Drug Dispensing Research Articles

Health service use before and after dementia diagnosis: a retrospective matched case–control study

ObjectivesThis study investigated patterns in health service usage among older adults with dementia and matched controls over a 10-year span from 5 years before until 5 years after diagnosis.DesignPopulation-based retrospective...

Impact of the use of anti-glaucoma medications on the risk of herpetic keratitis recurrence.

Numerous case reports have associated anti-glaucoma medications with recurrence of herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis. The aim of our study was to determine whether different anti-glaucoma agents are associated with recurrence of herpetic keratitis. This was a retrospective cohort study using health databases from a Canadian province from January 2001 to December 2012. A new cohort of users on topical prostaglandins (PGs), beta blockers (BBs), alpha-2 agonists (AAs) and carbonic anhydrase inhibitors (CAIs) was created. The date of the third anti-glaucoma drug dispensation within 90days was deemed the index date of the case. Herpetic keratitis events, as defined by an ICD-9/10 code for HSV or HZV keratitis, or the dispensation of an anti-viral medication by either an ophthalmologist or an optometrist, were examined prior to and following the index date. Risk ratios (RRs) were computed to compare the risk of HSV/HZV keratitis among the PG, BB, AA, and CAI groups individually and collectively while adjusting for age and sex. Among 19,986 users of glaucoma medications identified, there were 684 cases of HSV/HZV keratitis. There was no increased risk of HSV/HZV keratitis recurrence for any of the four glaucoma medications classes individually or collectively when adjusted for age and sex. There was also no increased risk for redeveloping either HSV keratitis only or HZV keratitis only amongst all anti-glaucoma users. There is no association between the use of topical ocular hypotensive therapies and HSV/HZV keratitis recurrence. Further studies are needed to confirm these findings.

Sodium Alginate-Natural Microencapsulation Material of Polymeric Microparticles.

From the multitude of materials currently available on the market that can be used in the development of microparticles, sodium alginate has become one of the most studied natural anionic polymers that can be included in controlled-release pharmaceutical systems alongside other polymers due to its low cost, low toxicity, biocompatibility, biodegradability and gelatinous die-forming capacity in the presence of Ca2+ ions. In this review, we have shown that through coacervation, the particulate systems for the dispensing of drugs consisting of natural polymers are nontoxic, allowing the repeated administration of medicinal substances and the protection of better the medicinal substances from degradation, which can increase the capture capacity of the drug and extend its release from the pharmaceutical form.

Pulmonary embolism in menopausal hormone therapy: a population-based register study

Objective Oral but not transdermal menopausal hormone therapy (MHT) increases the risk of venous thromboembolism. There is no evidence regarding the risk of the serious complication pulmonary embolism (PE). The aim was to investigate the risk of PE in women using MHT depending on administration route, type of progestin and treatment duration. Method The population-based case-control study covered 1,771,253 women aged 40–69 years, during 2006–2015. Diagnoses of PE (n = 13,974) and drug dispensations were received from national validated registers. Results Current MHT users had a higher risk of PE than non-users (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.05–1.26). First ever users had the highest risk (OR 2.07, 95% CI 1.23–3.50). Transdermal administration was not associated with increased risk of PE. The OR was slightly but non-significantly higher with estrogen combined with medroxyprogesterone acetate than with norethisterone acetate. Discussion The risk of PE was significantly increased in users of oral but not transdermal MHT, with the highest risk in first ever users of oral estrogen combined with medroxyprogesterone acetate. The risk was considerably lower in women with recurrent treatment, probably because of the healthy user effect. Conclusion PE was most common close to initiation of oral treatment. Transdermal MHT did not increase the risk of PE.

Quel impact des évolutions du circuit du médicament sur l’activité de dispensation durant la permanence pharmaceutique ?

