Comprehensive Pharmaceutical Care Research Articles

Investigating the Public Awareness and Utilization of Health Screening Services Offered by Community Pharmacies

Background: Community pharmacies are the integral part of the healthcare system offering healthcare services for patients. Pharmacists are expanding their roles by providing pharmaceutical services and comprehensive pharmaceutical care. Health screenings played an important role in early detection of diseases and potential risk factors. Objectives: To assess the extent of awareness, utilization and impact of using health screening services offered by community pharmacy among public and to identify the barriers to access these services. Methods: A cross-sectional study was conducted in different cities of Punjab, Pakistan. Data was collected using validated questionnaire after getting consent from general public. The sample size for this study was 151. SPSS version 26th was used as a statistical tool to analyze data. P-value < 0.05 were considered as statistically significant. Results: Health screening services were more used by middle age individuals and adults. Individuals holding bachelor’s degree (41.2%) and female respondents (42.9%) showed more satisfactory response than male respondents. Blood pressure screenings (53.6%), diabetes screenings (28.5%) and other services (34.4%) were mostly used by the participants Barriers to health screening services include lack of awareness, lack of time and preference to visit doctor. Conclusion: Screening services offered at community pharmacies are found satisfactory, convenient and economical by most people. However utilization of these services is less frequent indicating a need for improved awareness and public education about the services offered by community pharmacy. Attention should be given to reduce barriers to the use of health screening services.

Nuclear Pharmacy Training in the Era of Theranostics: Toward Meeting the Needs of Nuclear Medicine Patients for Comprehensive Pharmaceutical Care.

Nuclear Pharmacy Training in the Era of Theranostics: Toward Meeting the Needs of Nuclear Medicine Patients for Comprehensive Pharmaceutical Care.

Implementación piloto de la gestión integral de la farmacoterapia a pacientes hospitalizados con enfermedades cardiovasculares

Context: Comprehensive medication management service provides comprehensive pharmaceutical care to patients to meet their pharmacotherapeutic needs and improve their quality of life in terms of health. Aims: To describe the results of the pilot implementation of the comprehensive medication management service provided to inpatients with cardiovascular diseases. Methods: Longitudinal, prospective and intervention study was carried out, with qualitative research elements. The sample included patients with cardiovascular diseases and more than five days from the Cardiology Service of the “Saturnino Lora” Provincial Hospital in Santiago de Cuba. The care process was developed according to the OFIL's Guide for the implementation of Comprehensive Medication Management. The patients’ medication experiences were evaluated according to Ramalho de Oliveira et al. The evaluation of drug-related problems and the clinical outcomes was carried out according to the Pharmacotherapy Work-up Method. Results: Twenty patients were included, 65% male. The mean age was 66.2 ± 13.1 years. Eighty percent of the patients had hypertension. One hundred percent received antihypertensive and antithrombotic drugs. Forty percent reported body as a pharmacotherapeutic experience. One hundred and thirty-three drug-related problems were detected and 45.1% corresponded to safety problems. One hundred and fifty-five pharmaceutical interventions were performed and 89% were accepted. Ninety percent of the patients achieved positive clinical outcomes. Conclusions: The pilot implementation of the comprehensive medication management service contributed to the resolution of drug-related problems and showed positive clinical outcomes in patients with cardiovascular diseases.

Building a Hospital Pharmacist Workforce by a Diversified and Position-Oriented Learning System.

The role of hospital pharmacists has shifted from primarily ensuring drug supply to providing comprehensive pharmaceutical care. To accommodate this shift, new positions are needed. The traditional training model for hospital pharmacists is no longer sufficient for the evolving demands of pharmaceutical care and these new roles. This study aimed to describe the development of a position-oriented learning system explicitly tailored for hospital pharmacists and to assess its impact on workforce development and pharmacy service. The position-oriented learning system for hospital pharmacists, aimed at enhancing training and workforce development, was evaluated based on two critical criteria: the completion rate of learning modules and the subsequent improvement in pharmaceutical care at the hospital. The completion rate assessed the engagement and effectiveness of the training content. At the same time, the improvement in pharmaceutical care evaluated practical outcomes such as percentages of patients who received pharmaceutical care and percentages of inappropriate medication orders intercepted. In 2021, 218 employees participated in the learning system. The pharmacy department has identified 22 pharmacists for various positions through this system. The quantity and quality of pharmaceutical care have improved significantly. The position-oriented diversified learning system achieves the perfect combination of department development direction and individual career planning of employees. The learning system can significantly improve the learning efficiency of pharmacists, enhance the quality of various pharmaceutical care, and promote the development of disciplines.

