Effective Use Of Medicines Research Articles

Drug safety: an integrated approach

Drug safety is a system of established principles and practical recommendations aimed at ensuring the safe and effective use of medicines. The aim of the study was to develop principles and design a conceptual model of drug safety based on a systematic analysis and an integrated approach. Material and methods. Systematic analysis of literary and Internet sources, a systematic approach, logical analysis, graphical method, modeling. Based on the study of the specifics of the existing pharmaceutical market and its participants, the regulatory framework, literary and Internet sources characterizing the circulation of medicines, drug-related problems of patient treatment, ethical norms and rules and system analysis, the principles of drug safety are proposed. The concept of drug safety is considered as a three-dimensional phenomenon requiring an integrated approach. Taking into account the system analysis, a conceptual model of drug safety has been developed, which includes 6 key elements: ensuring the safety of medicines from the state, manufacturers of medicines, medical and pharmaceutical workers, patients, the need for support and training of specialists, as well as directions for their implementation. The external factors influencing the clinical effectiveness of drugs and improving the quality of work of medical and pharmaceutical specialists are shown.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

ОЦЕНКА И ПРОГНОЗИРОВАНИЕ РИСКА ПАЦИЕНТСКОГО НОН-КОМПЛАЕНСА В СИСТЕМЕ СПЕЦИАЛИЗИРОВАННОЙ ФАРМАЦЕВТИЧЕСКОЙ ПОМОЩИ НАСЕЛЕНИЮ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Cardiovascular, oncological and other diseases occupy a significant place in the structure of morbidity and causes of death of the population, the growth of which largely depends on lifestyle and risk factors. Identification of risk factors contributing to the development of cancer is one of the main achievements of epidemiology of the 21st century. Subsequent research helped scientists to build multifactorial algorithms for predicting the risks of cancer and mortality from them, which greatly facilitated the work of practitioners in the field of risk stratification. The above indicates that the research results of many foreign and domestic authors confirm that significant predictors of cancer are risk factors such as old age, pre-existing cancer in blood relatives, smoking, obesity, alcohol, certain types of viral infections, certain chemicals, ionizing radiation, including UV rays of the sun and others. It is known that reducing the influence of risk factors leads to a decrease in morbidity and mortality from cancer. An important condition in the treatment of oncological diseases is the rational and effective use of medicines. Pharmaceutical specialists play an active role in this process. In the treatment of long-term or lifelong diseases, such as cancer, great importance is attached to the process of daily pharmacotherapy, compliance with the rules of adherence to treatment or compliance. Thus, problems with patients performing medical appointments are based on a complex of factors, including psychological and behavioral ones, including patients' adherence to treatment.

Community pharmacy discharge medicines service activity as recorded in PharmOutcomes: a retrospective exploration and analysis.

Transition of care when a patient moves between healthcare locations is a risk factor for medication errors and medicines-related preventable harm. The aims of this retrospective service evaluation were to understand, by classifying and quantifying, the nature of interventions made by community pharmacy when receiving a discharge medicines service referral from a secondary care hospital, with a focus on two groups of high-risk medicines supplied at discharge-oral anticoagulants and weak opioids following hip or knee surgery. Records made on the PharmOutcomes™ platform by community pharmacists in response to referral for the NHS England discharge medicines service were analysed and summarized. This analysis was exploratory and interpretative in nature and used a convenience sample of patients who had consented for the service over 12 months from May 2022 to April 2023. During 12 months, 6811 referrals occurred, of which 71% were recorded as having different stages of the service completed on PharmOutcomes™. Medicines reconciliation, first-prescription review, and consultation stages decreased as patients progressed through the service. Slightly greater rates of completion were observed for patients receiving oral anticoagulants and for codeine or dihydrocodeine following hip and knee surgery, although overall referrals were low for this latter cohort. Through this service, community pharmacists are well placed to support the safe and effective use of medicines including oral anticoagulants and weak opioids posthospital discharge and potentially reduce incidents of avoidable harm. The variations in recorded completion rates across the three stages of the service and the apparent greater finalization rates for the high-risk medicines studied require further investigation.

Focusing on what matters to the patient when prescribing

As Head of Effective Prescribing and Therapeutics for the Scottish Government, Dr Alpana Mair is responsible for advising ministers on the safe, sustainable and effective use of medicines. Here, she talks to Joy Ogden about her work tackling polypharmacy and ensuring the focus is on what matters to the patient when prescribing.

