional and; practical reactions).

CONCLUSIONS

Pharmacists dealt with different concerns and challenges during the COVID-19 pandemic. They are one of the main primary care providers and need to be supported by the authorities to maintain their standard level of services.

[Retrospective surveys on intoxications with essential oils]

OBJECTIVES

Non-conventional medicines are not devoid of toxicity and it is relevant to establish an inventory of the general public's knowledge of essential oils. The objective is to identify the profile of the victims of a poisoning, the ways of administration and the symptoms as well as the incriminated essential oils.

METHODS

Two surveys, for the general public and health professional, were distributed (January-March 2019). In addition, data from the Angers poison control center for the period 2017-2018 were analyzed and compared with the data from our study.

RESULTS

Our surveys gathered 623 and 59 answers. The data of the poison control center of Angers counted 741 intoxications. The precautions for use and contra-indications of essential oils are not well known since 5% of the respondents identified them correctly. Our data show that using a mixture increases the risk of intoxication (P<0.02). The most cited essential oils in case of intoxication are Eucalyptus, Tea tree and Lavender. The symptoms mainly concern a cutaneous application (75%) and remain of short duration and without gravity. Concerning the intoxications referenced to the poison control center in Angers, the same essential oils are involved, the oral route is mostly used (70%) and the symptoms listed for 74% of intoxications concern oropharyngeal, ocular, abdominal and skin pain.

CONCLUSION

The delivery of essential oils is not harmless and the data obtained both through our surveys and the processing of data from the poison control center of Angers show that they must be used with caution.

[Prescriptions of statins in the elderly according to the type of healthcare establishment: An example of the usefulness of territorial hospital groups]

INTRODUCTION

The challenge of territorial hospital groups is to develop coherent care pathways for optimal patient care. Following the creation of a territorial pharmaceutical team, a common prescription review process was initiated in our health area. The objective of this study is to analyze the uses of statins in the elderly.

METHOD

The study included all statin-treated patients older than 75 years at the five participating institutions (including long-term nursing homes). In a prospective multicenter study, the benefit/risk ratio of statin prescription has been assessed up. Depending on the clinical situation, a proposal to stop or adjust the dosage could be made.

RESULTS

Nine hundred and forty-seven patients were included. Among them, 184 were treated with a statin. Forty-seven patients (26%) are treated in primary prevention and 137 patients (74%) in secondary prevention. Dosages are lower for long stays. Fifteen treatments interruption were accepted out of 44 proposals, mostly for long stays. The reasons given to continue treatment are the need for a new evaluation by a cardiologist or a high cardiovascular risk.

CONCLUSION

The variability of results according to the type healthcare institution makes territorial medical and pharmaceutical collaboration relevant. The challenge is to develop a coherent care pathway for optimal care of elderly patients, with congruent objectives.

[Community pharmacists are also first aid actors. Results of the survey on unscheduled care in pharmacies in the Grand Est region]

INTRODUCTION

According to the Public Healthcare Code, contributing to primary care is one of the pharmacist's key missions. Accessibility without appointment and the territorial network of pharmacies make the pharmacist an essential player in the management of unscheduled care, which remains an important gateway for users into the primary care system. This type of requests, daily in pharmacies, has not been yet the subject of a qualitative or quantitative evaluation. The Grand-Est Region, regrouping nearly 8% of French pharmacies, wanted to conduct a specific survey to quantify and assess the unscheduled care requests addressed to pharmacists on its territory.

METHODS

The survey by URPS Pharmacists and ARS Grand-Est was conducted by Tous Pour la Santé over a period of 12months from November 2020 to November 2021. Participation in the study was on a voluntary basis. The main objective of this study was to define the typology of unscheduled care requests addressed to the Region pharmacies and to characterize the responses provided.

RESULTS

One hundred and eighty-nine pharmacies (nearly 12% of Grand Est pharmacies, the participation rate could certainly have been higher if the study had not been conducted during the COVID-19 pandemic), representing 11,010 unscheduled care requests, took part in the survey. Despite the profession's massive desire to get involved in handling unscheduled care requests, the survey revealed a lack of specific training for pharmacists on this subject and an all-too-rare update from the AFGSU. User requests concern both daily healthcare needs and more specific chronic patients' needs. They evolve according to the profile of the applicant, the seasons, the days of the week and the type of pharmacy concerned. All ages are represented, including young adults. The average duration of care by the pharmacy team was 8minutes per request, even though in 20% of cases this did not lead to any delivery of product and in 11% of cases to no remuneration for the pharmacist.

