Drug Therapy Management Research Articles

Ketogenic diet: a pharmaceutical guide for the management of drug therapy in the pediatric population.

For a ketogenic diet to be effective, strict control of carbohydrate intake is paramount. Factors such as medications may upset this delicate balance. The aim of this commentary is to provide physicians who aretreating patients witha ketogenic diet, with a step-by-step guide. A list of unsuitable excipients was established. A flowchart with the title "Can this drug be prescribed to a patient following a ketogenic diet?" was then drafted. The first step is to determine the international nonproprietary name, dosage, form and composition. The amount of unsuitable excipients is calculated. Suitable alternatives may be discussed with the pharmacist. As a last resort, the ketogenic diet itself may need to be adapted. The answers provided are included in a database. Determining the amount of unsuitable excipients is a complex task requiring pharmaceutical expertise. Our flowchart can be used in order to provide a clear pathway for answering such questions.

Tools to prioritize outpatients for pharmaceutical service: A scoping review.

The performance of pharmacists in clinical services contributes to improving outcomes in patient drug therapy. In the context of streamlined resources and high health services' demand, the use of patient selection tools can screen those who would benefit more from a pharmaceutical service. This review aims to map and describe tools developed for patient selection for pharmaceutical services delivered in primary health care and outpatient settings. The search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Health Sciences. The search strategy included terms relating to patient selection and outpatient pharmaceutical service. We included papers on outpatient settings, and which described the tool developed for the selection of a patient for pharmaceutical service. Two reviewers extracted data of each study concerning the types and items making up the tool. The items composing the tools were grouped into categories. Twelve studies were included in the literature. Most of the studies were developed in the United States (53.8%), followed by Canada (30.8%). Approximately half of the studies developed tools for selecting patients for a medication review (46.2%), and only 15.4% for drug therapy management. Identification of patients at risk of drug-related problems, the need for pharmaceutical service follow-up, and patients at risk of hospital readmission were the main objective to develop the tools. In total, 92.3% of the developed tools had items related to drug therapy complexity, 76.9% to comorbidities and 61.5% to adherence/subjective aspects. Statistical methods were employed to evaluate the validation parameters, such as the ROC curve and internal consistency. Few studies that developed tools to select outpatients for pharmaceutical services were found. However, many tools showed unsatisfactory validation parameters. Thus, it is necessary to improve the development of instruments that can identify patients who would benefit from the pharmaceutical service accurately.

What Can Your Pharmacist Do for You? Role of Collaborative Drug Therapy Management in Hospice (QI641)

•Describe and explain the role of collaborative drug therapy management (CDTM) in community and inpatient hospice as it applies to physicians, pharmacists, and nurses.•Illustrate an innovative care model that emphasizes patient-centered, team-based care linking system and patient-level outcomes to manage individualized drug therapy in hospice.•Evaluate reduced pharmacoeconomic expenditures through optimal use of medications in CDTM. American healthcare systems, including community-based organizations, are grappling with rising healthcare costs and medication-related expenditures. Annually, more than 1.5 million preventable adverse events are caused by inappropriate use of medications. This costs our healthcare system $290 billion annually. Rising drug costs and medication safety concerns provide a rationale for increased clinical pharmacist collaborative medication management, especially in the hospice setting. In this poster presentation, we describe our innovative approach of CDTM. The process and requirements for this approach will be presented using a Massachusetts-based hospice as an example. CDTM allows a clinical pharmacist to therapeutically assess and identify patients' medication related needs and act as an extension of the physician. The goal is to optimize medication-related outcomes and includes selection, initiation, monitoring, and adjusting medications as defined in the CDTM agreement. Additionally, this quality improvement project evaluates the benefit of a pharmacist as a member of the interdisciplinary team and thus manage the overall pharmaceutical budget. Telephonic and/or virtual visit medication therapy management will be provided by clinical pharmacist(s) to hospice patients within two teams (n=160). Each patient's medical record will be reviewed and concurrently monitored on admission and subsequent IDT sessions with the entire team. Validity to be measured as a prospective cohort study. The teams that utilize a hospice pharmacist will see an increase in their Consumer Assessment of Heathcare Providers and Systems (CAHPS) scores and overall decrease in medication costs by 25% versus those teams that did not. Additionally, it is anticipated that over 500 drug therapy related matters will be resolved. This tailored care aims to improve quality of patient outcomes by symptom improvement, increase patient satisfaction and quality of life, and manage costs. This study highlighted the role of pharmacists in managing medications for hospice patients and described a clear path for a CDTM.

