Health Pharmacists Research Articles

Pharmacist helps patient with bipolar disorder get her life back on track

Pharmacist helps patient with bipolar disorder get her life back on track

Economic Evaluation of Introducing Public Health Pharmacist

Economic Evaluation of Introducing Public Health Pharmacist

The Three Ps: Psychiatry, Pharmacy, and Pharmacogenomics, a Brief Report From New Zealand.

We describe a case series of 22 individuals who were referred to our laboratory by a pharmacist based in a mental health hospital, for pharmacogenetic analysis due to severe or unexpected adverse drug reactions (ADRs) to psychiatric medication. The participants were genotyped for common variation in the CYP2D6, CYP2C19, and CYP2C9 genes, using Sanger sequencing. We tested variants in these genes as they have the strongest evidence with respect to altering the pharmacokinetics of commonly prescribed psychiatric medicine. Looking specifically at the subset of 18 European study participants, we observed a comparatively high but non-significant rate of pharmacogenetic variants, compared to allele frequency surveys in unselected population samples. For CYP2D6, we observed an elevated frequency of both poor (17%) and intermediate (33%) metabolizers when compared with previously reported frequencies (6% and 12% respectively). For CYP2C19, we observed an increased frequency of intermediate (33%) and ultra-rapid (17%) metabolizers compared to expected frequencies (21% and 4% respectively). For CYP2C9, the frequency of intermediate metabolizers (22%) was elevated compared to the expected population frequency (11%). While sample size is a major limitation of this brief report, we can conclude that patients with adverse reactions to antidepressant or antipsychotic drugs selected by a specialist mental health pharmacist appear to have a relatively high rate of genetic variants in pharmacogenes known to affect the pharmacokinetics of these drugs. The selective application of such pharmacogenetic tests by clinical pharmacists may be a valuable approach to clarify the basis for adverse or unusual responses to medication, and to guide ongoing prescribing decisions for this group of patients.

An evaluation of mental health clinical pharmacist independent prescribers within general practice in remote and rural Scotland.

Background A 12-month pilot was implemented in two general practices in remote and rural Scotland, with patients referred by general practitioners to specialist mental health pharmacist independent prescribers. Objective The objective was to evaluate the pilot service from the perspectives of the patients and the care team. Methods The pharmacists routinely recorded patient-specific data of all clinical issues and their actions at the time of each consultation. Further datasets comprised baseline and follow-up Patient Health Questionnaire (PHQ-9) and/or Generalised Anxiety Disorder (GAD-7) rating scales, a patient survey and interviews with members of the care team. Results Of the 75 patients, two-thirds (n = 47, 62.7%) were referred with a diagnosis of mixed depression and anxiety. There were 324 consultations (median 3, IQR 2-5, range 1-14) and 181 prescribing actions. At pilot completion, 34 patients (45.3%) had PHQ-9 and/or GAD-7 scores reduced by 50%. Patient questionnaires and staff interviews generated positive responses. Conclusion This pilot has provided evidence that specialist mental health pharmacist independent prescribers delivered quality care to patients with diagnoses of moderate to severe depression and/or anxiety. Whilst accepting study limitations, there is potential to translate the pilot model of care to sustained services throughout general practice.

Expert Interviews on Multilevel Barriers in Implementing Expedited Partner Therapy for Chlamydia

Expedited partner therapy (EPT) is an evidence-based practice in which partners of patients with chlamydia are given antibiotics or a prescription for antibiotics without prior medical evaluation. This practice facilitates partner treatment and prevents reinfection of the patient. EPT remains underutilized due to multilevel implementation barriers. Barriers may exist at the level of legislation, policy, health care system, health care provider (HCP), pharmacist, patient, or partner. Qualitative interviews were performed with 11 EPT experts across the United States to uncover barriers in implementation. Thirty-four barriers were identified and grouped into 1 of 15 themes. The themes that surfaced most frequently were liability and adverse events (policy and HCP level), funding (policy level), electronic medical records (health care system level), and awareness (HCP and pharmacy level). Tailored implementation strategies are needed to increase awareness among HCPs and pharmacists, to establish funding and to streamline processes in health care systems.

