Contribution Of Pharmacists Research Articles

The impact of pharmacist‐led strategies implemented to reduce errors related to cancer therapies: a systematic review

AbstractBackgroundPatients with cancer are managed across the whole healthcare spectrum. This complex system of interdependencies has high potential for errors to occur. This is a focus area for pharmacists, who possess the skillset to optimise cancer care across the health care system, identifying errors and other medication‐related problems (MRP).AimThe aim of this study was to identify and describe the impact of the pharmacist’s contribution in reducing cancer therapy‐related errors.MethodsA search of English‐language publications in Embase, Medline and CINAHL was conducted. Databases were searched from 1 January 2010 until 29 September 2020 to identify all quantitative studies of a descriptive, observational or experimental design. Articles describing pharmacist‐led interventions in adults receiving one or more cancer therapies including oral chemotherapy, intravenous chemotherapy or immunotherapy compared to no intervention, usual care or a service delivered by another healthcare professional were included. Researchers screened articles to identify eligible studies, and then data were extracted using a standardised data collection sheet. Quality assessment was undertaken using the modified Cochrane and the Newcastle Ottawa risk of bias tools. Data were reported as number or percentage.ResultsOf 2292 papers identified, nine studies were eligible for inclusion in this review. Pharmacist interventions consistently showed an increased identification of medication errors and medication‐related problems. Pharmacist contributions in many of the included studies comprised medication reviews and monitoring, laboratory monitoring, adverse drug reaction and drug–drug interaction management, adherence monitoring and medication counselling. All studies showed pharmacist intervention in cancer care resulted in fewer errors compared to control arms. Error minimisation was described for parenteral and oral cancer therapies and also for supportive medications such as antiemetics.ConclusionPharmacists reduce errors and potential patient harm in practice settings where cancer patients are treated. Pharmacists are an integral component of cancer care teams.

PNS70 Employment Preferences of Australian Pharmacists: Evidence from a Discrete Choice Experiment

The contribution of pharmacists to the development of a more efficient, productive and integrated healthcare system has been long discussed, mainly around the potential deployment of their clinical skills and knowledge to optimise medication use. When considering policy change in the pharmacy sector, understanding pharmacists’ preferences on different aspects of job opportunities when considering their career prospects is crucial. This paper aims to understand Australian pharmacists’ employment preferences using a discrete choice experiment. A labelled discrete choice experiments (DCE) was developed incorporating six key sectors of employment for pharmacy graduates: hospital pharmacy, community pharmacy, primary healthcare setting, pharmaceutical industry, government/academia, and non-pharmacy related sector. Each alternative is described by five attributes: role, flexible work schedule, career opportunities, geographic location, and annual salary. The DCE was embedded in the PAMELA (Pharmacy in Australia: Measuring Employment, Labour decisions, and Activity) survey, which was designed to investigate the employment preferences and work activities of Australian pharmacists. Generally hospital pharmacy was more desirable than pharmaceutical industry and non-pharmacy related sector while being less desirable than primary care settings. We also found that pharmacists significantly preferred higher annual salary than less and they preferred expanded roles in community pharmacy and primary care settings, of which the marginal willingness-to-pay values are about one third of pharmacists’ average annual salary. Our findings show that geographic location generally is the most important non-monetary job characteristics with the largest monetary values. Our findings has policy implications for the pharmacy workforce in terms of evidence on the willingness of the current pharmacist population to a reform of the integration of pharmacists in primary care network. We also provide some insights on what attracts PDHs to clinical and non-clinical sectors, which could be crucial in health workforce planning.