Pharmaceutical permanence (PP), outside the working hours of an in-house pharmacy (PUI), allows to guarantee the continuity of care in health-care institutions. A retrospective review of urgent drug dispensing was carried out in the light of changes in the drug circuit. The analysis of drug dispensations was performed over a period from 2011to 2019. The average number of drugs dispensed per shift, annual dispensations, and their variation by day of the week were studied. The increase is statistically significant and is found on both weekdays and weekends. Each drug was identified according to its Anatomical Therapeutic Chemical (ATC) classification. Data on the activities of our institution (number of hospitalizations, average length of stay) were also collected. In 2011, an average of 36medications were dispensed per on-call period, compared with 77in 2019 (a doubling of activity). The increase is statistically significant and is found on both weekdays and weekends. Neurological drugs and anti-infectives represent on average 43% of the drugs dispensed. At the same time, there was a decrease in average length of stay and an increase in hospitalizations (-10% and +16% respectively). The increase in the average number of medications dispensed per shift is notable. It reflects a strong and gradual increase in activity, which was increased when the full vacuum cabinets (FVCs) were introduced, which improved the quality and safety of the pharmaceutical circuit. The revision of the allocations and the information of prescribers on the drug circuit will optimize the activity and refocus it on the pharmaceutical analysis of urgent needs.

Patient misadventures caused by prescription errors detected at a brazilian community pharmacy

Background: Efforts to reduce medication errors in healthcare have been widespread around the world with the aim to improve the quality of care. Failures observed at the prescription phase are reported as being the most prevalent preventable errors. Adverse events related to inappropriate prescriptions are an important threat to patient safety. In this context, a community pharmacist is in a strategic position to evaluate, detect, and correct faults that may have occurred during prescribing. Consequently, this reduces the risk of negative clinical and economic outcomes. Objective: To identify the consequences of prescription errors that impede drug dispensing at a Brazilian community pharmacy for the perspective of patients. Method: We conducted a cohort study, with no comparison group, in a Brazilian community pharmacy, which included patients with prescription errors which made it impossible for correct drug dispensing. Patients were interviewed at the time of problem detection and followed up until an outcome was reached. Results: Of the 32 interviewed patients, 23 (71.9%) reported some damage to their health due to a delay in starting treatment, and 19 (59.4%) experienced extra expenses due to medication not being dispensed. Conclusion: Prescription errors that preclude the dispensing of any medication can lead to negative clinical outcomes and a financial loss to patients.

A prediction model for nonpersistence or nonadherence to direct oral anticoagulants in hospitalized patients with atrial fibrillation.

BACKGROUND: Medication adherence and persistence is fundamental for drug effectiveness, which is also true for the prevention of strokes in patients with atrial fibrillation (AF). Adherence to direct oral anticoagulants (DOACs) as first-line agents is often high in the early posthospital period. However, adherence often sharply declines (or eventually leads to nonpersistence) in the post-discharge ambulatory period, rendering stroke prevention ineffective. If patients at high risk of nonpersistence or nonadherence could be identified early, they could be offered early intervention measures to improve adherence and/or persistence. OBJECTIVE: To develop and internally validate a predictive model for medication nonadherence and nonpersistence to DOAC treatment in patients with AF after discharge using health insurance claims data. METHODS: We selected health insurance claims data between 2011 and 2016 from 8,055 patients with AF who were newly treated with rivaroxaban or apixaban after a hospital admission for stroke, transient ischemic attack, or AF. In the post-discharge ambulatory period, medication adherence was derived as the proportion of days covered, calculated from drug dispensation data. A maximum permissible 90-day gap between the end of a prescription and the next dispensation was used to estimate persistence. Candidate predictors were either derived from the index hospital admission or summarized from the previous year (eg, comorbidities or medication adherence to long-term treatments, such as ß-blockers, renin-angiotensin system inhibitors, statins, and thyroid hormones). A regularized logistic regression model was fitted using the least absolute shrinkage and selection operator in a split-sample approach (66.7% training data; 33.3% test data) to predict a composite of medication nonadherence/nonpersistence. Discrimination performance was assessed using the area under the receiver operating characteristic curve, the maximum sensitivity/specificity, and the scaled Brier score. A calibration curve fitted by linear regression was used to evaluate model calibration. RESULTS: The average age of the study participants was 79.7 years, 62% were female, and 3,515 patients (44%) were adherent and persistent (median follow-up of 185 days). Medication adherence to previous long-term treatments showed strong predictive properties. The developed model discriminated well (concordance statistic: 0.755), was well calibrated, and showed a scaled Brier score of 0.202 for identification of patients at risk. CONCLUSIONS: The model successfully predicted medication non-adherence/nonpersistence to DOAC treatment after discharge. Such a model could help ensure that targeted interventions are already in place at the time of hospital discharge, potentially preventing strokes and reducing costs. DISCLOSURES: Mr Wirbka is funded by the German Innovation Funds according to § 92a (2) Volume V of the Social Insurance Code (§ 92a Abs. 2, SGBV-Fünftes Buch Sozialgesetzbuch), grant number: 01VSF18019. Dr Haefeli received financial support from Daiichi-Sankyo, app development (https://www.easydoac.de/), and Bayer. He also received personal speaker fees from Bristol Myers-Squibb and Daiichi-Sankyo Online Seminar. Dr Meid is funded by the Physician-Scientist Programme of the Medical Faculty of Heidelberg University.

