Acceptance Of Pharmacists Research Articles

Infringement of clinical pharmacist's authority.

Clinical pharmacists are healthcare practitioners who have advanced education and training in comprehensive medication management. Clinical pharmacists work with other members of the healthcare team to manage particular medications or disease states. Even though clinical pharmacists are members of healthcare teams, there are still many cases of challenge in the interprofessional relationship with other healthcare team members, especially related to drug management. Increasing interprofessional communication between physicians and clinical pharmacists within the healthcare system could enhance the role of clinical pharmacists. Earlier studies reported that physicians were comfortable with pharmacists detecting and preventing prescription errors, but were uncomfortable with them recommending drug therapy to patients. Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services. The role of clinical pharmacists could be improved by increasing interprofessional communication between doctors and clinical pharmacists in the healthcare system.

Pharmacist-Led Medication Management in Acute Geriatric Medicine and Its Associations with Rehospitalizations: A Cohort Study

Introduction: Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners’ decision to continue or change discharge medication (GPD). Methods: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations. Results: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%). Discussion: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist’s acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.

Hepatitis C virus screening in community pharmacies: results on feasibility from a Swiss pilot

BackgroundHepatitis C virus (HCV) infections are a public health burden worldwide and often go undetected until sequelae develop. Offering HCV screening for the different vulnerable populations in community pharmacies could help prevent further undetected HCV infections. This pilot aimed to assess the feasibility and pharmacist acceptance of HCV rapid antibody saliva testing in community pharmacies.MethodsA structured pharmaceutical care intervention was developed that included addressing, informing, and screening clients, as well as referral and reporting to subsequent health care providers. Participating pharmacies from French-, German- and Italian-speaking parts of Switzerland were trained to provide this service to local vulnerable populations. Information on client recruitment, feasibility, and acceptability of HCV screening was collected.ResultsOf 36 pharmacies initially recruited, 25 started the pilot and approached 435 clients, 145 of whom (33%) were interested in screening. Eight of these rapid antibody tests returned positive (prevalence rate: 5.5%). Facilitators were being able to offer a free rapid test (73%), followed by having training prior to the project (67%) and having a new service to offer (67%). The possibility of clients reacting dismissively (53%) and of unsettling clients (47%) were reported to be the main barriers.ConclusionsThis pilot demonstrated the general feasibility of an HCV screening service with rapid antibody saliva testing in Swiss community pharmacies, which achieved a higher prevalence rate than national estimates. With appropriate communication training and remuneration, Swiss community pharmacies could be an important partner in implementing HCV elimination strategies.

Global engagement of pharmacists in test and treat initiatives: Bringing care from clinics to communities

The coronavirus disease 2019 pandemic has placed substantial strain on the global health care workforce, disrupting essential and nonessential services. Task sharing of test and treat services to nontraditional prescribers, such as pharmacists, can facilitate more resilient health care systems by expanding access to health services while simultaneously decreasing the pressure on traditional health care providers. Expansion of pharmacists’ scope of work has historically been hindered by sociopolitical, resourcing, and competency considerations; addressing these challenges will be key to including pharmacists in testing and treatment of priority diseases. Sociopolitical considerations include migrating to flexible national legislation and scope of practices as well as engagement with other health care providers and the public to increase the acceptance of pharmacists participating in test and treat services. Resourcing issues include health care financing for test and treat services to parallel established systems or use voucher systems and service competition. In addition, pharmacists can use their training in supply chain management to ease and prevent medication stockouts in test to treat initiatives. Investments in technologies that support disease surveillance, basic reporting, and interoperability with health management information systems can integrate these initiatives into health care systems. Competency considerations comprise test and treat specific education for the pharmacy profession to equip them with the knowledge and confidence to execute successfully. Monitoring and evaluating the outcomes of these services can facilitate the scalability of test and treat initiatives. Pharmacists are uniquely positioned to bring testing and treatment from the clinic to the community.

Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana.

BackgroundHypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug‐related problems (DRPs).AimTo determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients.MethodIt was a prospective cross‐sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis.ResultsA total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and “no” or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04–47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18–0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14–0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03–17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved).ConclusionDRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.

Understanding the factors influencing prescriber uptake of pharmacist recommendations in secondary care.

Pharmacists are increasingly recognized as medication experts who can bring much to clinical teams and decision making. The inclusion of a pharmacist into a multidisciplinary team, including ward rounds, can be sporadic in some settings, meaning pharmacists are not always present at the point of decision making. In this way, subsequent recommendations may not always be adopted. Understanding the perceptions of prescribers to pharmacist input and preferences for receiving pharmacist input, may result in more effective and efficient patient care. The purpose of this study is to understand how prescribers view pharmacist contributions and the factors that facilitate or hinder acceptance of pharmacist recommendations within a hospital setting. This mixed methods study consisted of two stages, initially focus groups and an online survey. Thematic analysis of the focus group discussions was conducted, and these formed the basis of the survey. A total of 17 prescribers participated in the focus groups and 99 of 335 prescribers participated in the survey. The questions centred on 4 key aspects, 1) the perceived role of a pharmacist, 2) communication strategies 3) the value added by pharmacists and 4) barriers and enablers to adopting pharmacist recommendations. Prescribers strongly valued dosing advice and information on medication interactions. Some prescribers did not believe that a pharmacist should attend ward rounds, with more senior clinicians seeing value of recommendations being given at the time of medication initiation. Within a busy clinical setting several barriers were identified, including communication method, differing priorities, presence of pharmacist at the time of decision making, and consultant led hierarchy. Several factors influence acceptance of pharmacists' recommendations. Working on communication methods may overcome some, but others such as pharmacist presence on rounds and consultant led decision-making hierarchy may be harder to change.

Implementing community pharmacy-based influenza point-of-care test-and-treat under collaborative practice agreement

BackgroundEarly and accessible testing for influenza with point-of-care testing (POCT) can be a critical factor for deciding to begin antiviral treatment. More than 10,000 pharmacies across the USA offer Clinical Laboratory Improvement Amendments-waived POCT for infectious diseases, such as influenza A/B. Knowledge of barriers and facilitators to large-scale POCT implementation may be useful in scaling POCT for influenza test-and-treat services (Flu POCT). The objective of this study was to explore the experiences of pharmacists who were early adopters of Flu POCT and treatment under collaborative practice agreement in community pharmacy settings.MethodsQualitative research design with in-depth, semi-structured virtual video interviews of licensed US community pharmacists. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR). Interviewees were selected via a purposeful sampling of pharmacists who were enrolled in a nationwide clinical trial involving pharmacy-based influenza test-and-treat under a collaborative agreement. Interviews were recorded and transcribed. A deductive analytic approach was used via constructs from the CFIR.ResultsSix pharmacists were interviewed. Interviews ranged from 28 to 70 min, with an average length of 46 min. Four broad themes emerged from the data, and each had corresponding subthemes and supporting quotes: influence of the Flu POCT service characteristics on pharmacy implementation, influence of factors outside of the pharmacy setting in Flu POCT implementation, factors within the pharmacy setting influencing implementation, and process of implementing Flu POCT. A novel pharmacy-based Flu POCT implementation framework is presented.ConclusionsImplementation of community pharmacy-based Flu POCT services is feasible; but, a thorough understanding of both barriers and facilitators to their implementation is needed to increase the spread and scale of these programs. Specifically, pharmacy stakeholders should focus efforts on increasing patient and provider awareness, pharmacist acceptance, leadership support, and support of health providers external to the pharmacy to improve implementation success.