Psychiatric Pharmacy: New Role of Pharmacists in Mental Health

Psychiatric Pharmacy: New Role of Pharmacists in Mental Health

Psychiatric Pharmacy: New Role of Pharmacists in Mental Health

Psychiatric disorders are one of the major causes of global burden of diseases. Stigma remains a major impediment in the delivery of mental healthcare. It has been found across various studies that attitudes of doctors of other specialties and other healthcare professionals also contribute to stigma due to their lack of knowledge and awareness about psychiatry and mental health problems. The number of mental health professionals remains abysmally low. Community pharmacists are accessible, knowledgeable, and capable of providing mental health promotion and care in communities. This may not be a role that is recognized by the public, and men in particular. However, psychotherapy paired with medication is the most effective way to promote recovery. Examples include: Cognitive Behavioral Therapy, Exposure Therapy, Dialectical Behavior Therapy, etc. Pharmacists can play a key role by providing mental health medication management support to improve access and address patients’ mental health needs.

Investigation into attitudes towards older people with dementia in acute hospital using the Approaches to Dementia Questionnaire.

Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the 'Approaches to Dementia Questionnaire'; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice.

Innovative Partnership Between a Rural Mental Health Center and Community Pharmacy: Integration of a Mental Health Pharmacist

The purpose of this article is to describe how an innovative partnership between a rural community mental health center, community independent pharmacy and College of Pharmacy and integration of a mental health pharmacist lead to identification of medication therapy problems (MTP's) and interprofessional team partnerships with center mental health professionals. A contractual arrangement was initiated between Northern Pines Mental Health Center (NPMHC), GuidePoint Pharmacy Services GPS) and the University of Minnesota College of Pharmacy (UMN CoP) to place a PGY1 resident at NPMHC. The resident was assigned to work closely with the Chief Medical Officer and provide initial comprehensive medication management (CMM) services to individuals who were enrolled in Assertive Community Treatment (ACT). A retrospective chart review was conducted to evaluate the impact of services provided. Patient inclusion criteria included ACT enrollees 18 years or older, a diagnosis of SPMI, taking at least one psychotropic medication, and participation in at least one resident-led CMM visit. Additional findings included the relationship between the pharmacist, the psychiatric physician, and other members of the ACT team. Descriptive statistics were used to document the findings. N = 30 met the inclusion criteria: 18 males and 12 females, age ranged from 24 - 69 with average of 44 years old. 110 MTPs were identified ranging from no MTPs to 10 MTPs per patient, with a mean of 4 MTPs/patient. There was an uneven distribution of MTPs between psychiatric and medical conditions, with a disproportionately high occurrence of "Needs Additional Drug Therapy" in medical conditions and "Adverse Drug Reaction" in psychiatric conditions. In addition, the services were valued by members on the ACT team. Rural residents with SPMI in intensive community treatment have complex medication needs that require the training and skills of a clinical pharmacist. Despite the inclusion of a medication list as part of the ACT fidelity standards MTPs may go unrecognized and unresolved without the services of a clinical pharmacist conducting CMM. The pharmacist and psychiatric physician formed a collaborative partnership to address medication issues. We conclude that there is a need for integrating clinical pharmacist services into rural mental health centers.

Recognizing and engaging pharmacists in global public health in limited resource settings.

Recognizing and engaging pharmacists in global public health in limited resource settings.

Hospital production cost of direct transcranial stimulation (tDCS) in the treatment of depression

Introduction Transcranial Direct Current Stimulation (tDCS), a medical device, has Grade B evidence-based efficacy for treatment-naive depressive patients, or with treatment, and no resistance. Its ease of use, its good tolerance and its cost of acquisition, lower than transcranial magnetic stimulation and electroconvulsive therapy, make it a good candidate as a therapeutic alternative in non-resistant depressions in primary care, associated with a medication management. No pricing or economic valuation currently exists for the tDCS in psychiatry. To our knowledge, no medical-economic evaluation has been conducted on tDCS. The objective of this study is to evaluate the cost of producing tDCS in the treatment of depression in hospitals, in real and pragmatic conditions. Methodology The methodology, derived from cost accounting, was validated by a multidisciplinary working group (clinicians, public health doctors, pharmacists, administrative, financial and health economists). Pragmatic, based on official and institutional documentary sources and field practice, she integrated the costs of materials, personnel and structure, to have an estimate closer to reality. We first estimated the cost of producing a tDCS session, based on our annual activity goal, and then the cost of a 15-session course. Sensitivity analysis, based on relevant parameters, supplemented these estimates. Results The cost of hospital production of a tDCS treatment in the treatment of depression was estimated at 1555.6 euros (99 € of material, 1 076.95 € of staff, 379.65 € of structural charges). Conclusion This cost analysis should be able to serve as a basis for other replication work, in other conditions (outpatient centers, specialized institutions, clinics), to arrive at a more general average estimate, with cost variability studies. And allow the development of pricing proposals, in compliance with regulations and health policy choices, and the development of medico-economic studies.

