Consultant Pharmacists Research Articles

Pharmacist Consult Reports to Support Pharmacogenomics Report Interpretation.

BackgroundThe clinical implementation of pharmacogenomics (PGx) has often involved teams that include pharmacists. PGx laboratories often provide baseline information within the laboratory report that is based on Food and Drug Administration and Clinical Pharmacogenomics Implementation Consortium guidance, but information is often provided independent of concurrent disease states or medication use, among other clinical factors. Major challenges to widescale implementation of PGx include lack of physician experience or confidence in interpreting the data. The purpose of this paper is to describe how pharmacists can help further personalize PGx information and identify clinical recommendations for a given patient.MethodsThis work was performed as a secondary objective of a study evaluating genetic biomarkers of opioid addiction risk. This portion of the study utilized a descriptive analysis of pharmacist consult reports that consist of individualized, patient-level clinical recommendations that take into account current medications, current health conditions, and PGx data. A panel of 60 common PGx targets were tested among patients being treated for chronic pain or opioid use disorder (OUD). A pharmacist consult report was generated and compared with standard laboratory reporting of general PGx information.ResultsOf the 252 patients, PGx reports for 198 (78.6%) contained red and/or yellow clinical decision support flags for medications with actionable or informative PGx guidance for currently prescribed medications. Pharmacists recommended modifications to current prescriptions for 31 (53%) of the patients with actionable flags and 17 (12%) of the patients with informative flags. Drug classes most commonly included medications for cardiology, depression and anxiety, pain (opioids) and gastrointestinal management. Taken together, 24.2% of the actionable and informative flags had immediate clinical value based on the pharmacist’s review. An additional 217 (86%) received one or more clinical recommendations not related to PGx.ConclusionWhile PGx provides another opportunity for pharmacotherapy personalization, PGx data must be considered within the context of other patient-specific factors. Pharmacists were able to streamline the PGx report flags and identify other pharmacotherapy interventions following application of patient-specific data, thereby developing a brief report of recommendations for the patient’s prescriber(s). Engaging clinical pharmacists in the PGx clinical decision process may help to facilitate more widespread PGx implementation.

Pharmacist led vaccination rates in opioid addicted obstetric patients

AbstractObjectiveTo evaluate whether patients seen at the Women's and Infants Substance Help Center (WISH) are in compliance with the 2016 Advisory Committee on Immunization Practices (ACIP) recommendations for influenza, tetanus/diphtheria/pertussis (Tdap), pneumococcal‐23, hepatitis A, hepatitis B, and human papillomavirus (HPV) vaccines.MethodsIn a retrospective cross‐section chart review, all patients with at least two WISH visits from September 1, 2014 to January 22, 2017 were included in the analysis. The primary objective evaluated compliance with ACIP recommendations. Data extraction included baseline demographics, patient‐specific vaccine indications, and vaccine history.ResultsNinety‐nine patients receiving buprenorphine (n = 80), methadone (n = 14), or no therapy (n = 5) from September 1, 2014 to January 22, 2017 were included. On average, patients were 28 years old and had the first visit at 19 gestational weeks (range 6‐35). Overall, WISH vaccination compliance was high for influenza (66%) and Tdap (86%) as well as the initial doses of hepatitis A (80%), hepatitis B (77%), and HPV (46%) vaccines. No difference was found between patients receiving buprenorphine and methadone. Patients who had at least 1 pharmacist consultation (n = 90) had significantly higher compliance with the initial doses of hepatitis A (92.1% vs 22.2%, P < .0001) and hepatitis B (86.4% vs 11.1%, P < .0001), and influenza vaccines (71.6% vs 33.3%, P < .0001) compared to those who did not (n = 9). Common reasons for vaccine non‐compliance were patient refusal, did not return to the clinic, or missed opportunity by the non‐pharmacist healthcare professional.ConclusionsOverall clinic vaccination rates were high and implies that pharmacy intervention significantly increased administration rates for hepatitis A, hepatitis B, and influenza vaccines.Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT 03039725.