Public awareness about clinical trials in Lithuania

Community pharmacists have the responsibilities of identifying and resolving medication-related problems (MRPs), thereby improving patient safety.To deliver a series of clinical case scenarios using WhatsApp and assess the impact of this method on the ability of pharmacists to identify MRPs.This study was conducted in 104 community pharmacies in the United Arab Emirates (UAE) over a period of six months. Recruited pharmacies were randomly allocated to either intervention or control groups using a 1:1 allocation ratio. Senior experts in clinical pharmacy created a series of clinical case scenarios based on their clinical practice and based on previous published studies related to MRPs. WhatsApp®, a well-known messenger application, which has been proven to be an efficient platform to improve communication between learners and educators, was used to deliver clinical scenarios-based educational interventions to pharmacists. Then, pharmacists from both groups filled a standardized data reporting form. The clinical importance of pharmacist recommendations was assessed by a multidisciplinary expert panel.The total number of patients with MRPs across the intervention and control groups was 492 versus 194 (p = 0.01). While the number of MRPs identified, the mean time needed to resolve MRPs for patients with major polypharmacy, and physicians' acceptance of pharmacist recommendations across the intervention and control groups were 492 versus 194, 1589 versus 255, 6.82 (±3.86) versus 10.78 (±6.38), and 1065/1284 (82.94%) versus 125/201 (62.18%), respectively, all with p < 0.05. Efficacy-related problems (27.56%) and safety-related problems (28.44%) were the most commonly identified MRPs by pharmacists in the intervention group. Clinically significance of pharmacist recommendations was a significant predictive factor for physicians’ acceptance of pharmacist recommendations.Clinical case scenarios delivered by WhatsApp may be useful for improving the ability of pharmacists to identify MRPs and for shortening the mean time needed to resolve MRPs.

Impact of a drug-related patient-reported outcome measure on drug-related problem identification, physicians' acceptance, and clinical and quality of life outcomes: a randomized controlled trial.

Data are scarce regarding the usefulness of a pharmaceutical therapy-related quality of life measure including the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL), for providing pharmaceutical care. To evaluate the impact of the PROMPT-QoL on identifying drug-related problems (DRPs), physicians' acceptance of pharmacist's recommendations on the DRP resolution, and clinical and quality of life outcomes. A single-blind randomized controlled trial was conducted at a tertiary public hospital in Thailand from October 2019 to May 2020. A total of 286 outpatients with chronic diseases were randomly allocated into the control group (provided with pharmaceutical care only) (N = 146) and the intervention group (provided with pharmaceutical care together with use of the PROMPT-QoL) (N = 140). A significantly higher mean number of DRPs could be identified in the intervention group than in the control group (p < 0.001). Moreover, there was a significantly higher proportion of physicians' acceptance of pharmacist's recommendations on the DRP resolution in the intervention than in the control group (p = 0.019). Regarding the clinical outcome, a significantly higher proportion of the DRP resolution was found in the intervention group than in the control group (p = 0.002). For quality of life outcomes, the intervention group yielded a significantly higher mean difference between posttest and pretest on the Medicine and Disease Information domain score of the PROMPT-QoL (p = 0.029) and the EuroQoL-Visual Analog Scale score (p = 0.031) than the control group. This study revealed that the application of the PROMPT-QoL together with pharmaceutical care favorably influenced identification of DRPs, physicians' acceptances, and clinical outcomes. Trial registration TCTR20201208005 on December 5, 2020.

Exploring pharmacist experience and acceptance for debunking health misinformation in the social media

&#x0D; Introduction: The increasing evidence of misinformation on pharmacy issues in Social Media (SM) may provide potential for pharmacist involvement. &#x0D; Aim: This study aims at exploring pharmacist experience and acceptance to debunk pharmacy misinformation in SM. &#x0D; Methods: Four Focus Group Discussions (FGDs) with 41 selected pharmacists were conducted. The FGDs collected participant’s experience with misinformation, action taken and participant’s acceptance for debunking misinformation. The FGDs were audio recorded, subsequently transcribed and thematically analysed. &#x0D; Results: The majority of respondents often clarified the misinformation. Pharmacist motivation, relationship with the sender, opportunities to response and ability to respond the misleading message are themes determining pharmacist acceptance for debunking misinformation in SM.&#x0D; Conclusion: Pharmacist has the potential to contain and prevent misinformation about health and pharmacy issues in SM.&#x0D;

A novel educational approach for improving medication-related problems in community pharmacies.