The International Working Group on New Developments in Pharmacovigilance: Advancing Methods and Communication in Pharmacovigilance

In 2019, the International Working Group (IWG), focusing on New Developments in Pharmacovigilance, was established. This group is coordinated by the Drug Safety Research Unit in the United Kingdom, and the mission of the IWG is to progress pharmacovigilance methodologies and promote the safe and effective use of medicines and vaccines, thereby further protecting patients. Novel therapeutics are continuously being developed to alleviate medical conditions, but with advancing technologies, innovative pharmacovigilance methodologies need to be developed to effectively monitor the use and safety of these products. With reduced timelines proposed for premarketing clinical trials and increased application of real-world evidence supporting regulatory approvals, products may be used in real-world clinical practice in shorter timeframes than before. Therefore, the need for effective methods of monitoring medicines and collecting safety data in real-time is of paramount importance to public health. The IWG aims to advance existing methodologies used in the detection, monitoring, and analysis of safety data in pharmacovigilance and to communicate best practice proposals to support decision making in health care. The IWG will identify areas requiring review of current processes or methodologic research and will communicate the output of the IWG through peer-reviewed publications, reports, and presentation of findings at relevant conferences and scientific meetings. The IWG is currently reviewing two areas in pharmacovigilance; case-level causality assessment and the strengths and limitations of data sources. The IWG is advancing these areas by producing two scoping reviews which will be easily accessible to regulatory agencies, industry, academia, and interested persons or organizations. The scoping reviews comply with the IWGs mission to progress pharmacovigilance methodologies and promote the safe and effective use of medicines and vaccines. The present article shares details of the objectives of the IWG and provides an overview on the status of IWG activities.

Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications.

Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.

Embedding research into clinical care to improve health outcomes

As well as Breckenridge Chair of Clinical Pharmacology at the University of Liverpool, Professor Reecha Sofat is Vice President (Clinical) of the British Pharmacological Society and an Associate Director for the British Heart Foundation Data Science Centre. Here, Professor Sofat talks to Joy Ogden about her research to improve understanding of disease and the effective use of medicines, and how her various roles complement each other.

Patient information leaflet in the era of digitalisation: a cross-sectional study on patients' attitudes and practices.

Patient information leaflets (PILs) are documents that are standardized in nature and provide guidance for patients or caregivers on the safe and effective use of medicines. Previous evidence suggests that written information is linked to enhancing the amount of information remembered. Currently, patients have become more involved in digital searches for information. However, there is variability in the quality and reliability of information obtained from the web. According to Saudi Food and Drug Authority regulations, pharmaceutical manufacturers are required to supplement each pharmaceutical product entering the Saudi market with a digital leaflet in addition to a paper leaflet. This research aimed to evaluate patients' attitudes and practices towards PILs. A cross-sectional study design using an anonymous online self-administered questionnaire was adopted. The study took place in Saudi Arabia between October and December 2022. A convenience sampling strategy was used to recruit the study participants. The questionnaire was adapted from previous research that investigated patient attitudes and practices towards PILs. A total of 463 participants agreed to take part in the study and completed the questionnaire. Physicians were the top utilized source for getting medicine information (92.7%), followed by pharmacists (84.7%), PILs (67.4%), searching the Internet (53.6%), and consulting family and friends (31.7%). About 78% of the participants reported often or always reading PILs for new drugs (78.2%), but this percentage was lower (45.4%) for repeat prescriptions. A positive perception towards PILs was observed among the study participants. While 54.6% of the participants indicated a preference for having both paper and digital information leaflets, 33.3% reported a preference for paper leaflets, and 12% indicated a preference for digital formats. Although patients had positive perceptions towards PILs, physicians were the top-consulted source for medicine information. Pharmacists should educate patients about the importance of referring to PILs which can also be accessed electronically in the case of a preference for a digital format, as the quality and reliability of the information obtained from the web cannot be confirmed.

Ten clinical pharmacological interventions in routine care to ensure better treatment outcomes.

Clinical Pharmacologists play a major role in facilitating the rational use of medicines.[1] The World Health Organization insists on integrating the Clinical Pharmacology discipline with the health service system[2]; however, there is procrastination in materializing this.[3] We describe ten instances wherein Clinical Pharmacological interventions improved prescribing and patient outcomes (Table 1). ... ... Clinical Pharmacologists and clinical pharmacists promote the safer and effective use of medicines.[13] Their consultations should be encouraged to improve treatment outcomes. No funding was obtained for this work. The authors have no relevant financial or non-financial interests to disclose. The idea for drafting this article was conceptualised by SD, SSS, and SKT. The patients described in this article were treated and consulted by SD, SSS, S. Sarkar, S. Sen, S. Selvarajan, SKT, JP, NC, and SRJ. The literature search was performed by SD and SM. Expert inputs were provided by AP, CSL, S. Selvarajan, and SKT. All authors contributed to the writing and proofreading of the final manuscript. The final manuscript was discussed and approved by all authors.