ДИСТАНЦИОННОЕ ФАРМАЦЕВТИЧЕСКОЕ КОНСУЛЬТИРОВАНИЕ С ИСПОЛЬЗОВАНИЕМ ЧАТ-БОТА

The article discusses the use of chatbots for a variety of tasks in the medical field – such as scheduling doctor’s appointments, monitoring patients with chronic conditions, and providing healthy lifestyle recommendations – and in pharmacy operations, including verifying pharmacy addresses and hours, searching for and ordering products, and accessing information about delivery and payment, as well as operator consultations. It identifies several challenges faced in pharmaceutical counseling: time constraints, lack of motivation, absence of a dedicated counseling space, and low demand for the service. Chatbots are proposed as a solution to these issues, offering the benefit of pre-determined specific questions to address the time shortage, while the virtual nature of counseling negates the need for a physical space. Pursuant to recommended standards and legal requirements, we have developed a seven-stage model for remote pharmaceutical counseling, tailored for digital implementation. When integrated into a website, mobile app, messenger, or other online pharmacy services as a chatbot, this model enables pharmacists to consider individual client needs and provide comprehensive pharmaceutical care remotely without significantly extending consultation times. Integration with online pharmacy services is suggested to be facilitated through an API (Application Programming Interface). Furthermore, the article describes a mechanism to safeguard user personal data in the application of this algorithm.

Evaluation of a novel clinical pharmacy tool in identifying and categorising drug-related problems in hospitalised patients: The MA2VER2ICK Tool Study

Abstract Introduction Literature searching has revealed a lack of high-quality research outlining the use of tools or checklists in hospitalised patients. Additionally, few tools identified relate directly to clinical pharmacy practice. The tools identified focus on specific disciplines (e.g. critical care) or specific tasks (e.g. handover). The MA2VER2ICK Tool is a novel clinical pharmacy tool which has recently undergone review and adaptation.[1] The tool is unique as it is comprehensive and applicable to all hospitalised patients, regardless of clinical discipline. The intended purpose of the tool is to assist clinical pharmacists in comprehensive pharmaceutical care planning. Aim Demonstrate the utility of the MA2VER2ICK tool in pharmaceutical care planning, by outlining the type and frequency of drug-related problems occurring in hospitalised patients. Methods A prospective, observational, cross-sectional study was conducted in a 560-bed acute university teaching hospital. Clinical pharmacists adopted the tool in their daily practice, in a mixed medical-surgical inpatient population, over four weeks. All drug-related problems identified were recorded and assigned to the applicable category within the tool, by the clinical pharmacist. Additionally, all drug-related problems were retrospectively assigned to applicable categories of the Pharmaceutical Care Network Europe Classification for Drug Related Problems Version 9.1,[2] for comparison, by two independent researchers. Results All identified drug-related problems identified were successfully categorised using the MA2VER2ICK Tool. In total, 753 drug-related problems were identified in 180 patients over four weeks, with 233 patient-pharmacist encounters occurring. The mean age of patients was 68.9±16 years, while 51.7% (93/180) were female and 48.3% (87/180) were male. The mean number of drug-related problems identified per patient was 4.2±3.6. The highest number of drug-related problems experienced by an individual was 20, while 17 patients experienced no drug-related problem. The majority of drug-related problems identified using the tool related to medication reconciliation (52.7%; 397/753), followed by prescription endorsement and administration (17.3%; 130/753) and pharmacotherapy optimisation (9.3%; 70/753). In comparison with the MA2VER2ICK Tool, the Pharmaceutical Care Network Europe classification system has a much larger range of categories for assigning drug-related problems. Despite this, a proportion of identified drug-related problems 1.6% (12/753) could not be categorised using this tool, while there were also several categories within the tool 43.2% (19/44) whereby no drug-related problems were assigned. Conclusion This study demonstrates that the MA2VER2ICK Tool is a robust clinical pharmacy tool, that is effective and practical in assisting clinical pharmacists with the identification of drug-related problems and thus is a useful guide to facilitate pharmaceutical care planning at the patient’s bedside. This is in comparison with the Pharmaceutical Care Network Europe classification system, which has less utility as a clinical pharmacy tool, but is better placed as a research instrument. Despite demonstrating the usefulness of the MA2VER2ICK Tool in identifying drug-related problems, the clinical significance of those identified was not assessed during this study. However, data collection occurred in real time, facilitating the identification of actual and potential problems, thus reducing the likelihood of underestimating the incidence rate.

