Health Pharmacists Research Articles

The role of community pharmacists in public health and public health related problems which they encounter

Background and Aims: This study was conducted in order to identify the role of community pharmacists in public health and the public health related problems which are encountered. Methods: In this cross-sectional study, 87 community pharmacists answered a questionnaire form about sociodemographic characteristics, public health counseling roles and barriers. The data was summarized as mean ± standard deviation and percentage. Chi-square test was used to compare the categorical data. Results: 93.1% of the community pharmacists considered that they had an active role in the protection of public health, while the percentage of those who thought they were able to realized it was 78.2%. Limited authority (63.2%), insufficient time and workload (52.6%) were the leading causes of ineffectivity of the pharmacists in public health. The causes that prevented receiving consultancy services were shame (64.4%), the education level of the client (51.7%) and gender difference between the pharmacist and client (48.3%). The pharmacists thought that their professional reputation should be improved in order to improve their consulting role (35%). Conclusion: Although there are many occupational problems of pharmacists in Turkey, pharmacists voluntarily provide a consultacy service about many subjects for the protection of public health. Legal arrangements are needed to make pharmacies public health counseling centers.

Managing medication supply chains: Lessons learned from Taiwan during the COVID-19 pandemic and preparedness planning for the future

Coronavirus disease 2019 (COVID-19) has posed unprecedented challenges for nations worldwide, among which medication shortages can cause a devastatingly negative impact on global health. Using Taiwan as an example, this report describes the sources of potential medication shortages, discusses the preparedness and contingency strategies to address medication shortages, and outlines the evidence-based recommendations on ensuring a stable medication supply and improving the quality and security of medicines.Many drug shortages have focused on shortfalls of overseas manufacturing, but the effect of the COVID-19 crisis on misallocation of medications within the nation’s internal supply chains is also a great concern. A wide range of stakeholders are involved in pharmaceutical supply chains, including government regulators, health care insurers, pharmaceutical companies, frontline physicians and pharmacists, patients and families, professional and patient associations or unions, and even individuals who acquire medications from abroad. Collaborative inputs and efforts from all these interdependent stakeholders are critical for establishing transparent preparedness and contingency plans to address drug shortages affected by disruptions of overseas manufacturing or stockouts in pharmacies owing to medication misallocation. Strategies have been documented and recommended in Taiwan and the United States to mitigate drug shortages and ensure the long-term quality and security of medicines.Barriers to accessing medicines are nothing new, but the COVID-19 pandemic poses urgent and even novel challenges to the stability and integrity of medication supply, which urges for a need to reconsider and reinforce effective management strategies for pharmaceuticals. Active management, transparent information, and timely communications are essential to ensure a stable supply of key therapeutic medications, especially during a pandemic.

Toward the Quadruple Aim: Impact of a Humanistic Mentoring Program to Reduce Burnout and Foster Resilience.

ObjectiveTo assess the effect of a faculty development program (Mentoring and Professionalism in Training [MAP-IT]) that fosters humanism in medicine on elements of burnout and the development of resilience.Participants and MethodsThe cohort of participants was drawn from a cross-section of disciplines and represented a diverse group of health professionals, including physicians, nurses, physician assistants, pharmacists, psychologists, social workers, and chaplains. The 106 participants were divided into 12 groups, each of which was facilitated by two or three leaders. Each group completed the MAP-IT curriculum from October 1, 2017, through July 31, 2018. All participants and leaders completed the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory (assessing emotional exhaustion, depersonalization, and personal accomplishment) before and after completion of the program.ResultsThe participants’ scores for emotional exhaustion and depersonalization remained unchanged following the completion of the MAP-IT curriculum. However, their scores for personal accomplishment and resilience increased significantly and approximated those of the leaders.ConclusionThe MAP-IT program has shown effectiveness both in fostering resilience and a sense of personal accomplishment. The time is ripe for institutional programming to create and foster the personal tools needed to prevent burnout and its sequelae.