SOCIOLOGICAL STUDY OF THE ROLE OF PHARMACEUTICAL CARE IN THE DISPENSING OF MEDICINES FOR THE PREVENTION AND TREATMENT OF ACNE

Relevance. Acne is the most common dermatological problem, the treatment of which requires a personalized approach for each patient. However, many patients refer to self-medication.
 Objective. To analyze the role of pharmaceutical care in dispensing medicines for the prevention and treatment of acne according to the results of a questionnaire survey.
 Materials and methods. 100 pharmacy workers were surveyed according to a single specially developed protocol, considering issues related to the dispensing of anti-acne drugs. Standardization, an anonymous questionnaire, statistical and graphic methods were used.
 Results. It was found that 89% of the surveyed pharmacy workers recommend drugs for the treatment/prevention of acne to visitors. In particular, azelaic acid (74%), salicylic acid (31%), clindamycin (49%), and benzoyl peroxide (37%) are more frequent recommendations. More than half of the respondents, mostly employees with 4-6 years of work experience (р<0.05), recommend visitors to take sorbents in combination with anti-acne drugs. It is important to note that almost 20% of pharmaceutical workers were contacted by visitors with the appearance of side reactions after using anti-acne drugs. Visitors note such complications as dryness (31.4%) and redness of the skin (19.6%), increased rash (21.6%). It has been established that most pharmacy workers provide visitors with information on medicines for responsible self-treatment and acne prevention. However, more than 30% of pharmacists do not use the "Prevention and symptomatic treatment of acne" protocol.
 Conclusions. Therefore, the provision of pharmaceutical care is a necessary condition for ensuring effective and safe pharmacotherapy of acne. While high-quality pharmaceutical care is possible if the pharmacy employees follow the pharmacist's protocol. Postgraduate training of pharmacists in pharmaceutical care in dermatology is important.

Anti-osteoporosis medication dispensing by clinical commissioning groups in England - an ecological study of variability in practice and of the effect of the Covid-19 pandemic.

To investigate whether the rate of Anti-Osteoporosis Medication (AOM) dispensing was related to prevalence of risk factors and hip fracture incidence in the local population. The Open Prescribing database was used to analyse dispensed AOM at the level of Clinical Commissioning Groups (CCGs) in England. Male Healthy Life Expectancy (MHLE), Female Healthy Life Expectancy (FHLE), the prevalence of smoking and active adults, the incidence of hip fracture and of alcohol related hospital admissions, and local dispensing of a comparator drug (atorvastatin) were considered as predictor variables. Linear and multilinear regression were performed. Using atorvastatin as a comparator, AOM dispensing was compared after the start of the Covid-19 pandemic with the same quarter the previous year. Rates of AOM per 1000 people aged over 65 years in a CCG area varied between 379.2 and 1129.1, with a mean of 670.3. Population risk factors were individually related to the amount of AOM dispensed in an area. Collectively, local activity levels in adults (p=0.042) and local hip fracture incidence (p=0.003) were significantly negatively correlated with rates of AOM dispensed. Rates of alendronate dispensing fell significantly at the start of the Covid-19 pandemic (p < 0.001), whilst atorvastatin dispensing rates significantly increased (p < 0.001). Lower rates of AOM dispensing were seen in areas with a higher proportion of active adults and higher incidence of hip fracture. Multidisciplinary services should be developed to address this care gap with consideration given to local population risk factors. Community pharmacists are ideally placed to play a vital role in osteoporosis management.

Practices, knowledge, and attitudes of community pharmacists towards dispensing drugs during the COVID-19 pandemic: A cross sectional study from Jordan.