The Power of Consumer Activism and the Value of Immunization Registries in a Pandemic

The Power of Consumer Activism and the Value of Immunization Registries in a Pandemic

Patients and families experience with pharmacist care at cystic fibrosis foundation accredited clinics.

Cystic fibrosis (CF) is a complex genetic, multiorgan disease. The CF Foundation (CFF) recommends a multidisciplinary team (physician, nurse, respiratory therapist, dietitian, physical therapist, social worker, mental health coordinator, clinic coordinator, and pharmacist) to work with patients and families. The objective of our study was to describe the impact of a pharmacist involved in the care of patients and families from their perspective. The CF Patient and Family Experience of Care (PFEC) is a voluntary, 50-question telephonic or internet-based survey designed to continuously collect information from patients and their families regarding their care experience. From August of 2017 through February of 2018, five questions were added to the internet survey to assess the impact of the pharmacist on the care experience. From the 666 respondents, 54% reported that a pharmacist was involved in their CF care. At two CF clinics designated as "full access" to a pharmacist, respondents reported a higher percentage of the CF-team discussed medications compared to those from three clinics designated as "limited access" to the pharmacist (95% vs 67%). Respondents in clinics with "full access" to a pharmacist were significantly more likely to get their medications refilled on time (78% vs 63%) and reported using fewer pharmacies to fill their medications. Pharmacist involvement in CF care may improve patient's access to medication and the ability to sustain use.

Providing a framework for assessment of the access to medicine.

Improving access to effective and safe medicines is one of the major goals of all health systems. To achieve this goal, assessment is a fundamental phase of national medicine programs for access improvement. Collecting and compiling applicable indicators and impart a comprehensive framework for assessing access to medicine, are the aims of this study. To investigate the published materials on access to medicines framework or indicators, a literature review with a systematic search was conducted using PubMed/ Medline, Scopus, and Google Scholar databases. The results were completed with a general search of documents in Iran Food and Drug Administration (IRFDA). Two independent researchers reviewed all the articles and documents. Thereafter the related indicators were extracted. In focused group discussion of academics and IRFDA experts, duplicate entries or ineffectual concepts were cleaned from the preliminary indicators. In the next step, Delphi questionnaire was sent to the 17 experts that work in academia, Social Security Insurance, IRFDA, Ministry of Health and Iran Pharmacist Association. The results of Delphi technique were finalized in an expert panel. One hundred and thirty one indicators were found in systematic search. After primary extraction of related indicators, 77 indicators were sent to the 17 experts in a Delphi form. The results of Delphi were finalized in a specialized-working group and 67 indicators were accepted in 5 categories including physical availability and geographical accessibility (19 indicators), affordability (23 indicators), human resources (4 indicators), quality and safety (5 indicators), information and rational use (16 indicators). The indicators that inclusively assess the full access to medicine in the concept of rational use have been categorized into five categories in this study. To determine the access to medicine status in each country further local surveys are necessary for all several indicators in each category. Graphical abstract The graphical abstract of accomplished steps.

Cultural Sensitivity and Global Pharmacy Engagement in Latin America: Argentina, Brazil, Ecuador, Guatemala, and Mexico

To establish and maintain successful global pharmaceutical and health care partnerships, pharmacists, pharmacy educators, and students should first learn more about the political, cultural, economic and health care dynamics that affect all of the parties involved in these arrangements. This paper explores Latin America within the context of transnational pharmacy and health-based engagement, including pharmacy-related concepts, health care and cultural considerations, behavioral health perspectives, and common misconceptions. Expert knowledge and experience were used to support and corroborate the existing literature about cultural dynamics of health. Recommendations are provided for how schools and colleges of pharmacy can enhance engagement in culturally sensitive partnerships within Latin America. Health-based profiles of Argentina, Brazil, Ecuador, Guatemala, and Mexico are presented to serve as models for establishing, enhancing, and maintaining partnerships across Latin America.

Role of the pharmacist in refugee health.

Role of the pharmacist in refugee health.

Cognitive deficits in problematic internet use: meta-analysis of 40 studies.

Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder. To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings. A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest. The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities. PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder. S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.

Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity

Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.

Medical education in India: Looking beyond doctor: Population ratio.