A Study to Assess the Effectiveness of Training Program on Knowledge and Practices Regarding Advanced Cardiovascular Life Support (ACLS) among Staff Nurses in MMIMS & R Hospital

Advance cardiovascular life support is a level of medical care which is used for clients with life threatening illness. Death can occur at any time due to causes like stroke, poisoning, accidents, suicide, injury, medication error, shock and cardiac arrest. Among these, cardiac arrest deaths remain major cause of mortality. Therefore, one of the measures to improve survival is by introducing the concept of “chain of survival”. The elements of the chain of survival include recognition of early warning signs, activation of the emergency medical system, basic cardiopulmonary resuscitation, defibrillation, intubation and intravenous delivery of medications. Advance cardiac life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies. Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Only qualified health care providers, physicians, paramedics, nurses, respiratory therapists, pharmacists, and other specially trained health care providers can provide ACLS, as it requires the ability to manage the patient’s airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology. Therefore, training program on ACLS is required for staff nurses, to gain knowledge and improve skill. Quantitative approach was selected with pre-test - post-test only design. 36 samples were chosen (working in ICU/ ICCU/ emergency/ medical wards / surgical wards) using random sampling technique. Training program was given to the study subjects and a structured questionnaire and structured checklist was used to collect data regarding Advanced cardiovascular life support of subjects before and after the administration of training program. Findings revealed that the mean post-test sore was greater than the mean pre-test score. Thus it is concluded that the training program on Advanced cardiovascular life support was effective for teaching and improving staff nurse’s knowledge and practices.

Digging for care-seeking behaviour among gold miners in the Guyana hinterland: a qualitative doer non-doer analysis of social and behavioural motivations for malaria testing and treatment

BackgroundAlthough Guyana has made significant progress toward malaria control, limited access to malaria testing and treatment services threatens those gains. Mining activities create breeding environments for mosquitoes, and the migrant and mobile mining populations are hard to reach with information and services. The Ministry of Public Health (MoPH) has trained volunteers to test and treat malaria cases in remote regions. However, it remains unclear how miners perceive these testers, the services they provide, or what their malaria care-seeking behaviour is in general. To better address these challenges, Breakthrough ACTION Guyana and MoPH conducted qualitative research from October to November 2018 in Regions 7 and 8 in Guyana.MethodsA total of 109 individuals, 70 miners, 17 other mining camp staff, and 22 other key stakeholders (e.g. community health workers, pharmacists, and regional leadership), participated in semi-structured interviews and focus group discussions. Results were derived using a framework analysis, with an adjusted doer and non-doer analysis, and organized using the integrated behaviour framework.ResultsMiners sought MoPH-approved services because of close geographic proximity to testing services, a preference for public service treatment, and a desire to correctly diagnose and cure malaria rather than just treat its symptoms. Those who chose to initiate self-treatment—using unregulated medications from the private and informal sector—did so out of convenience and the belief that self-treatment had worked before. Miners who completed the full MoPH-approved treatment understood the need to complete the treatment, while those who prematurely stopped treatment did so because of medication side effects and a desire to feel better as soon as possible.ConclusionReasons why miners do and do not pursue malaria testing and treatment services are diverse. These results can inform better MoPH programming and new solutions to improve malaria outcomes in Guyana.

Will Community Health Centers Survive COVID‐19?

Will Community Health Centers Survive COVID‐19?