Revisiting publish or perish

The term ‘publish or perish’ was first used in an academic context in a 1928 journal article.[1] Since then it has been widely adopted by academic institutions as a tool to incentivise individual staff members to publish scholarly articles to enhance both their own reputation and career progression, and thereby the reputation of the institution itself. With the increasing use of publications in performance indicators for academic staff as they progress through promotion rounds, and for institutions themselves as they compete with each other in ranking tables and for government funding, the expression is probably as true today as ever. However, when the academic discipline has immediate relevance to policy and practice in the real world, as do applied health sciences and health services research for the better provision of health care, the phrase ‘publish or perish’ takes on an alternative and arguably more important meaning. Research into the safe and effective use of medicines, and exploiting the expertise of the wider healthcare team such as the pharmacy team, often referred to as pharmacy practice research, contributes to those important portfolios of work. Reflecting on the content published in the International Journal of Pharmacy Practice in 2022, and focussing particularly on the papers published in this first issue of 2023, it is clear that the publication of research can fulfil a much greater role.

DRUG MISUSE AND SELF-MEDICATION AMONG PHARMACY STUDENTS IN JORDAN

Aim: To estimate risks and prevalence of self-medication and potential abuse risk among pharmacy students in Jordanian Universities. Materials and Methods: A cross-sectional study design was conducted with 450 students, selected using multistage sampling methods, from seven different universities. Data was collected by self-administrated questionnaires covering demographic and academic information, health-related information, use of self-medication, and pattern of self-medication among pharmacy students. Results: Out of 394 students who answer the questions, 76.9% reported that they had usually treated themselves in case of simple cases without physician or pharmacist consultation. Most commonly used drugs among the surveyed students were Paracetamol 60%, multivitamins supplement 74.25%, and herbal products 37.2%, combination of NSAIDs and Paracetamol 20.6%, and laxatives 19.4%. Cold and flu 25.5%, headache 22.3%, abdominal pain 7.9%, gastric pain 7.9%, cold and flu, headache, abdominal pain, and gastric pain 14.9% were the main conditions which contribute to self-medication practice. It was also found that Pharmacy students were over-confident with the type of cases they could treat without referral to a specialist physician, despite knowing that some of the symptoms may be due to serious health problems. Misuse of analgesics and laxatives was clear, and there was a weakness in knowledge of the indications for the use of the most common drug. Conclusions: The prevalence of self-medication among pharmacy students in Jordan is high, and medical teaching institutions need to educate students about the proper use of medicines. Strict legislation and more education on self-medication are necessary for effective use of medicines.

Knowledge, Attitude and Practice of Pharmacist about Inpatient Medication Therapy Management Services: National Cross-Sectional Study

Background: Medication therapy management is a patient-centered process to create treatment plans centered on each patient’s medication-related goals. It requires collaboration between pharmacists, patients, and other health care providers to ensure the safe and effective use of medicines. Objectives: assessment of Iraqi hospital pharmacists’ knowledge, attitude, and practice on MTMs providing. Methods: The cross-sectional study was conducted in seven Iraqi hospital pharmacists’ using a structured questionnaire delivered online. Results: A total of (90) pharmacists were enrolled in the study, (86.66%) between the age of (20–30) years old, (63.33%) females, (93.33%) with bachelors degree and (90%) inpatient pharmacist setting with (96.66%) of total pharmacist had 0–10 years of experience. Most pharmacists (56.66%) had a high level of knowledge and positive attitudes toward MTMs. Furthermore, pharmacists believed that MTM services might increase the quality of health care (83.33%), and (90%) were interested in acquiring more information about MTM service. On the contrary, obstacles identified by pharmacists that might affect MTM services (MTMs) implementation, the most common were lack of training (80%), lack of private counseling area (73.33%), hence, needing for more time spending during patients’ counseling (63.33%). Conclusion: Providing insights about the hospital pharmacists revealed that most of them have good knowledge, positive attitude, and inadequate practice regarding MTM service.

Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

Since COVID-19 was first recognised, there has been ever-changing evidence and misinformation around effective use of medicines. Understanding how pandemics impact on medicine use can help policymakers act quickly to prevent harm. We quantified changes in dispensing of common medicines proposed for "re-purposing" due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia. We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidized medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analog). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models and compared characteristics of initiators in 2020 and 2019. In March 2020, we observed a 99% (95%CI: 96%-103%) increase in hydroxychloroquine dispensing (approximately 22% attributable to new users), and a 199% increase (95%CI: 184%-213%) in initiation, with an increase in prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing. There was a small but sustained increase in ivermectin dispensing over multiple months, with an 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no change in the initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin was lower than expected from April through November 2020. While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we observed increases in the initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to the media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harm.