Heart failure management insights from primary care physicians and allied health care providers in Southwestern Ontario

BackgroundIt remains to be determined whether collaborative strategies to improve and sustain overall health in patients with heart failure (HF) are currently being adopted by health care professionals. We surveyed primary care physicians, nurses and allied health care professionals in Southwestern Ontario regarding how they currently manage HF patients and how they perceive limitations, barriers and challenges in achieving optimal management in these patients.MethodsWe developed an online survey based on field expertise and a review of pertinent literature in HF management. We analyzed quantitative data collected via an online questionnaire powered by Qualtrics®. The survey included 87 items, including multiple choice and free text questions. We collected participant demographic and educational background, and information relating to general clinical practice and specific to HF management. The survey was 25 min long and was administered in October and November of 2018.ResultsWe included 118 health care professionals from network lists of affiliated physicians and clinics of the department of Family Medicine at Western University; 88.1% (n = 104) were physicians while 11.9% (n = 14) were identified as other health care professionals. Two-thirds of our respondents were females (n = 72) and nearly one-third were males (n = 38). The survey included mostly family physicians (n = 74) and family medicine residents (n = 25). Most respondents indicated co-managing their HF patients with other health care professionals, including cardiologists and internists. The vast majority of respondents reported preferring to manage their HF patients as part of a team rather than alone. As well, the majority respondents (n = 47) indicated being satisfied with the way they currently manage their HF patients; however, some indicated that practice set up and communication resources, followed by experience and education relating to HF guidelines, current drug therapy and medical management were important barriers to optimal management of HF patients.ConclusionsMost respondents indicated HF management was satisfactory, however, a minority did identify some areas for improvement (communication systems, work more collaborative as a team, education resources and access to specialists). Future research should consider these factors in developing strategies to enhance primary care involvement in co-management of HF patients, within collaborative and multidisciplinary systems of care.

Evaluation of Pharmacy Model in a Trial of Free Essential Medicine Access.

Background: In Canada, pharmacists accessing electronic health records (EHR) and mailing medications to patients are relatively uncommon. We evaluated a pharmacy model implemented in a clinical trial that combined allowing the pharmacist access to patients’ EHR and mailing medications to participants. Methods: We conducted thematic analysis of comments made by participants and prescribers, and chart stimulated recalls with the pharmacist involved with the novel pharmacy model implemented in a clinical trial. Results: Major themes from participant’s comments related to the ease of obtaining information about medications from the pharmacy and satisfaction with the delivery. Prescribers felt that this model facilitated collaboration with the pharmacist and welcomed suggestions regarding therapeutic medication changes. Major themes from the pharmacist’s chart stimulated recalls were that access to participants’ EHRs allowed for improved drug therapy management and participant experience, and this pharmacy model increased participant’s access to pharmacy services. Discussion: According to the pharmacist and prescribers, this pharmacy model facilitated their collaboration in prescribing appropriate medications and participants were generally satisfied with the delivery of medications. Conclusion: Participants and prescribers were generally supportive of a pharmacy model that combined allowing the pharmacist access to participants’ EHR and medication mailing. This allowed the pharmacist more opportunities for drug therapy management and collaboration with prescribers. It also improved the participant’s access to pharmacy services, although those services were not always fully utilized.

The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review.

Background and aim of the work:A safer drug therapy is a relevant aspect of nursing care and an essential component of the clinical governance function. Nurses are key players in the identification and prevention of medication errors that could occur in the drug management process. In the literature there is a particular interest to environmental and organizational factors, while, as we know, the subjective components are little considered. In psychology, the theory that prefers individual factor, at the expense of the environmental one, is Theory of Planned Behavior (TPB), although it has been little applied in the health field. The aim is to search the existing literature on the medication errors and the TPB to predict the intentions that foreshadow risk behaviours of nursing interns.Methods:This scoping review is grounded by Arksey and O’Malley’s framework.Results:Attitude is the most determining predictor of intention. For many students reporting an error would lead to a loss of trust in the nursing profession and this could prevent the report. Nevertheless, some of them affirmed to be positively judged when they did it. It was then observed that a better education on safety raised the level of self-confidence and the sense of responsibility of the students, making them more inclined to the drug therapy management.Conclusions:The Theory of planned behaviour is essential to forerun the behavioural intention of students on the pharmacological safety and the collaborative practice through predictive factors, as attitude, subjective norms and perceived behavioural control. (www.actabiomedica.it)

Assessment of the Impact of Pharmacist-led Transitions of Care Services in a Primary Health Center.