P0814NEW STRATEGIES TO DECREASE THE ANNUAL RATE OF DIALYSIS INITIATIONS AT A HOSPITAL IN CENTRAL TOKYO

Abstract Background and Aims The Japanese Government and the Japanese Society of Nephrology (JSN) have enacted measures against chronic kidney disease (CKD) since 2008. Since then, the number of age-adjusted dialysis initiations has decreased. However, the absolute number has not decreased due to aging of the population. In response, the Japanese Government launched new CKD measures in 2018, with a focus on earlier intervention by nephrologists, utilizing referral criteria from family doctors to nephrologists. The primary goal of the new measures is to decrease the annual number of dialysis initiations nationwide by 10% by 2028. The Japan Kidney Association (JKA), also established in 2018, has appointed representatives in each prefecture to work on CKD measures according to the local requirements in cooperation with the Government, family doctors, and organizations. The large number of family doctors and medical examinations facilities that refer to the hospital in central Tokyo lead to difficulty determining the referral criteria that is used. Therefore, the aim of this study is to formulate new CKD measures in our hospital as one of the JKA representatives of Tokyo. Method A retrospective survey of medical history was conducted for 104 patients who initiated hemodialysis or peritoneal dialysis at our hospital in 2018. These patients represent approximately 3% of the total number of dialysis initiations in Tokyo, with 33 patients originating from outside Tokyo prefecture. Of the 104 patients, 80 were male with an average age 65.9 years. The primary disease of patients was comprised of 30 with diabetic nephropathy, 25 with renal sclerosis, 16 with chronic glomerulonephritis, 4 with polycystic kidney disease, and 29 from other or unknown diseases. Results Of the 86 patients whose information was confirmed, 45 patients were referred to nephrologists from 15 departments in our hospital, including 12 from diabetic departments, 7 from urology departments, 4 from cardiovascular departments, 3 from the emergency department, oncology department, and neurology department, and 11 from various other departments. The remaining 41 patients were from outside our hospital (30 from family doctors and 11 from medical examination facilities). Of the 57 patients whose eGFR was confirmed at referral, 21 were referred with eGFR<15, 27 at 15≦eGFR<30, and only 9 were referred at eGFR≧30. Criteria of eGFR<45 or proteinuria≧1+ or 0.5g/gCr is recommended in the 2018 Evidence-based Clinical Practice Guideline for CKD by the JSN. Conclusion According to the medical history of 104 patients who initiated dialysis at our hospital in 2018, the timing of referral to nephrologists was often later than recommended. Patients were referred to nephrologists from at least 15 departments in our hospital. Therefore, it is important for the referral criteria to be widely disseminated not only among family doctors but also among hospital departments and medical examination facilities. Specifically, in-hospital referrals are considered to be less burdensome for patients than out-of-hospital referrals and are therefore expected to be first-targets for new strategies. In addition, in recent years, the frequency of measurement of sCr and eGFR has increased in medical examinations, where the dissemination of referral criteria becomes even more important. Furthermore, the JSN and the JKA have committed to develop medical staff, including nurses/public health nurses, registered dietitians, and pharmacists, to be certified kidney disease educators who have basic knowledge of CKD. Since these occupations can intervene before referral to nephrologists, they are expected to have a significant effect on CKD measures.

Are Canadian cannabis dispensaries counselling pregnant women appropriately?

