Pharmacists Research Articles

How can community pharmacy teams prevent prescription and over-the-counter opioid misuse in North East England? A qualitative study using the Capability, Opportunity and Motivation Behaviour (COM-B) model.

This study aims to identify factors that influence the role of community pharmacy teams in preventing prescription and over-the-counter (OTC) opioid misuse. Qualitative design using interviews; thematic analysis was used to generate themes mapped to the Capability, Opportunity and Motivation Behaviour (COM-B) model. Community pharmacies in North East England. 28 community pharmacy staff including 16 pharmacists, 1 pharmacy assistant, 10 dispensers and 1 pharmacy technician. Factors related to the capability component include communication skills, ability to identify service users who misuse OTC opioids, and education and training. Factors in the opportunity component include staff and funding, tools for identification and referral of service users at risk of opioid misuse, and relationship with other healthcare professionals. For the motivation component, attitude towards role, attitude of pharmacist or pharmacy manager, perception about commissioners and commissioned services, and attitude towards service users were identified. This study identified factors that could influence community pharmacists' roles in opioid misuse. A critical factor influencing community pharmacy teams preventing opioid misuse is access to a single system to record the use of both OTC and prescription opioids. This would enable teams to identify service users misusing or at risk of misusing opioids, while supporting staff education and training and regulatory compliance. Future research should focus on developing interventions using these identified factors to enhance community pharmacists' roles in opioid misuse prevention.

Survey of dysphagia and related medications in nursing home residents using the Eating Assessment Tool (EAT-10) applied by community pharmacists: A single-center retrospective study

BackgroundThis study aimed to assess the prevalence of dysphagia among nursing home residents and to examine the association between medication use and impaired swallowing function.MethodsBetween January and December 2023, we conducted a retrospective survey across 14 nursing homes visited by community pharmacists. Swallowing function was evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire. Residents were categorized into two groups: those with reduced swallowing function (EAT-10 score ≥ 3) and those with normal swallowing function (EAT-10 score < 3). The association between medication use and swallowing function was analyzed using univariate and multivariate logistic regression models.ResultsSignificant differences were observed between the reduced (n = 101, 36.9%) and normal swallowing function (n = 173, 63.1%) groups in terms of age (P = 0.022), body mass index (BMI) (P < 0.001), and nursing care level (P < 0.001). Propensity score matching was performed to adjust for confounding factors, yielding 72 matched pairs. Analysis of the matched cohort revealed a significant association between antipsychotic use and reduced swallowing function (odds ratio [OR], 2.600; 95% confidence interval [CI], 1.210–5.560; P = 0.014).ConclusionsThis study identified a significant association between antipsychotic drug use and reduced swallowing function. Medication reviews incorporating assessments of swallowing function may help mitigate the risk of aspiration. Further prospective studies are warranted to validate these findings and to clarify causal relationship between medication use and swallowing dysfunction.

Roles of community pharmacists in managing negative effects

Roles of community pharmacists in managing negative effects

Antibiotics stewardship: prevalence, nature, and factors associated with dispensing of antibiotics without prescription among community pharmacists in Nigeria.

Dispensing antibiotics without a prescription is common among community pharmacists in low- and middle-income countries despite its association with antibiotic resistance. This study describes the prevalence and nature of dispensing antibiotics without prescription among community pharmacists in Nigeria and its associated factors. A cross-sectional study was conducted among community pharmacists in Nigeria with a validated, online, self-administered questionnaire. Reliability was assessed with Cronbach's alpha. Descriptive and inferential statistics were performed with SPSS Version 2023 at a 0.05% significance level. A total of 420 community pharmacists participated in the study. The Reliability result was 0.860, implying the data collection tool's perfect internal consistency. Independent pharmacies represented 87.4% of the respondents, and most were in urban areas (71.4%). Most respondents (98.1%) dispensed antibiotics without prescription, with (84.2%) sometimes requesting laboratory investigations before dispensing antibiotics. Cephalosporin (74.8%), penicillin (70.2%), and quinolones (68.3%) were the major classes of antibiotics dispensed. The pharmacists' confidence in their clinical skills (78.8%), ability of the antibiotics to cover a broader range of microorganisms (78.0%), inability of patients to access healthcare services in other places (67.3%), emergencies (58.3%), affordability (49.0%), patients' demand (38.2%), absence of sanctions (34%), not getting prescriptions (33.1%), were the key deciding factors for the pharmacists to dispense antibiotics without prescription or substitute class of antibiotics. Factors like financial incentives, fear of losing clients, fear of expiry, competition from other pharmacies, and trust in patients' self-diagnosis were low in driving decisions to dispense antibiotics without prescriptions. Non-prescription dispensing of antibiotics is high among community pharmacists in Nigeria, and is related to various factors. A strategic approach, including mandatory health insurance schemes, prescription and dispensing policies, and enforcement of antimicrobial stewardship regulations by the Nigerian government, is necessary to improve ethical practice and address the irrational dispensing and use of antibiotics in Nigeria.