Pharmacists have an important role in providing correct information, education, and counseling to the public during the COVID-19 pandemic and other health crisis. In order to perform their duties in a correct manner, they must receive adequate and evidence-based information from official resources. The objectives of the study were to examine the practices of community pharmacists towards dispensing drugs during the COVI-19 pandemic and assess their knowledge concerning the safety and efficacy of these drugs in managing the COVID-19 infection. This was a web-based cross-sectional study conducted through the distribution of the questionnaire via the social media through a google form. The drugs examined were azithromycin, hydroxychloroquine, dexamethasone, and certain antiviral drugs. A total of 485 community pharmacists responded to the questionnaire. Pharmacists dispensed these medications based on the physician's orders, 420 (86.6%), according to the pharmacist´s recommendations 327 (67.4%), or upon patient´s request 278 (57.3%). Azithromycin was the most dispensed drug and two thirds of the pharmacists dispensed drugs more than 10 times. Community pharmacists did not possess adequate knowledge concerning the effectiveness and safety of the drugs in the management of COVID-19 infection. In the multivariate linear regression analysis; education, type of university, and the average number of daily customers were statistically significant, p values: 0.004, 0.002, and 0.016, respectively. Pharmacists did not have a positive attitude towards dispensing drugs based on their own recommendations. More than half of the pharmacists agreed that they thought it was a correct decision to give these drugs based on their own judgment. Community pharmacists should not receive information from non-official sources. Strict regulations and implementation of disciplinary actions against pharmacists that dispense prescription only drugs based on their medical judgment are necessary to stop this illegal behavior. A proactive role demonstrated by the pharmacists and based on scientific facts will reduce misconceptions and hazardous behavior of self-medication using prescription only drugs based on rumors and fictitious news.

Impact of the COVID-19 pandemic and its control measures on cardiovascular and antidiabetic drugs use in France in 2020: a nationwide repeated cohort study.

Since pandemic start, patients may have faced difficulties in accessing to care and treatment. This study aimed at assessing the impact of COVID-19 pandemic and its control measures on the use of drugs indicated in cardiovascular prevention and diabetes mellitus in France. From 09/17/2018 to 09/20/2020, a repeated cohort analysis was performed using the French nationwide health insurance databases. The pandemic impact was assessed using time-series analyses and unobserved components model for the weekly number of patients with (i) drug dispensing, (ii) ongoing treatment, (iii) treatment initiation, (iv) treatment disruption. Overall, 14,822,132 patients with cardiovascular drug dispensings and 3,231,618 with antidiabetic ones were identified. After a sharp spike in the amount of dispensings in the week the first national lockdown was announced, the period was marked by decreased levels and trends. Altogether, the estimated impact of the pandemic on dispensings appeared limited over the lockdown period (1–3% lack in dispensings). During lockdown, the weekly numbers of treatment disruptions remained stable whereas a significant decrease in treatment initiations was observed for almost all drug classes (e.g. β-blockers initiations: − 8.9%). Conversely, the post-lockdown period showed increases in treatment disruptions especially for antihypertensive and lipid lowering drugs (e.g. statins disruptions: + 4.9%). The pandemic and associated measures had a significant impact on cardiovascular and antidiabetic drugs use in France, mostly consisting in decreases of treatment initiations over lockdown and increases in treatment disruptions afterwards. Both could result in increased morbimortality that remains to be assessed.

ABC/VEN-analysis of drug consumption at the level of an intensive care and resuscitation unit of a maternity hospital

Objective . To study the parameters of ABC/VEN analysis, to identify the most expensive drugs and determine ways of cost rationalization. Materials and methods . ABC/VEN analysis was carried out on the basis of an intensive care and resuscitation unit of a maternity hospital. The material for the study was the list of drug dispensation by the departments of the hospital over the first quarter of 2022. Results . The total costs in the intensive care and resuscitation unit were 104 596 52 rubles. For class A drugs, the costs amounted to 85 357 99 rubles, class B – 15 529 88 rubles, and class C – 3 708 65 rubles. Conclusion . The use of ABC- and VEN- analyses has made it possible to reveal that funds for drug provision in the unit as a whole are spent quite expediently.

