Clinical Pharmacist Recommendations Research Articles

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Survey-based perceptions of impact of clinical pharmacists by attending physicians and medical residents/fellows

BackgroundAnecdotal concern existed at our institution that over-reliance on clinical pharmacist recommendations for medication-related decisions could negatively impact medical resident/fellow learning. PurposeThe primary objective of this study was to evaluate perceived rounding clinical pharmacist impact by comparing perceptions of attending physicians with medical residents/fellows. MethodThis survey-based cohort study utilized two 10-item, 5-point Likert-scale surveys to evaluate perceptions of impact of clinical pharmacists on medical resident/fellow learning and overall reliance on clinical pharmacists at an academic tertiary care medical center. Mann-Whitney tests were utilized for statistical evaluations and statistical significance was set at a p-value of <0.05. DiscussionMedical residents/fellows perceived that clinical pharmacists positively impacted their overall learning more so than attending physicians’ (p = 0.002). Additionally, attending physicians perceived a greater reliance on clinical pharmacists by medical residents/fellows for information on medication adverse effects (p = 0.02). ConclusionsBoth attending physicians and medical residents/fellows believed that clinical pharmacists positively impact medical resident/fellow learning experiences.

Emergency Department Use in Black Individuals With Diabetes.

The prevalence of diabetes is higher in Black than in White individuals, and Blacks seek emergency department (ED) care for diabetes more often than Whites. This randomized controlled trial compared the efficacy of a novel intervention called the Diabetes Interprofessional Team to Enhance Adherence to Medical Care (DM I-TEAM) to usual medical care (UMC) to prevent return diabetes-related ED visits and hospitalizations over 12 months in 200 Black individuals with diabetes after an ED visit. The trial also identified baseline variables associated with return ED visits and hospitalizations. The DM I-TEAM provided diabetes education and behavioral activation services delivered by race-concordant research assistants, telehealth visits with a diabetes care and education specialist and primary care physicians, and clinical pharmacist recommendations. Participants had a mean age of 64.9 years, and 73.0% were women. There was no treatment group difference in return diabetes-related ED visits or hospitalizations over 12 months (DM I-TEAM n = 39 [45.3%] vs. UMC n = 37 [38.5%], χ2 = 0.864, P = 0.353). Baseline variables that were associated with return diabetes-related ED visits or hospitalizations were longer duration of diabetes, higher number of chronic health conditions, higher number of previous ED visits or hospitalizations, greater anticholinergic medication burden, lower satisfaction with primary care physicians, and lower trust in physicians (all P ≤0.05). Among Black individuals with diabetes, the DM I-TEAM interprofessional intervention was no better than UMC at preventing return diabetes-related ED visits or hospitalizations. High medical morbidity, greater anticholinergic medication burden, low satisfaction with primary care physicians, and physician mistrust were associated with diabetes-related ED visits or hospitalizations independent of treatment. Before clinical interventions such as the DM I-TEAM can be effective, reducing system-level barriers to health, improving physician-patient relationships and medication prescribing, and building community health care capacity will be necessary.

Clinical pharmacist interventions in ambulatory psychogeriatric patients with excessive polypharmacy

Psychogeriatric primary care patients are frequently treated with excessive polypharmacy (≥ 10 medications), leading to complications and increased costs. Such cases are rarely included in treatment guidelines and randomized controlled trials. This paper evaluates the impact of clinical pharmacist medication reviews on the quality of pharmacotherapy in primary care psychogeriatric patients with excessive polypharmacy. The retrospective observational multicentric pre-post study included patients (aged 65 or above) treated with at least one psychotropic and ten or more medications. Clinical pharmacists’ recommendations were retrieved from medication review forms for the period 2012⁠–⁠2014. The study outcome measures were the number of medications, potentially inappropriate medications in the elderly (PIMs), potential drug-drug interactions which should be avoided (pXDDIs), and adherence to treatment guidelines. The study included 246 patients receiving 3294 medications, of which 14.6% were psychotropics. The clinical pharmacists proposed 374 interventions in psychopharmacotherapy. The general practitioners accepted 45.2% of them (169). Accepting clinical pharmacist recommendations reduced the total number of medications by 7.5% from 13.4 to 12.4 per patient (p < 0.05), the total number of prescribed PIMs by 21.8% from 312 to 244 (p < 0.05), the number of pXDDIs by 54.9% from 71 to 31 (p < 0.05) and also improved treatment guidelines adherence for antidepressants and antipsychotics (p < 0.05). Clinical pharmacist interventions significantly improved the quality of psychopharmacotherapy by reducing the total number of medications, PIMs, and pXDDIs. Accepting clinical pharmacist interventions led to better treatment guidelines adherence.