Prioritizing Quality over Quantity: Defining Optimal Pharmacist-to-Patient Ratios to Ensure Comprehensive Direct Patient Care in a Medical or Surgical Unit.

The expanding scope of practice of hospital pharmacists has contributed to improvements in patient care; however, workload remains a barrier to the provision of optimal pharmaceutical care. Established ratios to guide clinical pharmacy staffing on medical and surgical units are lacking in Canada. To determine the pharmacist-to-patient ratio that allows for provision of comprehensive pharmaceutical care to each patient on a medical or surgical unit and to determine which comprehensive care tasks can be delivered in settings where staffing is limited. A multiphase study was conducted in 6 hospitals. First, a modified Delphi study was conducted to define and prioritize the elements of comprehensive pharmaceutical care. Next, a work sampling study was conducted to establish the frequency of each task and the time required for completion. Finally, a workforce calculator was used to determine pharmacy staffing ratios. Ten pharmacists participated in the modified Delphi study, and 31 participated in the work sampling study. A total of 15 comprehensive care tasks were identified, 7 of which were categorized as tasks to prioritize in settings where staffing is limited. The optimal staffing ratios were 1 pharmacist to 13 patients in internal medicine teaching units, 1 pharmacist to 26 patients in hospitalist or internal medicine nonteaching units, and 1 pharmacist to 14 patients in surgical units. The optimal staffing ratios determined in this study should enable pharmacists to provide comprehensive care to each patient. Implementing these staffing ratios could increase the consistency of clinical pharmacy services, improve patient outcomes, and improve pharmacists' work satisfaction. Further research is required to validate these ratios in a variety of settings.

Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer.

Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.

Students’ experiences and attitudes toward a newly developed simulation-based pharmaceutical care clinical rotation: A pre-post study design

PurposeThis study aims to evaluate Doctor of Pharmacy (PharmD) students’ experience with the newly developed simulation-based pharmaceutical care (PC) rotation by evaluating their knowledge and attitudes towards PC before and after the rotation. MethodsA self-administered questionnaire was distributed to sixth year PharmD students enrolled in the clinical training rotation “Comprehensive Pharmaceutical Care” during the 2020/2021 academic semesters at Jordan University of Science and Technology’s (JUST) Faculty of Pharmacy. Questionnaires were distributed before and after completing four experiential training weeks and consisted of three sections. The first section collected students’ demographic details while the second and third sections evaluated students' knowledge about, and attitudes toward PC, respectively. Descriptive statistics were used to describe and compare changes in students' knowledge and attitudes pre-and post-rotation. ResultsA total of 106 valid questionnaires were completed with a response rate of 99.07%. The rates of correct answers increased after the rotation with median total knowledge score increasing from 8 to 10 (out of 13, P value < 0.001). Significant improvements in students’ understanding of aspects relating to the concept and process of PC, and the role of clinical pharmacist in PC provision, were shown post the simulation-based clinical rotation. Similarly, their attitudes toward performing PC were either improved or emphasized. In contrast results also revealed that specific aspects of the rotation require further refinement, such as the comprehensiveness of the PC process and responsibilities in providing PC. ConclusionsPharmD students’ understanding and attitudes toward PC were either improved or emphasized after the simulation-based PC rotation. This study highlights the value of simulation as a unique instructional technique that can assist educators to develop PC competencies for pharmacy students.

New Zealand pharmaceutical care pioneer Bernard McKone honored by King Charles III.

