BackgroundGroup education has demonstrated benefits among people with diabetes, including reduced A1C and improved self-monitoring practices. Despite this, attendance rates are low for a variety of reasons, including lack of understanding of potential benefits among patients. ObjectivesThe pharmacist-led diabetes self-management education program at a community hospital has low attendance. This project assesses characteristics associated with attendance and compares outcomes among attendees and non-attendees. MethodsRetrospective data was collected between July 2022 and December 2023. Variables included: age, sex, class attendance, pre- and ≥ 90-day post-class A1C, pre- and post-class BMI, attending pharmacist-led clinic prior to scheduled class, social determinants of health screening survey responses, and diagnosis of depression or anxiety. Results103 patients were identified. 53 % attended at least one class out of a series of four. Attendance at the pharmacist-led diabetes clinic (70 % among attendees versus 30 % among non-attendees, p < 0.001) was associated with attendance. Age, gender, concurrent mental health diagnoses (depression and anxiety), and SDOH related needs were not associated with attendance. Baseline A1C was similar for attendees and non-attendees (9.6 vs. 9.7 %, respectively). Post-class A1C was 7.4 % for attendees of at least one class and 8 % for non-attendees. Patients who attended all four classes achieved a mean A1C <7 %. DiscussionThere are many factors that lead to lack of engagement with group education for diabetes. Referral to group education by a pharmacist who has established rapport with the patient and can speak to specific details about benefits of the classes may improve attendance at diabetes group education.

BackgroundThe implementation of telepharmacy technology has expanded significantly, particularly during the COVID-19 pandemic, to ensure continuous pharmaceutical care services. This practice is vital in rural and underserved areas where access to healthcare is limited. ObjectiveThis study aims to assess the knowledge, perception, and readiness of young pharmacists in rural Indonesia towards telepharmacy-assisted pharmaceutical services. MethodsA cross-sectional study was conducted from January to July 2023 in rural areas of Java, Sumatra, and Kalimantan, Indonesia. A convenience sampling method was employed with the aim of recruiting 520 registered pharmacists under 35 years of age (23–34 years old). Data were collected using an online questionnaire adapted for the local context and analyzed using SPSS version 26.0. ResultsThe study achieved an 86.67 % response rate. Most participants were female (73.1 %) and aged between 26 and 30 years (53.8 %). Nearly all pharmacists (97.1 %) held a Pharm.D degree. The knowledge assessment showed high awareness of telepharmacy's importance and its role during the COVID-19 pandemic, with 96.15 % recognizing the need for a strong internet connection. Positive perception was noted, with 90.38 % agreeing that telepharmacy enhances medication access in rural areas. However, concerns about increased error rates and workload were highlighted. A substantial proportion of pharmacists expressed readiness for conducting drug counselling via video consultation (44.23 %) and showed a willingness to undergo relevant training (59.62 %). ConclusionYoung pharmacists in rural Indonesia demonstrate a good level of knowledge and generally positive perceptions about telepharmacy, with notable readiness among pharmacists with less than five years of experience. While there is notable willingness to engage in telepharmacy practices and training, addressing concerns about workload and data security through targeted support and training will be crucial for the successful implementation of telepharmacy, potentially enhancing healthcare access in rural areas.

BackgroundThe Medication-Related Burden Quality of Life (MRB-QoL) is a 31-item valid and reliable patient-reported measure of medicine burden on functioning and well-being in people with long-term conditions (LTC). ObjectivesTo translate, culturally adapt, and content validate the MRB-QoL into Arabic. MethodsA rigorous approach to cross-cultural adaptation proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guideline was followed. After 3 forward translations and 2 backward translations, a multidisciplinary expert panel assessed the content validity (CV) of the items through a 2-round e-modified Delphi method followed by two-step cognitive debriefings with patients with LTC using think-aloud and probing techniques. An item-content validity index (I-CVI) score of ≥0.78 was considered acceptable. The original questionnaire developers and other researchers, as members of the review committee, reviewed and approved the Arabic version. ResultsFive semantic and 3 cultural translation discrepancies were identified and resolved by rewording the items. The 2 backward translations did not reveal significant problems, and equivalence to the original tool was confirmed following committee review. The Arabic version showed acceptable CV parameters. E-modified Delphi involved 9 experts in round one and 7 in round 2. The I-CVI scores ranged from 0.67 to 1.0, and agreement was reached after 2 rounds. The CVI for the final version of the MRB-QoL was 0.96. Expert panel review showed that the MRB-QoL-Arabic version is relevant (CVI = 0.92), important (CVI = 0.97), clear (CVI = 0.98), and comprehensive in measuring the burden of medicines. Data from 5 cognitive interviews showed that items and concepts included in the Arabic version of the MRB-QoL are relevant to the targeted sample, clear, and easy to understand. ConclusionThe MRB-QoL Arabic version was developed and content validated. However, further evaluation of its other psychometric properties is necessary before it can be utilized in clinical and research settings. Using this tool will enable a more accurate understanding of the effects of treatment burden on patient well-being, thereby guiding care toward minimally disruptive medicine.