Pharmacist contribution in the multidisciplinary team in a neonatal intensive care unit

The newborn, admitted to a neonatal intensive care unit, due to his clinical severity, needs many medications; this increases the risk of problems related to drugs. The inclusion of the pharmacist in a multidisciplinary team can contribute for drug monitoring. Develop and implement a plan for pharmacist insertion in this scenario. It was developed as a work plan, and presented to service heads. The project was included in the Qualineo Program of the Ministry of Health. The pharmacist worked with an intensive care team, promoting rational use of medicines and detecting problems related to them. Initially, the pharmacist presented his objectives and how this could contribute to assist newborns. The nursing technicians had many doubts regarding drugs dilution and reconstitution that were clarified by the pharmacist. The nursing and technicians asked questions related to incompatibilities between medications, access routes and products for infusion. Doctors consulted the pharmacist about products available for prescription. The insertion in the team resulted in reduction of non-standard products; use of appropriated infusion system; reduced pharmaceutical supplies expenditure, and extension of the team's perception. In summary, a pharmaceutical insertion in the team improved care, and promoted rational use of medicines.

The burden of COVID-19 on pharmacists

The unprecedented changes brought about by the global coronavirus disease 2019 (COVID-19) pandemic have had important impacts on society. The pandemic has provided an opportunity to highlight the crucial role pharmacists play in the provision of health care. The critical and unique role of pharmacists in pandemics and other disasters has been highlighted in the past (severe acute respiratory syndrome and Ebola outbreaks) and more recently with reports of the contributions of pharmacists during the global COVID-19 pandemic. Many reports have documented that health care professionals are experiencing significant psychological morbidity as a result of providing essential care and services during the global COVID-19 pandemic. In these reports, pharmacists are not well represented, and, therefore, it is essential to understand the impact of COVID-19 on pharmacists across multiple practice settings. This is particularly true as the experiences of pharmacists working through previous pandemics and disasters, and the associated psychological burden, are likely to offer insights and be useful in supporting the psychological well-being of pharmacists during the global COVID-19 pandemic. Research into the effect of the global COVID-19 pandemic on pharmacists should improve the understanding of the impact and the psychological morbidity associated with their role as frontline health care professionals.

A New Case Manager for Diabetic Patients: A Pilot Observational Study of the Role of Community Pharmacists and Pharmacy Services in the Case Management of Diabetic Patients.

The adherence of type 2 diabetes mellitus (DM2) patients with an individual care plan (ICP) is often not satisfactory, nor does it allow for a significant improvement in outcome, because of poor accessibility to services, poor integration of pathway articulations, poor reconciliation with the patient’s life, or the lack of a constant reference person. The purpose of this study was to evaluate the contribution of community pharmacists and pharmacy services in improving adherence with periodic controls in DM2. The study was conducted at a rural pharmacy. A sample of 40 patients was calculated with respect to a historical cohort and subsequently enrolled. Clinical and personal data were collected in an electronic case report form. Pharmacists acting as a case manager followed patients carrying out their ICP developed by an attending physician. Some of the activities foreseen by the ICP, such as electrocardiogram, fundus examination, and self-analysis of blood and urine, were carried out directly in the pharmacy by the pharmacist through the use of telemedicine services and point of care units. Activities that could not be performed in the pharmacy were booked by the pharmacist at the accredited units. Examination results were electronically reported by the pharmacist to the attending physician. The primary endpoint was the variation in patient adherence with the ICP compared to a historical cohort. Secondary endpoints were variation in waiting time for the examinations, mean percentage change in glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure, impact on healthcare-related costs, and perceived quality of care. Adherence to the ICP significantly increased. Waiting times were reduced and clinical outcomes improved with conceivable effects on costs. Patients appreciated the easier access to services. Community pharmacists and pharmacy services represent ideal actors and context that, integrated in the care network, can really favor ICP adherence and obtain daily morbidity reduction and cost savings through proper disease control and an early diagnosis of complications.

Global contributions of pharmacists during the COVID-19 pandemic.

