Effect Of Pharmacist Intervention Research Articles

The Effect of Pharmacist Interventions on the Antimicrobial Prevention Pattern in Vascular and Gastrointestinal Surgeries: A Prospective Study

Introduction: Surgical site infections (SSIs) are common postoperative complications, necessitating effective preventive strategies such as pharmacist interventions. This study explores the impact of pharmacist interventions on the antimicrobial prophylaxis model in vascular and gastrointestinal surgeries. Methods: We enrolled 200 adult postoperative patients, dividing them into two groups of 100 each. Initially, both groups received antibiotics based on surgeons' recommendations. Subsequently, all participants underwent pharmacist consultations. The first group continued antibiotics per surgeons' guidance, while the second group followed pharmacists' recommendations. We then compared SSI incidence between the two groups, recording data in an SPSS file. Results: Initially, surgeons prescribed prophylactic antibiotics for 71% of the first group and all of the second group. Pharmacist interventions revealed inaccuracies in antibiotic type, dosage, or duration in 80% and 88% of cases, respectively. The second group better adhered to recommended guidelines for treatment duration (P=0.007), accurate dosage (P=0.0001), and re-administration necessity. Moreover, SSI occurrence significantly decreased in the second group (P=0.0001). Conclusion: Pharmacist interventions play a critical role in reducing SSI incidence. Further research is needed to elucidate pharmacists' roles in decreasing postoperative infections and complications and establishing guidelines for their presence in surgical wards.

Trends in Implementation of Loading Dose of Voriconazole from 2010 to 2019 and Influencing Factors of Loading Dose Based on a Japanese Administrative Claim Database: A Retrospective Cohort Study.

A loading dose of voriconazole (VRCZ) is recommended to increase its blood concentration at an early stage. However, the trends in the implementation of the loading dose in VRCZ in Japan has not yet been clarified. In addition, although pharmacists play many important roles in antimicrobial stewardship, the effect of pharmacist intervention on the implementation of a loading dose of VRCZ has not yet been reported. Therefore, this study aimed to clarify the implementation of loading dose of VRCZ and the influencing factors of loading dose. This study used an administrative claims database that included patients who received injectable VRCZ between 2010 and 2019. The implementation of loading doses in the VRCZ was evaluated annually. Multivariate logistic regression analysis was performed to identify the factors influencing loading dose. Overall, 2197 patients were included. The implementation rate of the loading dose remained below 65% throughout the study period. Among medical fees that can be calculated through pharmacist intervention, only the infection prevention and control premium significantly increased the implementation of loading dose of VRCZ (odds ratio: 1.587, 95% confidence interval: 1.053-2.392). In conclusion, antifungal stewardship may have been promoted at medical institutions that established infection prevention and control. In the future, pharmacists will need to intervene more actively from the beginning of VRCZ administration.

Effect of pharmacist intervention on antibiotic prophylaxis in orthopedic internal fixation: A retrospective study.

Despite the availability of guidelines and official policies, antibiotic prophylaxis in clean surgery remains suboptimal. The aim of this study was to evaluate the clinical effects and cost-effectiveness of pharmacist-led intervention in the perioperative anti-infection prophylaxis of patients undergoing orthopedic internal fixation. We performed a retrospective analysis based on the medical records of internal fixation surgery in a tertiary hospital from July 2019 to June 2020. Data were divided into two groups based on whether a full-time pharmacist participated in the treatment. The research parameters included use of antibiotics, rationality of medication, postoperative complications, and related cost. To deal with selection bias, propensity score matching method was employed at a ratio of 1:1. Meanwhile, a cost-effectiveness analysis was used to evaluate the impact of pharmacist intervention on antibiotic prevention in internal fixation surgery. A total of 537 participants were included in this study. After matching, 236 patients were comparable in each group. During the pharmacist intervention period, less pharmacologic prophylaxis (96.6% vs 100.0%, p=0.007) and shorter prophylaxis duration (1.60 vs 2.28 days, p<0.001) were observed. The reasonable rate increased dramatically in usage and dosage (96.6% vs 83.9%, p<0.001), timing of administration (94.5% vs 78.4%, p<0.001) and medication duration (64.4% vs 37.7%, p<0.001). In addition, pharmacist intervention yielded net economic benefits. A remarkable reduction was observed in average length of stay (10.43 vs 11.14 days, p=0.012), drug cost ($610.57 vs $706.60, p=0.001) and defined daily doses (2.31 vs 3.27, p<0.001). The cost-effectiveness ratios, divided drug cost savings by cost of pharmacist time, were 28:1 for drug and 2:1 for antibiotics, respectively. Pharmacist-driven antibiotic stewardship for orthopedic internal fixation patients improved compliance with peri-procedure antibiotic prophylaxis, and reduced the cost and utilization of antibiotics. This helped to bring significant clinical and economic benefits.