CONCLUSION

This survey confirmed the role of the pharmacist in responding to unscheduled care requests as a first-line actor and referral agent in the health system. The implementation of shared multiprofessional protocols, including first and foremost general practionners, and the recognition of the contribution of pharmacy teams would allow to define a framework to optimize the patient's journey through the healthcare system.

[Role and responsibility of the pharmacist in the implementation of the Compulsory Health Insurance policy in Mali]

OBJECTIVE

To study the role and responsibility of the pharmacist who can contribute to the sustainability of compulsory health insurance in Mali.

MATERIALS AND METHODS

This was a descriptive cross- sectional study that took place in Bamako from October 1, 2016 to December 31, 2017. We conducted a literature review and interviews with 36 pharmacists, 400 policyholders, 90 prescribers, and 04 resource personsfrom delegated management organizations. Analysis of the interview data was done using SPSS 20.

RESULTS

A total of 2 Acts and 6 Orders in Council enshrine the legislative and regulatory provisions of the AMO. Most insured persons (90%) thought the pharmacist was a drug specialist. More than 80% of the medications on the care sheets were fully available. Among their tasks in implementing the AMO, 38.9 % of pharmacists mentioned the availability of medicines, 27.70 % the application of good dispensing practices and 16.7 % the right to substitution.

CONCLUSION

Substitution of unavailable drugs is a factor that can contribute to reducing health care costs for patients and to their satisfaction.

[Vaccination against COVID-19 in pharmacies in the Auvergne-Rhône-Alpes region. Study conducted three months after the start of vaccination]

Introduction

Le développement de vaccins contre le SARS-Cov-2 a permis le déploiement de la vaccination notamment par l’intermédiaire des pharmaciens officinaux, déjà autorisés à la vaccination anti-grippale en France.

Méthodologie

Nous avons interrogé les pharmaciens d’officine de la région Auvergne-Rhône-Alpes pour un état des lieux de la pratique vaccinale anti-COVID-19 dans la région. Un questionnaire leur a été transmis ; l’analyse a été réalisée conjointement avec l’URPS-Pharmaciens.

Résultats

Au total, 739 officines ont participé à notre enquête, et nous ont fait part de leurs impressions pour l’organisation de la vaccination anti-COVID 19 et des informations à transmettre aux patients.

Conclusions

L’engagement des pharmaciens d’officine à la vaccination anti-COVID-19 témoigne de l’attachement des pharmaciens à leur patientèle, et de leur place privilégiée dans la prévention en France. L’élargissement de leurs compétences à la vaccination générale de la population attend une légitimité des pouvoirs décisionnels.

[Food allergy at school: Personalized healthcare project and adrenaline]

In Europe, the prevalence of food allergy is estimated at 6-8% of children. Ten to 20% of pediatric food-induced anaphylaxis reactions occur at school. Individual healthcare plans (IHP) for food allergy aim at: identifying children at risk of allergic reactions; reducing the risk of allergen exposure; providing emergency kits containing adrenaline auto-injectors (AAI) if needed with emergency action plans and instructions about when and how to use AAI. In France, IHP were introduced into law in 2003 and was updated in 2021. The number of IHP for allergy is increasing since 10 years (50,000 IHP for allergy/year). While the recommendations of the learned societies have resulted in the national harmonization of criteria for the implementation of IHP for allergy and for the prescription of emergency kits with AAI, adrenaline remains underused. In 2019, a national policy stated that all high schools must have a provision of spare AAI in case of anaphylaxis and the promotion of school staff training about food allergy and anaphylaxis was encouraged. These recommendations should be assessed widely and allergy training should be widespread. Pharmacists play an important role to take care of food-allergic children: provision of AAI prescribed for the most at-risk food allergic patients, advice and information on AAI. The pharmacist is therefore a key player in the therapeutic education of the patient to reinforce the key messages on the efficacy and safety of adrenaline used for anaphylaxis.