Challenges and opportunities in community pharmacists’ identification and management of dry eye disease: a qualitative study

Abstract Objective To explore Malaysian community pharmacists’ (CP) challenges in identifying and managing dry eye disease (DED) and opportunities to optimize DED care, as previous studies reported inconsistencies in DED identification by community pharmacy staff, and few publications describe Malaysian CP views on DED management in community pharmacy settings. Method Using the Social Ecological Theory for Community Health Promotion, individual in-depth interviews were conducted (May–June 2023) with 20 CP in Malaysia’s Klang Valley. Participants with diverse DED management experiences were recruited using purposive and snowball sampling until data saturation. Interviews were audio-recorded, transcribed, independently coded by two researchers, and thematically analysed. Key findings CP faced 12 challenges in identifying and managing DED: patient-related (brand rigidity, ‘quick fix’ attitude, inadequate health literacy, and self-efficacy skills), provider-related (imprecise assessment, referral difficulties, knowledge gaps), therapeutics-related (short shelf life, affordability), and pharmacy-related (limited manpower, inadequate private consultation space, low eye health visibility). The 12 opportunities for optimizing DED care were community-related (eye health education, holistic approaches, public awareness), profession-related (decision-support mobile health applications integrated with evidence-based DED management protocols to streamline consultation processes, interdisciplinary collaborations), industry-related (pharmaceutical and medical device advancements, comparative data on medication value, promotion of proactive management), and organization-related (management-mandated resource allocation, ancillary staff education, and expanded products and services). Conclusion Malaysian CP encountered challenges in identifying and managing DED. Knowledge sharing and collaborations with ophthalmologists improve DED management by CP, while clinicians can stay updated on medication-related recommendations and treatment adherence. The role of digital health in these processes requires further study.

Billing Deprescribing Interventions: Portrait of an Initiative in Québec, Canada

ABSTRACTBackgroundDeprescribing is a patient‐centred process in which a healthcare professional reduces or stops medications to improve health outcomes. Since late 2022, community pharmacists in Québec, Canada, have been able to bill for deprescribing interventions, enabling more robust deprescribing research in large cohort studies.ObjectiveThis study aimed to assess the prevalence of deprescribing claims in Québec community pharmacies from January 1, 2023, to November 30, 2024, and to identify the most commonly deprescribed medication classes.MethodsWe analysed the total number of deprescribing claims submitted by pharmacists during this period and categorized deprescribed medications using the American Hospital Formulary Service classification.FindingsOver 90 000 claims were submitted for deprescribing interventions, with most involving central nervous system medications. Although the number of claims increased over time, the overall volume remained modest.ConclusionWhile limitations remain, such as the gradual adoption of billing interventions, Québec's reimbursement model for deprescribing interventions provides an important framework for research, offering a mechanism to study deprescribing in real‐world settings.

Technology-enabled community pharmacies: qualitative evaluation of a framework for assessing technology solutions.

