Continuous Pharmaceutical Care Research Articles

Assessment of knowledge, perception, and readiness for telepharmacy-assisted pharmaceutical services among young pharmacists in rural Indonesia

BackgroundThe implementation of telepharmacy technology has expanded significantly, particularly during the COVID-19 pandemic, to ensure continuous pharmaceutical care services. This practice is vital in rural and underserved areas where access to healthcare is limited. ObjectiveThis study aims to assess the knowledge, perception, and readiness of young pharmacists in rural Indonesia towards telepharmacy-assisted pharmaceutical services. MethodsA cross-sectional study was conducted from January to July 2023 in rural areas of Java, Sumatra, and Kalimantan, Indonesia. A convenience sampling method was employed with the aim of recruiting 520 registered pharmacists under 35 years of age (23–34 years old). Data were collected using an online questionnaire adapted for the local context and analyzed using SPSS version 26.0. ResultsThe study achieved an 86.67 % response rate. Most participants were female (73.1 %) and aged between 26 and 30 years (53.8 %). Nearly all pharmacists (97.1 %) held a Pharm.D degree. The knowledge assessment showed high awareness of telepharmacy's importance and its role during the COVID-19 pandemic, with 96.15 % recognizing the need for a strong internet connection. Positive perception was noted, with 90.38 % agreeing that telepharmacy enhances medication access in rural areas. However, concerns about increased error rates and workload were highlighted. A substantial proportion of pharmacists expressed readiness for conducting drug counselling via video consultation (44.23 %) and showed a willingness to undergo relevant training (59.62 %). ConclusionYoung pharmacists in rural Indonesia demonstrate a good level of knowledge and generally positive perceptions about telepharmacy, with notable readiness among pharmacists with less than five years of experience. While there is notable willingness to engage in telepharmacy practices and training, addressing concerns about workload and data security through targeted support and training will be crucial for the successful implementation of telepharmacy, potentially enhancing healthcare access in rural areas.

Impact of pharmaceutical care on hospital readmissions for heart failure: a randomised trial

ObjectivesTo evaluate the impact of pharmaceutical care on the number of readmissions and visits to the emergency department due to heart failure 30 days after hospital discharge, based on a...

Impact of continuous pharmaceutical care led by clinical pharmacists during transitions of care on medication adherence and clinical outcomes for patients with coronary heart disease: a prospective cohort study.

Objectives: The study aimed to explore the impact of a continuous pharmaceutical care (CPC) program during care transitions on medication adherence and clinical outcomes for patients with coronary heart disease (CHD). Methods: A prospective cohort study was conducted from April 2020 to February 2021. Patients diagnosed with CHD were selected and divided into intervention (CPC) and usual care (UC) groups by nurses at equal intervals based on admission time. The intervention group received CPC services provided by clinical pharmacists (including medication reconciliation, disease education, medication guidance, lifestyle counseling, and follow-up services) and usual care. The UC group received only routine medical care. The study compared medication adherence, clinical indicators (low-density lipoprotein cholesterol [LDL-C], blood pressure [BP], glycated hemoglobin [HbA1c] control rates), the incidence of adverse drug reactions (ADRs), and readmission rates (overall, major adverse cardiovascular events [MACEs]-related, and CHD risk factors-related) at admission and 1, 3, and 6 months after discharge between the two groups. Results: A total of 228 patients with CHD completed the study, including 113 patients in the CPC group and 115 patients in the UC group. There were no significant differences (p > 0.05) in both groups in demographic and clinical characteristics at baseline. A total of 101 drug-related problems were identified in the CPC group (an average of 0.89 per person). The CPC group showed significantly higher medication adherence at 1, 3, and 6 months after discharge than the UC group (p < 0.05). At 3 and 6 months after discharge, the intervention group had significantly higher control rates of LDL-C (61.11% vs. 44.64% at 3 months, 78.18% vs. 51.43% at 6 months), and BP (91.15% vs. 77.39% at 3 months, 88.50% vs. 77.19% at 6 months). The CPC group had higher HbA1c control rates (53.85% vs. 34.21% at 3 months, 54.05% vs. 38.46% at 6 months) than the UC group. However, the differences were not statistically significant. The incidence of ADRs 6months after discharge was significantly lower in the CPC group than in the UC group (5.13% vs. 12.17%, p < 0.05). The CPC group had a lower overall readmission rate (13.27% vs. 20.00%), MACE-related readmission rate (5.31% vs. 12.17%), and readmission rate related to CHD risk factors (0.88% vs. 2.61%) 6months after discharge compared to the UC group. However, these differences were not statistically significant (p > 0.05). Conclusion: CPC led by clinical pharmacists during care transitions effectively improved medication adherence, safety, and risk factor control in patients with CHD.

Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation.

BackgroundThe COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC.ObjectiveThe aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China.MethodsThe total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients’ gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients’ satisfaction in using the remote prescription service.ResultsA total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform.ConclusionsThe remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service.

Pharmaceutical Care Contributes to the Advanced Management of Patients Receiving Immune Checkpoint Inhibitors.

We previously reported that successive pharmaceutical care by oncology pharmacy specialists contributes to quality outpatient chemotherapy. However, there are a few reports regarding such care during immune checkpoint inhibitors (ICIs) treatment, despite increasing patients being treated with ICIs and the profile of immune-related adverse events being quite different from that of the adverse effects of cytotoxic agents. We retrospectively evaluated the effectiveness of continuous pharmaceutical care in outpatient ICI treatment, focusing especially on the period of providing pharmaceutical recommendations. The adoption rate, efficacy, and period of pharmaceutical interventions, such as prescription questions and pharmaceutical recommendations, were evaluated. A total of 3597 ICI administrations (366 patients) were evaluated. We performed 2625 face-to-face medication counseling. A total of 282 prescription questions and 147 pharmaceutical recommendations were conducted. Approximately 70% of the questions were regarding ordering of laboratory examination, and 86.5% of these questions were adopted. Pharmaceutical recommendations were categorized into medication recommendations (81.1%), examination recommendations (10.8%), and recommendation of expert consultation (8.1%). The adoption rate of pharmaceutical recommendations was 96.0, and 70% of the medication recommendations attenuated the symptoms. Finally, the provision rate of pharmaceutical recommendations was significantly higher in the first 3 months after ICI treatment initiation. We found that pharmaceutical care contributes to an improved quality of outpatient ICI treatment, and face-to-face pharmaceutical counseling up to 3 months after ICI treatment initiation is the most important.

Survey of the Efficacy of Long-term and Successive Pharmaceutical Care in Outpatient Chemotherapy by Oncology Pharmacy Specialists

It is important that pharmacists ensure safe chemotherapy implementation. In addition to inspecting chemotherapeutic prescriptions according to patient condition and drug-drug interactions, the management of chemotherapy-induced adverse effects and associated pharmaceutical intervention is one of the most important responsibilities of pharmacists in medical care teams. In May 2016, an oncology pharmacist was set responsible for the specialized, long-term, and successive pharmaceutical care, including instructions about appropriate use of medication at an outpatient chemotherapy center. We evaluated the effectiveness of the continuous pharmaceutical care. The number of medication counseling and associated pharmaceutical interventions increased with time. Specifically, the number of pharmaceutical interventions (prescription questions and pharmaceutical proposals) was 745 (459 and 286, respectively) in the surveillance period, which significantly increased compared to that observed within the same duration before posting an oncology pharmacist. The adoption rate was approximately 70% for prescription questions and 98% for pharmaceutical proposals. We also found that approximately 70% of the proposals attenuated the painful symptoms. Furthermore, approximately 60% of all pharmaceutical interventions were established after the third visit; in particular, approximately 20% of the pharmaceutical proposals were suggested after the sixth visit, indicating that continuous medication counseling results in an increase in pharmaceutical proposals. In conclusion, long-term and successive pharmaceutical care by oncology pharmacy specialists in outpatient chemotherapy contributes to a safe and less onerous chemotherapy implementation, as it has been highly adopted, is effective in many cases, and has been proven to be important for risk management in chemotherapy.