Objectives With the recent legalization of cannabis in Canada, there are more than 400 licenced dispensaries nationwide. It is important to understand information that women of reproductive age are obtaining. Women may use cannabis products during pregnancy for various reasons, including nausea and vomiting. Our objective was to explore recommendations that licensed Canadian dispensary employees give to pregnant women. Methods This was a nationwide cross-sectional study of licensed cannabis dispensaries. We used a mystery caller approach, which is permitted under Canadian law. The caller stated they were 8 weeks pregnant, experiencing nausea and vomiting and asked for recommendations about cannabis products. Further scripted questions were used to explore specific information regarding fetal risk, and whether employees recommended speaking to a health care provider. Results There were a total of 457 dispensaries licensed for recreational use in Canada, as of October 17, 2019. Only 439 dispensaries were available for contact. The majority (93%) recommended against cannabis products during pregnancy. Recommendations were similar within each province. The majority (80%) of dispensaries recommended discussion with a health care provider or pharmacist. Conclusions The majority of licensed Canadian dispensary employees recommended against the use of cannabis products for use in early pregnancy, and most suggested asking a healthcare provider for more information without prompting. This data differs significantly from the original study in Colorado, wherein nearly 70% of dispensaries recommended a cannabis product in pregnancy. This information is encouraging for health care providers taking care of pregnant women in Canada. With the recent legalization of cannabis in Canada, there are more than 400 licenced dispensaries nationwide. It is important to understand information that women of reproductive age are obtaining. Women may use cannabis products during pregnancy for various reasons, including nausea and vomiting. Our objective was to explore recommendations that licensed Canadian dispensary employees give to pregnant women. This was a nationwide cross-sectional study of licensed cannabis dispensaries. We used a mystery caller approach, which is permitted under Canadian law. The caller stated they were 8 weeks pregnant, experiencing nausea and vomiting and asked for recommendations about cannabis products. Further scripted questions were used to explore specific information regarding fetal risk, and whether employees recommended speaking to a health care provider. There were a total of 457 dispensaries licensed for recreational use in Canada, as of October 17, 2019. Only 439 dispensaries were available for contact. The majority (93%) recommended against cannabis products during pregnancy. Recommendations were similar within each province. The majority (80%) of dispensaries recommended discussion with a health care provider or pharmacist. The majority of licensed Canadian dispensary employees recommended against the use of cannabis products for use in early pregnancy, and most suggested asking a healthcare provider for more information without prompting. This data differs significantly from the original study in Colorado, wherein nearly 70% of dispensaries recommended a cannabis product in pregnancy. This information is encouraging for health care providers taking care of pregnant women in Canada.

Consumer’s Perspective, Attitude, and Compliance on the Prescribed Antibiotics

The study aimed to determine the level of perspective in terms of knowledgeand belief, attitude in terms of experience and preference, and compliancetowards antibiotics, as well as to identify correlations between the variables. Thedescriptive correlational method was used and was conducted among the first tothird-year pharmacy students of Liceo de Cagayan University. Questionnaires weredistributed to 140 participants enrolled in the second semester of the academicyear 2020-2021. Findings showed that with correct perspective in terms of theirbelief and knowledge of antibiotics provides a more compliant consumer. On theother hand, attitude in terms of their experience and preference doesn’t have asignificant correlation with compliance. The majority has the right perspective,participants have no determining experience that affects their compliance resulting,in an undetermined attitude, and compliance gained an average of 4.15, makingthe majority compliant to the prescribed antibiotic. Concluding, compliance isaffected by their perspective on the antibiotic, and attitude was deemed to have nosignificant correlation with compliance. Findings showed that there is a significantrelationship between perspective and compliance. The health care system,pharmacists, and medical colleges should focus on educating people of the effectsand appropriate use of antibiotics. Keywords : consumer perspective, consumer attitude, antibiotic, compliance,adherence

P106 Psychological and self-management support for people with systemic vasculitis or CTDs: a mixed methods study of health professionals’ perception of provision in Rheumatology and Nephrology departments in the UK