Dear Respectable Editor, The requirement of medical doctors for a given population provided by WHO through a metric, though not rigorous, is a general guideline to review performance of health-care services and plan health personnel management.[1] The number of doctors is just one of the factors in the planning of health workforce. India is home to different forms of health practitioners of not only allopathic medicine but also native or indigenous medicine which are abbreviated as AYUSH. We also have a sizeable number of doctors who have graduated from countries across the world.[2] They need to be considered as part of the health-care team which add diversity to the services provided. The recent editorial in this journal points to this and explains how it impacts the doctor: population ratio.[3] Doctors are heterogeneous in nature. We are in a situation where health-care professionals are available but not utilized optimally due to discrepancies in the numbers of undergraduate and postgraduate courses that are available.[45] It is important to recognize the reasons for this situation. Medical education is considered incomplete if not accompanied by at least a postgraduate degree. Due importance needs to be given for postgraduate careers of doctors and other members of health-care team. An overemphasis of one specialty of doctors (family medicine) may not solve the problems of health workforce and health-care delivery. It is important to recognize the role of family medicine doctors along with other broad specialty doctors for primary and secondary level care. It is essential to understand that primary and secondary level care does not and should not refer to rural and semiurban areas alone. All levels of care must be made available in both rural as well as urban areas. The levels of care must not be confused with the geography. In addition to physicians, we need adequate numbers of other members of the health-care team. It is essential to define professional standards and optimize the human resources for health of all categories including allied health professionals, nurses, pharmacists, social workers, and community workers. Health system consists of hospitals and health centers that function under both government and private sectors. Health workforce suppliers include medical colleges, AYUSH colleges, dental colleges, nursing and allied health colleges, and health universities. Creation of the concept of health-care team and ensuring sufficient numbers of people of each category of health-care professionals need to be done. Our focus needs to be on building and maintaining the infrastructure and creating optimal work–space environments driven by the need of the population that they plan to serve. The direction of focus should be that the health-care needs drive the health-care resources which include both human resource as well as infrastructure. In summary, the numbers that need attention are the health indicators, and to improve them, our focus needs to be on building health infrastructure with appropriate utilization of human resources. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Diabolution Project Madrid: Diabetic patient management focused on the person

Introduction: In 2016, the SEMFyC and a multidisciplinary group of experts from all over Spain promoted a project based on the importance of the holistic management of T2DM patients.It became a relevant support to emphasise the patient management within the framework of the implementation of care strategies to chronicity document. The main conclusion out of this document was that T2DM must be approached from an integral perspective with a clear focus on the patient, rather than a pathology-based management related to glycaemic control. Besides, all the stakeholders involved must be considered, taking into account their needs throughout the entire healthcare process. As a result, 23 key interventions grouped under 6 categories. Brief description of the practice change implemented: Going from managing the TM2D patient with a vision focused on the control of the glycated hemoglobin towards managing the patient based on their risk profile. Objective and theory of change: The Madrid Diabolution project pursues the implementation of this strategy through a prioritization of initiatives in which all care levels associated to the patient management are considered. Achieve a paradigm shift of the management of a chronic disease, which allows all stakeholders to be aware of the importance of carrying out health care focused on the patient's preferences Target: Diabetic patients. Patient community environment, including the health professionals involved. Timeline and structure: To develop the project at regional level, a multidisciplinary group of experts has been created, in which health managers, doctors, nurses, pharmacists and patients take part. The project has been structured in three major blocks: 1. Detection of opportunities: The group of experts through a focus group identified already implemented initiatives within the TD2M management, which could fit in the Diabolution framework. Moreover, non-related TD2M management initiatives were implemented too. Using the structure of the previous document, identify the most relevant and priority initiatives out of the 23. 2. Development of initiatives: Initiatives considered to have the greatest impact on patient based-management were prioritized. Besides, since these initiatives were aligned with Madrid’s Health System needs, they were easily adapted. The initiatives were validated by the group of experts following a Delphi methodology of two voting rounds. Thus, these initiatives were elected after being subsequently scored. With the result, 7 interventions have been prioritized: 1. Train nursing to enhance the patient's 2. Inform professionals of the resources available to them in the community 3. Train professionals in shared decision-making 4. Review and improve indicators 5. Create the integrated care process of the diabetic patient 6. Manage the patient with DM2 holistically 7. Incorporate in the evaluation the variables included in the processes Conclusions: When we start projects focused on the patient and not focused on the disease, a wide range of initiatives emerge, allowing us to increase the involvement of all the agents of the patient environment community, besides the self-care health. Lessons learned: Creating multidisciplinary projects involving all agents in the management of TD2M transforms the historically disease focused projects into enhancing patients’ experience projects.