Community pharmacists have the responsibilities of identifying and resolving medication-related problems (MRPs), thereby improving patient safety. To deliver a series of clinical case scenarios using WhatsApp and assess the impact of this method on the ability of pharmacists to identify MRPs. This study was conducted in 104 community pharmacies in the United Arab Emirates (UAE) over a period of six months. Recruited pharmacies were randomly allocated to either intervention or control groups using a 1:1 allocation ratio. Senior experts in clinical pharmacy created a series of clinical case scenarios based on their clinical practice and based on previous published studies related to MRPs. WhatsApp®, a well-known messenger application, which has been proven to be an efficient platform to improve communication between learners and educators, was used to deliver clinical scenarios-based educational interventions to pharmacists. Then, pharmacists from both groups filled a standardized data reporting form. The clinical importance of pharmacist recommendations was assessed by a multidisciplinary expert panel. The total number of patients with MRPs across the intervention and control groups was 492 versus 194 (p=0.01). While the number of MRPs identified, the mean time needed to resolve MRPs for patients with major polypharmacy, and physicians' acceptance of pharmacist recommendations across the intervention and control groups were 492 versus 194, 1589 versus 255, 6.82 (±3.86) versus 10.78 (±6.38), and 1065/1284 (82.94%) versus 125/201 (62.18%), respectively, all with p<0.05. Efficacy-related problems (27.56%) and safety-related problems (28.44%) were the most commonly identified MRPs by pharmacists in the intervention group. Clinically significance of pharmacist recommendations was a significant predictive factor for physicians' acceptance of pharmacist recommendations. Clinical case scenarios delivered by WhatsApp may be useful for improving the ability of pharmacists to identify MRPs and for shortening the mean time needed to resolve MRPs.

Resources Assessment for Penicillin Allergy Testing Performed by Pharmacists at the Patient's Bedside.

Background:False penicillin allergies lead to increased antimicrobial resistance, adverse effects, and health care costs by promoting the use of broad-spectrum antibiotics. The Infectious Diseases Society of America recommends the implementation of allergy testing.Objectives:The primary objective of this research was to estimate the number of pharmacist full-time equivalents (FTEs) required for an intervention aimed at determining penicillin allergy in hospitalized patients. Acceptance of pharmacists’ suggestions on antibiotic therapy are described.Methods:A quasi-experimental study was conducted in a 712-bed university hospital involving hospitalized patients with a suspected penicillin allergy and an infection treatable with penicillin. The time required for the intervention, which included a questionnaire, penicillin allergy testing (skin-prick test, intradermal injection, and oral provocation test), and recommendations on antibiotic therapy were measured to calculate the number of pharmacist FTEs.Results:A total of 55 patients were included. Scarification allergy testing was performed on 37, intradermal allergy test on 33, and oral provocation test on 26 patients. The intervention ruled out penicillin allergy in 26 patients, with no serious adverse effects. The intervention was associated with a median weekly pharmacist FTE of 0.15 (interquartile range = 0.12-0.25). The acceptance of pharmacists’ suggestions was high and led to 9 patients being switched to an antibiotic with a narrower spectrum of activity.Conclusions and Relevance:This study describes penicillin allergy testing and the number of median weekly hospital pharmacist FTEs required, which was approximately 0.15. These data may aid in the implementation of this safe intervention that promotes narrower-spectrum antibiotherapy.