Effect of Pharmacist Intervention on Emergency Department Geriatric Patients with Polypharmacy

Background: Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety.

Pharmacist care in hypertension management: systematic review of randomized controlled trials

Abstract Background Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care. One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. Methods In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. The outcomes are the change in BP, BP at follow-up, or BP control. Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis. We published the study protocol in BMJ Open. Results A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence. After removal of duplicates, 1744 were independently screened based on title and abstract by two authors (VG, ST), and 242 full texts were evaluated. A total of 72 studies with 32641 patients are currently included for data extraction. These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25). The data extraction and analysis are ongoing. Results will be presented at the congress. Conclusions This systematic review provides updated evidence on the effect of pharmacist intervention on BP management. Heterogeneity in the effect of interventions will be carefully evaluated which will help the implementation of effective interventions in various healthcare settings. Key messages • Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. • This systematic review provides updated evidence on the effect of pharmacist intervention on blood pressure management.

The Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-Analysis.

The existing trials have focused on a variety of interventions to improve outcomes in renal failure; however, quantitative evidence comparing the effect of performing multidimensional interventions is scarce. The present paper reviews data from previous randomized controlled trials (RCTs), examining interventions performed for patients with chronic kidney disease (CKD) and transplants by multidisciplinary teams, including pharmacists. Methods: A systematic search with quality assessment was performed using the revised Cochrane Collaboration’s ‘Risk of Bias’ tool. Results and Conclusion: Thirty-three RCTs were included in the review, and the data from nineteen protocols were included in further quantitative analyses. A wide range of outcomes was considered, including those associated with progression of CKD, cardiovascular risk factors, patient adherence, quality of life, prescription of relevant medications, drug-related problems (DRPs), rate of hospitalizations, and death. The heterogeneity between studies was high. Despite low-to-moderate quality of evidence and relatively short follow-up, the findings suggest that multidimensional interventions, taken by pharmacists within multidisciplinary teams, are important for improving some clinical outcomes, such as blood pressure, risk of cardiovascular diseases and renal progression, and they improve non-adherence to medication among individuals with renal failure.

Effect of Pharmacist Interventions on Hospital Readmissions for Home-Based Primary Care Veterans

Several studies indicate that when patients transition from one level of care to another, errors may occur. Pharmacists can play an integral role in the transitions of care process. At Michael E. DeBakey Veteran Affairs Medical Center, the Home-Based Primary Care (HBPC) service has implemented a streamlined hospital discharge plan to improve 30-day readmission rates after 1 year of HBPC enrollment. Our aim was to identify specific pharmacist interventions to improve the HBPC discharge process and ultimately, improve hospital readmission rates. A Plan-Do-Study-Act quality improvement project was initiated. We conducted a review of veterans enrolled in HBPC from October 2019 to March 2020. Of 175 patients assessed postdischarge, a medication reconciliation was completed by an HBPC pharmacist in 118 (67.4%) patients. Of the 118 medication reconciliations completed, 92 (78%) interventions were made by HBPC pharmacists. During the 6-month study period, 30-day hospital readmission rates decreased from 19% to 13%. This study demonstrates several opportunities for interventions to lower readmission rates. Using the results from this study, education has been provided for the HBPC service and its readmission committee.