PHARMACIST LEAD PATIENT COUNSELLING: IMPACT ON QUALITY OF LIFE IN ASTHMA PATIENTS

Safe and effective drug therapy depends on patients being well informed about their medication. The proper use of drugs and patient education are vital for asthma management. Increasing patient’s knowl-edge about their asthma therapy is a necessary component of asthma management. This study was carried out to assess the patient counseling impact on quality of life (QOL) in asthma patients using SF 36questionnaire. In this study a total of hundred patients diagnosed with asthma were enrolled by considering the inclusion and exclusion criteria. Out of this, 50 (50%) patients were in intervention and 50 (50%) patients in the control group. As per our study it was found that the predominant risk factor for Asthma was fumes and smoking was found to be the major risk factor in males. After patient counseling intervention group showed improvement in QOL from the baseline to1st and 2nd follow-ups. But control group doesn’t show significant improvement in the QOL from the baseline to 1st and 2nd follow-ups. Physical activity and daily activity was also found to be increased during second follow-up in intervention group than in control group. Our study concluded that continuous education programs and counseling should be conducted for chronic diseases to emphasize and re-emphasize the importance of Quality of Life, to prevent recurrences, reduce progression of disease and ultimately minimize the hospitalization and there is a need of continuous pharmaceutical care services/ monitoring to improve the better quality of life.

Comprehensive Pharmaceutical Care in a Vascular Surgery Department

ObjectiveThe pharmacist must work with the clinical team across the continuum of care to develop and therefore improve the patient's quality of life. In this study, we present the results from a continuous pharmaceutical care programme for patients admitted to an angiology and vascular surgery department. Material and methodsA 5-month prospective study to evaluate the results of a pharmaceutical care programme in an angiology and vascular surgery department. The pharmacist went on the rounds with the clinical team from Monday to Friday and helped make decisions on treatment, and detect and resolve conciliation discrepancies upon admission and discharge, and drug-related problems during the hospital stay. ResultsWe detected and resolved 273 conciliation discrepancies in 99 patients and 76 drug-related problems in 46 patients. Global acceptance of pharmacist interventions was 96%. ConclusionsSeventy-four percent of patients presented conciliation discrepancies. Efficiency of pharmaceutical activity across the continuum of care is demonstrated by the high acceptance of the interventions.

Atención farmacéutica integral a los pacientes de un servicio de Cirugía Vascular

La actuación conjunta del farmacéutico con el resto del equipo sanitario durante todo el proceso asistencial es necesaria para el desarrollo de la atención farmacéutica y así mejorar la calidad de vida del paciente. En este estudio se presentan los resultados de un modelo continuo de atención farmacéutica en pacientes ingresados en un servicio de Angiología y Cirugía Vascular (ACV). Estudio prospectivo realizado durante 5 meses para evaluar el resultado de la actividad de un farmacéutico clínico en un servicio de ACV. El farmacéutico participa en el pase de visita de lunes a viernes y en la toma de decisiones con el equipo multidisciplinar, detectando y resolviendo errores de conciliación (EC) al ingreso y al alta y problemas relacionados con la medicación (PRM) durante la estancia hospitalaria. Se han detectado y resuelto 273 EC en 99 pacientes y 76 PRM en 46 pacientes. La aceptación global de las intervenciones farmacéuticas ha sido del 96%. Un 74% de los pacientes han presentado EC. La eficiencia de la actividad farmacéutica a lo largo del proceso hospitalario queda recogida en el alto grado de aceptación de las intervenciones realizadas. The pharmacist must work with the clinical team across the continuum of care to develop and therefore improve the patient's quality of life. In this study, we present the results from a continuous pharmaceutical care programme for patients admitted to an angiology and vascular surgery department. A 5-month prospective study to evaluate the results of a pharmaceutical care programme in an angiology and vascular surgery department. The pharmacist went on the rounds with the clinical team from Monday to Friday and helped make decisions on treatment, and detect and resolve conciliation discrepancies upon admission and discharge, and drug-related problems during the hospital stay. We detected and resolved 273 conciliation discrepancies in 99 patients and 76 drug-related problems in 46 patients. Global acceptance of pharmacist interventions was 96%. Seventy-four percent of patients presented conciliation discrepancies. Efficiency of pharmaceutical activity across the continuum of care is demonstrated by the high acceptance of the interventions.