Background: The impact of pharmacist-led transition of care services with collaborative drug therapy management has shown to improve patients' outcomes and decrease health costs. Compelling statistics show higher readmission rates for under-insured patients compared with insured patients at primary health care clinics. Methods: This is a single center, prospective, cohort study designed to examine team-based collaborative drug therapy management and its effect on therapeutic outcomes of under-insured patients with target chronic diseases managed in a primary health center. Targeted chronic diseases included dyslipidemia, diabetes, hypertension, anticoagulation disorders, chronic obstructive pulmonary disease, and heart failure. The primary outcome measures included percentage of time in therapeutic international normalized ratio (INR) and percentage of patients at targeted goals of blood pressure, lipids, and hemoglobin A1c (HbA1c). Secondary outcomes included reduced emergency department visits, number of patient encounters, hospital readmissions within 30 days of discharge, and disease exacerbation rates. Results: Patients were at INR goal 58% of the time compared with 52% at baseline (P = .66). There was a 9% improvement in mean HbA1c in the intervention group when compared with baseline (9.6% vs 10.9%, P = .03). With pharmacist intervention, 73.8% of the patients had their blood pressure at goal compared with 50% at baseline (P = .14). A limited number of patients were readmitted for different reasons, including uncontrolled disease states. Conclusions: The pharmacist-physician collaborative drug therapy management led to improved blood pressure control, average HbA1c, and time in therapeutic INR range. A decrease in health care utilization was also identified.

Effects of ethanol extract of the resin exudate of boswellia dalzielii hutch on pain in mice

This study aimed to determine the analgesic properties and the acute toxicity of Ethanol Extract of the Resin Exudate of Boswellia dalzielii (EERBD) in mice animal model. We used the writhing or acetic acid abdominal constriction, tail-immersion, and hot plate tests to assess the analgesic effect of EERBD at three doses (100, 200, and 400 mg/kg). To study the acute toxicity of EERBD, 24 female mice were divided into four groups (n=6) and were orally treated with EERBD at the doses of 0, 2000, 4000, and 5000 mg/kg, as per OECD (Organization for Economic Co-operation and Development) guidelines No. 420. In the acetic acid-induced writhing reflex model, the EERBD ministration decreased the mean total number of writhes at the two doses (100 and 400 mg/kg), which were found highly significant (P < 0.001) compared to control group. In the tail immersion model, the EERBD administration at the dose of 400 mg/kg significantly increased the pain reaction time (P < 0.001 as compared to control) at 30 min, but another tested sample had no significant latency. In the hot-plate model, the drug extract created significant (P < 0.001) increase in the latency period compared to the control group at oral doses of 100 and 400 mg/kg when compared to initial time and control group (4.5 ± 1.29 s) with protective effect from 4.25 ± 1.50 s after 30 min. Administration of EERBD at the dose of 200 mg/kg showed no significant analgesic activity based on writing, tail immersion, and hot-plate tests. The extract did not show toxicity signs or death at dose of less than 5000 mg/kg per oral. The results suggest that EERBD contain bioactive substances with analgesics effects; hence, it might be a better alternative to conventional drug therapy for pain management.

A LITERATURE REVIEW ON ORAL HYPOGLYCEMIC DRUGS – MECHANISTIC ASPECTS

Diabetes mellitus (DM) is a worldwide rising concern that leads to an increased rate of morbidity, mortality, and health-care costs. DM is a chronic, endocrine disorder associated with hyperglycemia. The current estimated DM prevalence is over 422 million and has been progressively increasing over the past decades. Consequently, it is considered a significant problem in health-care settings. Health-care professionals who deal with such patients need to have an adequate information and drug therapy management including drugs and its regimen that are presently available in the market. This review provides an overview of potential diabetic drugs and their mechanisms. Hence, it will be proved beneficial for health-care professionals.