IMPACT OF PHARMACIST LED HYPERTENSION MANAGEMENT

Objective: The study objective was to analyze the effect of pharmacist interventions in improving blood pressure control. Methods: The prospective interventional study was conducted on a population who were known hypertensive for more than 2 years. They were randomly categorized into two groups, interventional group and usual care group. Pharmaceutical care, involving telephonic follow-up, adherence analysis, patient education was given in the former group in a time interval of 2 months for about 12 months while the later was on regular therapeutical care only. Blood pressure was monitored in each follow-up. The difference in control of blood pressure was measured in terms of mm/Hg unit. The improvement in the measure from start and end of the study was analyzed within the group and between the groups. Results: Lowered blood pressure was observed in both the groups in the end of study. But statistically significant difference was seen in interventional group compared to the other. Involvement of pharmacist led care helped in achievement of AHA goal. Conclusions: Including clinical pharmacist in a health-care team can provide unerring therapeutic regimen to patients thereby their health-care outcome.

Effectiveness of pharmacist intervention for deprescribing potentially inappropriate medications: a prospective observational study

BackgroundPotentially inappropriate medications (PIMs) and polypharmacy in older adults lead to increase the risk of adverse drug events. This study aimed to evaluate the effectiveness of pharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm on correcting PIMs, reducing the number of medications, and readmissions.MethodsA prospective observational study was conducted at a Japanese University Hospital enrolling new inpatients aged ≥65 years prescribed ≥1 daily medication. Pharmacists detected PIMs based on the criteria combined the screening tool of older persons’ potentially inappropriate prescriptions criteria version 2 with the screening tool for older persons’ appropriate prescriptions for Japanese, examined changes using the deprescribing algorithm, and suggested changes to the physician. The proportion of patients whose number of medications was reduced at discharge and the rate of readmissions within 30 and 90 days were compared between patients without PIMs (without PIMs group), patients who were not suggested to change PIMs (no suggestions group), and patients who were suggested to change PIMs (suggested group).ResultsThe study enrolled 544 patients (median age 75.0 years, 54.4% males, median number of medications 6.0/patient). The number of patients with PIMs was 240 (44.1%), and 304 patients had no PIMs (without PIMs group). Among the patients with PIMs, 125 (52.1%) patients received pharmacist suggestions to change ≥1 PIMs (suggested group), and 115 patients received no suggestions for change (no suggestions group). The total number of PIMs was 432, of which changes were suggested for 189 (43.8%). Of these 189 cases, 172 (91.0%) were changed. The proportion of patients whose number of medications was reduced was significantly higher in the suggested group than in the without PIMs group and the no suggestions group [56.8% (71/125) vs. 26.6% (81/304) and 19.1% (22/115), respectively; P < 0.001 in both comparisons]. There were no significant differences in the rates of readmissions within 30 and 90 days among the three groups.ConclusionsPharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm was effective for correcting PIMs and may be associated with a reduction in the number of medications.

Effect of Pharmacist Interventions on Medication Adherence to Capecitabine in Cancer Patients: A Systematic Review

Oral chemotherapy poses challenges regarding patient medication adherence. Pharmacists play a vital role in supporting medication adherence to achieve the effectiveness of therapy. This review aimed to evaluate the impact of pharmacist interventions on medication adherence in patients with cancer taking capecitabine. The literature was systematically reviewed using Scopus, ScienceDirect, Sage Journal, Springer Link, PubMed, and Google Scholar. Key text words included “adherence, pharmacist intervention, capecitabine, oral chemotherapy, and cancer.” We collected original articles published from January 2010 to June 2021 in English that reported pharmacist interventions to enhance capecitabine adherence in adult patients with cancer and assessed adherence rates pre- and post-intervention. Two independent researchers extracted data relevant to inclusion criteria and determined the methodological quality of studies using the Joanna Briggs Institute Critical Appraisal Checklist Tools. A total of 4179 articles were retrieved, of which five were eligible for review. The most common pharmacist intervention strategy was a combination of patient education, with oral and written information provided. Components of patient education were the characteristics of capecitabine, including its mechanism of action, side effects, and their management; current therapeutic regimen; importance of adherence; and risk of non-adherence. Pharmacist interventions provide beneficial impacts on medication adherence, beliefs about medication, and tolerability of side effects. The findings suggest that pharmacist interventions support medication adherence improvement and highlight the role of pharmacist interventions in pharmaceutical oncology care services. Further studies are necessary to assess pharmacist interventions’ long-term effects and clinical outcomes.

Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

BackgroundClinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients’ quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital.MethodsA before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4–12 mg/L), phenytoin (10–20 mg/L), or valproic acid (50–100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test.ResultsA total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists’ intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018).ConclusionEpilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient’s response and determine the most effective treatment with the fewest adverse drug reactions.Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04967326

Pengaruh Intervensi Apoteker terhadap Tingkat Bahaya Drug-Related Problems pada Pasien Geriatrik Rawat Inap

Geriatric patients are at high risk of Drug-Related Problems (DRPs) associated with multimorbidity, physiologic changes, and pharmacologic alterations, that caused by the aging process. The pharmacist plays an important role in optimizing the effectiveness and safety of the patient’s drug therapies. This study aims to know the effect of pharmacist intervention in reducing the harmful levels of DRPs and to know the factors associated with the reduction of DRPs harm level in hospitalized geriatric patients. This research uses quasi-experimental study with a one-group pretest and posttest design. This research was conducted in Panti Rapih Hospital between March-April 2021, with patients’ inclusion criteria of ≥ 60 years old, with internal diseases cases, and identified DRPs in the therapy. The exclusion patient criteria are hospitalized in the intensive unit and Covid-19 ward. A pharmacist reviewed patient drug therapy, identified and solved DRPs. The harm level of DRPs was compared before and after pharmacist interventions. The harm level of DRPs was determined through professional adjustment according to The Harm Associated with Medication Error Classification tools, then analyzed using Wilcoxon test with a level of confidence 95%. Factors of age, the number of drugs received by the patient, comorbidities, and acceptance of the intervention were investigated for their effect on reducing the harm level of DRPs using a multivariate logistic regression test. A total of the research subject were 28 inpatients, with 47 DRPs identified. The most frequent DRPs were adverse drug reactions (27,66%). Among all interventions, 77,36% of them were accepted with full implementation. The pharmacist intervention resulted in a significant reduction in the harm level of both potential and actual DRPs (p &lt; 0,05). A factor of the number of drugs received by patients and acceptance of pharmacist intervention was associated with the reduction of the harm level of DRPs (p &lt; 0,05). This study shows that multidisciplinary collaboration is needed in the care of geriatric patients.

Effect of Pharmacist Intervention on Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients in Primary Healthcare in Indonesia.

Objective:In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets.Methods:A quasi-experimental study with a pretest–posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles.Findings:After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent (“not often”) consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7).Conclusion:The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.

Effect of Pharmacist Intervention in Outpatient Clinic—Pain Evaluation for Nerve Block Patients Using Pain Vision—

Effect of Pharmacist Intervention in Outpatient Clinic—Pain Evaluation for Nerve Block Patients Using Pain Vision—

PHARMACIST INTERVENTION ON THE INCIDENCE OF DRUG RELATED PROBLEMS IN PATIEN WITH CHRONIC KIDNEY DISEASE IN RSU PKU MUHAMMADIYAH BANTUL