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events.

Federally-mandated consultant pharmacist-conducted retrospective medication regimen reviews (MRRs) are designed to improve medication safety in nursing homes (NH). However, MRRs are potentially ineffective. A new model of care that improves access to and efficiency of consultant pharmacists is needed. The objective of this study was to determine the impact of pharmacist-led telemedicine services on reducing high-risk medication adverse drug events (ADEs) for NH residents using medication reconciliation and prospective MRR on admission plus ongoing clinical decision support alerts throughout the residents' stay. Quality improvement study using a stepped-wedge design comparing the novel service to usual care in a one-year evaluation from November 2016 to October 2017. Four NHs (two urban, two suburban) in Southwestern Pennsylvania. All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period. Upon admission, pharmacists conducted medication reconciliation and prospective MRR for residents and also used telemedicine for communication with cognitively-intact residents. Post-admission, pharmacists received clinical decision support alerts to conduct targeted concurrent MRRs and telemedicine. Main outcome was incidence of high-risk medication, alert-specific ADEs. Secondary outcomes included all-cause hospitalization, 30-day readmission rates, and consultant pharmacists' recommendations. Consultant pharmacists provided 769 recommendations. The intervention group had a 92% lower incidence of alert-specific ADEs than usual care (9 vs 31; 0.14 vs 0.61/1,000-resident-days; adjusted incident rate ratio (AIRR) = 0.08 (95% confidence interval (CI) = 0.01-0.40]; P = .002). All-cause hospitalization was similar between groups (149 vs 138; 2.33 vs 2.70/1,000-resident-days; AIRR = 1.06 (95% CI = 0.72-1.58); P = .75), as were 30-day readmissions (110 vs 102; 1.72 vs 2.00/1,000-resident-days; AIRR = 1.21 (95% CI = 0.76-1.93); P = .42). This is the first evaluation of the impact of pharmacist-led patient-centered telemedicine services to manage high-risk medications during transitional care and throughout the resident's NH stay, supporting a new model of patient care.

Impact of a contactless prescription pickup kiosk on prescription abandonment, patient experience, and pharmacist consultations

ObjectiveInvestigate the impact of increased access to new and refilled prescriptions by means of an automated pickup kiosk (Asteres ScriptCenter) on prescription abandonment rates, patient experience, and pharmacist consultations. DesignNonrandomized, observational study using retrospective, deidentified data from the filling pharmacy, the kiosk, and a pharmacist-completed counseling documentation log over a 35-month study period. Setting and participantsHospital employees opting to use a kiosk located in the lobby with 24 hours a day, 7 days a week access for pickups and a telephone pharmacist consultation service compared with employees using the regular counter at the filling pharmacy. Outcome measuresReturn to stock (RTS) rate to assess prescription abandonment, time to prescription pickup, consultation duration, kiosk user assessment, and pharmacist assessment of counseling ability. ResultsApproximately 9% of employees (440) enrolled to use the kiosk, with 5062 kiosk pickups recorded for new prescriptions (29%), refill prescriptions (33%), and over-the-counters (38%). The mean kiosk RTS (4.3% ± 3.2) was lower than that at the regular counter (5.6% ± 0.8), P = 0.04, whereas the mean time to pickup was approximately 1 day greater at the kiosk than the regular counter (2.8 ± 0.4 vs. 1.8 ± 0.2, P < 0.001). The average kiosk consultation was approximately 1 minute shorter (2.0 ± 1.4) than that of the regular counter (3.4 ± 1.9, P < 0.001), and fewer patients using the kiosk (15.7%) had additional questions at the end of a consultation session than patients at the regular counter (38.8%, P < 0.001). Most of the kiosk users agreed that their prescription questions were answered and that kiosk convenience was an important reason for using the filling pharmacy. Almost all (>90%) pharmacists indicated that they were able to effectively counsel patients at the kiosk and the regular counter. ConclusionThe kiosk, used by self-selected health care workers located in a hospital workplace setting with 24 hours a day, 7 days a week access, was a convenient, contactless pickup extension of the filling pharmacy with a lower prescription abandonment rate and similar pickup and consultation characteristics as at the regular pharmacy counter.