Throughout the SARS‐CoV‐2 (COVID‐19) global pandemic, pharmacists were rarely mentioned as essential frontline health care providers by the news media, the public, or politicians. Around the world, pharmacists are working on the frontlines of health care every day providing essential health care services during the pandemic. Pharmacists are medication experts providing patient care in a variety of settings including hospitals, clinics, community pharmacies, long‐term care, physician offices, and national and public health. In this paper, we describe how pharmacists from high and low‐middle income countries contributed to essential patient care and well‐being of the public during the COVID‐19 pandemic. While the news media, the public, and politicians often overlooked pharmacists as essential frontline health care providers, we hope that this list of contributions by pharmacists from nine countries in this article can help to change this perspective.

Examining the role of pharmacists in medication handover–facilitating opioid substitution therapy through transitions of care

AbstractAimsThis audit aimed to assess the prevalence and completeness of documented medication handover regarding opioid substitution therapy (OST) during transitions of care in to and out of a major tertiary teaching hospital, focusing on surgical admissions. The secondary aim was to evaluate the proportion of handover episodes that involved a clinical pharmacist, and to determine the impact of pharmacist involvement on the completeness of documented OST handover.Method and ResultsA 5‐year retrospective audit was conducted for surgical patients undergoing OST prior to admission to a major tertiary teaching hospital. Data were collected pertaining to: handover on admission of 13 OST‐related metrics deemed important for appropriate ongoing clinical care, whether medication handover to the community OST team was documented on discharge, and the involvement and impact of pharmacists in these processes. Sixty‐one admissions were included in the audit. On average, just over half (7.4/13) of the predefined OST‐related metrics audited, were documented on admission. Only 57% of patients had OST handover to the community team documented on discharge. Pharmacist involvement on discharge significantly increased completeness of OST handover documentation on admission and increased the proportion of patients with documented OST handover on discharge.ConclusionMedication handover relating to OST on admission and discharge was frequently incomplete, posing a potential risk to safe and appropriate ongoing care, highlighting the need for education and procedures to guide this process. Pharmacist contribution in handover of OST medication‐related information increased completeness of documentation, demonstrating their role in facilitating medication‐related communication during transitions of care.

Role of pharmacists during the COVID-19 pandemic in China-Shanghai experiences.

The roles and contributions of pharmacists in Shanghai during the coronavirus disease 2019 (COVID‐19) pandemic are described in this report. Five pharmacists have been appointed as members of an expert interdisciplinary health care team tasked with taking care of all adult patients with COVID‐19 in Shanghai in a designated hospital, the Shanghai Public Health Clinical Center (SPHCC). They work with pharmacists at SPHCC, having responsibilities that include drug supplies, dispensing, pharmacy intravenous admixture services (PIVAS), prescription audits, medication reconciliations, pharmacotherapy, therapeutic drug monitoring, and patient education. Due to the pandemic, pharmacy operations in all hospitals are modified to adhere to guidelines for infection risk mitigation and personnel protection. Community pharmacies serve as the public access point to health care and medical supplies, providing services beyond dispensing and medication counselling. The establishment of internet hospitals (telehealth facilities) provide new opportunities for delivering pharmaceutical care and working with health care professionals. Pharmacists also participate in evaluating new treatments and keeping health care teams informed of new findings for potential treatment considerations. In response to the critical need for health care professionals in Wuhan, 68 pharmacists from different parts of the country went there to work with the local pharmacists. Through assuming new roles and adapting existing practice, pharmacists have acquired invaluable experiences for future practice advancement. In order to assume these responsibilities effectively, pharmacists need to be equipped with the necessary skills for meeting the evolving health care challenges.

An Unparalleled Spirit of Collaboration Amid the COVID-19 Pandemic

The COVID-19 pandemic is having a profound impact across the United States and the rest of the world. Health care professionals, including pharmacists, are working on the frontlines and across the spectrum of public health and research. To fully optimize the contribution of pharmacists during this crisis, state and federal policies and regulations that limit pharmacists' roles had to be identified and modified. A strong coalition of national pharmacy organizations, including the American Association of Colleges of Pharmacy, embarked upon an unprecedented level of collaboration to produce a joint statement identifying key policy recommendations. This collective continued working together as the full force of the pandemic was realized and engaged with policy makers at the state and national levels to advocate for these policy recommendations. Ideally the lessons learned in terms of the power of working together in a crisis will reframe future collaborations to the benefit of the profession and ultimately to the patients we serve.