Optimal provision of pharmacists' professional services requires integrated digital health platforms and ideally an evaluation framework to guide implementation and adoption. The Technology Evaluation Key (TEK) framework, which combines three published models describing technology usage behaviour, had not been applied to identify technological needs for community pharmacists to enable practice. This research aimed to describe pharmacists' needs relating to information communication technology (ICT) platforms and apply the findings to refine the TEK framework. This study was conducted in Australia between June and July 2022 (approval number HRE2022-0249). A systematic scoping review, face and content validation, and field testing guided the development of the interview tool. Semi-structured online interviews were conducted with participants until data saturation, where no new themes emerged. Following Braun and Clarke's six-step reflexive thematic analysis, a deductive-to-inductive approach was utilised to identify themes, which were applied to the TEK framework to refine domains. Coding was conducted by [A.O.] and confirmed by consensus with the other authors. Twenty-four pharmacists were interviewed. Thematic analysis identified technological needs that included greater system integration, interoperability, and increased user access to nationally commissioned ICT systems. The TEK framework was refined from nine to eight domains accordingly (healthcare system, organisation, practitioner, ICT, user experience, logistics and operations, system integrity, and clinical impact). This study highlighted areas for improvement in implementing ICT platforms to meet the needs of community pharmacists as users of these technologies. The refined TEK framework can guide ICT development, implementation, and evaluation.

Advanced pharmacy service provision in community pharmacy across the United Kingdom and Ireland: A Scoping review.

Advanced pharmacy service provision in community pharmacy across the United Kingdom and Ireland: A Scoping review.

The outcomes of pharmacist-led pharmaceutical care within community pharmacies: An overview of systematic reviews.

The outcomes of pharmacist-led pharmaceutical care within community pharmacies: An overview of systematic reviews.

Practical naloxone communication tips for pharmacists: Lessons learned from the Linguistic Model of Patient Participation in Care.

Practical naloxone communication tips for pharmacists: Lessons learned from the Linguistic Model of Patient Participation in Care.

Implementation of a proposed algorithm to assess and de-label false penicillin allergy labels in the community.

Community pharmacists could have a pivotal role to play in de-labelling false penicillin allergies or preventing false penicillin allergy labels from occurring to reduce inappropriate prescribing of less effective and broader-spectrum antibiotics. A quasi-experimental study aimed at implementing and evaluating an algorithm to assess and de-label false penicillin allergy labels in the community. Between April and May 2024, the algorithm was rolled out to five community pharmacies in Victoria, Australia. De-labelling outcomes of Type A reactions were recorded. Barriers and enablers to implementing the penicillin allergy assessment algorithm were also collected through semi-structured interviews. Of 18,646 patients who presented to the pharmacies, 163 individuals (0.87 %) had a penicillin allergy label. Of these 163 patients, 30 (18.4 %) patients were assessed as having a Type A reaction (a non true allergy; non-immune related). All patients with Type A reactions were engaged in an attempt to de-label their allergy; 77 % of patients were accepting whilst 23 % were hesitant or non-receptive, due to time restraints or disbelief that their allergy is not a true allergy. Qualitative interview data revealed there remains a public misconception that antibiotic allergy labels do not impact the appropriateness of antibiotic prescribing or affect patient safety through increased risk of adverse drug events and antimicrobial resistance. The proposed algorithm was able to support the de-labelleling of false penicillin allergies. Future research could implement the use of the algorithm in other primary care settings and ascertain the long-term retention of the initiation of de-labelleling in the community.

Pharmacist prescribing in cancer services: a scoping review

Pharmacist prescribing in cancer services: a scoping review

Red Yeast Rice Supplement Consumption and Health Hazards in Japan ― What role is desired for community pharmacists?

Red Yeast Rice Supplement Consumption and Health Hazards in Japan ― What role is desired for community pharmacists?

Financial threats and opportunities experienced by rural community pharmacies.

Financial threats and opportunities experienced by rural community pharmacies.

Promoting outpatient medication safety in Finland: A mid-term review of a national medication safety programme for community pharmacies (2021-2026).

Promoting outpatient medication safety in Finland: A mid-term review of a national medication safety programme for community pharmacies (2021-2026).

Capabilities, opportunities and motivations within Australian community pharmacy to deliver clinical care standard-aligned care for knee osteoarthritis: A mixed-methods evaluation.