[Roles and impacts of the pharmacist in the management of insomnia: A literature review]

BACKGROUND

Insomnia is a common sleep disorder that affects a large portion of the population in a situational, recurrent, or chronic way. In Canada, it is estimated that 13% of the population suffers from it.

OBJECTIVE

The primary objective of this literature review is to identify and describe studies dealing with the role and impact of the management of insomnia by a pharmacist.

METHOD

PubMed®, EMBASE® and CINALH Complete were searched to extract articles published between January 1st, 1990 and May 28, 2020. Studies on the role and impact of management of insomnia by a pharmacist, in French and English, descriptive or quantitative, with or without control group were included. Articles that did not deal with insomnia as the primary topic or where insomnia is a secondary condition were excluded, conference abstracts and studies showing no concrete results. The following variables were extracted: author, type of study, duration, location, sample size and characteristics of participants, description of pharmacist interventions, limits and biases, outcomes assessed and results. The quality of the pharmacists' interventions description was evaluated with DEPICT2.

RESULTS

Our review identified eight articles published from 2006 to 2018 evaluating 14 types of outcomes and 41 separate outcomes. A total of 37% (7/19) of the quantitative outcomes had statistically significant positive results, regarding insomnia qualification, symptoms and adequate use. Six studies were conducted in community pharmacy. The quality score varied between 8 and 10 out of 11.

CONCLUSION

There is little data on the role and impact of the management of insomnia by a pharmacist. The pharmacist can have a positive impact, particularly when practicing in a community pharmacy. Given the limited data and the prevalence of insomnia, it appears relevant to invest in pharmaceutical evaluative research for this condition.

[The professions of colonial pharmacist in French West Africa]

During the twentieth century, French colonial rule in West Africa was marked by the establishment of a homogeneous health organization in the colonies. It was based on the health service of the colonial troops, the hospital service under the general service and other services such as health police, epidemics and hygiene. This health system made it possible to protect the colonizers and indigenous populations from the major endemics of the time, to conduct research on new diseases hitherto unrecognized and to bring "civilization" to the overseas territories. The pharmacist's missions in the colonial health system were manifold. Our study aims to shed light on the profession of colonial pharmacist in the health history of French West Africa. To do this, it concerned the period between the creation of the Federation of French West Africa (1895) and the end of colonization (1960). Drawing on the available documentation, including archival material and bibliographic sources, this article shows that the colonial pharmacist was already exercising a multidisciplinary profession. He was in fact hospital manager, wholesaler-distributor, pharmacy, biologist, chemist, botanist, teacher, central actor in public health.

Vaccine distrust: Investigation of the views and attitudes of parents in regard to vaccination of their children

BACKGROUND

In France, many parents have lost confidence in vaccinations, which has a direct impact on immunization coverage. Pharmacists, like other health professionals, often encounter parents exhibiting vaccine distrust.

METHODS

Using a survey distributed in a school and in a number of volunteering pharmacies, the objective of this study was to gain a better understanding of the views and the attitude of parents in regard to vaccination of their children.

RESULTS

Our results show that the main concerns were in regard to vaccine adjuvants, the risk of short- and long-term adverse effects, and the risk of developing a disease or a disability as a result of vaccination. The parents, although they tended to express a degree of reluctance and apprehension, in general, they were not opposed to vaccination, and they sought objective scientific information and full transparency regarding all aspects of vaccine composition, adverse effects, and effectiveness. Cooperation of all the parties involved in the health system on this subject is essential for a seamless chain of care and to improve vaccination coverage.

CONCLUSION

The information collected, combined with a review of the international literature, allow avenues for dialogue adapted to parents' opinions to be established and thus assist health professionals to communicate effectively regarding vaccines, which is a bona fide public health issue.

