Greater Involvement Of Pharmacists Research Articles

Barriers and facilitators of medicines reconciliation at transitions of care in Ireland \u2013 a qualitative study

BackgroundMedication error at transitions of care is common. The implementation of medicines reconciliation processes to improve this issue has been recommended by many regulatory and safety organisations. The aim of this study was to gain insight from healthcare professionals on the barriers and facilitators to the medicines reconciliation implementation process.MethodsSemi-structured interviews were conducted in Ireland with a wide range of healthcare professionals (HCPs) involved with medicines reconciliation at transitions of care. Thematic analysis was undertaken using an adaptation of a combined theoretical framework of Grol, Cabana and Sluisveld to classify the barriers and facilitators to implementation of medicines reconciliation.ResultsThirty-five participants were interviewed, including eleven community pharmacists (CPs), eight hospital pharmacists (HPs), nine hospital consultants (HCs), five general practitioners (GPs), and two non-consultant hospital doctors (NCHDs). Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology (ICT) support. Solutions (facilitators) suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions (linked prescribing databases, decision support systems) and increased funding to provide additional (e.g. admission and discharge reconciliation) and more advanced services (e.g. community pharmacist delivered medicines use review).ConclusionsMedicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations.

National survey of diabetes self-management program coordinators views about pharmacists’ roles in diabetes education

ObjectivesTo examine the viewpoints of diabetes self-management training (DSMT) program coordinators about the roles and engagement of pharmacists who participate in DSMT programs, and the engagement between community pharmacies and DSMT programs by developing and administering a nationwide survey. DesignA mixed-methods exploratory sequential design; initial qualitative phase followed by a quantitative phase. Six in-depth interviews of DSMT program coordinators and intensive literature review informed the development of a 20-item survey instrument. Survey responses were descriptively analyzed, and themes were generated from context analysis of open-ended questions to generate the overall findings. Setting and participantsThe survey was distributed in 2017 to 742 active American Association of Diabetes Educators DSMT program coordinators in the United States. Outcome measuresProportion of DSMT programs engaging pharmacists and description of pharmacist’s roles. Content areas pharmacists teach in DSMT programs. Challenges faced by pharmacists in completing 1000 direct patient hours as a prerequisite for attaining Certified Diabetes Educator certification and strategies used to overcome them. Perceived benefits of pharmacist involvement by coordinators and patients. ResultsOne-third of DSMT programs have pharmacists involved with most using pharmacists as educators. Coordinators believe that pharmacist care is highly beneficial to patients and recognize that community pharmacist’s care is an added benefit to patients. However, collaborative practices are not well established between community pharmacists and DSMT programs. Program coordinators identified challenges they face when trying to involve community pharmacists in program delivery. ConclusionCoordinators of DSMT programs and their patients see pharmacists’ care as highly beneficial within DSMT programs. Increasing participation and scope of community pharmacists’ involvement is desired by both DSMT coordinators and the patients they serve. There is substantial growth potential for both greater involvement of pharmacists in DSMT programs and enhancing links to community pharmacists’ care.

Greater pharmacist involvement can improve medicines supply chain, report says

Greater pharmacist involvement can improve medicines supply chain, report says

ReCAP: Comparison of Independent Error Checks for Oral Versus Intravenous Chemotherapy.

Intravenous (IV) chemotherapy is routinely delivered to patients in hospital settings, where safeguards such as independent checks and guidelines govern their administration. In contrast, oral chemotherapy, which is typically ordered in a cancer center but dispensed and administered in the community and home, respectively, is subject to fewer controls. Research in the United States has found that few safeguards in routine use for IV chemotherapy have been adopted for oral chemotherapy; however, less is known about the Canadian context. The objective of this study was to determine whether similar safeguards, in the form of independent checks, existed to identify potential errors related to both formulations. Human factors specialists conducted observations and interviews in cancer center clinics, a cancer center pharmacy, and four community pharmacies across Nova Scotia. Processes were analyzed to determine if an independent check was performed, which qualified provider completed the check, and at what point of the process the check occurred. A total of 57 systematic checks were identified for IV chemotherapy, whereas only six systematic checks were identified for oral chemotherapy. Community pharmacists were the only qualified professionals involved in independent systematic checking of oral chemotherapy, which occurred during ordering and dispensing. There is an enormous opportunity for pharmacists and other qualified professionals to take on an expanded role in improving patient safety for oral chemotherapy. Greater involvement of pharmacists, in both the clinic environment and the community, would facilitate increased systematic checking, which could improve patient safety related to oral chemotherapy.

What Secondary School Career Advisors in New Zealand Know about Pharmacy and How that Knowledge Affects Student Career Choices

To explore what career advisors at secondary schools (high schools) in New Zealand know about the pharmacy profession, how they obtain that knowledge, and what their potential influence is on students' decisions to study pharmacy. This study employed a cross sectional questionnaire design. A postal questionnaire was sent to 250 randomly selected secondary schools in New Zealand. The response rate was 112/248 (45%). Responding career advisors were familiar with many of the roles of pharmacists (mean knowledge score 11.5 out of 16). Over 90% of career advisors were familiar with the roles of pharmacists in the community setting; however, many had a poorer understanding of other pharmacist roles. One suggestion for improving the promotion of pharmacy within secondary schools was a greater involvement of pharmacists and pharmacy students in the promotion of pharmacy as a profession. Career advisors need a broader understanding of the potential roles of pharmacists. Increasing contact from practicing pharmacists and undergraduate pharmacy students are potential ways of increasing student interest in pharmacy.