Abstract Background People with a connective tissue disease (CTD) or systemic vasculititis have diseases which can be life and organ threatening, require complicated medication regimens and impact on all aspects of health-related quality of life. People are routinely managed across multiple medical specialities and have to navigate their way through complex health care systems. The aim of this study was to investigate current psychological and self-management support available for people with CTDs and vasculitis in rheumatology and nephrology departments in the UK. Methods An online survey of health professionals in rheumatology and nephrology departments was conducted with follow-up interviews. The survey comprised 45 multiple-choice and free-text questions. Quantitative material was analysed descriptively. Follow-up interviews were recorded, transcribed and analysed thematically, together with free-text survey responses, to identify health professionals’ perceptions on unmet needs and key improvements required. Results The online survey included 120 health professional respondents (34 % specialist nurses, 51% doctors and 12 % allied health professionals and pharmacists). Respondents worked primarily in rheumatology (52.9%) and nephrology (21.5%). Access to self-management programmes or clinics for people with CTD and vasculitis was available in 23% of rheumatology and 8% of nephrology departments. In response to the question “How well is your team providing self-management support to people with CTD and vasculitis?”, 38% of respondents reported not very well, or not well at all. Direct access to psychological support (either within their department or within the hospital) was available for patients in 76.9% of nephrology and 32.8% of rheumatology departments. Where psychological referrals were direct, the assessment of the quality of the service by health professionals was higher than when the referrals were indirect (i.e when patients were either referred to primary care or asked to self-refer) (X2=13.83, p < 0.001). Over 80% of health-professional respondents reported they would like additional training in providing self-management support. Key themes from the qualitative data included the need for dedicated psychological support within departments, self-management programmes (specifically for people with CTD and vasculitis or opening up established programmes for people with other conditions), the benefits of a whole team approach (specialist teams not individual clinicians working to empower patients to take a lead in managing their own care), individual staff training needs ( training in brief psychological interventions and support for health professionals to set up self-management programmes) and signposting to additional resources for patients and their families ( disease-specific written and online information and support from patient charities). Conclusion People with CTD and vasculitis have complex needs and systemic improvements in support are required. Patients in nephrology departments are more likely to have access to psychological support than those in rheumatology. There is inadequate access to structured self-management programmes in both nephrology and rheumatology. Disclosures J.C. Robson None. M. Shepherd None. M. Ndosi None. L. Harper None. C. Flurey None. S. Logan None. K. Austin None. E. Dures None.

Efficiency of health resource utilisation in primary-level maternal and child health hospitals in Shanxi Province, China: a bootstrapping data envelopment analysis and truncated regression approach

BackgroundDistrict- and county-level maternal and child health hospitals (MCHHs) are positioned to provide primary maternal and child healthcare in rural and urban areas of China. Their efficiencies and productivity largely affect the equity and accessibility of maternal and child health care. This study aimed to assess the efficiency of district- and county-level MCHHs in China and identify their associated factors.MethodsThirty-three district- and 84 county-level MCHHs were selected from Shanxi Province in 2017. At the first stage, bootstrapping data envelopment analysis (DEA) models were established to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of district- and county-level hospitals. At the second stage, the estimated efficiency scores were regressed against external and internal hospital environmental factors by using bootstrap truncated regression to identify their determinants.ResultsThe average TE, PTE and SE scores for district-level MCHHs were 0.7433, 0.8633 and 0.9335, respectively. All hospitals were found to be weakly efficient, although more than 50% of the hospitals performed with efficient SE (SE scores≥100%). As for county-level MCHHs, their average TE, PTE and SE scores were 0.5483, 0.6081 and 0.9329, respectively. The hospitals with TE and PTE scores less than 0.7 accounted for more than 60%, and no hospital was observed to operate effectively. Truncated regressions suggested that the proportion of health professionals, including doctors, nurses, pharmacists, inspection technician and image technician (district level: β = 0.57, 95% CI = 0.30–0.85; county level: β = 0.33, 95% CI = 0.15–0.52), and the number of health workers who received job training (district level: β = 0.67, 95% CI = 0.26–1.08; county level: β = 0.34, 95% CI = 0.14–0.54) had a positive association with efficiency scores. The amount of financial subsidy (β = 0.07, 95% CI = 0.05–0.09) was found to be directly proportional to the productive efficiency of the county-level MCHHs.ConclusionThe operational inefficiency of district- and county-level MCHHs in Shanxi Province is severe and needs to be substantially improved, especially in terms of TE and PTE. Hiring additional medical personnel and ensuring the stability of the workforce should be prioritised. The Chinese government must provide sufficient financial subsidy to compensate for service costs.