[Prevention of iatrogenic risk and screening of chronic kidney disease]

Ten percent of the world's population is affected by chronic kidney disease that can lead to kidney failure. In France, nearly three million people are concerned, half of whom are undiagnosed, 85,000 people are on dialysis or waiting for a kidney transplant. Each year, 11,000 new diagnoses of severe renal failure are made, one third of which had not been treated before. Kidney failure is constantly increasing due to the aging of the population and the resurgence of chronic diseases, including obesity and cardiovascular diseases such as high blood pressure and diabetes, two conditions that impair renal function. The pharmacist, a local actor, is well placed to help patients adhere to their treatment and manage it to the best of their quality of life. It is up to the pharmacist to check the dosages according to the degree of renal involvement, ideally noted on the prescription or, failing that, by asking the patient the results of his recent biological examinations. The consultation of the pharmaceutical file and, ultimately, the shared medical file, will make it possible, in a concerted management of the patient's care pathway, to also detect possible drug interactions. By dispensing the prescribed drugs, the pharmacist can also warn against those known to be known for their nephrotoxicity, especially nonsteroidal anti-inflammatory drugs. In the case of over-the-counter products, the pharmacist may discourage a person at risk from taking certain drugs containing nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen. Because of their potential renal toxicity, the pharmacist is competent to alert, especially on certain food supplements, herbal products, and is legitimate to participate in screening campaigns.

Benefits of pharmacist-led flu vaccination services in community pharmacy

Seasonal influenza is a major cause of excess winter deaths and increased hospital admissions. There is a high level of economic burden associated with the infection. Although vaccination targets have been set to tackle this international issue, many countries struggle to reach these coverage targets for their at-risk populations using traditional delivery methods. Traditional providers include family doctors and nurses; however, pharmacist-led influenza vaccination has become a more commonly utilised aid to support vaccination targets. Community pharmacies are convenient and widely accessible and evaluations consistently demonstrate that patients are satisfied with pharmacist-led vaccinations. Allowing community pharmacists to administer influenza vaccination as an alternative option for delivery helps to increase the coverage rate of vaccination. In addition, commissioning community pharmacists to provide this service has been shown to contribute to achieving targets for those at-risk. Pharmacist-led influenza vaccination services can create value for payors and reduce pressure on health systems. This review aims to demonstrate the success of pharmacy-led influenza vaccinations, and the impact it has had in driving up immunisation rates within other countries. Experiences of countries such as England, Portugal and the United States provide evidence to demonstrate the benefit to both the patient and the health system.

[Selection and optimal sequence of critical elements for medication review: A simulation with hospital pharmacy residents]

OBJECTIVES

The main objective of this study was to compare the responses of pharmacy residents regarding critical steps for medication order review, in the presence or absence of clinical pharmacists on patient care units, to describe the sequence of these steps and to compare them to an optimal sequence. The secondary objectives were to test this sequence in a simulation and to assess the residents' level of agreement on medication order review.

METHODS

Twenty-two validation steps were selected from guidelines. A simulation on order review was organized in three steps: selecting elements judged to be necessary or not for the order review critical path, then organizing this sequence in chronological order, implementation of this critical path on two simulated practical cases, resident perceptions about order review in their training.

RESULTS

Forty-one residents participated in the activity. Responses were heterogeneous regarding the elements' sequence and the time required for the review of a simulated case (3-13minutes). A majority of residents considered that their training was insufficient (29/41), that pharmacists validated differently (27/41), and that it was impossible to review the 22 proposed items for each prescription (30/41).

CONCLUSIONS

This article highlights heterogeneous medication order review practices among pharmacy residents, due to a lack of training in their curriculum according to them. It is essential to acquire medication order review standard both locally and nationally.

Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals

OBJECTIVE

In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities.

METHODS

We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires.

RESULTS

A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros.

CONCLUSION

Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities.

[Updates on prevention and treatment of melanoma: Pharmacist involvements and challenges]

Melanoma is a skin cancer that represents an actual public health problem. Its incidence is increasing every year. Environmental risk factors have been clearly identified. Early diagnosis of a suspicious skin lesion should be possible by any health professionals because the prognosis is correlated with the evolution of the disease and the presence of metastases. The advent of new therapies in metastatic forms with the development of immunotherapies and kinases inhibitors has significantly changed the management of this disease. New therapies are available in retail pharmacies and involve health professionals out of the hospital. This article is intended for community and hospital pharmacists and summarizes recommendations for primary and secondary prevention. It updates on new targeted therapies. It wants to give advices to the community pharmacists about the effective use of those treatments for melanoma.