PS-010 Role of pharmacist in preventing Drug-Related Problems associated to prescription of total parenteral nutrition by clinical status

BackgroundPharmaceutical Interventions (PI) have been documented in patients with parenteral nutrition, mostly adjustments in the composition. In our hospital the physician prescribes total parenteral nutrition (TPN) by clinical status and...

A cross‐sectional analysis of over‐the‐counter codeine use among an Australian sample of people who regularly inject drugs

The study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a sample of people who inject drugs; and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain. This study analysed annual survey data from a convenience sample of people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting System. People who have injected drugs (n = 902) on at least a monthly basis in the preceding six months across Australia were interviewed. Participants were asked about their use of OTC codeine and their experience of pain. One third (35%) of participants had used OTC codeine in the preceding six months and 52% (95% confidence interval 48.7-55.3) of this group had exceeded the recommended dose on their last occasion of use. This clearly places them at increased risk of harms associated with toxicity from the accompanying analgesic found in combination codeine products. Multivariate analyses demonstrated that those exceeding the recommended codeine dose of OTC codeine were more likely to be experiencing moderate to very severe pain. There is a need to evaluate the approach to pain management in this population. Greater pharmacist involvement, real-time monitoring of sales, the development of screening tools to identify those at risk of harm and further education of primary care practitioners could be beneficial in reducing the risk of harm associated with these medications for all users of OTC codeine, including people who inject drugs.

Expanding the definition of nonprescription drugs: potential impact on pharmacists.

In March 2012, the US Food and Drug Administration (FDA) held a public hearing regarding a proposed “new paradigm” where the FDA would move toward approving certain medications that normally require a prescription to nonprescription status under conditions of safe use.1 These conditions of safe use, which could involve pharmacy-based kiosks or other aids that lead the patient through an evidence-based algorithm for a particular drug product, performance of simple diagnostic tests by pharmacists, or some other type of pharmacist intervention, may significantly expand the current role of pharmacists in retail and clinic pharmacy settings. Over 240 million individuals self-treat with nonprescription medications annually and approximately 60 million of these would not otherwise seek treatment; therefore, the potential impact of expanding the definition of nonprescription drugs is enormous.2 Currently, medications are approved by the FDA either as prescription or nonprescription.1 The FDA requires a medication to be dispensed under a valid prescription if, “because of its toxicity or other potentiality for harmful effect, or the method of its use, or the collateral measures necessary to its use, it is not safe for use except under the supervision of a practitioner licensed by law to administer such drug.” The agency has wide latitude to decide whether or not data submitted as part of a new drug application are sufficient to ensure that a drug is safe for use under its proposed labeling and if the new medication should be prescription-only. The FDA has begun to consider expanding the definition of nonprescription medications for a variety of reasons, not the least of which is the sometimes burdensome process of obtaining a prescription. Oftentimes, patients must see a prescriber in person to obtain an initial prescription and, in some cases, for additional refills. The time and cost associated with prescriber visits can discourage patients from receiving needed medications.3 In addition, undertreatment of a variety of common disorders (eg, hypertension, dyslipidemia, asthma) is a well-recognized problem in the United States.1 By making certain prescription medications widely available without a prescription, but with standardized conditions for safe use, the FDA hopes to address this public health issue. The FDA is considering multiple potential approaches to the expanded definition of nonprescription drugs, including the following1: requiring an in-person visit to a prescriber for an initial prescription, but then allowing a specific number of refills to be authorized under conditions of safe use without a return visit (most beneficial for rescue medications such as asthma inhalers or epinephrine injection for allergic reactions), allowing some medications to be available simultaneously as both prescription and nonprescription medications under conditions of safe use (allowing for greater flexibility in obtaining needed medications), approving medications that generally have required a prescription as nonprescription products in conjunction with some sort of pharmacist intervention. The FDA believes that reducing or eliminating the number of “required” prescriber visits through some of the above mechanisms may not only allow prescribers to focus care on the more seriously ill, but may also decrease overall health care costs. All of these approaches, if adopted, would have an impact on the role of the pharmacist, particularly in the retail setting where pharmacists are the most accessible to patients. Some diseases or conditions might require confirmation of a diagnosis or routine monitoring using a diagnostic test that could be available in a pharmacy.1 Pharmacists may then use the results to determine whether use of a certain drug product is appropriate for a specific patient. Other potential roles for the pharmacist include assessing whether the patient has any conditions or risk factors that would indicate that the drug should not be used or assisting patients in choosing between various drug products. There are potential challenges to carrying out this initiative, including changing nonprescription regulations, concerns from prescribers regarding separating patients from appropriate medical care, liability issues, and the impact on health care costs.3 Already, the American Medical Association (AMA) has adopted a policy that opposes federal and state legislation that allows pharmacists to prescribe medications without a valid order by a physician and also opposes letting pharmacists dispense medications beyond the expiration of the original prescription.4 These moves by the AMA stem directly from the March public hearing. In addition, some individuals have questioned whether moving prescription products to nonprescription status would actually increase patient use, because most insurers do not cover nonprescription medications. FDA officials have acknowledged these concerns but state that the agency is looking toward the future, when all health care providers will be better connected through the use of electronic health records and patient portals. In addition, greater pharmacist involvement has the potential to increase patient participation in their health care needs and improve medication adherence. The agency is gathering public input on this issue until May 7, 2013.