Pharmacist gender and physician acceptance of antibiotic stewardship recommendations: An analysis of the reducing overuse of antibiotics at discharge home intervention.

To assess association of pharmacist gender with acceptance of antibiotic stewardship recommendations. A retrospective evaluation of the Reducing Overuse of Antibiotics at Discharge (ROAD) Home intervention. The study was conducted from May to October 2019 in a single academic medical center. The study included patients receiving antibiotics on a hospitalist service who were nearing discharge. During the intervention, clinical pharmacists (none who had specialist postgraduate infectious disease residency training) reviewed patients on antibiotics and led an antibiotic timeout (ie, structured conversation) prior to discharge to improve discharge antibiotic prescribing. We assessed the association of pharmacist gender with acceptance of timeout recommendations by hospitalists using logistic regression controlling for patient characteristics. Over 6 months, pharmacists conducted 295 timeouts: 158 timeouts (53.6%) were conducted by 12 women, 137 (46.4%) were conducted by 8 men. Pharmacists recommended an antibiotic change in 82 timeouts (27.8%), of which 51 (62.2%) were accepted. Compared to male pharmacists, female pharmacists were less likely to recommend a discharge antibiotic change: 30 (19.0%) of 158 versus 52 (38.0%) of 137 (P < .001). Female pharmacists were also less likely to have a recommendation accepted: 10 (33.3%) of 30 versus 41 (8.8%) of 52 (P < .001). Thus, timeouts conducted by female versus male pharmacists were less likely to result in an antibiotic change: 10 (6.3%) of 158 versus 41 (29.9%) of 137 (P < .001). After adjustments, pharmacist gender remained significantly associated with whether recommended changes were accepted (adjusted odds ratio [aOR], 0.10; 95%confidence interval [CI], 0.03-0.36 for female versus male pharmacists). Antibiotic stewardship recommendations made by female clinical pharmacists were less likely to be accepted by hospitalists. Gender bias may play a role in the acceptance of clinical pharmacist recommendations, which could affect patient care and outcomes.

Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic.

Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients' adherence to the clinical pharmacist interventions as well as the physicians' acceptance of these recommendations. This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations. Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p=0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient's compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%. The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients' confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.

Positive evidence for clinical pharmacist interventions during interdisciplinary rounding at a psychiatric hospital

Clinical pharmacists have not yet become an integral part of interdisciplinary ward rounds in most psychiatric hospitals across the European Union. This retrospective observational pre-post study examined the impact of clinical pharmacist recommendations in an interdisciplinary medical team during psychiatric hospital rounding. The study included all patients in a Slovenian psychiatric hospital who were hospitalized 2019–2020. The clinical pharmacist made 315 recommendations for a total of 224 participants (average age M = 59.4, median = 56). Psychiatrists accepted 295 (93.7%) of the recommendations. After the recommendations, the number of expressed and potential drug-related problems decreased in 166 (93.8%) and 129 (93.8%) interventions, respectively. Three months after discharge, 222 accepted recommendations were continued (70.5%). The most common recommendations were related to antipsychotics (19.4%, N = 61) followed by antidepressants (16.8%, N = 53). Including a clinical pharmacist in the interdisciplinary ward rounds at a psychiatric hospital reduced the number of expressed and potential drug-related problems with a very high recommendation acceptance rate. These results are the first in Central Europe to explore the benefits of including a clinical pharmacist in ward rounding.