Bernard (Bernie) McKone of Cromwell, Otago, in the South Island of New Zealand, was appointed a 2023 officer of the New Zealand Order of Merit by King Charles III for service to patients and the pharmaceutical sector.1 In a career spanning more than 40 years, McKone has worked at the leading edge of the pharmacy profession. In 1994, McKone and four New Zealand colleagues traveled to the United States seeking to adapt the tenets of pharmaceutical care practice through collaborations with colleagues in Minnesota and elsewhere.2 These collaborations culminated in development of the Comprehensive Pharmaceutical Care program that remains viable in New Zealand. McKone’s dedication to his community, patients, and profession also earned him distinction as a 2021 Pharmaceutical Society of New Zealand (PSNZ) Gold Medal recipient, the highest honor bestowed by the society, often regarded as proportional to the American Pharmacists Association Remington Honor Medal.3 The New Zealand Order of Merit was instituted by royal warrant in 1996 to recognize those who, “in any field of endeavour, have rendered meritorious service to the Crown and the nations or who have become distinguished by their eminence, talents, contributions, or other merits.”4

Application of comprehensive pharmaceutical care program in identifying and addressing drug-related problems in hospitalized patients with osteoporosis

BackgroundMore information about the impacts of comprehensive pharmaceutical care program (CPCP) on the identification and resolution of drug-related problems (DRPs) is needed. This study aimed at researching the characteristics of DRPs in osteoporosis patients and evaluating the effect of CPCP in identifying and addressing DRPs.MethodsWe performed a prospective interventional study in a teaching hospital. CPCP was established and conducted to identify and resolve DRPs by a multidisciplinary team (MDT) based on the Pharmaceutical Care Network Europe (PCNE) classification V9.0. Six pharmacists and one doctor worked directly in the study. All data was obtained from electronic medical records, direct observation and visits. The statistical analyses were performed using the SPSS Statistics software version 26.0.ResultsTwo hundred nineteen patients with osteoporosis were included in the final analysis. A total of 343 DRPs were identified, with an average of 1.57 DRPs per patient. The most common DRPs identified were “treatment safety P2” (66.8%; 229/343), followed by “other P3” (21.0%; 72/343) and “treatment effectiveness, P1” (12.2%; 42/343). The primary causes of DRPs were “dose selection C3” (35.9%; 211/588), followed by “drug use process C6” (28.9%; 170/588) and “drug selection C1” (12.6%; 74/588). Seven hundred eleven interventions were proposed to address the 343 DRPs, with an average of 2.1 interventions per DRP. The acceptance rate reached 95.9, and 91.0% of these accepted interventions were fully implemented. As a result, only 30 DRPs were unsolved before discharge. Additionally, the number of drugs was found to be associated with the number of DRPs significantly (p = 0.023).ConclusionDRPs frequently occurred in hospitalized osteoporosis patients. CPCP could be an effect option to solve and reduce DRPs for osteoporosis patients and should be implemented widely to increase patient safety.

Pilot study to validate a standard operating procedure for providing health education to diabetic patients

IntroductionThe lack of standard operating procedures (SOPs) to provide health education to patients with diabetes means that this service is provided in a heterogeneous, isolated and intermittent manner, thus limiting quality. ObjectiveTo validate a SOP to provide health education to diabetic patients using Delphi methodology and determining its efficacy in clinical practice by performing a pilot study. MethodsThe SOP was designed from a theoretical analysis of the available literature; a participatory brainstorming technique was used to define the processes included in the SOP. The research was carried out at the Comprehensive Pharmaceutical Care Polyclinic of a Mexican Institute of Health Sciences, from August 2017 to March 2020. The pilot test was carried out on 15 outpatients with diabetes type 1 and 2. The validation was carried out by a panel of experts using Delphi methodology, the consensus among the experts was estimated by determining Kendall's coefficient of concordance. The practice clinical efficacy of the SOP was determined by a pilot study in 15 diabetic patients using process indicators. ResultsThe SOP was structured in nine sections with the process approach described in the ISO 9001:2008 standards. The criteria issued by the experts relating to content, records and data extraction tools allowed improvement of the SOP. The pilot test showed that health education, following the SOP, improved metabolic control, level of knowledge, therapeutic adherence and the attitudes of more than 80% of patients. ConclusionsThe SOP designed and validated by experts was effective in educating patients with diabetes due to the high impact achieved with the intervention and incorporates indicators to guarantee the quality of the health service provided.