THE USE OF INTERNET AND SOCIAL MEDIA FOR DRUG INFORMATION SERVICES IN PHARMACIES IN YOGYAKARTA PROVINCE: A STUDY OF ASTHMA CARE

Industrial revolution 4.0 is the process of digitizing the industry that leds health services in the era of application of Information and Communication Technology (ICT) called e-health. The application of ICT in Pharmacy is known as e-pharmacy. The role of pharmacists in Drug Information Services by utilizing ICTs has an effect on e-health literacy which ultimately supports the success of patient therapy. This is very important for patients with chronic diseases who are receiving treatment for a long time, one of which is asthma patients. Therefore, this study aims to explore pharmacist perceptions regarding the use of the internet and social media for drug information services, with a case study of services in asthma patients. This research is descriptive with a qualitative approach. Data is collected by interviews using an interview guide that has been validated in a professional judgment. Interviews were conducted with pharmacist participants who provided pharmacy services to asthma patients, who were selected purposively in March to July 2019. Data from interviews were transcribed verbatim, then a thematic analysis was performed. Ethical clearance has been obtained under number 945/ C.16/ FK/ 2019. The results of the study mention the use of the internet and social media indicate the potential capabilities of pharmacists in health services and also the challenges of transformation to the role of pharmacists in the e-pharmacy era. This study also mentions the urgency of establishing regulations regarding e-pharmacy that is driven by the violation from the internet and social media use. Improvement of ICT infrastructure in the pharmacy field as well as the pharmacist's contribution on the provision of drug information for chronic diseases, including asthma, are urgently required.

Emerging from the other end: Key measures for a successful COVID-19 lockdown exit strategy and the potential contribution of pharmacists.

As the world edges towards relaxing the lockdown measures taken to control the spread of the novel coronavirus SARS-CoV-2 (COVID-19), governments have started putting in place a variety of measures to avoid a second peak in the number of infections. The implementation of and adherence to such measures will be key components of any successful lockdown exit strategy. Ranging from expanded testing and widespread use of technology to building the public's trust in the post COVID-19 world, there is a role for pharmacists to play. In this commentary, these measures and the potential contribution of pharmacists to their successful implementation are outlined and discussed.

Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries.

The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries.

A Dentist, Pilot, and Pastry Chef Walk into a Bar…Why Teaching PPCP is Not Enough

For both education and practice, the dissemination of the Joint Commission of Pharmacy Practitioner's Patient Care Process for Pharmacists has heightened attention to the need for a defined care process for pharmacists. Yet, when one compares this framework with those described in other disciplines, what makes it specific to pharmacy? Graduates must establish their unique role in patient care management among the health care team. Therefore, it is essential that pharmacy educators prepare students to contribute uniquely and communicate articulately about those contributions. This involves intentionally teaching an explicit clinical assessment process and a recognized taxonomy for communicating medication-related needs. In addition, educators must: ensure integration of patient care frameworks unique to pharmacists in curricula, commit to critical evaluation of care process instruction, and partner with external stakeholders to establish the distinct contributions of pharmacists to team-based care.

Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

AbstractIntroductionPharmacist‐physician collaboration has shown positive results in improving patient outcomes. Chronic care management (CCM) is a reimbursable service for Medicare beneficiaries in the community setting which includes comprehensive care management and other activities. The pharmacist contribution to CCM services and their associated impact on patient health outcomes has not been fully explored.ObjectivesThe objectives of this study were to: (a) implement a collaborative CCM service between a community pharmacy and family medicine clinic for their common hypertensive patients; (b) measure blood pressure change for patients receiving the CCM intervention; and (c) report financial viability for the community pharmacy and family practice clinic partnership.MethodsSingle group prospective pilot intervention in an independent community pharmacy and family medicine clinic in a small city in the Midwest United States. Forty‐five patients with uncontrolled hypertension who are patients to both community pharmacy and clinic were recruited, and 26 received CCM interventions in person or over the telephone from the community pharmacists to manage medications for hypertension. Our main outcomes were blood pressure values and financial viability.ResultsTwenty‐six patients received at least one community pharmacist encounter. These patients had an average 7.3 mm Hg decline (P = .006) in systolic blood pressure (SBP) and a 2.4 mm Hg decline (P = .079) in diastolic blood pressure (DBP) at 9 months. The total revenue over the study period was $5842. Total revenue for the community pharmacy and clinic was $2785 and $3057, respectively.ConclusionThe community pharmacy/clinic collaboration resulted in improved blood pressure control, a new source of revenue for the community pharmacy, and increased revenue for the clinic. Further research is needed on CCM revenue sharing between physicians and pharmacists to generalize the results.

PRACTICES AND PERCEPTION OF NIGERIAN COMMUNITY PHARMACISTS TOWARDS ANTIMICROBIAL STEWARDSHIP PROGRAM

Objective: Community pharmacists have an important role in promoting the appropriate use of antibiotics. There is a paucity of data describing the contributions of community pharmacists in antimicrobial stewardship program (ASP) in Nigeria. This study evaluated the practices and perceptions of community pharmacists towards ASP.
 Methods: This was a cross-sectional study conducted among community pharmacists in two cities in Northern Nigeria: Minna and Kaduna, using a 30-item validated and pre-tested questionnaire. Data collected between April and May 2019 and analyzed using SPSS version 23.
 Results: Of 130 community pharmacists, 98 completed and returned the questionnaire (response rate: 75.3%). More than 90% strongly agreed/agreed that ASP is important to reduce inappropriate use of antibiotics and antibiotic resistance, improve patient’s clinical outcomes. However, lack of training (56.1%), lack of cooperation from physicians (61.2%) and lack of access to patient records (66.8%) were identified as barriers to community pharmacists’ involvement in ASP. Overall, community pharmacists had good practices (median score: 3.5; IQR: 1–5) and positive perceptions (median score: 4.0; IQR: 3–5) towards ASP. Job status and dispensing antibiotics without prescription were significantly associated with practice, while age and job status were associated with perception towards ASP.
 Conclusion: Community pharmacists demonstrated good practices and positive perceptions towards ASP. However, lack of training and lack of cooperation from prescribers limit their involvement in the program. Training of community pharmacists in antimicrobial stewardship and inter-professional collaboration are recommended.

How to Improve Clinical Pharmacy Practice Using Key Performance Indicators

Key performance indicators (KPIs) are measurable tools to keep track of progress on a specific performance objective of an institution. By selecting the proper KPI, we can identify the area of improvement in structure, process and outcome. KPIs should be SMART (Specific, Measurable, Attainable, Relevant, and Time bound). In addition, KPIs should be easy to understand, evidence based, reliable, acceptable and feasible. Clinical pharmacy key performance indicator (cp KPI) is a standard quantitative measure of progress for a specific clinical activity performed by clinical pharmacist. These cp KPIs serve as objective indicators to measure the efficiency of delivery of evidence-based patient care. The clinical services provided might be upon patient admission, during admission and at discharge in addition to outpatient services. Medication reconciliation at admission, pharmaceutical care plan and patient counseling at discharge are examples for process KPI for clinical services provided by pharmacist, while rate of adverse drug reaction and patient re admission are examples for outcome KPI. In conclusion application of cp KPI and quality metric is a great opportunity to give the general public a valuable insight into the contributions of clinical pharmacists to improve the overall quality of clinical care. This could help the profession demonstrate how pharmacy knowledge and skills are used to deliver patient outcomes rather than the supply of medicines. Selecting the suitable cp KPI will help us improve clinical pharmacy services and patient outcome.