Sex-related differences in health-care use in adult patients with inflammatory arthritis in Ontario, Canada: a population-based cohort study

<h2>Abstract</h2><h3>Background</h3> Timely access and appropriate use of health-care resources is crucial for the management of people with inflammatory arthritis. Sex (biological) and gender (sociocultural) are important health determinants that influence different aspects of care, such as referral to specialists, performance of diagnostic tests, continuity of care, and prescription patterns, which ultimately affect disease outcomes. We aimed to compare health-care use between males and females with inflammatory arthritis. <h3>Methods</h3> This population-based study was conducted using health administrative data of Ontario, Canada. We included Ontario residents aged 20 years or older with valid health insurance and diagnosed with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis using Ontario health administrative data (the Ontario Health Insurance Plan Claims Database). Sex (the primary predictor of this study) was coded as male or female in the database. Health-care use (the study outcome) was assessed at least once per year for 3 years before and after an inflammatory arthritis diagnosis and compared between males and females using regression models, after adjusting for demographics and comorbidities. Prescription dispensation was assessed at least once per year for 3 years after the diagnosis in individuals aged 66 years or older at the time of diagnosis. Results were expressed as female to male adjusted odds ratio (OR) with 95% CIs. <h3>Findings</h3> Between April 1, 2010, and March 31, 2017, 41 277 people with rheumatoid arthritis (28 575 [69%] females), 8150 with ankylosing spondylitis (4160 [51%] females), and 6446 with psoriatic arthritis (3483 [54%] females) were analysed. Males were significantly older (mean 60·4 years [SD 14·2]) than females (mean 57·1 years [15·2]) in the rheumatoid arthritis cohort. Across the cohorts, multimorbidity was more common in females (75–81% <i>vs</i> 58–66% in males) as was depression (8% <i>vs</i> 4%) and osteoporosis (4–5% <i>vs</i> 1%), whereas cardiovascular disease was more common in males (7–15% <i>vs</i> 4–7% in females). Females were more likely to visit family physicians (adjusted OR ranging from 1·10 [95% CI 1·05–1·15]; p<0·001 to 1·15 [1·04–1·28]; p<0·01) and rheumatologists (adjusted OR from 1·32 [1·22–1·43] to 2·28 [1·92–2·70]; p<0·001). Females also had higher odds for receiving imaging before a diagnosis in all 3 cohorts (adjusted OR from 1·15 [1·10–1·20] to 1·18 [1·12–1·23]; p<0·001 for x-rays and adjusted OR from 1·27 [1·09–1·48] to 1·44 [1·15–1·80]; p<0·01 for ultrasound examinations). Similarly, laboratory tests were more likely to be ordered for female patients before diagnosis than for males (adjusted OR from 1·10 [1·05–1·15] to 2·17 [1·89–2·50]; p<0·001) across all cohorts. These sex differences were most notable among people with rheumatoid arthritis and ankylosing spondylitis, and in the prediagnostic period. Males were more likely to visit the emergency department immediately before an inflammatory arthritis diagnosis (adjusted OR from 0·76 [95% CI 0·72–0·81]; p<0·001 to 0·87 [0·80–0·95]; p<0·01). After diagnosis, females were more likely to remain in rheumatology care (adjusted OR from 1·12 [1·01–1·25]; p=0·04 to 1·24 [1·19–1·30]; p<0·001). Prescription dispensation of non-steroidal anti-inflammatory drugs (adjusted OR 1·14 [1·04–1·25]; p<0·01) and opioids (adjusted OR 1·46 [1·27–1·68]; p<0·001) was higher in older females (aged 66 years or older) with rheumatoid arthritis and conventional disease-modifying antirheumatic drug use was higher in older females with ankylosing spondylitis (adjusted OR 1·66 [1·24–2·22]; p<0·001). <h3>Interpretation</h3> Females with inflammatory arthritis are more likely to use health care than males, which might indicate sex-related biological differences in disease course or gender-related sociocultural differences in health-care access, health-care seeking behaviour or patient–provider interactions. <h3>Funding</h3> Enid Walker Graduate Student Award for Research in Women's Health (partial).

Multimorbidity Clusters in the Oldest Old: Results from the EpiChron Cohort.