The role of the pharmacist in mental health: An investigation of the impact of pharmacist-led interventions on psychotropic medication adherence in patients with diabetes

ObjectiveTo evaluate the impact of targeted telepharmacist mental health adherence interventions for patients with type 2 diabetes. MethodsThis retrospective review involved the analysis of a telepharmacist-led mental health intervention. The subjects included: patients aged 18 years or more with type 2 diabetes, enrolled in an adherence service and who had been prescribed psychotropics. Psychotropic medication adherence was measured using the proportion of days covered (PDC) 6 months before and after the telepharmacist-led medication intervention. ResultsA total of 8167 patients (67% women), with a mean age of 63 ± 11 years, were included in the study. Most alerts for psychotropics were for selective serotonin reuptake inhibitors (SSRIs) (53%, n = 4334), selective norepinephrine reuptake inhibitors (SNRIs) (22%, n = 1775), second-generation antipsychotics (11%, n = 909), and bupropion (10%, n = 782). Alerts with the greatest volume of PDCs (above 85%) at postintervention follow up included SSRIs (51%, n = 2228), SNRIs (50%, n = 884), and second-generation antipsychotics (47%, n = 424). Before the alert, the mean PDC was 66% ± 12% across all medications studied. Post intervention, the mean PDC rose to 79% ± 19. A paired t-test revealed statistically significant improvement in adherence overall, with the greatest change observed in these alert groups: SSRIs (P < 0.001), alpha-2 antagonist (P < 0.001), SNRIs (P < 0.001), and bupropion (P < 0.001). ConclusionThis retrospective review showed that pharmacist-led targeted, adherence interventions greatly improved psychotropic medication adherence in adult patients with type 2 diabetes. Future work is warranted to investigate the impact on type 2 diabetes medication adherence and health markers (e.g., HbA1c values) in larger and more diverse populations of patients with comorbid type 2 diabetes and a mental health condition.

Reducing long acting antipsychotic injection dosage frequency: A pilot study in a community mental health team

Background Antipsychotic long acting injections (LAI) allow a range of dosage intervals to be administered. Short intervals can be inconvenient for patients and staff. There are few clinical reasons for using them yet this is common practice. Aims This study aimed to examine the feasibility of reducing LAI frequency with service user consent. Methods The study took place in a community mental health team in the north of England. A specialist mental health pharmacist reviewed records of all service users on LAI and drew up an action plan. Each service user then met with the consultant psychiatrist for medication review. Result Nineteen out of thirty service users on LAI had intervals less than the maximum licensed. The frequency was reduced in eight cases. After 6 months follow–up, there was no deterioration in symptoms. In nine cases, antipsychotic doses were also reduced as a result of the review. Conclusion Where a service user is prescribed a LAI with a short dosage interval consideration should be given to increase the interval. This can free up service user and staff time. A medication focused review can also lead to other benefits such as dosage reduction.

Results of the 2017 inspection campaign of French phase I/II research sites in Île-de-France following the BIA 10-2474 accident: Medical vs. regulatory relevance

Following the serious adverse events that occurred in January 2016 during the BIA10-2474 First-in-Human study, the French Ministry of Health asked the Regional Health Agencies to inspect operations at all research sites conducting phase I/II clinical trials of experimental drugs. The aim of this study was to assess the medical relevance of the inspections made in Île-de-France (Paris region) in 2017. All 30 sites of Île-de-France region fully authorized to perform phase I/II trials were inspected by a public health physician and a public health pharmacist. Their reported list of observations was submitted to three physicians with longstanding experience of early pharmacology studies performed in academic or private research facilities. These physicians were asked to adjudicate each observation according to their perceived medical importance regarding safety. Adjudications were first performed separately and disagreements were later settled during a final adjudication meeting. At least one disagreement occurred initially among the 3 adjudicators for 84 of the 120 observations (70%) reported by the inspectors. Following reconciliation, the 3 physicians agreed that 20% of the observations were likely to have potentially serious medical consequences. These observations mainly concerned the management of emergencies and of serious adverse events and the continuity of care. Maintenance of on-site inspections periodically carried out by regulatory authorities granting authorisations to perform phase I/II trials are justified. However, the medical relevance of these inspections can be improved with more emphasis on factors affecting the safety of research participants than on administrative or purely regulatory issues.