&lt;pre&gt;Chronic kidney disease (CKD) is a disease that often appears in various countries. Progressive decline in kidney function in patients with chronic kidney disease can lead to unexpected events from drug use, due to decreased kidney function in excreting the drug and its metabolites in addition to the co-morbidities that often arise. Drug Related Problems (DRPs) is one of the problems that can arise from a treatment. Drug Related Problems (DRPs) in addition to impacting the effectiveness and safety of a treatment can also cause morbidity, mortality and treatment costs incurred by the patient. This study aims to look at the picture of DRPs that occur in CKD patients and the effect of pharmacist intervention on DRPs in PKU Muhammadiyah Hospital Bantul by comparing DRPs that arise before and after pharmacist intervention. This research is descriptive with an observational cohort design. Data was collected prospectively in a cohort to see DRPs drawings and the influence of pharmacist interventions on the incidence of DRPs in inpatient CKD patients at PKU Muhammadiyah Hospital in Bantul in the period August-October 2017. The DRPs category followed the PCNE V7.0 DRP classification, recorded DRPs in the problem category for 19 cases (45.2%) and the category of loading were 24 cases (57.1%). The most drug related problems were found to be non-optimal therapy (28.6%), the time / interval of drug administration (26.8%), the combination of drugs with drugs (16.7%) and there were indications of no drugs (11.9% ). Pharmacists intervened with the incidence of DRPs found, pharmacists intervened in the form of changing instructions for using drugs (30.7%), giving information / recommendations to prescribers (16.7%) and providing education to patients (11.9%). Pharmacist intervention can prevent or overcome the DRPs found. Conclusions in this study there are still DRPs that occur in inpatient CKD patients. The involvement of pharmacists can prevent or reduce the incidence of DRPs and ensure efficient, effective and safe drug therapy.&lt;/pre&gt;

Effects of Pharmacist Interventions on HFrEf Outcomes A Systematic Review and Meta-analysis

Introduction Heart failure (HF) is a complex clinical syndrome with a significant economic and health burden. While practice guidelines recommend a multidisciplinary approach in HFrEF care, the impact of pharmacist participation on HF outcomes remains inconclusive. Methods A systematic review and meta-analysis was performed and reported according to PRISMA guideline from five databases including PubMed, Embase, Cochrane, Scopus and CINAHL. Randomized controlled trials (RCTs) that evaluated pharmacist interventions compared were compared with usual care in HFrEF patients. Data were pooled using a random-effects model. The primary outcome was all-cause mortality. Secondary outcomes were all-cause hospitalization and health-related quality of life (HRQoL) at 6 months. Results Twenty-nine trials identified 6,965 predominantly HFrEF patients. The average age was 72.0 years (IQR 66.0-76.0) and 48% were men (IQR 40.0%-68.0%). The majority of trials included NYHA FC II-III with median left ventricular ejection fraction (LVEF) of 38.5% (IQR 34.5-49.5%). Pharmacist interventions were associated with a significant reduction in all-cause mortality (RR 0.74; 95% CI 0.60-0.91; p= 0.004) and all-cause hospitalizations (RR 0.86; 95% CI 0.75-0.99; p =0.034). There was a significant improvement in 4 domains of SF-36 including role physical (SMD 0.20, 95% CI 0.04 to 0.37, p=0.015), role emotional (SMD 0.17, 95% CI 0.00 to 0.33, p=0.047), mental health (SMD 0.33, 95% CI 0.17 to 0.50, p Conclusions Pharmacist interventions in HFrEF population significantly reduced all-cause mortality and all-cause hospitalizations. Several dimensions of quality of life were also improved. Integration of pharmacist into a HFrEF care team or care pathway should be strongly considered as an important element of a multidisciplinary team.

Effectiveness of Pharmacist Intervention on Capecitabine Relative Dose Intensity, Adherence, Knowledge &amp; Safety Among Cancer Patients in Malaysia

Effectiveness of Pharmacist Intervention on Capecitabine Relative Dose Intensity, Adherence, Knowledge &amp; Safety Among Cancer Patients in Malaysia

Influence of Pharmacist Intervention on Re-Elevation of Glycated Hemoglobin for Diabetic Outpatients.