Deprescribing: A Tool to Optimize Medications Across the Continuum of Care

Deprescribing: A Tool to Optimize Medications Across the Continuum of Care

Community pharmacy-based injectable naltrexone service delivery models and best practices.

Opioid use disorder (OUD) is a major public health issue in the United States. Medications for OUD (MOUD), which combines the use of approved medications with counseling and behavioral therapies, represents an evidence-based approach to treat individuals living with an OUD. However, MOUD has not kept up with increased demand and new treatment approaches are needed. One approach is injectable naltrexone, an approved and effective MOUD treatment, provided by pharmacists, who are more geographically accessible and have legal authority to administer it in some states. To explore how different community pharmacists provide injectable naltrexone treatment and identify best practices. An exploratory sequential mixed-methods design was used to investigate pharmacy-based naltrexone injection practices, involving a pharmacist questionnaire and interviews with pharmacists, prescribers, and community stakeholders. An inductive/iterative content analysis approach, guided by an initial straw model, was used to identify and explore conceptual categories for the interviews. The final sample included 68 pharmacy surveys and 14 total interviews with pharmacists (n=9), prescribers (n=3), and community stakeholders (n=2). Pharmacies providing naltrexone injections reported administering over 700 injections in the past year. Interviews revealed benefits and barriers to pharmacist-provided injections and the importance of the prescriber-pharmacist relationship in OUD treatment. Three pharmacy treatment delivery models were identified, compared to the initial straw model, and informed development of a best practices checklist for community pharmacies interested in establishing or expanding a naltrexone injection service. The study demonstrates how community pharmacies developed and implemented a naltrexone injection service. Pharmacists' and prescribers' feedback clearly suggests an untapped interest, as well as resources, in realizing pharmacists' roles as providers of injectable naltrexone treatment. Implementation research could inform the development and evaluation of an intervention based on these best practices to further explore the utility of community pharmacy-based naltrexone injection services.

Implementation of good pharmacy practice standards; a step forward in Libya’s pharmacies

The practice of pharmacy in health care societies continues to undergo evolutionary and even radical changes. It has changed to a personal health service charged with assuring pharmaceutic and therapeutic appropriateness of all its functions in the care of patients. The purpose of this study is to review and analysis the historical stages of development of the good pharmaceutical practice (GPP) requirements and to recommend a guideline for the implementation of GPP standards in Libya as a way to improve the pharmaceutical care and profession. The study designates that the development of the GPP standards should be committed at the public professional organizations levels as pharmaceutical syndicates and associations as the national regulation of pharmacy practices in various countries and the local health authorities. This requires basic skills of documentation, professional and communication with all relative professions and it, therefore, is important to establish standards for community, hospital and consultant pharmacists to promote the pharmaceutical mission.

Impact of Training Consultant Pharmacists on Antimicrobial Stewardship Programs in Long-Term Care Facilities

Background: The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and &gt;90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P &lt; .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P &lt; .01) and 106.47 versus 141.59 (P &lt; .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P &lt; .001) and DOT by 1.92 per 1,000 RD (P &lt; .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P &lt; .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.Funding: Merck &amp; Co., Inc, provided funding for this study.Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.

Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None

Assessment of primary care practitioners'attitudes and interest in pharmacogenomic testing.

Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnairewas designed and then disseminated to PCPs across theMedStar Health System. Results: Ninety of 312 (29%) PCPs responded and wereincluded in analyses. Seventy-six (84%) had heard of PGx and 12 (13%)previously ordered PGx testing. Most, 68 (76%), believed PGx can improvecare; however, a minority, 23 (26%), reported confidence in usingPGx in prescribing decisions.Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx forantidepressants (75%), proton pump inhibitors (72%) andother medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.