Patients' understanding and perceptions of treatment as determinants of adherence to warfarin treatment

Abstract Focal points

Pharmacists’ Interventions for Optimization of Medication Use in Nursing Homes

The elderly use more medications than younger adults. In addition, the prevalence of inappropriate prescribing is high in nursing homes. The aim of this review was to collect and interpret the results of clinical studies of interventions involving pharmacists aimed at improving the quality of prescribing in nursing homes, and to identify the key elements for a successful intervention. To this end, we searched MEDLINE, International Pharmaceutical Abstracts and EMBASE from January 1987 to May 2008. Studies were selected that (i) involved a pharmacist; (ii) took place in the nursing home setting; (iii) involved residents aged > or =65 years; (iv) included residents with a range of diseases (not targeted at a specific pathology); (v) were controlled trials (randomized or not). The search strategy retrieved eight controlled studies that fitted the inclusion criteria. A meta-analysis was not possible because of the difference in outcomes chosen in the publications. We found mixed evidence for the effectiveness of various interventions by pharmacists on pharmacotherapy in the nursing home setting. Pharmacists can have different roles in the nursing home such as performing regular medication reviews, being an active member of a multidisciplinary team and/or educating physicians, nurses and other nursing home staff about medication use. Our review shows that the available evidence is mixed concerning the effectiveness of interventions by pharmacists on pharmacotherapy in the nursing home setting. At the same time, greater pharmacist involvement has been shown in published studies to increase physicians' and nurses' knowledge and awareness about medication. Evidence is scarce, however, and there is a need for large, well conducted randomized controlled trials in the nursing home setting. Attention should be paid to the choice of outcome measures and to multidisciplinary collaboration when assessing the effects of pharmacists' interventions on medication use in nursing homes.

Trans‐Tasman Comparison of Non‐Prescription Medicine Purchasing Behaviour

ABSTRACTBackgroundThe non‐prescription medicine market is subject to professional practice policy and legislative influences, including trans‐Tasman harmonisation initiatives.AimTo establish a baseline comparison of purchasing behaviour for non‐prescription medicines in community pharmacies in Australia and New Zealand.Method2 comparable survey databases were merged and analysed. The Australian survey was conducted in 15 pharmacies in August 2004 (n = 3017) and the New Zealand survey was conducted in 6 pharmacies in July 2005 (n = 1092). Both used the same questionnaire, completed via observation of the sale and interview with all available customers. Data included customer demographics, purchasing behaviour and the observed incidence of staff‐customer consultation during the sale.ResultsGeneral descriptors of the 2 cohorts were similar. Analysis of purchasing behaviour variables revealed significantly higher incidence of pharmacy staff involvement in product selection and customers' predetermined brand choices in Queensland compared to New Zealand. However, there was a significantly higher rate of observed questioning and advice by pharmacy staff in New Zealand across all schedules of medicines, with greater involvement of pharmacists alone in Queensland.ConclusionA number of trans‐Tasman differences were identified in non‐prescription medicine purchasing behaviour from two limited samples of pharmacies. Future concurrent and national‐scale research is recommended to explore and monitor these findings with respect to trans‐Tasman medicines regulatory harmonisation and professional pharmacy initiatives.

Pharmaceutical services in hospices

Hospices were surveyed to identify the types of pharmaceutical services provided. The directors of 75 hospice organizations were sent questionnaires regarding: (1) the type and scope of pharmaceutical services and (2) their conception of the future of the hospice movement. Of the 48 usable responses, 37 reported pharmacist affiliation. Of the 11 organizations that did not have a pharmacist affiliated, 10 reported they anticipated using a pharmacist's services in the future. Most (68%) pharmacists who worked in hospices were consultants. Pharmaceutical services included the development of policies and procedures regarding drug storage and handling, inservice education, drug information, and patient education. Of the organizations without a pharmacist, 91% provided only outpatient care; of hospices with pharmacists, 51% provided outpatient, 14% inpatient, and 36% outpatient and inpatient care. Forty-six percent of the hospice directors considered the pharmacist affiliated with their organization to be a member of the interdisciplinary team; 55% of such pharmacists worked full-time with the hospice. Hospice directors expressed a need for greater pharmacist involvement in inservice education, staff consultation, and research on pain.