Aneurysmal bone cyst of the pelvis and extremities: Contemporary management

Aneurysmal bone cysts are tumors of bone occurring predominantly in the metaphyses of long bones and posterior elements of spine in adolescents and young adults. Radiographically, on x-rays they appear as eccentric metaphyseal expansile lytic lesions containing “fluid-fluid” levels. Computed tomographic scan and magnetic resonance imaging clearly define the cysts and fluid-fluid levels; the former delineates cortical expansion and the latter the fibrovascular component clearly. Magnetic resonance imaging is particularly useful in differentiating aneurysmal bone cysts from malignant lesions. Histologically, these cysts are characterized by fibrovascular tissue, multinucleated giant cells, inflammatory cells, fiber-osteoid, “blue bone,” and blood filled lacunae. Chromosomal translocation has been found, implying a neoplastic basis for the development of aneurysmal bone cysts. Malignant transformation has been reported where radiation therapy was used, and in cysts associated with sarcomas. A high ratio of cellular component as compared with osteoid, and a high mitotic index have been reported to be associated with higher recurrence after treatment. Management is aimed at addressing patients’ symptoms and preventing/treating fracture, and can broadly be divided into nonoperative management (drug and radiation therapy), minimally invasive strategies (angiographic embolization, percutaneous injections), and operative management (curettage and bone grafting, en bloc excision). To reduce chances of recurrence, adjuvants such as electrocautery, high speed burr, phenol, cryotherapy, and argon beam laser have been used with variable degrees of success. With contemporary management, a cure rate of 70%–90% is expected.

ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education-2018.

The results of the 2018 ASHP national survey of pharmacy practice in hospital settings are presented. Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online using Qualtrics. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. The response rate was 16.6%. The percentage of hospitals that routinely have pharmacists assigned to provide drug therapy management has increased. Transitions-of-care processes have generally increased over the last 6 years. The percentage of hospitals with pharmacists in a wide variety of clinic types and clinical practice areas has increased over the last 2 years. Opioid stewardship programs are emerging in many U.S. hospitals, with pharmacists participating or taking the lead in program implementation. Outsourcing of compounded sterile product preparation is common. The proportion of hospitals not using any technology when compounding sterile preparations has declined. Pharmacy departments commonly track and monitor trends for administrative, operational, quality, and outcome metrics. Pharmacists continue to improve drug therapy monitoring for patients in U.S. hospitals. They are also responding to public health issues related to medication use. These advancements include taking an active role in opioid stewardship programs, safe compounding of sterile medications for patients, and reducing the need for hospital-based care.

Community pharmacists' knowledge, attitude, and practice of Irritable Bowel Syndrome (IBS): the impact of training courses.

Introduction: Irritable Bowel Syndrome (IBS) is a common chronic functional gastrointestinal disorder. Pharmacists have a vital role in patient education and in drug-therapy management for IBS. This survey is the first study in Iran, to evaluate knowledge, attitude, and practice (KAP) of community pharmacists on IBS, and the impact of training courses on the improvement of their skills.Objective and setting: This pre- and post-cross-sectional study was conducted to evaluate IBS-KAP amongst Community pharmacists in Shiraz, Iran.Methods: Pretested questionnaires were designed to assess professional characteristics and KAP components of the community pharmacists regarding IBS. All pharmacists from Shiraz were invited to participate in a 3-day training course on IBS. The participants were requested to complete the questionnaire before commencing the training course (pre-test), at the end of the 3-days course (post-test), and also 3 months after the course (follow-up test).Results: Correct answers to all parts increased after the training course, as well as in the follow-up stage, which was statistically significant in all three parts (P<0.05). The increases in correct answers were seen in the fields of attitude, practice, and knowledge.Conclusion: It seems that continuing IBS training courses are essential for pharmacists, regarding the fact that they can play an important role in assisting patients with IBS, as they are easily accessible healthcare professionals.

PDG74 DRUG UTILIZATION OF PATIENTS WITH RESPIRATORY DISEASE AT COMMUNITY PHARMACIES IN CHINA: AN ANALYSIS OF CHEMICAL DRUGS (2014-2017)