Capabilities, opportunities and motivations within Australian community pharmacy to deliver clinical care standard-aligned care for knee osteoarthritis: A mixed-methods evaluation.

Pharmacists’ experience with patients suspected to be addicted to over-the-counter codeine and their attitudes towards potential remediation strategies: a cross-sectional study

BackgroundCroatia is one of the European Union (EU) countries where low-dose codeine products (LDCP) can be purchased over the counter (OTC) directly from community pharmacists without a prescription. The misuse and dependence potential of OTC LDCP have raised growing public health concerns. As the first point of contact for patients seeking these medications, pharmacists play a critical role in identifying misuse and implementing harm-reduction strategies. However, little is known about the experiences and perspectives of pharmacists in Croatia regarding codeine addiction. This study aimed to examine the experience of pharmacists in Croatia with patients addicted to over-the-counter codeine and their attitudes toward potential remediation strategies.MethodsA cross-sectional study was conducted between October 18, 2021, and December 23, 2021. Eligible participants were pharmacists, members of the Croatian Chamber of Pharmacists, employed in community pharmacies in Croatia. The data were collected via an online questionnaire that examined the attitudes and experiences of pharmacists in Croatia regarding OTC medicines containing codeine and the demographic characteristics of pharmacists.ResultsOut of 2800 active pharmacists in Croatia, 594 participated in the study (21% response rate). The majority (92%) saw patients who regularly purchased high quantities of OTC products containing codeine and for whom pharmacists suspected they could be addicted to this medicine. Most participants occasionally talked to patients about possible codeine abuse and addiction. Two-thirds of participants did not report suspected adverse reactions associated with OTC codeine use to the national pharmacovigilance system, despite patients indicating a potential link. More than half of the participants noted that codeine-containing medicines should be switched from OTC to prescription-only status.ConclusionsThis study showed that 92% of pharmacists in Croatia encountered patients who may be misusing or are dependent on OTC codeine products. However, they indicated limited engagement in formal reporting or intervention. The findings highlight the need for more precise guidelines, enhanced pharmacist education, and consideration of regulatory changes, such as reclassifying codeine-containing medicines to prescription-only status, to support pharmacists in mitigating risks associated with codeine misuse.

Pharmacist-Led Patient Education in Secondary Stroke Prevention: A Systematic Review

The recurrence rate of stroke, particularly ischaemic stroke, is considered high, which highlights the importance of secondary stroke prevention. Pharmacists are becoming increasingly involved in poststroke care. Ease of public access to community pharmacists provides opportunities for pharmacists to educate patients about the significance of secondary stroke prevention. The literature outlining comprehensive educational materials for stroke patients to prevent secondary stroke is still limited. This review aimed to obtain the details of the educational material presented by the pharmacist and to determine whether it led to positive outcomes—a comprehensive search involved PubMed, Scopus, Science Direct, and Cochrane Library databases. The Joanna Briggs Institute’s (JBI) critical appraisal techniques were utilised to analyse the quality assessment for all study categories. As many as 12 studies were deemed eligible for inclusion. There are seven main categories under which information on secondary stroke prevention education is presented: modifiable risk factors, medication therapy management (MTM), medication adherence, cardiovascular risk factors, stroke (disease state), patient engagement, and quality of life. Pharmacists, mostly in community settings, play an important role in managing stroke risk factors (blood pressure, low-density lipoprotein [LDL], and A1c), promoting medication adherence, preventing hospital readmissions, increasing the level of knowledge, and enhancing patient satisfaction, which showed a favourable effect on preventing stroke recurrence following the pharmacist’s educational intervention.

Strengthening the role of community pharmacy in HPV vaccination roll-out in Serbia at national and local levels: A pharmacy-based education approach.