Providing pharmaceutical care remotely through medicines delivery services in community pharmacy

BackgroundThe delivery of pharmaceutical care – and what that means – has been at the centre of many transformations of the pharmacy profession in the last century. Today, the exponential growth of pharmacies which provide pharmaceutical care exclusively online has placed increased scrutiny on the quality of the care they provide. AimAs more patients are managed by remote pharmaceutical care (via medicines delivery services), we sought to critically evaluate this service to identify new research directions. MethodsThe COnsolidated criteria for REporting Qualitative research and Standards for reporting qualitative research guideline provided the methodological framework throughout this process. ResultsWe reveal that although home delivery services ensure that many patients have access to their medicines, it may reduce time available to provide comprehensive pharmaceutical care, particularly in traditional brick-and-mortar pharmacies. ConclusionWe highlight a critical need for research in this area and suggest a variety of research directions: is remote pharmaceutical care a matter of convenience? Does remote pharmaceutical care help patients adhere to their medicines? How do digital health innovations impact care across patient demographics? What does comprehensive pharmaceutical care mean for patients?

The impact of a comprehensive pharmaceutical care intervention in addition to cardiac rehabilitation program on outcomes of post-acute coronary syndrome patients: A pilot study

ObjectiveTo test the efficacy of Comprehensive pharmaceutical care intervention added to cardiac rehabilitation program(CR programs) in improving echocardiographic parameters, nutritional status and High sensitivity C-Reactive Protein(hs-CRP), in post-acute coronary syndrome patients. MethodsA prospective; randomized, controlled study. 40 post-acute coronary syndrome patients, participating in CR program, were randomly allocated to either the control group(n = 20) or the intervention group(n = 20). Pharmaceutical care intervention included face-to-face education about the disease, healthy lifestyle, medication adherence, drug related problems management and goal setting. hs-CRP and cardiac parameters were measured at baseline and after 3 months. ResultsAfter three months,the intervention group showed a significant decrease in left ventricular end systolic volume (p = 0.0026) and left ventricular end diastolic volume (p = 0.0009) compared to the control group. Also, intervention group showed a significant increase in nutritional status (p = 0.037) and the patients' knowledge about the disease and drugs (p = 0.0001). However, there was no significant change in hscrp level between groups. ConclusionOur findings indicate that Comprehensive pharmaceutical care intervention added to CR programs significantly improved cardiac parameters and nutritional status. This is best explained by increasing adherence to cardiovascular medications and to healthier lifestyle and optimizing medication knowledge and doses. Practice implicationsImplementing Comprehensive pharmaceutical care intervention added to CR programs could improve the cardiac function and nutritional status of post-acute coronary syndrome patients.

Randomised Trial of The Role of Medicine and Pharmacists on Christian Community

Introduction: Medicine has been an inseparable part of human civilization since there will always be a health problem in human life. In developing countries, certain religions and beliefs may distort the perception of medicine which lead to social problems that are faced by pharmacists and clinicians. Indonesia has a social background of animism and dynamism that it inherited from its ancestors and it made the community still believe in shaman healers and traditional or alternative medicine without scientific proof. Objective: This study measures community trust in medicine and pharmacists, especially Christian communities based on their spiritual beliefs and provides a descriptive description based on the measure. Variables involved include age, baptism status, and level of education. The benefit of this research for pharmacists is to provide pharmaceutical services based on community spiritual trust to create a comprehensive pharmaceutical care design, both scientifically and spiritually. Method: The research method used is cross-sectional. The measurement is done by a questionnaire with a Likert scale. The results of this study indicate that the role of medicine and pharmacists in the Christian community is influenced by age, baptism status, and education level. Result: High scores from the questionnaire results were obtained from the adult age group (17-60 years), high school education level, diploma and bachelor's degree, as well as the status of being baptized. Conclusion : the role of medicine and pharmacists in the Indonesian Christian community is more prevalent at a more mature age, higher educational level, and baptized status.

Outpatient practice of Internet pharmacy for major critical diseases based on comprehensive pharmaceutical care

Outpatient practice of Internet pharmacy for major critical diseases based on comprehensive pharmaceutical care

Effective Pharmacist led interventional strategies to improve outcomes in hypertensive patients: a narrative review

The role of pharmacist intervention as a cost-effective alternative to physician in disease management is increasingly been recognized. Studies have demonstrated that pharmaceutical care can improve drug therapy as well as patient satisfaction in chronic health conditions including cardiovascular diseases. This study is aimed to review and outline a comprehensive pharmaceutical care plan from the randomized controlled trials previously conducted to assess the impact of pharmacist-managed care on disease outcomes in hypertensive patients. Compared with usual care, the pharmaceutical intervention involved patient evaluation, patient education and counselling, medication review and management, patient monitoring and follow-up, and feedback to the primary physician as major strategies.