Experiences and Expectations of Ethnic Minorities and Majorities towards Community Pharmacy Medicines-Related Services in Estonia.

The unique professional competence of pharmacists can support the safe and effective use of medicines by patients. Additionally, it is important to acknowledge and incorporate the needs of patients with various cultural and social backgrounds. The objective of this study was to assess and compare the experiences and expectations of Russian- and Estonian-speaking pharmacy customers about medicines-related services in Estonian community pharmacies. Cross-sectional study among pharmacy customers was conducted in Estonia 2018–2020. For data analysis, an Independent t-Test was used to compare experiences and expectations of respondents towards medicines-related services. The study involved 552 pharmacy customers: 58.5% (n = 323) Estonians and 41.5% (n = 229) Russians. The majority of the total sample (78.3%) considered the pharmacist competent to help. Medicines-related concerns were more common among Russians (p = 0.037), however, they sought less contact to consult a pharmacist than Estonians (p < 0.001). Furthermore, expectations about different medicines-related services in the future were higher among Estonians than among Russians (p < 0.001). Community pharmacists in Estonia should focus more on person-centered care to better meet the expectations and needs of different ethnic groups about medicines-related services. It is also important to reduce the language barrier and to increase the recognition of cultural traditions by health professionals.

A national initiative to promote public involvement in medicine safety in Scotland: the use of a population survey to identify candidate behaviours for intervention development

Abstract Introduction Medicines are the most commonly used healthcare intervention (1). Every medicine has benefits and harms. One of the five objectives of the WHO Global Patient Safety campaign, Medication Without Harm, is to “empower patients, families and their carers to become actively involved and engaged in treatment or care decisions, ask questions, spot errors and effectively manage their medications” (2). Effective strategies are needed to promote greater public involvement in the safe and effective use of medicines. Aim The aim of this study was to explore the prevalence of public behaviour in terms of information-/advice-seeking about medicines in general, newly prescribed medicines, and pain management including their use of oral, over-the-counter (OTC) analgesics. The survey also included exploration of self-reported behaviour regarding their use of pharmacies and OTC analgesics. Methods A cross-sectional online survey of 1000 adults (aged &amp;gt;16years) in Scotland was undertaken in collaboration with Ipsos MORI. The content was informed by a multi-stakeholder prioritisation event (held in November 2019) and supplemented with information from earlier studies, including national surveys using Citizen Panels. The following themes were included in the questionnaire: The data were input online by respondents then cleaned and weighted by Ipsos Mori using random iterative method (RIM) weighting to the known offline population proportions for age, gender, region and working status. All data were analysed and presented using descriptive statistics. Results Most respondents (78%, n=777) had used a pharmacy in the previous 12 months to obtain a prescription medicine and slightly fewer (61%, n=610) to obtain an OTC medicine. Low levels of information- and advice-seeking were reported especially on receipt of new prescription medicines. Few (5%) respondents ‘always’ discussed their new prescription medicine with pharmacy staff and 29% reported ‘never’ engaging in this behaviour. Older people (&amp;gt; 35 years) were less likely to engage in this behaviour. Up to 65% of respondents reported ‘always’ engaging with specific aspects of the appropriate use of OTC analgesics e.g. appropriate dose. Potentially unsafe behaviours were identified with medicine disposal. Nearly one third (29%) of respondents considered waste bin disposal to be of low or no harm, and 19% considered disposal of medicines via the toilet/sink to be of low/no harm. Conclusion Despite the extensive use of pharmacies, low levels of information-/advice-seeking were reported especially on receipt of new prescription medicines. Potentially unsafe behaviours were also identified with medicine use and disposal. The key determinants of these behaviours will be explored in more detail and theory-based interventions will be developed and tested to evaluate their effect. Respondent opinion (positively or negatively) regarding their perceptions regarding community pharmacies and/or pharmacy personnel could have been influenced by the increased use and/or awareness of community pharmacy services due to the pandemic. References (1) National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE Guidelines [NG5]. 2015. https://www.nice.org.uk/guidance/ng5 (accessed 13/10/2021). (2) Medication without harm - Global patient safety challenge on medication safety. Geneva: World Health Organization, 2017. Licence: CCBY-NC-SA3.0IGO.