Multimorbidity is challenging for both patients and healthcare systems due to its increasing prevalence and high impact on people’s health and well-being. The risk of multimorbidity increases with age, but there is still more to discover regarding the clinical profile of the oldest old. In this study, we used information from the EpiChron Cohort Study to identify multimorbidity patterns in individuals who died during the period 2010–2019 at the ages of 80–89, 90–99, and ≥100. This cohort links the demographic, clinical, and drug dispensation information of public health system users in Aragón, Spain. We saw a significantly lower number of chronic diseases and drugs and a lower prevalence of polypharmacy in centenarians compared to those aged 80–99. K-means clustering revealed different multimorbidity clusters by sex and age group. We observed clusters of cardiovascular and metabolic diseases, obstructive pulmonary conditions, and neoplasms, amongst other profiles. One in three octogenarian women had a metabolic pattern (diabetes, dyslipidaemia, and other endocrine–metabolic disorders) with the highest number of diseases (up to seven) and prevalence of polypharmacy (64%). We observed clusters of dementia and genitourinary disorders in individuals on medication with anticholinergic activity. Our study offers an opportunity to better understand the urgency of adequately addressing multimorbidity in our older adults.

Perception of anaesthesia staff of an automated drug dispenser as an anaesthesia workstation: Running title: Automated Drug Dispenser for Anaesthetics

RationaleAutomated drug dispensers have replaced floor stocks and medication cabinets in all hospital areas. Anaesthesia workstations have been proven to be particularly challenging owing to the critical patients under their care and the nature of the medications they administer. Aims and objectivesTo understand how well anaesthesia personnel accept an automated drug dispenser cabinet (ADC) as an anaesthesia workstation and investigate its effect on drug management and costs in the operating room (OR). MethodsWe used mixed methods. The first part consisted of a cross-sectional study evaluating anaesthesia staff satisfaction with the ADC using a questionnaire based on the technology acceptance model (TAM). Second, we analysed the expenditure of five commonly used anaesthetic medications by the OR before and after the introduction of the ADC. ResultsWe received 63 responses from 96 anaesthesia department employees, giving us a 65.6% response rate. There was a significant positive relationship between perceived usefulness (PU), perceived ease of use (PEOU), and technology acceptance (TA) (p<0.001). Regarding PU, 38 (60.3%) respondents felt that the ADC improved their performance as anaesthetists, and 52 (82.5%) felt that it improved patient safety. Regarding ease of use, 45 (71.4%) respondents found the ADC easy to use, and 55 (87.3%) felt that learning how to use the ADC was easy. The satisfaction rate among anaesthesia department employees was 73%. Regarding drug management, the OR expenditure on hyperbaric bupivacaine, propofol, fentanyl, dexamethasone, and ondansetron dropped significantly by 462, 3,516, 1,806, 660, and 258 vials, respectively. The drop in expenditure on these five medications alone resulted in savings of 35,543.94 SAR (9,744.23 USD). ConclusionADCs can replace anaesthesia workstations and lead to cost savings and improved drug management in ORs. However, in order to succeed, cooperation will be required between the anaesthesia providers, pharmacy department, and hospital administration.

OTC Drug Abuse: Role of Clinical Pharmacist in its Management

Over the counter medications is a part of self-care and self-medication practices that are essential for any health care system. The ease of availability at low cost increases the abuse of these OTC drugs among the population. As these medications can be purchased without any consultation of physician or prescription, its abuse can lead to several health-related issues and addiction. Pharmacists being accessible to interfere with the patients and drug dispensing, they can educate and create awareness among the general public as well as the patients about the OTC drug abuse, addiction and their ill effects. Multiple challenges are also being faced by the pharmacists while interacting and counseling the patients in order to prevent OTC drug abuse. OTC drug addiction is a major problem being faced and their management mainly includes drug detox therapy, drug rehab therapy and sober lifestyle modifications. This article provides a brief review on the potential OTC drugs abuse and their management. This review further explains the challenges faced by the pharmacists during OTC drug abuse management. By proper monitoring of these OTC medications, their abuse may be controlled more effectively, thereby providing better pharmaceutical care.