The analysis of the pharmacy activities under voluntary health insurance programs

Timely and comprehensive pharmaceutical care to the population, in particular by their providing with medicines and pharmacy products, is the mission of pharmacies, and their cooperation with insurance companies contributes to improving the quality of the pharmaceutical provision for all segments of the population.Aim. To analyze the pharmacy activities under voluntary health insurance programs and determine the approaches to improving the pharmaceutical provision of the population.Materials and methods. Data from a chain pharmacy (Kyiv) by the indicators of cooperation with insurance companies and medical coordinators for the period of May-December 2017 (the turnover of prescription drugs covered by insurance companies, inventory) were used. The method of the system analysis, graphical method, financial and economic analysis, and the method of scientific generalization were applied in the study.Results. The experience of cooperation of a chain pharmacy as a subject of insurance relations with insurance companies and medical coordinators under voluntary health insurance programs, as well as projects of vitamin fortification and vaccination of the population was studied. The approaches to establishing cooperation with insurance companies were determined. The dynamics of changes in the turnover of prescription drugs covered by insurance companies and the inventory of the pharmacy was analyzed. The approaches to improving the pharmaceutical provision for persons using voluntary medical insurance services and, therefore, to increasing the financial results of the economic activities of pharmacies based on the results of cooperation with insurance companies and coordinators were determined.Conclusions. The analysis of the pharmacy activities under the programs of voluntary health insurance has been performed; the approaches to the improvement of the pharmaceutical provision both of the insured persons and the population as a whole have been determined. It has been determined that continuous review of inventories, defect analysis, improvement of the speed and quality of service of the insured persons, increase in the speed of order processing from insurance companies, development of loyalty with insurance companies, compliance with contractual terms of medical insurance of the insured persons, continuous staff training, continuous search for new projects of cooperation with insurance companies contribute to the improvement of the pharmaceutical provision of the population and, as a consequence, the increase in the financial results of the economic activity of pharmacies.

Hepatitis C virus infection and the role of a pharmaceutical care program.

The design, implementation, and assessment of a comprehensive pharmaceutical care program (CPCP) for hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAA) are described. The advent of DAA regimens has caused the evolution of the role of hospital pharmacists, leading to the development of more specialized models of pharmaceutical care. Three clinical pharmacists were incorporated into the pharmacy department of a general tertiary teaching hospital in Madrid, Spain, with the aim of developing and implementing a CPCP for HCV-infected patients. Pharmacists were responsible for proposing standards and local guidelines to physicians, monitoring adherence to guidelines, managing drug interactions and adverse drug events (ADEs), providing patient education, and evaluating health outcomes and costs. Implementation steps included (1) estimation of the healthcare demand and pharmacy resources, (2) definition of the workflow of the CPCP, (3) definition of the treatment care plan, for which tools were developed to support pharmaceutical validation, detection, and management of ADEs and drug-drug interactions, and (4) program assessment in terms of safety and cost-effectiveness. The pharmacists' interventions performed, severity of errors intercepted, and patients' satisfaction with the CPCP were also assessed. This CPCP demonstrates that the involvement of the pharmacist throughout the care plan prevents harmful medication errors in this population (0.1 per patient) and prompts significant cost savings (€1.2 million for 1,930 treated patients). The implementation of a CPCP developed by hospital pharmacists for patients treated with DAA for HCV infection is an effective approach for preventing harmful medication errors and improving cost- effectiveness.

Fairview Pharmacy Services clozapine monitoring program: Description and evaluation of a clinical pharmacy service.

Fairview Pharmacy Services, part of an academic health system, comprises 35+ outpatient pharmacies in Minneapolis, Minnesota. In 2013, the nonprofit organization opened a satellite location at the University of Minnesota Psychiatry Clinic. The original goals of the service were to improve patient satisfaction and medication adherence through comprehensive pharmaceutical care and clinic provider support. A clozapine monitoring program was envisioned and developed by the pharmacists and now provides optimal medication monitoring, dispensing, and coordination for approximately 100 patients.