Purpose: The effect of pharmacist intervention on blood sugar control in diabetic outpatients in a pharmacist-managed clinic was studied by focusing on the re-elevation of the glycated hemoglobin (A1c) level defined as a continuous variable. Methods: A retrospective chart review was performed at the Mizushima Kyodo Hospital from April 2014 to March 2016. Of the 221 diabetic outpatients who were provided guidance by nurses and nutritional managers, 62 further consulted the pharmacist-managed clinic. The remaining 159 patients were enrolled in a nonintervention group. Finally, the data of 115 patients with A1c level of ≥7.5% and A1c re-elevation were extracted. Intergroup comparison was performed between the pharmacist intervention (n = 26) and nonintervention (n = 89) groups. In both the groups, the starting point (baseline) was the time when the A1c level of ≥7.5% was observed. Subsequent monitoring was performed once in every 3 months. The average cumulative level of A1c re-elevation (CARE) was compared between groups. Patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, and male and female patients were also compared. Furthermore, the number of days until the re-elevation of the A1c level from the baseline was also compared. Results: The CARE values were 0.89 ± 0.86% and 1.51 ± 1.25% in the pharmacist intervention and nonintervention groups, respectively, showing a significant difference (P = .0195). There were no significant differences between patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, or between males and females. The number of days until the re-elevation of A1c level from the baseline also showed no significant difference. Conclusion: Pharmacist intervention for diabetic outpatients in pharmacist-managed clinics significantly suppressed CARE when compared with effects of no intervention, and this could be useful for preventing the exacerbation of diabetes.

Impact of pharmacist educational intervention on disease knowledge, rehabilitation and medication adherence, treatment-induced direct cost, health-related quality of life and satisfaction in patients with rheumatoid arthritis: study protocol for a randomized controlled trial

BackgroundThe objective of this study is to evaluate the effectiveness of pharmacist intervention in improving disease knowledge, adherence to treatment, health-related quality of life (HRQoL) and direct cost of treatment. The study also documents patient satisfaction with pharmacist counselling as a quality control measure.Methods/designThis is a randomized, single-blind, two-arm, controlled trial in patients with rheumatoid arthritis visiting outpatient rheumatology clinics in Karachi, Pakistan. We will enroll patients with established diagnosis of rheumatoid arthritis over 3 months. The patients would be randomized through a computer-generated list into the control group, i.e., usual care or into the intervention group, i.e., pharmaceutical care, in a ratio of 1:1, after providing signed written consent. The study will take place in two patient-visits over the course of 3 months. Patients in the intervention group would receive intervention from the pharmacist while those in the control group will receive usual care. Primary outcomes include change in mean score from baseline (week 0) and at follow up (week 12) in disease knowledge, adherence to medications and rehabilitation/physical therapy. The secondary outcomes include change in the mean direct cost of treatment, HRQoL and patient satisfaction with pharmacist counselling.DiscussionThis is a novel study that evaluates the role of the pharmacist in improving treatment outcomes in patients with rheumatoid arthritis. The results of this trial could set the foundation for future delivery of care for this patient population in Pakistan. The results of this trial would be published in a peer-reviewed journal.Trial registrationClinicalTrials.gov, NCT03827148. Registered on February 2019.

Effectiveness of pharmaceutical support by pharmacists in urinary care teams

To facilitate timely removal of urinary catheters and promote self-voiding among inpatients, urinary care teams have been established in some Japanese medical institutions. However, direct evidence of the effectiveness of pharmacist intervention in urinary care teams is limited. We evaluated the efficacy of pharmaceutical support by a pharmacist in a urinary care team. Between September 2017 and August 2018, 84 patients met the criteria for initiating continuous intervention. Patients with (20 cases) and without (8 cases) adoption of pharmaceutical support (initiation or discontinuation of treatment for dysuria) were scored for urinary function (including degree of independence of urination and score of lower urinary tract disorder) and for urinary situation. Comparative analysis results showed that pharmacist intervention in the adoption cases resulted in significantly improved scores for urinary function than in non-adoption cases. Similarly, pharmaceutical support resulted in improved overall urinary situation in the patients (85.0% of adoption cases compared to 37.5% of the non-adoption cases). The most common pharmaceutical support was a recommendation to discontinue drugs that induce dysuria (65.0% of the cases). Taken together, our findings suggested that pharmacists are important members of urinary care teams.