This study aimed to explore the situation of chemical drugs used for patients with respiratory disease at community pharmacies in China. Using the data from the China Health Industry Intelligence System Database from 2014 to 2017, which collected data from community pharmacies (n = 11,450) in 185 cities over China. Comprehensive analysis of the utilization of chemical drugs in respiratory disease in community pharmacies from the perspectives of market share, indications, and prescription. The sales of chemical drugs in the community pharmacies raised from 11.4 billion yuan in 2014 to 13.9 billion yuan in 2017 with the compound annual growth rate is 6.58%. The market share of prescription drugs increased from 24.99% in 2014 to 32.20% in 2017.The market concentration rate of chemical drugs is gradually decreasing, which the concentration of TOP10 reduced from 51.53% in 2014 to 47.64% in 2017. The nature of prescriptions and indication of the Top 10 chemical drugs in 2017 were: (1)Pediatric paracetamol, atificial cow-bezoar and chlorphenamine maleate granules(OTC, cold); (2)Compound paracetamol capsule(OTC, cold); (3) Compound paracetamol tablets(OTC, cold); (4)Pediatric paracetamol granules(OTC, cold); (5)Loratadine tablets(OTC, allergic rhinitis); (6)Salmeterol xinafoate and fluticasone propionate powder for inhalation(prescription ,asthma); (7)Montelukast sodium chewable tablets(prescription, asthma); (8) Ambroxol hydrochloride and clenbuterol hydrochloride oral solution(prescription, bronchitis); (9)Ibuprofen suspension(OTC, cold), (10)Budesonide formoterol powder inhalation(prescription, asthma). At community pharmacies in China, the chemical drugs for patients with respiratory disease, especially the OTC, are mainly used to treat colds, and the prescription drugs for asthma treatment increase rapidly. More interventions are needed to enhance drug therapy management of respiratory disease.

PRS48 DRUG UTILIZATION OF PATIENTS WITH RESPIRATORY DISEASE AT COMMUNITY PHARMACIES IN CHINA: AN ANALYSIS OF LEADING PRESCRIPTION AND OVER-THE-COUNTER DRUGS

This study aimed to investigate the leading prescription and over-the-counter (OTC) drugs used for patients with respiratory disease at community pharmacies in China. Using the data from the China Health Industry Intelligence System Database in 2018, which collected data from community pharmacies (n = 11,450) in 185 cities over China. The top 50 drugs (including chemical drugs and Chinese patent medicine (CPM)) used as prescription or OTC drugs were analyzed. In 2018, in terms of sales, the top 50 drugs accounted for 52.81% market share of respiratory disease at community pharmacy, including 40 OTC drugs and 10 prescription drugs. Among the top 50 drugs, the market share of OTC drugs of was about 10 times that of prescription drugs. The nature and indication of the 10 leading prescription drugs were: (1) Pudilan Xiaoyan oral liquid (CPM, pharyngitis); (2) Salmeterol xinafoate and fluticasone propionate powder for inhalation (chemical drug, asthma); (3) Montelukast sodium chewable tablets (chemical drug, asthma); (4) Budesonide formoterol powder inhalation (chemical drug, asthma); (5) Xiao'er Chiqiao Qingre granules (CPM, cold); (6) Ambroxol hydrochloride and clenbuterol hydrochloride oral solution (chemical drug, bronchitis); (7) Bailing capsule (CPM, bronchitis); (8) Xiao’er Feire Kechuan granules (CPM, cold); (9) Suhuang Zhike granule (CPM, pharyngitis); (10) Montelukast sodium tablets (chemical drug, asthma). The leading 40 OTC drugs included 8 chemical drugs and 32 CPMs, which were used for cold (21 drugs), pharyngitis (10 drugs) and cough (5 drugs). Complex interventions are needed to improve drug therapy management of the leading prescription and OTC drugs for patients with respiratory disease at community pharmacies in China. Community pharmacists should pay special attention to the use of chemical drugs and CPM by respiratory patients at the same time.

Ambulatory Care Training Within Postgraduate Year 2 Pediatric Pharmacy Residency Programs.

This study evaluates pediatric ambulatory care training opportunities for postgraduate year 2 (PGY2) pediatric pharmacy residents. An online survey was disseminated to PGY2 pediatric pharmacy residency directors. The questions involved the number and type of pediatric ambulatory care rotations offered; number of preceptors who practice in pediatric ambulatory care; whether or not a pediatric ambulatory care rotation is a requirement of the program; length and format of the rotations; amount of time residents spend in the pediatric ambulatory care setting; and the resident's role during pediatric ambulatory care rotations. The survey yielded an 85% response rate (n = 41/48). Most residency programs offer at least 1 pediatric ambulatory care rotation (n = 38; 93%), most of which are longitudinal experiences, and two thirds of programs require their resident(s) to complete a pediatric ambulatory care rotation (n = 27; 66%). These experiences involve a variety of specialty clinics, and residents assume diverse roles and responsibilities. Few programs offer residents the opportunity to practice under a collaborative drug therapy management agreement (n = 6; 15%) or develop new clinical services (n = 6; 15%). Most residency program directors (n = 39; 95%) reported that less than 25% of their residency graduates work in the pediatric ambulatory care setting. Ambulatory care experiences in PGY2 pediatric pharmacy residency programs are diverse in number and scope. There is an opportunity to expand pediatric ambulatory care rotation offerings, particularly with respect to collaborative drug therapy management and the establishment of new clinical services.