Pharmacists' different profiles characterization about opioid substitution treatments

INTRODUCTION

Delivering practices of opioid substitution treatment (OST) in community pharmacies are heterogeneous. This study aims at drawing up an inventory and at characterizing different populations of pharmacists, regarding their practices and perceptions.

METHODS

We distributed a questionnaire to pharmacists, which was divided into two parts: socio-demographic questions, and 49 binary questions collecting pharmacists' perceptions. Statistical analyses were performed using SAS 9.3 and SPAD7 software. The categorical variables were expressed as numbers and percentages. We characterized the different profiles of pharmacists using a multivariate analysis method.

RESULTS

We analyzed 303 questionnaires; 60.8% of our cross-section of pharmacists consider that OSTs are a treatment for chronic disease, a treatment in which they consider that they play a key role. Regarding OSTs, 89.3% felt "comfortable" with current regulations, while 77.3% have mastered possible interactions with other drugs. 16.8% of pharmacists equate the act of delivering OSTs as a "legal narcotic deal". Regarding the patients, 49.2% of pharmacists consider them as "different", and 39.1% fear that they cause relationship problems. Most pharmacists perceive the role they are meant to play, although a lack of training and the need for recommendations have been highlighted. PCA allowed us to characterize 4 different profiles of pharmacists.

CONCLUSION

Continuous training adapted to the different profiles we drew up will be offered in order to allow pharmacists to deepen their knowledge about drug dependence and related care support.

[Hospital pharmacists' perception of pharmacovigilance in Quebec]

OBJECTIVES

To assess the pharmacovigilance perception of Quebec's hospital pharmacists.

METHODS

Cross-sectional study. A questionnaire with 16 questions was developed in order to assess respondents' perception of their ability to practice pharmacovigilance, factors that can influence adverse drug reactions reporting and measures to increase reporting rate. The online questionnaire was sent to hospital pharmacist from Quebec in April 2014. The results were presented in the form of descriptive data.

RESULTS

A total of 179/252 (71%) hospital pharmacists responded. More than 90% of respondents considered that they were able to practice all activities related to pharmacovigilance. During one year of practice, 98% of respondents faced at least one serious or unexpected adverse drug reaction and 77% notified at least one adverse drug reaction to Health Canada. The factors encouraging more than 89% of respondents to notify were: the severity, the rapidity of onset, the visibility of the reaction, the fact that the adverse drug reaction was unexpected or due to a recent marketed drug. More than 69% of respondents considered the overwork as the principal obstacle to the notification. The majority of respondents supported the implementation of 13/14 measures in order to increase reporting rate.

CONCLUSION

Hospital pharmacists from Quebec presented a favorable ability to practice pharmacovigilance. Analysis of their perception of pharmacovigilance helped to identify improvements, such as the implementation of a pharmacovigilance coordinator in the health center.

[Euthanasia and/or medically assisted suicide: Reflection on the new responsibility of the hospital pharmacist]

CONTEXT

Concern about euthanasia and medically assisted suicide is currently growing around the world and particularly in France. Though not authorized at present in France, the role of hospital pharmacist in this issue needs to be discussed.

OBJECTIVES

This article aims to gather medical and legal literature of European Union member states on these issues and particularly in France. To propose a practical thinking on the possible role of hospital pharmacist.

RESULTS

Among European Union, euthanasia and/or assisted suicide have already been introduced in some member states' laws. In France, Leonetti law currently sets the legal framework for the management of end of life. To address the society's demand on these issues, French President F. Hollande made two ethics committees responsible for working on it. Both were mainly against euthanasia and assisted suicide. Though a bit forgotten in this debate, hospital pharmacist needs to be associated in the thinking, as the main "drug-keeper". Indeed, guidelines are necessary to outline and ensure a safe drug use, complying with professional ethics, if lethal doses are voluntarily prescribed.

CONCLUSION

Pharmaceutical work is in constant evolution and is addressing new issues still unanswered, including assisted suicide and euthanasia. French pharmaceutical authorities should seize upon them, in order to guarantee pharmaceutical ethics. These practices, if authorized by law, should remain exceptional, and law strictly enforced. The pharmacist could be one of these "lawkeepers".