Acceptance of Pharmacist’s Extended Roles by other Healthcare Providers in the Arab Region: Review Article

Pharmacists play critical roles in the primary healthcare system with other healthcare providers (HCPs). Extended pharmacists&rsquo; roles and pharmaceutical services have been adopted in developed countries. However, the practice of the pharmacy profession in the majority of Arab countries in the Middle East and North Africa (MENA) region still depends on conventional activities with exceptions of providing new pharmaceutical care services in some countries such as UAE, Qatar, and Saudi Arabia.

Effects of Health Informations System “Dosing Gama” on Time Efficiency in Dosage Adjustment Evaluation

Indonesian Ministry of Health shows an increase in patients with impaired kidney and liver function by 10-50% since 2007. The increase is a challenge for pharmacists in conducting pharmaceutical care, which is that dose adjustment for these patients takes a long time. Dosing GAMA, an application that has been developed in 2018, is expected to overcome these obstacles. This study aims to identify the use of the Dosing GAMA application to assist pharmacists in making dose adjustments evaluation more efficient and to assess pharmacist's acceptance of the application. This study was a quasi-experimental study using post-test with control group design. Respondents were recruited by selecting pharmacists according to the inclusion criterion. The control group consisted of 26 pharmacists who made dose adjustments manually, and the intervention group consisted of 26 pharmacists who made dose adjustments using the Dosing GAMA application. Data were obtained by measuring the time required by the pharmacist to make dose adjustments. The intervention group was then asked to complete a perceived acceptance questionnaire. The study indicated that Dosing GAMA could reduce the time needed for dose adjustment evaluation (p&lt;0.05). An average time spent by pharmacists with Dosing GAMA was shorter than that spent by those who made dose adjustments manually without application (13.81±0.78 min vs. 27.5±1.23 min). Overall, the pharmacists have high perceived acceptance of the application. The study results can be used as the basis for developing the application. Furthermore, it is expected that the Dosing GAMA can improve pharmacists’ performance in providing effective pharmaceutical care.

Determinants of national drug products acceptance across patients, pharmacists, and manufacturers: A mixed method study

Introduction The national pharmaceutical industry is pivotal for both the health sector and the national economy. This study aims to identify determinants of national drug products acceptance. The objectives of this study were to quantitatively measure the level of patient and community pharmacist acceptance of national drug products available in community pharmacies and to qualitatively explore the barriers facing national pharmaceutical companies and investigate the suggested solutions. Methods This cross-sectional study used an explanatory mixed method design. It was conducted in Baghdad, Iraq from July through October 2018. The study included two surveys (one for pharmacy customers and another for pharmacists) and thereafter semi-structured interviews of national pharmaceutical company owners/managers. The interview guide was developed based on preliminary quantitative results. Thematic analysis was used to analyze the interview findings. Results We received 123 patient surveys and 125 usable pharmacist surveys. We conducted seven interviews and stopped when we reached saturation. Integrated qualitative and quantitative findings showed that the main determinants of national drug product acceptance are product characteristics (namely price, packaging, brand, and availability), healthcare providers effect on product promotion and perceived effectiveness, and regulations enforced by authorities mainly the Ministry of Health. Conclusions Product price was the number one modulating factor in patient decision-making when purchasing a drug product. It appears that physicians and pharmacists are playing negative or at least neutral role in promoting national drug products and sustaining patients trust in national drug products. Current policies appeared to slow national drug industry growth and limit manufacturers’ ability to expand their share in the market. Manufacturer marketing efforts can help in gaining physicians and pharmacists support of the national drug product. Reforms to current drug policy and regulations were proposed by manufacturers.

Perceived Benefit of Immunization-Trained Technicians in the Pharmacy Workflow.