Oncology Pharmacist’s Role and Impact on the Multidisciplinary Patient-Centre Practice of Oncology Clinic in Public Hospitals

Oncology pharmacy service was developed and integrated into the multidisciplinary team of oncology clinic in 2013 at the United Christian Hospital aiming to enhance the holistic patient-centre practice of the clinic through the optimization of the safety and efficacy of anti-cancer treatment. This review aims to describe the role and impact of oncology pharmacists (OPs) in clinical setting to optimize anti-cancer treatment for cancer patients in a multidisciplinary care approach. From selection, prescribing, procurement to monitoring and patient education, OPs significantly contribute to the safety and effective use of anti-neoplastics in any circumstances. OPs provide professional advices to oncologists in choosing the appropriate anti-cancer agents for specific cancer and designing personalized anti-cancer treatment according to patients’ fitness and appropriateness for chemotherapy. Parenteral and oral chemotherapeutic agents carry heightened risk of causing significant patient harm when they are used in errors. Thus, OPs also develop standardized chemotherapy orders and ensure the final dose is appropriate in terms of both hematological and non-hematological responses and tolerability. Moreover, OPs play an important role in procuring anti-cancer drugs and sourcing alternative drug choices that will deliver similar clinical outcomes. In addition, OPs also assure the clinical integrity of anti-cancer drugs for full anti-neoplastic activity and safe administration of these drugs by nursing staff to minimize potential occupational risk. Most importantly, OPs play a vital role in providing direct patient care functions such as drug therapy monitoring and management (e.g. ensure that patients receive sufficient pre-medications for administration of anti-cancer drugs), and medication counseling for patients and their carers to better understand their anti-cancer treatment. The positive impact of integrating OPs into the multidisciplinary patient-center practice of oncology clinic includes (1) reduction in potentially life-threatening medication incidents and cancer drug administration errors in public hospitals; (2) collaboration with oncologists to select the most suitable cancer drug regimens for patients; (3) prevention of potential occupational risk to the healthcare professionals who handle cancer drugs; and (4) provision of optimal therapy treatment, monitoring and counseling to patients to reduce side effects and hospital readmission. The professional drug knowledge of OPs adds value to the multidisciplinary team in oncology clinics and the growth of OPs into effective direct patient care in oncology clinics should be encouraged to optimize medication-related outcomes.

Barriers interfering with establishment of Collaborative Drug Therapy Management (CDTM) agreements between clinical pharmacists and physicians

PurposeThe current level of awareness among health care providers towards working under collaborative agreements, and the barriers that interfere with establishing CDTM agreements between clinical pharmacists and physicians were studied. MethodsA structured survey was developed after reviewing the literature on CDTM. The questions were validated to assess the level of awareness regarding the role of clinical pharmacists in providing drug therapy management, and to determine the main barriers for not having collaborative agreements with different specialties. In addition to demographic data, physicians’ education background, reasons for not having clinical pharmacy services in their clinics, and their perceptions for signing a collaborative agreement were also collected. The sample for the study was obtained from different health specialties in Saudi Arabia. The validated survey was sent and received within approximately two months, Oct-Nov 2017. ResultsWe have received 55 responses from different sectors, a 79% response rate. Most physicians had worked before with a clinical pharmacist (76%) and of which 60% valued the services provided by the clinical pharmacist as extremely important and very important (29.1%; 30.9%) respectively. When physicians asked if they have heard about the Collaborative Drug Therapy Management agreement or the term CDTM, 67% of respondents haven’t heard that before. Most of the responses, regarding the physicians’ awareness of the actual CDTM agreement services, were correct. Only 18% selected incorrect CDTM services. The results showed higher percentages of physicians agreeing with the benefits of CDTM agreement as it can improve overall patient care, reduces risk of drug related adverse events or interactions and allows clinical pharmacists to be part of patient care; 85.5, 83.6 and 83.6 respectively. Physicians who rated the possibility to be involved or to encourage other health care professionals in signing collaborative agreements as high were 76.3 and 74.5 respectively. Based on their specialty, emergency medicine’s physicians were most likely to have a CDTM agreement and to encourage others too. On a scale from zero to hundred, the average of the responses rating lack of knowledge about such an agreement as potential barrier on preventing CDTM agreements was 69 ± 0.30. While the gender barrier had the lowest rating with a mean of 15. ConclusionThere is a huge lack of knowledge and understanding about the role of clinical pharmacists and in CDTM concept. This lack of knowledge affected on having collaborations between clinical pharmacists and physicians in different settings. Educating health care providers and stakeholders about the role of clinical pharmacists in providing drug therapy management and encouraging the concept of CDTM among healthcare providers are the main solutions to enhance clinical pharmacist’s role in patient care.