Effectiveness of an Advanced Clinical Decision Support System on Clinical Decision-Making Skills in a Call Center Medication Therapy Management Pharmacy Setting: A Pilot Study.

(1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, p = 0.02). There was no significant change between control group pre- and post-test segments (p = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting.

Characterization of drug-related problems and associated factors in ambulatory patients in China.

This study aimed to investigate the prevalence and the type of drug-related problems (DRPs) in ambulatory patients and identify factors that may be associated with risk of DRPs. Consecutive patients were enrolled from pharmacist outpatient clinics between January 2018 and June 2019. The pharmacists performed a comprehensive assessment of the patient's drug therapy. The DRPs and recommendations were evaluated using the DOCUMENT classification system. The study population consisted of 248 patients with a mean age of 72.55±6.29. The patients had a mean of 7.55±4.72 ongoing medications during patients' routine clinic visits. A total of 1188 DRPs were identified during the study period. An average of 4.79 DRPs per patient was detected. Sixty-two different traditional Chinese patent medicines (TCPMs) contributed to 102 DRPs. Drug selection (24.9%) was the most common DRP followed by under treated (24.2%) and monitoring needed (24.2%). The number of medications taken was the significant factor for DRPs. Pharmacists made 1092 recommendations to address the DRPs (an average 0.92 recommendations per DRP). A change in therapy was the most common recommendation (43.6%), followed by the category 'monitoring' (28.6%). The overall acceptance rate of clinical pharmacist recommendations was 88.7%. More than a half (51.6%) of all interventions were assigned a moderate level of clinical significance. Drug-related problems were commonly observed among ambulatory Chinese patients. Clinical pharmacists had a valuable role to play in identifying and solving the DRPs.

PUK26 MULTIDISCIPLINARY CARE OF RENAL TRANSPLANT RECIPIENTS: THE ROLE OF CLINICAL PHARMACIST

There are limited data about the role of clinical Pharmacist as a direct care provider for renal transplant recipients, especially in the Arab world. This study aims at describing a single center experience in providing clinical pharmacy services for recently kidney transplanted patients. A pilot descriptive study has been conducted from January 2019 till April 2019 in the renal transplant unit of the Armed forces hospitals southern region, Saudi Arabia. A clinical Pharmacist attended the renal transplant selection committee weekly meetings, attended daily rounds, provided necessary drug therapy recommendations, responded to drug information requests, conducted medication reconciliation upon patients' admission and discharge and provided verbal and written pre and post-transplant patient education (during admission, post-transplant clinics visits and through social media) During the study period, 21 patients transplanted in the unit (52.4% females, mean age = 40.5 years SD=17.35 years). The clinical Pharmacist had 141 recommendations (6.7 recommendations per patient). Sixty-two recommendations (44%) were medication reconciliation related, 11 recommendations (7.8%) based on drug information requests while the remaining 48.2% were pharmacotherapeutic recommendations provided during daily rounds. Clinical pharmacist's recommendations involved immunosuppressive agents (34.8%), Antimicrobials (13.8%), bone-mineral disorders medications (11.5%), Electrolytes (9.4%), Anemia management medications (8.6%), Anticoagulants (4.3%), Antihypertensives (3.6%), antidiabetics (2.9%) and Miscellaneous medications (11.1%). The recommendations involved medications doses increases (38.2%),medications added (25%), doses reductions (16.2%), therapeutic drug monitoring lab requests (11.8%), medication discontinuation (5.9%) and medication substitution (2.9%). The overall physicians' acceptance rate of clinical Pharmacist's recommendations was 95.6%. The study findings suggest that clinical pharmacists could positively impact the quality of care for renal transplant recipients and promote their medication safety.