Clinical community pharmacists have continually restructured their workflow to serve the community by optimizing patient care outcomes. Defining the perceived benefits of having an immunizing pharmacy technician in the workflow can help to redefine the way community pharmacists operate during patient immunization. The purpose of this study is to share the opinions of supervising pharmacists that have an immunizing technician within their workflow model and highlight their contributions. Pharmacists involved in this novel workflow model were interviewed two times, once in 2017 and then in 2020, to gauge opinions over time. Findings in the results of this study included such themes as: (1) Pharmacists’ perceived improvement in workflow flexibility; (2) The choice of the correct technician to immunize within the pharmacy; (3) Pharmacists’ perceived improved workflow time prioritization; (4) Limited available training as a barrier to implementation; and (5) The initial apprehension and later acceptance of pharmacists with respect to the innovation. As technician immunization administration spreads beyond early adopter states, further research into the impact on pharmacy workflow is needed.

The Clinical Pharmacist-Led Consultation for Infectious Diseases in Guizhou Province, China: A Survey Among Hospital Pharmacies.

BackgroundAs antimicrobial resistance became an increasing threat to global public health, Clinical Pharmacist-led Consultation (CPC) for Infectious Diseases (ID) was developed in China. We conducted a survey among hospital pharmacies to investigate the present situation and potential determinants of CPC for ID in China's Guizhou Province.MethodsThe study was conducted by sending the questionnaire to the directors of hospital pharmacy who were members of Guizhou Province Pharmaceutical Administration Collaboration Network (GPPACN) from April to May 2019. We implemented the Firth's logistic regression model to analyze the factors that influence the implementation of CPC. The acceptance rate of consultation suggestions (ARCS) and effective response rate after acceptance of pharmacists' suggestions (ERRAPS) were pooled by meta-analysis using a random effect model, respectively. A pairwise meta-analysis was performed to compare the effective response rate between patients whose treatment followed the pharmacists' suggestions and those whose treatment did not.ResultsA total of 83 hospitals covering 9 regions in Guizhou Province were included in this survey. The results showed that 50 hospitals (60.24%) developed the CPC for ID. Staffing ID, respiratory, or general clinical pharmacist had a significantly positive effect on the implementation of CPC [adjusted odds ratios = 7.298, 95% CI (confidence interval): 2.232 to 23.858]. The pooled ARCS and ERRAPS for secondary hospitals were 97.59% (95% CI: 94.27 to 100.00%) and 88.36% (95% CI: 84.71 to 92.17%), respectively. Importantly, CPC improved the prognosis of ID patients [risk ratio (RR) = 6.49, 95% CI: 2.84 to 14.82] in these hospitals.ConclusionCPC adoption is gradually increasing among hospitals and will be a promising intervention for ID treatment at grassroots medical institutions in Guizhou Province. Training more clinical pharmacists to specialize in ID, respiratory, or general diseases might be the most practical measure to promote the development of CPC for ID.

The role of pharmacist in handling drug-related problems in breast cancer patients at Dr. Cipto Mangunkusumo Hospital

Background: DRP (Drug-Related Problems) affects the outcome of chemotherapy treatment to cancer patients. Matters related to DRP can be prevented by a pharmacist by providing drug information to doctors or other health professionals. The objective of this study was to determine the description of DRP, type of DRP, recommendations given by pharmacists on DRPs, acceptance of the results of recommendations and analysis of factors that affect DRPs.Methods: The research method was carried out through a cross sectional study in which observational data collection was conducted concurrently. The study population was all breast cancer patients from the Division of Surgical Oncology in the period January - April 2018 as many as 228 people. The collected data consisted of dosage suitability, suitability of carrier fluid volume, patient adherence to the schedule for breast cancer patients, recommendations given by pharmacists and the results of acceptance of pharmacist recommendations.Results: Based on research findings, the incidence of DRP was 76.3%. Most problems were regarding carrier fluid volume (64.5%) and dose mismatch (30%). There was also a DRP combination of carrier fluid volume and dose of 19%. The pharmacist’s recommendation was to change the dose by 15.52%, change the carrier fluid volume by 60.92%, and change the dose and volume of the carrier fluid by 23.56%. The recommended dosage received by doctors was 13 patients (7.47%), changing the volume of carrier fluid received by doctors by 106 patients (60.92%).Conclusions: Pharmacists can prevent DRPs through providing drug information to doctors or other health professionals so that increased communication between health professionals is required.