BackgroundControlled substances (CS) are ‘diverted’ (stolen) from healthcare facilities via many integrated and diverse mechanisms due to a lack of safeguards. There remains a gap in understanding how healthcare workers (HCWs) leverage their social networks (e.g., their role/tasks and interactions with other roles/tasks) within the medication use process (MUP) that contribute to diversion. Social network analysis (SNA) is an analytic approach used to map and analyze social connections, which can help identify influential interdependence between HCWs and tasks susceptible to drug diversion. ObjectivesTo map the social network structures of MUP tasks vulnerable to CS diversion in two Inpatient pharmacies and compare diversion risks by identifying influential tasks and HCWs. MethodsThis was an exploratory sequential mixed methods study conducted in the Inpatient pharmacies at two large hospitals in Toronto, Canada. Initial analysis used previously collected clinical observation data to identify key pharmacy roles and tasks vulnerable to CS diversion. Subsequently, a cross-sectional survey was conducted to collect demographic information on HCWs and assess their engagement in the identified vulnerable tasks. Clinical observations and survey data were used to perform two-mode SNA to identify connections between HCWs and tasks susceptible to drug diversion. ResultsThe analysis identified different network structures across both sites but highlighted the importance of strategic Pharmacist or Technician Supervisor oversight to moderate-high vulnerability tasks. Pharmacy technicians were found to be the network's most central actors, while Pharmacists had a more supportive role on the network's periphery, providing oversight. Across both sites, there was strong connectivity between HCWs and tasks, indicating a higher level of security against potential undetected diversion. ConclusionBy strategically involving Pharmacists or Technician Supervisors, diversion risk can be mitigated through cross-checking and quality control. Through identifying the network structure of each unit, hospitals can identify opportunities for future interventions to prevent diversion.

BackgroundEnsuring patient safety is of paramount importance in healthcare systems. Rising concerns about medical errors in the UK have necessitated a greater focus on studying the nature of such errors, particularly those involving high-risk medications. ObjectivesTo conduct a retrospective analysis of incidents related to patient safety in the UK based on data from the National Rporting and Learning System (NRLS). MethodsThis study was conducted based on a review of the National Reporting and Learning System (NRLS) patient safety reports published between January 1, 2015, and December 31, 2015. NHS Improvement provides details regarding incidents following approval using a data-sharing agreement. In total, 1500 incidents were analszed and equally divided among the three categories of high-risk drugs: opioids, insulin, and anticoagulants. Excel® features and deductive reasoning (thematic analysis) were used for data analysis. ResultsThe results showed that the insulin category had both the highest risk and most errors compared with anticoagulants and opioids. These errors primarily result from issues related to administering, prescribing, and dispensing the drugs. Inadequate drug checks, communication difficulties among staff and patients, and high staff workloads are often linked to these errors. ConclusionThis study confirms that the NRLS database is a valuable source of data, and the suggestions put forth, based on these results, could contribute to the formulation of measures that diminish the occurrence of errors related to high-risk drugs in healthcare settings. Information technology should enhance medication safety by tracking the process of medication use.

BackgroundAntimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR. ObjectivesThis study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level. MethodsThis study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings. ResultsInterviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies. ConclusionThis study underscores the necessity of public awareness, pharmacist–patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use.

Diabetes caused 6.7 million deaths in 2021, equating to one death every five seconds, with its global financial burden projected to rise from $1.32 trillion in 2015 to $2.12 trillion by 2030. Severe hypoglycemia necessitates interventions like deprescribing, behavioral strategies, and technology for prevention. Deprescribing aims to reduce unnecessary medication use, enhance rational prescribing, prevent prescribing cascades, and improve health outcomes in elderly patients. Evaluating electronic leaflets can support deprescribing based on patient-centered care and shared decision-making. ObjectiveTo analyze information on deprescribing in oral antidiabetic leaflets from national medicines regulatory authorities, focusing on elderly patients with type 2 diabetes. MethodsThis documental study analyzed electronic leaflets of oral antidiabetics from the official websites of nine Medicines Regulatory Authorities: Australia, Brazil, Canada, New Zealand, Singapore, South Africa, UK, USA, and EU, covering drugs listed in the WHO's Essential Medicines List 2023. The analysis focused on the alignment of deprescribing information with the Ontario deprescribing algorithm for oral antidiabetics developed by the Bruyère Institute in Canada. ResultsOut of 72 expected leaflets, 64 (88.9 %) were retrieved. Only 18 leaflets (28.1 %) explicitly discussed deprescribing oral antihyperglycemics. Hypoglycemia and drug interaction risks were addressed in 55 leaflets (85.9 %). Caution for use in patients over 65 was mentioned in 32 leaflets (50 %), and 23 leaflets (35.9 %) addressed the risks of tight glucose and HbA1c targets. ConclusionDespite a high retrieval rate, 11.1 % of leaflets were missing, and those available contained inconsistent deprescribing information. There are significant disparities in guidance across regulatory authorities. Standardized, updated leaflets that address deprescribing in frail older patients could enhance prescribers' confidence and support shared decision-making