Cervical cancer is a significant public health concern in Serbia, with high morbidity and mortality rates (27 and 14.2 per 100,000 women, respectively in 2020). The primary cause of cervical cancer is human papillomavirus (HPV) infection, and HPV vaccination has proven to be an effective prevention strategy. This publication discusses the implementation of the first pharmacy-based education (PBE) program realized through the project of Pharmaceutical Chamber of Serbia - "Ask me about HPV" which aimed at raising awareness of the general population about the importance of HPV vaccination. The program aimed to strengthen the role of community pharmacists in the HPV vaccination roll-out. A total of 250 pharmacists were selected and trained to provide information on HPV infection and promote vaccination uptake. The program aimed to counsel and to educate young adults and parents/guardians. A total of 24,327 subjects were educated during the program's implementation from February to May 2023, young adults (N=11,313) and parents/guardians (N=13,014). Data showed that only 4.9% of young adults and 6.4% of children (of the parents/guardians surveyed) in Serbia are vaccinated against HPV. The questionaries of 1,387 subjects already vaccinated were excluded from the further analysis and final analysis was performed based on the counseling of 22,941 participants. A significantly higher percentage of parents/guardians stated that they would have their children vaccinated against HPV after counseling at the pharmacy than young adults (42.3% and 34.1% respectively). On the other hand, of those respondents who stated they would get vaccinated after consulting at the pharmacy, a significantly higher number of young adults (51%), compared to parents/guardians (48%), would receive the vaccine specifically at the pharmacy. The results of the project indicate that education of the general population on the benefits of HPV vaccination is highly needed. The expected outcomes of this educational program are increased awareness of the burden of illness, improved consumer education, the potential for higher vaccination rates, and consequently a reduction in cervical cancer incidence and mortality in Serbia.

Emergency Department Visits for Medication-Related Events With vs Without Pharmacist Intervention

Medication-related events (MREs) are a frequent cause of emergency department (ED) visits and patient harm. To assess the efficacy of a pharmacist-led transition of care program in reducing ED visits related to the same MRE at 6 months compared with usual care. This prospective, open-label, parallel-group randomized clinical trial was conducted from November 2018 to July 2021 at the ED of Montpellier University Hospital, Montpellier, France, with a 6-month follow-up period. Adult patients with an MRE detected at ED admission were included. MREs included adverse drug events with or without misuse and medication nonadherence with unfavorable clinical evolution. End points were assessed blindly from the randomization arm. Data were analyzed from January 2022 to March 2024. Participants were randomized to a pharmacist-led transition of care program or usual care. Usual care included the ED pharmacist carrying out a medication history. In the transition of care group, ED pharmacists additionally made a postdischarge telephone call to the general practitioner (GP) and community pharmacist, along with a letter, notifying them about MRE type, suspected medication, and management recommendations. The primary outcome was the proportion of patients with an ED visit for the same MRE at 6 months (same symptom and medication involved). Secondary outcomes included proportions of all-cause and MRE-related ED visits, hospitalizations, deaths, and medical office visits. Among 330 patients analyzed, 187 (56.7%) were female, the median (IQR) age was 71 (50-83) years, and the median (IQR) home medications count was 6 (3-10). A total of 167 patients were randomized to the transition of care group and 163 to the control group. At 6 months, fewer participants in the transition of care group had ED visits related to the same MRE (5 [3.0%] vs 36 [22.1%]; risk difference [RD], -19.1 percentage points; 95% CI, -26.0 to -12.2; P < .001), all-cause ED visits (35 [21.0%] vs 57 [35.0%]; RD, -14.0 percentage points; 95% CI, -23.6 to -4.4), hospitalization related to the same MRE (3 [1.8%] vs 29 [17.8%]; RD, -16.0 percentage points; 95% CI, -22.2 to -9.8), and more GP office visits (88 of 158 [55.7%] vs 26 of 146 [17.8%]; RD, 37.9 percentage points; 95% CI, 28.0 to 47.8) and specialist office visits (67 of 158 [42.4%] vs 35 of 146 [24.0%]; RD, 18.4 percentage points; 95% CI, 8.1 to 28.8) related to the same MRE. All-cause hospitalization and death were similar between groups. In this randomized clinical trial, a pharmacist-led transitional care intervention in the ED among patients with MRE significantly reduced ED visits and hospitalizations for the same MRE. If replicated in subsequent trials, this strategy offers a novel approach for reducing drug-related harms. ClinicalTrials.gov Identifier: NCT03725046.