Фармакотерапія гострого вірусного гепатиту В: погляд клінічного провізора

Aim. To conduct the analysis and estimation of acute viral hepatitis B pharmacotherapy through identification of drug-related problems; to form a list of recommendations with elements of pharmaceutical care concerning some aspects of acute viral hepatitis B pharmacotherapy. Materials and Methods. The objects of research: 27 medical records of patients with acute viral hepatitis B who were hospitalized to one of Lviv City Hospitals in the first quarter of 2016; medical and technological documents on acute viral hepatitis B management; results of clinical research and clinical case reports; The Pharmaceutical Care Network Europe classification (version 5.01) for drug-related problems. Methods: systemic approach, clinical-pharmaceutical, clinical-pharmacological, statistical, and analytical. Results and Discussion. All patients with acute hepatitis B received only pathogenetic and/or symptomatic pharmacotherapy which corresponds to modern scientific approaches of rational pharmacotherapy of acute hepatitis B. The total number of identified drug-related problems was 192 (a mean of 7,1±1,4 drug-related problems per patient), out of them: 30,1% - potential drug-drug interactions; 27,5% - insufficient dosage of drugs; 14,6% - co-administration of medications with the same active ingredients (duplicate prescriptions); 11,5% - excessive duration of pharmacotherapy; 6,3% - incorrect drugs; 4,7% - incorrect route of drug administration; 1,6% - contraindicated use of drugs; 1,6% - excessive dosage of drugs; 1,6% - technical drug-related problems; and 0,5% - insufficient duration of pharmacotherapy. Conclusions. According to the results of this study, the list of clinical pharmacist's recommendations (messages of pharmaceutical care) have been formed which can be used for improving the quality and safety of pharmacotherapy. Key words: clinical pharmacist, acute viral hepatitis B, drug-related problems, rational pharmacotherapy

Implementation of clinical pharmacist recommendations and services at a University Hospital in Yemen.

Background Studies have revealed that the inclusion of a clinical pharmacist as a member in multidisciplinary medical team has been associated with improved medication use, reduced adverse drug reaction, reduced cost of treatment, and improved health outcomes. Objective The objectives of this study were to evaluate the implementation of clinical pharmacy recommendations and services, the acceptance rate by the physicians, and the anticipated outcomes of the recommendations at a hospital in Yemen. Methods Different units of the University of Science and Technology Hospital, Sana'a were included in this study. All the recommendations and services provided by the clinical pharmacist during daily activities were documented between June 2013 and November 2015. The provided recommendations were classified based on the type, acceptance rate, and the anticipated outcomes. Main outcome measure Type and quality of clinical pharmacists' recommendations, anticipated impact of the recommendations on health outcomes, and their acceptance rate. Results Throughout the study period, a total of 957 patients in different hospital units were visited and provided with a total of 3307 interventions and services. The most frequent types of clinical pharmacist's interventions were drug discontinuation (23.6%, n = 782), inappropriate dose interval or time (n = 735, 22.2%), and add medication (18.9%, n = 626). Overall, 61.8% (n = 2044) of the provided recommendations were accepted by the physicians. The most anticipated outcomes were improved the effectiveness of therapy (45.1%, n = 1909), avoid adverse drug reactions (29%, n = 1228), and decrease the cost of medications (18.8%, n = 797). Conclusion Clinical pharmacist's recommendations resulted in improving drug therapy and decreasing adverse effects for inpatients at the University of Science and Technology Hospital. This suggests that the implementation of clinical pharmacy services is essential and has a positive outcome on patient care.

Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit

ObjectiveTo determine the clinical pharmacist‐generated cost avoidance and benefit‐cost ratio in a medical intensive care unit (MICU).MethodsAll accepted clinical pharmacist recommendations on a multidisciplinary, rounding service at an academic medical center over a 12‐month period were evaluated. Cost avoidance values from each intervention were determined using a systematic framework. Total cost avoidance was calculated by summing the cost avoidance for each general category. Average rates of cost avoidance per day and hour were calculated by dividing total cost avoidance by number of days and hours the clinical pharmacist provided care. Average interventions and cost avoidance per day and hour were calculated for weekday and call status. Differences between months, day of the week, and call status were evaluated using chi‐square goodness of fit tests.ResultsOver 12 months, 8866 clinical pharmacist‐recommended interventions were implemented, averaging 38.9 interventions per workday. The four most commonly accepted interventions were minor adverse drug event prevention (n = 4023, 45%), dosage adjustment: no continuous renal replacement therapy (n = 1162, 13%), antimicrobial therapy initiation and streamlining (n = 966, 11%), and antimicrobial pharmacokinetic evaluation (n = 777, 9%). All interventions resulted in a total cost avoidance of $3 270 178, averaging $14 731 per workday. Interventions per hour (P &lt; 0.001) and average cost avoidance per hour (P &lt; 0.001) differed significantly across workdays. For on‐call days compared with postcall days, there were a similar average number of interventions per hour (10.2 vs 9.8, P = 0.28) and average cost avoidance per hour ($3741 vs $3622, P = 0.47); the benefit‐cost ratio was 24.5:1.ConclusionsThe clinical pharmacist‐generated cost avoidance over a 12‐month period in the MICU was $3 270 178 and the benefit‐cost ratio was 24.5:1. Day of the week but no call status affected average cost avoidance. Employing a clinical pharmacist to be part of the multidisciplinary MICU team can reduce health care expenditures through cost avoidance.

Assessment of drug related problems and clinical pharmacist interventions in paediatric department of a tertiary care teaching hospital

Background: Drug-related problems (DRPs) are frequent in hospitalization in pediatrics. The main aim of present investigation is to assess drug related problems and clinical pharmacist interventions in pediatric department of tertiary care hospital.Methods: It was a prospective, observational and interventional study carried over a period of 6 months.Results: A total of 66 patients were identified with drug related problems. Among them 31 (42%) were in between 1month–2 years followed by 25 (34%) were in between 2-11 years, 10(24%) were in between 11-18 years of age. 30(45.3%) patients were prescribed with 0-3 drugs followed by 21 (31.3%) were prescribed with 3-5 drugs, 15(23.3%) were prescribed with 6-10 drugs. Most of the DRP’s observed in the study were drug interactions 52(78.78%) [major-19 (36.53%), moderate-27 (5192%) and minor-6(11.53%)] followed by adverse drug reactions 12 (18.18%), and duplication errors were 2 (3.03%). Majority of the clinical pharmacist recommendations were duration change 52 (34.66%), drug change 10(6.66%), dose reduction 2 (1.35%) followed by drug termination 2 (1.33%). Major significance of DRPs were noted high 31(57.96%), whereas 25 (39.8%) were moderate and 8 (12.12%) were minor. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high in 57 (86.66%) cases while in 9 (13.33%) cases suggestions were accepted but therapy was not changed. There were no cases with neither suggestion were accepted nor therapy changed.Conclusions: Clinical pharmacist involvement in inpatient pediatric care can significantly help to identify, resolve and prevent the drug related problems. The study concluded that the clinical pharmacist has a significant role in patients care at hospital.

Drug Therapy Problem Identification and Resolution by Clinical Pharmacists in a Family Medicine Residency Clinic.

There are limited data to evaluate the impact of ambulatory clinical pharmacist recommendations on family medicine resident prescribing and monitoring of medications. The purpose of this study is to begin to gain insight in this area by answering the research question, "How many ambulatory clinical pharmacist recommendations for drug therapy problem (DTP) resolution are implemented on the day of a medication therapy management (MTM) visit in an outpatient family medicine residency clinic?" This is a retrospective chart review of face-to-face MTM encounters conducted by ambulatory clinical pharmacists (including pharmacist residents) from August 1, 2012 to June 30, 2015 at a family medicine residency clinic. Descriptive statistics were conducted to both quantify the number of DTPs identified and resolved on the day of the MTM visit as well as categorize the DTPs. Based on the 728 MTM encounters analyzed, patients were an average of 53.6 years old and took 11.9 medications to treat 5.7 medical conditions. A total of 3057 DTPs were identified in the 728 encounters, of which 1303 were resolved the same day as the MTM visit. This resulted in an average of 4.2 DTPs identified and 2.0 resolved per visit per patient. The most common DTP category identified in this study was the need for additional drug therapy (41.6%). Approximately half of the ambulatory clinical pharmacist's DTP resolution recommendations were implemented the same day they were identified, which highlights the strength of team-based patient care and interprofessional collaboration in a residency teaching clinic.