Key Strategies to Reduce Waiting Time in Outpatient Pharmacy

Waiting time in the outpatient pharmacy is still a problem in hospitals. This study aimed to identify the root causes and implement solutions to reduce the waiting time at a type C hospital. This study applied a descriptive approach. The potential causes were identified using HFMEA (Healthcare Failure Mode Effect and Analysis) confirmed through an online survey on 15 staff involved in pharmacy services. Scoring and Focus Group Discussion were used to identify the priority problems and solutions. The study results revealed six causing factors of the lengthy waiting time at the outpatient pharmacy, which were doctor's schedule, absence of specific time target for each drug preparation stage, changes of the drug storage, drug stock different from the planning, incomplete standard operating procedures, and one counter for prescription collection and drug dispensing. Three solutions were implemented in six days: checking drug stock in every shift, developing an SOP, and separating the counters for prescription collection and drug dispensing. The implementation results showed a significant increase in the waiting time percentage of compounded drugs, which met the standard (≤60 minutes) from 26% to 43%. This increase was even higher for non-compounded drug waiting time (&lt;20), from 27% to 48%. Drug stock checking, procedure standardization, and separation of service counters are the keys to reducing outpatient pharmacy waiting time.

Assessment of Community Pharmacists Knowledge on dispensing of Antimicrobial drugs and Prevention of Antimicrobial Resistance in Community practice

The antimicrobial resistance has more impact on the health care division which would increase the mortality and hospital readmission duration. Our objective is to assess the community pharmacist’s knowledge on dispensing of antimicrobial drugs and prevention of antimicrobial resistance in community practice. A cross-sectional study was conducted for six months. A sample size of 150 registered community pharmacists participated in the study. We have used simple random techniques to select the community pharmacists. Questionnaire were distributed to the community pharmacists at pre and post visits and the response was analyzed. The collected data was analyzed using graph pad prism software. The mean and standard deviation was calculated and P&lt;0.005 was considered to be statistically significant. For 25-30 years of age , community pharmacists were more 68 (45.33%) as compared to other ages. Pre visit before and after average mean antimicrobial resistance score was found to be 4.87. Proper implementation of antimicrobial resistance prevention programmes would drastically increases the rational use of antimicrobials could and minimizes the health care cost.

Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study.

Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2)and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic.

ObjectivesCaring for osteoporosis patients has proven challenging during the COVID-19 pandemic due to repeated lockdowns in Austria. The distinct possibility of insufficient treatment regimens is therefore a matter of pressing concern. The aim of the study was to assess alterations in dispensing anti-osteoporotic drugs during the COVID-19 pandemic.Patients/methodsThis study was a nationwide retrospective register-based observational study which included all patients in Austria aged ≥50 who received at least one prescription for anti-osteoporotic medication between January 2016 and November 2020. Pseudonymised individual-level patients' data were obtained from social insurance authorities. Anti-osteoporotic agents were divided into: (i) oral bisphosphonates, (ii) intravenous bisphosphonates, (iii) selective estrogen receptor modulators (SERMs), (iv) teriparatide (TPTD) and (v) denosumab (DMAB). We used interrupted time series analysis with autoregressive integrated moving average models (ARIMA) to predict drug dispensing.ResultsThere were 2,884,374 dispensations of anti-osteoporotic drugs to 224,598 patients between 2016 and 2020. The mean monthly prescriptions for oral bisphosphonates (−14.5 %) and SERMs (−12.9 %) decreased during the COVID-19 pandemic when compared to the non-COVID-19 period. Dispensing for intravenous bisphosphonates (1.7 %) and teriparatide (9.5 %) increased. Prescriptions for DMAB decreased during the first lock-down, however increased by 29.1 % for the total observation time.The Arima models showed that in March 2020 (beginning of the 1st COVID-19 lockdown), there was a decrease of 778 dispensings, with a further increase of 14 dispensings every month for denosumab; a decrease by 178 dispensings, with a further increase of 23 dispensings every month for zolendronic acid; a decrease by 2950 dispensings, but with a further increase of 236 dispensings every other month for ibandronate and a decrease by 1443 dispensing with a further decrease of 29 dispensings for alendronate than predicted, had the lockdown not occurred.ConclusionsThe total number of prescriptions dispensed to patients treated with anti-osteoporotic medications declined rapidly during first COVID-19 lockdown. The observed decrease of DMAB during the first lockdown rebounded in the following months. Considering the massive treatment gap for osteoporosis, and the related fracture risk, clinicians should continue treatment, even during a pandemic.