外来化学療法部におけるＴＳ‐１服用患者に対する継続的な薬学的管理―患者教育システムの構築と積極的なファーマシューティカルケアヘの取り組み―

TS-1 is an oral anticancer agent used for a variety of cancers.In the clinical setting,many patients take TS-1 concomitantly with intravenous anticancer agents in several different regimens.In November,2006,we started giving consultation to outpatients taking TS-1 and undergoing chemotherapy concomitantly and providing continuous pharmaceutical care to enhance safety in their treatment.We made a consultation sheet for each patient and managed the administration schedule using a TS-1 check sheet and stickers for patient notebooks,which were used on each visit.From November,2006 to April,2007,we provided 482 consultations to 85 patients taking TS-1.As a result of pharmacists checking administration schedules and compliance at every visit to the outpatient oncology unit,no errors were made in the administration period of TS-1 for any patient.Pharmacists advised patients not only concerning administration schedules and dosages of TS-1,but also about opium and other concomitantly administered medications.The creation of the TS-1 check sheet has enabled pharmaceutical consultation to be standardized so every pharmacist can offer similar pharmaceutical consultation to each patient.Two-hundred-and-thirty-eight questions asked concerned anticancer agents (42%),medications other than anticancer agents (41%),opium (9%),and others (8%).Also,in 93 instances,pharmacists asked doctors to prescribe medications to prevent or reduce adverse effects that patients complained of and 96.8 % of such requests were reflected in prescriptions.In conclusion,it is effective for pharmacists to provide continuous consultation to patients who are taking TS-1 and visiting the Outpatient Oncology Unit,and such consultation enables patients to participate in ensuring that their outpatient chemotherapy is both safe and effective.

A Performance Improvement Program for Home Infusion Pharmacy

This article describes the key concepts involved in performance improvement, the cycle for improving organizational performance: design, measure, assess, improvement, and innovation. The performance improvement program for a home infusion pharmacy is described, acknowledging the need for the pharmacist to be an integrated health care team member who collaborates and communicates with patients, physicians, and nurses to achieve continuous pharmaceutical care. Two performance indicators that address the need for pharmacists to provide pharmacokinetics and nutritional clinical monitoring for home health care patients are described.

Inpatient High-Dose Chemotherapy with Outpatient Autologous Stem Cell Support: A Model of Continuous Pharmaceutical Care

The adult autologous bone marrow transplant (ABMT) program at Duke University Medical Center has developed an innovative outpatient approach to managing patients with solid tumors with ABMT during their postchemotherapy period of myelosuppression and recovery. The use of colony-stimulating factors in combination with peripheral blood progenitor cells (PBPCs) and bone marrow for hematologic support plus implementation of prophylactic antibiotics with sequential once-daily empiric antibiotic modification regimen were key to the success of this approach. This program reduces the duration of hospitalization, and thus the costs associated with a traditionally complex and difficult therapy. More than 400 patients have been treated in the outpatient setting since May 1992. Patients are initially admitted for 5 days of hospitalization to receive combination high-dose chemotherapy with continuous hydration and antiemetic support. Twenty-four hours after completion of chemotherapy, patients are discharged on oral prophylactic antibiotics, electrolyte supplements, and antiemetic agents. Close to half of the patients are readmitted to the inpatient unit during their period of ambulatory supportive care. Continuous provision of drug therapy and clinical pharmacy services require ongoing communication between pharmacy and both outpatient and inpatient personnel. Months of planning with nurse, physician, and pharmacist input were required to develop a program that meets the changing needs of patients undergoing a complex and potentially toxic therapy. Reliable 7-day pharmaceutical services was one of the essential components required for operation of such an outpatient program. This article reviews the basic principles and procedures used in treating patients in the Duke Outpatient ABMT program, with a focus on the complexity of supportive care issues that occur in the ambulatory setting, and the development of integrated pharmacy services for the program will be discussed.