Effect of the pharmacist-managed cardiovascular risk reduction services on diabetic retinopathy outcome measures.

Background:Diabetic retinopathy (DR) is a progressive, sight-threatening long-term complication of diabetes. Diabetes disease management reduces the risk of developing or progression to a severe form of DR. However, there are no reports of the potential role of pharmacists in DR progression.Objective:For this study, we performed a retrospective data analysis of patients with diabetes seen at cardiovascular risk reduction services provided by pharmacists with an objective to determine the potential role of pharmacists in the DR progression. These services involve pharmacists working in collaborative drug therapy management (CDTM), using a collaborative practice agreement (CPA) with primary care physicians.Methods:Patient records and ophthalmological notes were collected for 317 individuals seen by the pharmacists (intervention group) and 320 individuals seen only by a physician (control).Results:Statistical analysis was performed on 148 individuals in an intervention group and 120 individuals in the control group for which complete records were available. Retinopathy progression remained stable in 89.6 % of individuals in the intervention group compared to 87.9% in the control group. Moreover, the relative risk of retinopathy progressing to a severe form was 1.17 for the control group compared the intervention group.Conclusions:Our studies provide a proof-of-concept that pharmacists-managed care possesses a potential role in protection from DR, and paves a way for future pharmacists managed care with an emphasis on reducing diabetic complications.

Identification of potentially inappropriate medications with risk of major adverse cardiac and cerebrovascular events among elderly patients in ambulatory setting and long-term care facilities.

PurposeCardiovascular diseases (CVDs) are extremely common among the elderly, but information on the use of potentially inappropriate medications (PIMs) with cardiovascular risk is scarce. We aimed to determine the prevalence of PIMs with risk of cardiac and cerebrovascular adverse events (CCVAEs), including major adverse cardiac and cerebrovascular events (MACCE).Patients and methodsA cross-sectional study was performed using a convenience sample from four long-term care facilities and one community pharmacy in Portugal. Patients were included if they were aged 65 or older and presented at least one type of medication in their medical and pharmacotherapeutic records from 2015 until December 2017. The main outcome was defined as the presence of PIMs with risk of MACCE and was assessed by applying a PIM-MACCE list that was developed from a previous study. All medications included in this list were assessed for their availability in Portugal.ResultsA total of 680 patients were included. Of those, 428 (63%) were female with a mean age of 78.4±8.1 years. Four-hundred and four (59.4%) patients were taking medications associated with CCVAEs risk (mean =1.7±1.0 drugs/patient), including 264 patients (38.8%) who used drugs with MACCE risk (mean =1.4±0.8 drugs/patient). Fifty percent of patients with a previous history of CVD (n=521) were taking PIMs with risk of CCVAEs, including 30.0% with risk of MACCE.ConclusionOur findings show that 50% of patients with previous history of CVD were taking drugs with risk of CCAVEs and 30% with risk of MACCE. More tailored tools for the management of drug therapy in elderly patients with CVD are of major importance in clinical practice.

Credentialing of Pediatric Pharmacists in Collaborative Drug Therapy Management.

Pediatric clinical pharmacists have evolved over the last 2 decades and have proven to be a key player in the multidisciplinary team. The American College of Clinical Pharmacy recently published (in 2015) a position statement on collaborative drug therapy management and comprehensive medication management. The Council on Credentialing in Pharmacy published a 2014 article on credentialing and privileging of pharmacists. Neither offered requirements for pediatric pharmacists in training and credentialing. This position statement provides a detailed outline defining adequate training for a pediatric clinical pharmacist in order to participate in collaborative drug therapy management for pediatric patients.