Incorporation and Impact of a Clinical Pharmacist in a Hospital-Based Neurology Clinic Treating Patients with Multiple Sclerosis.

Clinical pharmacists are uniquely positioned to assist with the complexities of medication management for patients with multiple sclerosis (MS). The objective was to describe clinical pharmacy services provided, as well as provider satisfaction with and perceived impact of incorporating a clinical pharmacist in MS patient care. The study consisted of a retrospective medical record review and a provider survey conducted in an outpatient neurology clinic at an academic medical center. Between April 2017 and June 2018, electronic medical records of patients with documented interventions by a pharmacist were reviewed to describe clinical pharmacy services provided to patients with MS. A voluntary, anonymous survey was distributed to neurology providers to evaluate provider satisfaction with and perceived impact of clinical pharmacist involvement in MS patient care. There were 64 patients identified with 378 documented interventions made by clinical pharmacists. Pharmacist interventions were mostly related to facilitating medication access (n = 208), pretreatment screening (n = 57), patient counseling (n = 51), and providing drug information (n = 43). All nine providers surveyed indicated that facilitating medication access, counseling patients, and managing drug interactions were moderately or very important clinical pharmacy services. Furthermore, all providers surveyed strongly agreed that pharmacist involvement decreased time to therapy initiation and provider time spent on medication management. Clinical pharmacists play an integral role in MS patient care, particularly with facilitating medication access. Prospective studies are needed to further evaluate the contribution of clinical pharmacists in MS patient care.

Primary health care policy and vision for community pharmacy and pharmacists in Australia

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.

Critical care pharmacy services in the Western Region of Saudi Arabia

Background: The value of critical care pharmacists (CCPs) in intensive care units (ICUs) has been well documented, and various studies have demonstrated the positive impacts of CCPs. Despite growing evidence supporting the contributions of clinical pharmacists in general and CCPs in particular in improving patient outcomes, many hospitals in the Kingdom of Saudi Arabia (KSA) still lack clinical pharmacy services. Most studies that have measured the impacts of CCPs in ICU settings have been conducted outside Saudi Arabia, with a significant gap in the literature related to CCP-related impacts, needs and obstacles in Saudi Arabia. Objective: To evaluate the current status of CCP services and the CCP services that are needed in Saudi Arabia as well as the barriers to establishing these services. Setting: Governmental and non-governmental hospitals in the western region of the KSA. Method: This was a cross-sectional survey-based study conducted in the western region of the KSA. The questionnaire included questions investigating current CCP services, which include clinical, educational, administrative and research services. Additional questions assessed the obstacles, needs and limitations related to the development of CCP services. Main Outcome Measures: The primary outcome is to describe the current status of ICU pharmacists in the KSA. Secondary outcomes of interest are the evaluation of the need for CCP services and the identification of the main barriers to establishing these services. Results: Of the 130 hospitals with ICUs to which surveys were emailed, 94 (72%) responded. Forty-three percent of responding hospitals had an ICU multidisciplinary team structure that included a pharmacist who visited the unit during medical rounds. Up to 54% of the hospitals with CCP services had one dedicated pharmacist present at bedside and during medical rounds. Approximately 78% of the ICU pharmacists performed one or more clinical activities. Training pharmacy interns was one of the major educational activities provided by ICU pharmacists. Clinical services (42%) were the most needed services, followed by educational (14%) activities. Limited job availability was the main barriers to having CCP services among hospitals. Conclusion: Critical care pharmacists in the western region of the KSA mainly provide fundamental clinical services, with limited engagement in desirable and optimal services such as research activities. The limited CCP services in the KSA are due to several barriers that warrant national efforts from the Ministry of Health (MOH) and the Saudi Commission for Health Specialists (SCFHS).

Primary health care policy and vision for community pharmacy and pharmacists in Indonesia.

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.