Drug Prescription Practice and Behavior

Counseling has evolved into an essential component of community pharmacy practice. Patient counseling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. There are currently no solid theoretical foundations for research on physician prescribing choices. In fact, doctors' drug prescriptions are a complex phenomenon that are influenced by a number of factors. The majority of current studies in the field of drug prescription use an exploratory approach rather than a theoretical one to describe how doctors make decisions. In Libya, a prescription of medications can easily be obtained from community pharmacies without prescription, resulting in potential drug misuse and health hazard. It was stated previously that there was overprescribing of certain categories of drugs written by Libyan physicians which necessitating further improvement. This review aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice in Libya, focusing on counseling, and rational prescription based on the World Health Organization prescribing indicators.

Impact of Change in Community Pharmacists' Role on Their Estimated Demand

Pharmacists play a key role in optimizing the safe and effective use of medicines in the super-aged society in Japan. Recently, community pharmacists' role has been transformed and expanded to provide patient-centered care. This study aimed to simulate a change in the demand for community pharmacists resulting from this shift in their role, from 2019 to 2035. The change in demand was estimated by the number of prescriptions obtained from publicly available sources of information. The number of required community pharmacists was calculated separately for full-time and part-time pharmacists and the pharmacists engaged in home medical care. This number was calculated using the estimated demand, the number of prescriptions dispensed per day, and annual working days. We evaluated the effect of changes in the working conditions, which include changes in the dispensing process time, rate of part-time staff and their work time, and number of home medical care per day, on the number of community pharmacists. When the number of prescriptions dispensed per day was set at 19.8, the demand for community pharmacists was estimated as 188,314 in 2035. Furthermore, due to the changes in the working conditions, the demand is expected to change from 153,362 to 266,944. Although the increasing provision of drug information time leads to an increasing number of pharmacists, combining it with work efficiency services could prevent or decrease it. The optimal supply and demand balance of community pharmacists should be determined by both, promoting pharmaceutical care services and improving work efficiency.

Virtual clinical pharmacy services: A model of care to improve medication safety in rural and remote Australian health services.

PurposeTo describe a virtual clinical pharmacy service as a model of care to support rural and remote Australian hospitals that otherwise would not have access to onsite pharmacists.SummaryMany small hospitals in Australia do not have an onsite hospital pharmacist and struggle to support and optimize patient care. To increase access to a hospital pharmacist’s specialized skills and medication knowledge, a virtual clinical pharmacy service was designed and implemented in 8 hospitals across rural New South Wales, Australia in 2020. The virtual clinical pharmacy service focuses on the core role of hospital pharmacists, including obtaining a best possible medication history, medication reconciliation at transitions of care, medication review, interprofessional team meetings, provision of patient-friendly medication lists, antimicrobial stewardship, and patient and clinician education. The model is aligned with recognized standards of practice for the delivery of clinical pharmacy services in Australian hospitals. This article details a model of care for translation across other settings. It provides the necessary details on clinical services, processes, supporting structures, an evaluation framework, and other important considerations for implementing virtual pharmacy services.ConclusionThis research provides policymakers, health service planners, and practitioners with a model for providing comprehensive clinical pharmacy services virtually to increase the safe and effective use of medicines. Future publication of the findings of a formal evaluation of the model’s acceptability and effectiveness is planned.

Where National Medicines Policies Have Taken Us With Patient Involvement and Health Technology Assessment in Africa.

The Covid-19 pandemic has highlighted global knowledge about, but lack of equitable access to, life-changing medicines, and other innovative medical products by populations in African low and middle income countries. The World Health Organization (WHO) and other international non-profit foundations and organizations are constantly striving to address inequity. In the 1970s, WHO initiated a regularly updated essential medicines list, together with the concept of national medicines policies (NMPs) to ensure access and availability, affordability, rational, and effective use of medicines which are considered essential in addressing predominant population health issues and disease burden. We studied the NMPs of Ghana, South Africa, Uganda and Zimbabwe to highlight some of the important issues that these countries experience in the safe and effective use of medical products. Thailand is an example of how health technology assessment (HTA) can provide a country with an internationally supported, clearly defined and transparent process to broaden access to medicines and services. These medical services can add considerable value in accordance with local values and priorities. Involvement of civil society adds democratic legitimacy to such processes. Community health workers and patient advocacy groups are important in raising awareness and knowledge of safety issues and the effective use of quality medicines. They can apply pressure for increased funding to improve access to healthcare. Medicines and services that contribute to supported self-care are of benefit in any setting. Joint efforts across African countries such as with the African Medicines Agency are important in addressing some of the major health issues.