Improvements in Antibiotic Appropriateness for Cystitis in Older Nursing Home Residents: A Quality Improvement Study With Randomized Assignment

ObjectiveTo determine the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. DesignQuality improvement study with randomized assignment. Settings and ParticipantsTwenty-five nursing homes in United States were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. MethodsA 12-month trial of a low-intensity multifaceted antimicrobial stewardship intervention focused on uncomplicated cystitis in nursing home residents vs usual care. The outcome was the modified Medication Appropriateness Index as assessed by a blinded geriatric clinical pharmacist and consisted of an assessment of antibiotic effectiveness, dosage, drug-drug interactions, and duration. ResultsThere were 75 cases (0.15/1000 resident days) in intervention and 92 (0.22/1000 resident days) in control groups with a probable cystitis per consensus guidelines. Compared with controls, there was a statistically nonsignificant 21% reduction in the risk of inappropriate antibiotic prescribing (nonzero Medication Appropriateness Index score rate 0.13 vs 0.21/1000 person days; adjusted incident rate ratio 0.79; 95% confidence interval 0.45‒1.38). There was a favorable comparison in inappropriateness of duration (77% vs 89% for intervention vs control groups, respectively; P = .0394). However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%, respectively; P = .0463). Similarly, the intervention group had a nonsignificant trend toward more problems with dosage (primarily because of the lack of adjustment for decreased renal function) than the control group (32% vs 25%, respectively; P = .3170). Both groups had similar rates of problems with choice/effectiveness (44% vs 45%; P = .9417). The most common class of antibiotics prescribed inappropriately was quinolones (25% vs 23% for intervention versus control groups, respectively; P = .7057). Conclusions and ImplicationsA low-intensity intervention showed a trend toward improved appropriate antibiotic prescribing in nursing home residents with likely uncomplicated cystitis. Efforts to improve antibiotic prescribing in addition to the low-intensity intervention might include a consultant pharmacist in a nursing home to identify inappropriate prescribing practices.

Integrating targeted consultant pharmacists into a new collaborative care model to reduce the risk of falls in older adults owing to the overuse of opioids and benzodiazepines

Using central nervous system (CNS)–active medications increases older adults’ risk for falls and fall-related injuries. Opioids and benzodiazepines are among the most widely used CNS-active medications and because of their addictive potential and widespread use for common ailments such as chronic pain, anxiety, or sleep, are also among the most difficult to deprescribe. Reducing the dose burden of these 2 medication classes in older adults—to balance safety with efficacy—is a challenge that requires persistence and strategic support structures to be successful.We propose a novel care model that uses the support of targeted consultant pharmacist services to help primary care providers reduce the unnecessary use of opioids and benzodiazepines in their patients who are older adults. This care model holds promise to not only offer providers additional time-saving clinical support but to help their practices improve patient outcomes, such as a reduction in medication-related falls and excess opioid use.

P66 Standardising strengths of unlicensed medicines in a large London hospital trust