Evaluating provider acceptance of pharmacist interventions in the Discharge Companion Program and its association with readmission reduction

ObjectiveTo evaluate provider acceptance of pharmacist interventions within the Discharge Companion Program (DCP) and its association with hospital readmissions. MethodsThis retrospective record review included patients referred to the DCP between January and October 2018. DCP pharmacists’ interventions were assessed for provider acceptance on follow-up consultation or readmission. A chi-square test assessed the association between provider acceptance, communication modality, and technology used. A logistic regression model assessed the association between readmission risk and variables of interest. An a priori alpha level of 0.05 was used. ResultsOf the 197 patients referred to the DCP, 102 met inclusion criteria. DCP pharmacists made a total of 271 interventions; 185 (68.7%) required provider action. The most common intervention type was medication addition or discontinuation (n = 74, 40%); the communication mode was between DCP nurses and primary care provider offices or skilled nursing facilities (n = 56, 54.9%); and the preferred technology was the telephone (n = 58, 56.9%). Provider acceptance rate was 30.8% (n = 57) of actionable interventions, although it was not significantly associated with 30-day readmission reductions (P = 0.833) and did not differ significantly when interventions were communicated to other health care professionals (P = 0.53). The specific intervention communication mode (i.e., telephone, facsimile, or both) of pharmacist interventions did not significantly affect provider acceptance (P = 0.133). The overall readmission rate was 22.5% (n = 23), and the only significant predictor of 30-day readmission was the number of comorbidities (odds ratio 1.28 [95% CI 1.03–1.58], P = 0.024). ConclusionProvider acceptance of pharmacists’ interventions did not significantly affect 30-day readmission rates, regardless of communication mode (telephone or facsimile) or technology used. However, the DCP successfully identified numerous medication-related problems. Further study is warranted regarding provider acceptance of pharmacist recommendations on 30-day readmission reduction.

Physicians\u2019 acceptance of pharmacists\u2019 interventions in daily hospital practice

Background The physicians’ acceptance rate of pharmacists’ interventions to improve pharmacotherapy can vary depending on the setting. The acceptance rate of interventions proposed by pharmacists located in the hospital pharmacy over the telephone and factors associated with acceptance are largely unknown. Objective To determine the physicians’ acceptance rate of pharmacists’ interventions proposed over the telephone in daily hospital practice and to identify factors associated with acceptance. Setting A retrospective case–control study was performed concerning adult patients admitted to a university hospital in the Netherlands. Method Pharmacists’ interventions, based on alerts for drug–drug interactions and drug dosing in patients with renal impairment, recorded between January 2012 and June 2013 that were communicated over the telephone were included. Factors associated with physicians’ acceptance were identified with the use of a mixed-effects logistic model. Main outcome measure The primary outcome was the proportion of accepted interventions. Results A total of 841 interventions were included. Physicians accepted 599 interventions, resulting in an acceptance rate of 71.2%. The mixed-effects logistic model showed that acceptance was significantly associated with the number of prescribed drugs (16 to ≤ 20 drugs ORadj 1.88; 95% CI 1.05–3.35, > 20 drugs ORadj 2.90; 95% CI 1.41–5.96, compared to ≤ 10 drugs) and the severity of the drug-related problem (problem without potential harm ORadj 6.36; 95% CI 1.89–21.38; problem with potential harm OR 6.78; 95% CI 2.09–21.99, compared to clinically irrelevant problems), and inversely associated with continuation of pre-admission treatment (ORadj 0.55; 95% CI 0.35–0.87). Conclusion Over the study period, the majority of pharmacists’ interventions proposed over the telephone were accepted by physicians. The probability for acceptance increased for patients with an increasing number of medication orders, for clinically relevant problems and for problems related to treatment initiated during admission.