Primary Health Care and Community Pharmacy in Ireland: a lot of visions but little progress.

Ireland is small country with a population of 4.8M which spent 6.9% of its gross domestic product on healthcare in 2018. Health services are provided through a twin track approach – all public services are largely free to those eligible (32.44% in 2019) and private patients pay for most services. Most of the expenditure on medicines is paid by the government while visits to General Practitioners (GPs) are an out-of-pocket expense for private patients under 70 years of age, and private health insurance provides cover for most hospital services. Healthcare professionals in the primary care sector contract to provide public services with the Health Services Executive (HSE) which is responsible for the day-to-day running of the service. Primary care teams began to be formed in 2001 to try to link and integrate the provision of care but since these are led by GPs neither community pharmacists nor dentists joined these teams. The focus of policy remained the primary care team until a proposal to create a public health service to provide universal health coverage called Sláintecare was agreed in 2017. However, implementation of Sláintecare has been slow and piecemeal. The government regularly devises policies to control prescribing and the HSE, together with other regulators has implemented generic substitution and preferred drugs and limited access to expensive drugs through schemes for particular patient groups. A programme called Healthy Ireland has taken on the health promotion policies but pharmacists have been excluded from most programmes although some campaigns have included them. Community pharmacy organisations have tried to develop pharmacy services and while a few which are targeted at specified patient groups, such as opioid substitution, emergency administration of certain drugs, emergency hormonal contraception and seasonal influenza vaccination have been remunerated for public patients by the HSE, other services have not. GP organisations defend their members’ scope of practice and seek to influence policy makers to channel schemes and services through general practice. There is no professional body to represent pharmacists that is independent of any trade union responsibilities and this has weakened the profession’s advocacy. Pharmacists are one of the most trusted group of professionals in Ireland and have maintained their practices throughout periods of recession and declining income from government. Whether pharmacists can argue that the optimisation of a patient’s medicines depends upon their contribution and will benefit the health service remains an open question.

How to Optimize Integrated Patient Progress Notes: A Multidisciplinary Focus Group Study in Indonesia.

IntroductionHospitals in Indonesia are obligated to implement Integrated Patient Progress Notes (IPPNs), also known as the “Catatan Perkembangan Pasien Terintegrasi”. A progress note contains the entire interaction between patients and health professionals, including physicians, nurses, pharmacists, dietitians, and physiotherapists. However, since the first launch in 2012, obstacles and problems in completing this integrated documentation remains nationwide.AimThe objective of this investigation was to identify health professional’s perspectives on obstacles and problems using IPPNs and facilitators that may optimize their use.MethodsFive focus group discussions (FGDs) involving 37 participants took place. All FGDs were recorded, translated, and transcribed verbatim. A thematic analysis was used to interpret the data.ResultsThe thematic analysis of the material revealed three main categories for each of the two topics; Topic 1. Perceived problems hindering integrated documentation: lack of supervision, competence, workload; topic 2: perceived strategies to optimize integrated documentation: organizational support, joint practices, integrating technology with IPPN.ConclusionThe results indicate that health professionals see the importance of using IPPNs but only if implemented with educational and organizational support and that the use of an electronic patient record may be more effective than a paper record. To continue the implementation of IPPNs, it is suggested that it is preceded by educational and organizational support.

Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials

Background: Many states have pharmacist contraceptive prescribing laws with several others in the process of enacting similar legislation. Little continuity or standardization exists across these programs, including development of counseling materials. Although the risk of unplanned pregnancy is greatest among adolescents and young adults, developed materials are not always sensitive to youth. Objective: To use a modified Delphi method to develop standardized youth-friendly counseling tools that are sensitive to pharmacy workflow during pharmacist contraceptive prescribing. Methods: A multidisciplinary expert panel of women’s health pharmacists, community pharmacists, adolescent medicine pediatricians, obstetrician–gynecologists, and public health advocates was assembled and reviewed materials over 3 iterations. Comments were anonymized, summarized, and addressed with each iteration. A graphic designer assisted with visual representation of panel suggestions. Reviewer feedback was qualitatively analyzed for emergent themes. Results: The Delphi method produced 5 main themes of feedback integrated into the final materials including attention to work flow, visual appeal, digestible medical information, universal use of materials, and incorporating new evidence-based best practices. Final materials were scored at a Flesch-Kincaid grade of 5.1 for readability. Conclusions: The use of the Delphi method allowed for the efficient production of materials that are medically accurate, patient-centered, and reflect multiple disciplinary perspectives. Final materials were more robust and sensitive to the unique needs of youth.

PharmValCalc: A calculator tool to forecast population health pharmacist impact.

(1) Describe the development of a population health pharmacist (PHP) value calculator to forecast pharmacist staffing, care quality impact, and ROI; (2) exemplify PHP value through ACO stakeholder perspectives; and (3) discuss the use of the pharmacist value calculator to engage pharmacy, clinical, administrative, and financial leaders in discussions to initiate or expand pharmacist integration within population health (PH) initiatives. The role of the pharmacist in population health (PH) is evolving as healthcare payment moves towards population-based, value-driven care. However, a challenge remains to identify the optimal use of the pharmacist in PH initiatives to maximize quality and cost performance. PharmValCalc was developed to demonstrate the value proposition for PHP interventions. PharmValCalc can be used to forecast PHP impact to: (1) reduce preventable, medication-related 30-day all cause hospital readmissions and emergency department (ED) visits for elderly patients, and (2) improve medication-related quality performance for uncontrolled patients with diabetes and hypertension. PharmValCalc forecasts the required PHP full-time equivalents (FTE), care quality performance goal improvement, and return on investment (ROI). While other pharmacist impact calculators have been developed, PharmValCalc is uniquely designed for the 4 common PHP interventions listed above. In addition, provider executives verified that the estimated calculator outputs for each outcome (i.e., PHP FTE, care quality goal performance, and ROI) are within acceptable ranges to justify new or expanded PHP interventions in different ACO settings. PharmValCalc is a pragmatic tool for pharmacists and pharmacy leaders in value-based organizations to use when planning the initiation or expansion of PHP interventions with executive-level medical or administrative decision-makers.

Combining a Career in Clinical Practice and Research: The Benefits at Junior Career Level

Clinical academic careers programmes have developed in England and Wales to enable clinical staff outside of medical and dentistry – namely Nurses, Midwives, Allied Health Professionals, Pharmacists and Healthcare Scientists (NMAHPPS) to develop their academic and research skills alongside clinical practice. These schemes have complemented pre-existing national clinical academic careers pathways for Nurses, Midwives and Allied Health Professions (NMAHPs). Multi-professional case studies from the West Midlands and Wales are used to illustrate the benefits of clinical academic careers for individuals at junior career (pre-doctoral) level. The following case studies will be included: Jed Jerwood, an art psychotherapist, who is aspiring to be an evidence-based practitioner; Jonathan Price, a physiotherapist, who is developing support networks and navigating the system; and Sian Thomas, a nurse, who is developing opportunities to influence local and national practice. The benefits of clinical academic careers and the support from the English and Welsh programmes can be demonstrated in individuals at junior career level. A range of benefits are described including the emergence of autonomous evidence-based practitioners, developing their networks and collaborations, along with a plan for the future.

Beaumont Health pharmacist Janna Fett dies at 32 years.

Beaumont Health pharmacist Janna Fett dies at 32 years.