BackgroundA UK national position statement on standardised strengths of unlicensed liquid medicines recommend that when children require unlicensed liquid medications, they should receive the recommended strength. By standardising strengths of these medicines, the risk of errors being made in the doses given to children will be reduced and prevent accidental under and overdoses.1 Our Trust has 4 hospital sites since merging in 2012, we found the process of switching to a standard strength far from simple.MethodsThe strengths of unlicensed liquid medicines listed in the position statement available on the pharmacy dispensing system (JAC) were identified, along with the speciality users. Pharmacy and clinical leads were consulted for agreement to switching to the standardised strengths. Pharmacy procurement identified new products in standardised strengths and products were reviewed for suitability by paediatric pharmacist. A cost impact analysis was carried out. Communication was sent to stakeholders including, doctors, nurses, pharmacy and primary care.Results and DiscussionWe found the standardised strengths of azathioprine, clonazepam, ethambutol, isoniazid, melatonin, omeprazole, phenobarbitone and pyrazinamide strengths were on formulary. Clopidogrel, hydrocortisone, sertraline and tacrolimus liquids are not used. Different strengths of the listed unlicensed liquid medicines were used by different sites and specialties. Lead speciality pharmacists agreed with the standardisation. We identified use of unlicensed products where licensed products are available (sildenafil 20 mg/5 mL and furosemide 5 mg/5 mL). We added the use of these items to our review. We were not able to agree on a single standard strength for some items; the neonatal intensive care unit (NICU) have babies under 500 g who may require furosemide, spironolactone and sildenafil in doses that measure less than 0.1 mL using the recommended strengths. This volume is deemed less than satisfactory to be measured safely1. It has been agreed with the neonatal lead pharmacist that additional strengths of the sildenafil (unlicensed 20 mg/5 mL), spironolactone (unlicensed 10 mg/5 mL) and furosemide (20 mg/5 mL) be available for inpatient NICU use only. The potential for patients to be discharged on the non-standard strength is reduced by specifying ‘Not for discharge - inpatient use only’ on the pharmacy system as well as having them only as NICU stock from medicines distribution. Patients admitted on other strengths will be switched (with consent); to minimise risk pharmacists will ensure carers are aware of the change &amp; correct dose volume to administer and endorse TTAs noting the change in concentration for the GP. Primary care have been engaged with the switch and invited the consultant pharmacist to discuss this at the interface meeting. We were not able to source the recommended midazolam 10 mg/5 mL. The switch to chloral hydrate to 1 g/5 mL was calculated to have a significant cost pressure therefore it was agreed that that we would not change from chloral hydrate 500 mg/5 mL at this time as it is mainly used in the in-patient setting within our Trust. Based on current usage there is an estimated cost saving of over £5 k based on the switch of sodium chloride, sildenafil, furosemide and spironolactone. The impact will be reviewed in 6 months.ConclusionA successful switch requires a team approach but will benefit patient safety and save money.ReferenceThe Neonatal and Paediatric Pharmacists Group (NPPG) and Royal College of Paediatric and Child Health (RCPCH). Position statement 18–01 Using Standardised Strengths of Unlicensed Liquid Medicines in Children. Version 2. May 2019.

Pediatric pharmacists' perspectives on essential skills and activities for community pharmacists caring for pediatric patients: A mixed-methods study.

Provision of care to pediatric patients represents a set of unique challenges for pharmacists. Pharmacists practising in pediatric-specialty areas (acute care or ambulatory) have unique perspectives on approaches to pediatric care that can be shared to support pharmacists less familiar with this group of patients in providing effective, patient-centred care. This was a mixed-methods study using data from pharmacist interviews to quantify and qualitatively describe the approaches to care most commonly reported by pediatric-specialty pharmacists when asked to provide advice to pharmacists on providing pharmaceutical care to infants and children. Data were coded in duplicate using an inductive approach, and discrepancies were resolved by consensus. The number of times a theme (or subtheme) was mentioned and the number of pharmacists who mentioned it were used as markers of the relative importance of the content. The themes (and subthemes) that emerged as most important were clinical activities (dose checks, considering indication, using up-to-date height/weight), caregiver counselling (demonstrating measurement, discussing administration), medication safety (using consistent concentrations of liquids), compounded medications (risks of, use of caution), adherence (formulation considerations, palatability), avoiding use of over-the counter products (except analgesics/antipyretics) and use of external supports (colleagues, caregivers, resources). We present a collated and prioritized list of practical approaches for pharmacists to use when caring for pediatric patients across the spectrum of practice. Can Pharm J (Ott) 2020;153:xx-xx.

Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer

ObjectivesOlder patients with cancer have increased risk for comorbidity, polypharmacy (PP) and drug related problems (DRP). The aim of this study was to assess the effect of a clinical pharmacist and geriatrician medication review (MR) among older outpatients with cancer to optimize management of comorbidities during comprehensive geriatric assessment (CGA). Material and MethodsWe conducted a single-center prospective study among older outpatients with cancer (≥75 years). A pharmacist consultation was added into CGA process. The clinical pharmacist detected and assessed PP and DRP such as potentially inappropriate medications (PIM) according to the Laroche French list and STOPP criteria, START criteria and adverse drug events (ADE) risk. After a multidisciplinary MR, the proposals for prescription modification were sent to general practitioners (GPs). ResultsFifty-one consenting patients were recruited between May 2016 and March 2017, with a median age of 83 years. Prevalence of PP was 80.4%. 165 DRP were detected among 86% patients (median number of DRP = 3.0): 19.4% were misuse, 43.6% underuse, and 37.0% overuse. A significant decrease was observed in prevalence of PIM use (Laroche: 31.4% versus 5.9%, p = 0.002), START criteria (66.7% to 5.9%; P < 0.001) and ADE score (4.0 before MR versus 2.0 after, p = 0.023). A trend was observed for a lower number of medications (10.0 versus 8.0, p = 0.092) and on STOPP criteria prevalence (56.9% versus 31.4%, p = 0.12). ConclusionA clinical pharmacist and a geriatrician MR is effective to detect and reduce DRP in older outpatients with cancer.

Empathy or Empath? increasing Self-Awareness for Healthy Patient-Provider interactions

Dr. Olga Hilas, associate professor from St. John's University, reflects on her Pain Management Traineeship with the American Society of Consultant Pharmacists Foundation.

Empathy or Empath? increasing Self-Awareness for Healthy Patient-Provider interactions.

Dr. Olga Hilas, associate professor from St. John's University, reflects on her Pain Management Traineeship with the American Society of Consultant Pharmacists Foundation.

California Community Pharmacist Preparedness in Ordering and Interpreting Laboratory Tests

Introduction The passage of Senate Bill 493 (SB 493) granted California pharmacists the ability to order and interpret lab tests without physician approval. Despite this legislation, not all pharmacists are aware of, or exercise, this authority. The goals of this study are to describe 1) pharmacists' willingness, 2) perceived factors influencing pharmacist preparedness, and 3) challenges and barriers to ordering laboratory tests in the community setting. Methods This is a prospective, descriptive survey study that was performed using online survey software from August 31, 2017, to October 4, 2017. An anonymous link was distributed to California pharmacists via California Society of Health-System Pharmacists (CSHP) and California Pharmacists Association (CPhA) email newsletters. Additionally, targeted interviews of pharmacists were conducted by phone to qualitatively assess barriers as well as successful practices. Institutional Review Board (IRB) approval was obtained prior to initiating the study. Results Sixty-six pharmacist respondents completed the online survey. The reported two biggest barriers to ordering lab tests identified by community pharmacists were 1) lack of available time and 2) compensation structure. Despite these barriers, most pharmacists were willing to order and interpret laboratory tests and accept the liability, regardless of a reimbursement guarantee. Conclusions Community pharmacists self-report preparedness to order and interpret laboratory tests. Barriers in carrying out this task include lack of staff, resources, compensation, and reimbursement structure.

Evaluation of the completeness of information sources used to prepare the best possible medication histories at a tertiary teaching hospital in Jordan.