Pharmacists in humanitarian crisis settings: Assessing the impact of pharmacist-delivered home medication management review service to Syrian refugees in Jordan.

Refugees all over the world are facing several health-related problems. Chronic diseases among Syrian refugees in Jordan are high. The Home Medication Management Review (HMMR) service could be ideal to optimize refugees' health management. To assess the impact of the HMMR service on the type and frequency of Treatment Related Problems (TRPs) among Syrian refugees living in Jordan. This prospective randomized single blinded intervention-control study was conducted in three main cities in Jordan, between May and October 2016. Syrian refugees with chronic conditions were recruited and randomized into intervention and control groups. The HMMR service was conducted for all patients to identify TRPs at baseline. Data were collected via two home visits for all study participants. Clinical pharmacist's recommendations were written in a letter format to the physicians managing the patients in the intervention group only. Physicians' approved recommendations were conveyed to the patients via the pharmacist. Interventions at the patient level were delivered by the pharmacist directly. Patients were reassessed for their TRPs and satisfaction 3 months after baseline. Syrian refugees (n = 106) were recruited with no significant differences between the intervention (n = 53) and control groups (n = 53). A total of 1141 TRPs were identified for both groups at baseline, with a mean number of 10.8 ± 4.2 TRPs per patient. At follow-up, there was a significant decrease in the number of TRPs among the intervention group (P < 0.001, paired sample t-test) but not among the control group (P = 0.116). Physicians' approval rate of the pharmacist's recommendations was high (82.9%), and more than 70.0% of refugees in the intervention group reported high satisfaction with the HMMR service. Identified TRPs are high amongst Syrian refugees living in Jordan. The HMMR service significantly reduced the number of TRPs, and was highly accepted by the physicians. Refugees reported high satisfaction with this service.

Health Technology Assessment To Improve Patient Care Through Pharmaceutical Care: Clinical Pharmacist’s Perspective

Drug Related Problems could result in the medication errors, adverse events, drug interactions and harm to patients. AIM: The main aim of the study was to assess and evaluate the Clinical Pharmacist’s interventions in health care i.e., HTA and its application to improve and optimize patient care through pharmaceutical care and to achieve accuracy in patient treatment. A prospective, observational and interventional study. Ethical approval was obtained before starting the present study. The inpatient medication charts and orders drug related problems were identified, analysed and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services, using the parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, resulting clinical interventions made. out of 360 clinical pharmacist interventions followed, male (71.66%) predominance was noted over females (28.33%). Most of the DRP observed were dispensing errors(26.11%),improper drug selection (17.22%),followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing(26.11%), and drug change (18.05%). The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Clinical pharmacists have greater potential in preventing and/or minimizing the DRPs. CONCLUSION: Technology assessment in health care is a multidisciplinary field of policy analysis which studies ethical, social, medical and economic implications of development, diffusion and use of health technology. From the multidisciplinary health technology assessment the methods followed for this study were found to be useful for not only enhancing the appropriate use of drugs in a clinical setting but also sow a seed for the evolvement of HTA in India with clinical pharmacist as its pathfinder.

Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients

Drug related-problems pose additional worse outcomes in cancer patients treated with chemotherapy. A vital role of the clinical pharmacist is the detection and prevention of drugrelated problems. The provision of patient education is an important step to reduce and prevent drug-related problems during chemotherapy administration. The objective of this study was to assess the occurrence of drug-related problems and the importance of effective provision of patient education and appropriate recommendations by the clinical pharmacist in reducing and solving of these problems in diabetic patients suffering from cancer. A prospective study carried out on 50 diabetic patients as a single group with new diagnosis of diverse cancer types eligible for chemotherapy adminitration recruited between September 2014 and April 2015 at the oncology unit in one of the Teaching and Research Hospital (Istanbul-Turkey). Drug-related problems were evaluated, and proper patient education alongside pharmacist recommendation regarding chemotherapy was provided during the required chemotherapy protocol schedule. (n=65) of the drug-related problems were contributed to inappropriate IV fluid selection; (n=33) were attributed to low drug dose prescribed, and (n=30) to high drug dose prescribed. Drug-related problems totally solved due to clinical pharmacist recommendations were 69.57% (n=80). There was a significant increase in the occurrence of paleness (P=0.0001); urinary frequency (P=0.003); loss of appetite (P=0.0001), nausea (P=0.0001), vomiting (P=0.0001); and numbness (P=0.0001). A significant decrease in the occurrence and severity of chemotherapy-related adverse effects was observed as a mild urinary frequency (P=0.0001) and mild vomiting (P=0.0001) after the clinical pharmacist recommendations and provision of patient education. Results of this study revealed that diabetic cancer patients are definitly prone to the occurrence of drug-related problems and adverse drug reactions. Clinical pharmacist is expected to provide a well-defined education and care to those patients and the outcomes of pharmacist recommendations may diminish and prevent many drug-related problems and adverse drug reactions and by this, influence patients’ desire to complete the course of chemotherapy.

Impact of live medication therapy management on cholesterol values in patients with cardiovascular disease

ObjectiveTo compare the impact of clinical pharmacist (CP) recommendations through a live, primary care-based, medication therapy management (MTM) protocol on low-density-lipoprotein (LDL) cholesterol in patients who have cardiovascular disease (CVD) with standard, chart-review MTM. MethodsPatients with established CVD who were not at their LDL goal were identified and analyzed by either a chart-review MTM service or a live, one-on-one pharmacist–physician MTM service over a 6-month timeframe. For the chart-review MTM service, recommendations were communicated through an electronic medical record (EMR) that the physician and pharmacist had access to. ResultsPrimary outcomes included mean LDL reduction from baseline, number of patients achieving their LDL goal, and percent of implemented CP recommendations. Mean LDL reduction from baseline in the chart-review MTM group and the live MTM group was 36 mg/dL ± 23.2 mg/dL (P = 0.001) and 62 mg/dL ± 28.3 mg/dL (P = 0.001), respectively. The difference between these two groups was statistically significant (P = 0.001). The chart-review MTM group had 30% of patients reach their LDL goal with 66.3% of CP recommendations implemented compared to 51.3% and 86.3% for the same parameters in the live MTM group (P = 0.006 and P = 0.003, respectively). ConclusionAlthough both MTM services provide a significant LDL reduction from baseline in patients with CVD, live MTM provides significantly greater LDL reductions, implemented CP recommendations, and goal attainment than chart-review MTM. Thus, live MTM services are more effective than chart-review MTM services, at least within the clinics that these protocols were assessed for the purposes of this study.

Proactive clinical pharmacist interventions in critical care: effect of unit speciality and other factors

Clinical pharmacists working in critical-care areas have a beneficial effect on a range of medication-related therapies including improving medication safety, patient outcomes and reducing medicines' expenditure. However, there remains a lack of data on specific factors that affect the reason for and type of interventions made by clinical pharmacists, such as unit speciality. To compare the type of proactive medicines-related interventions made by clinical pharmacists on different critical-care units within the same institution. A retrospective evaluation of proactive clinical pharmacist recommendations, made in three separate critical-care areas. Intervention data were analysed over 18 months (general units) and 2 weeks for the cardiac and neurological units. Assessment of potential patient harm related to the medication interventions were made in the neurological and cardiac units. Overall, 5623, 211 and 156 proactive recommendations were made; on average 2.2, 3.8 and 4.6 per patient from the general, neurological and cardiac units respectively. The recommendations acceptance rate by medical staff was approximately 90% for each unit. The median potential severity of patient harm averted by the interventions were 3.6 (3; 4.2) and 4 (3.2; 4.4) for the neurological and cardiac units (P = 0.059). The reasons for, types and drug classification of the medication recommendations demonstrated some significant differences between the units. Clinical pharmacists with critical-care training make important medication recommendations across general and specialist critical-care units. The patient case mix and admitting speciality have some bearing on the types of medication interventions made. Moreover, severity of patient illness, scope of regular/routine specialist pharmacist service and support systems provided also probably affect the reason for these interventions.