In this study we aimed to evaluate the completeness of three different medication information sources that are commonly used to collect and obtain the Best Possible Medication History (BPMH). This is an observational study which was held at Jordan University Hospital. After identifying eligible patients, the BPMH was obtained from three different sources separately. These sources include medical file, pharmacy database, and patients' interview. Information from all of these sources was compiled to create the BPMH. The BPMH was used as the standard against which every other information source was compared and given a "completeness score" according to a systematic scoring system. Among the 196 participating patients who were included in the study, 113 (57.7%) were recruited from internal medicine and 83 (42.3%) from surgical department. Patients' interview showed the highest median completeness score (71.4%) among the three used sources followed by pharmacy database (35.3%), and medical files (28.2%). The median completeness score for the compiled BPMH obtained by the pharmacist was 93.0%. The compiled BPMH completeness score was inversely proportional to the numbers of medications in the compiled BPMH (R = -.392, P value<.001). Moreover, patients with lower income showed better median BPMH completeness score compared with those with higher income (95.2% (IQR = 16.7%) vs 88.9% (IQR = 15.7%), respectively, P value = .042). The results show that pharmacist's interview with the patients scored the highest percentage of completeness compared with hospital pharmacy database and medical file and is, therefore, considered more comprehensive in obtaining the BPMH.

The Implementation of Good Pharmacy Practice Standards at Pharmacies in Ha Dong District, Hanoi in 2018

&#x0D; This study describes the current implementation of the Good Pharmacy Practice (GPP) standards by a number of selected pharmacies in Ha Dong, Hanoi in 2018. Staff members of the selected pharmacies were interviewed using the questions developed based on the GPP standards. The analysis of the interview results shows that by qualification, the interviewed pharmacists fell into three groups: intermediate diploma, associate’s diploma and bachelor’s degree, accounting for 43.23%, 54.23% and 2.54%, respectively. All the studied pharmacies fully fulfilled the GPP requirements in terms of equipment for and arrangement of their functional areas. 74.58% of the pharmacies had their own drug stores; 11.86% of them practiced computerized business management. A hundred percent of the executive pharmacists well fulfilled their job duties, which guaranteed the availability of 100% of drug transactions for electronic search. However, 90.68% of the investigated pharmacies let their pharmacists make changes to prescriptions. As a concluding remark, although the selected pharmacies in Ha Dong district met the general GPP standards, the maintenance of the standards implementation, consultant pharmacist qualification and computerized management still need further improvement.&#x0D; Keywords&#x0D; GPP, pharmacies, Ha Dong district.&#x0D; References&#x0D; [1] Ministry of Health, Circular 02/2018/TT-BYT dated January 22, 2018. The Circular stipulates the roadmap for implementing the principles and standards of Good practice of drug retailing establishments, 2018[2] To Hoai Nam, Analysis of the operation of pharmacies recognized as a "Good pharmacy practice - GPP" standard in Hanoi urban districts between 2010 and 2012, Hanoi University of Pharmacy, 2013.[3] Dinh Thu Trang, Analysis of pharmacies’ operation meeting the "Good pharmacy practice" - GPP in Thu Dau Mot City, Binh Duong Province in 2014, First Specialized Thesis, Hanoi University of Pharmacy, 2015.[4] Nguyen Thi Kim Anh, Analysis of pharmacies activities in Hai Duong city, First Specialized Thesis, Hanoi University of Pharmacy, 2016.[5] Tran Van Cuc, Assessing the status of GPP-compliant pharmacies in Da Nang city, Specialized Pharmacist Thesis 2, Hanoi University of Pharmacy, 2014.[6] Bui Thanh Nguyet, Analyzing the implementation of the "Good pharmacy practice - GPP standard" of pharmacies in Ho Chi Minh City in 2014, First Specialized Thesis, Hanoi University of Pharmacy, 2014 .[7] Ministry of Health, Circular 07/2017/TT-BYT of the Ministry of Health on promulgating the list of over-the-counter medicines, dated May 3, 2017 of the Minister of Health, 2017.[8] Vu Tuan Cuong, Analysis of implementation of applying "Good pharmacy practice - GPP standard" at drug retail establishments in Quang Ninh province, Second Specialized Thesis, Hanoi University of Pharmacy, 2010.[9] Huynh Thuc Lam, Analysis of implementation of good pharmacy practice (GPP) in Hon Dat district, Kien Giang province, Pharmacist Thesis, Tay Do University, Pharmacy – Nursing Specialty, 2017.&#x0D; &#x0D;