Medication Management Services Research Articles

Mobile Stroke Unit Management in Patients With Acute Ischemic Stroke Eligible for Intravenous Thrombolysis.

Clinical trials have suggested that prehospital management in a mobile stroke unit (MSU) improves functional outcomes in patients with acute ischemic stroke who are potentially eligible for intravenous thrombolysis, but there is a paucity of real-world evidence from routine clinical practice on this topic. To determine the association between prehospital management in an MSU vs standard emergency medical services (EMS) management and the level of global disability at hospital discharge. This was a retrospective, observational, cohort study that included consecutive patients with a final diagnosis of ischemic stroke who received either prehospital management in an MSU or standard EMS management between August 1, 2018, and January 31, 2023. Follow-up ended at hospital discharge. The primary analytic cohort included those who were potentially eligible for IV thrombolysis. A separate, overlapping cohort including all patients regardless of diagnosis was also analyzed. Patient data were obtained from the American Heart Association's Get With The Guidelines-Stroke (GWTG-Stroke) Program, a nationwide, multicenter quality assurance registry. This analysis was completed in May 2024. Prehospital management in an MSU (vs standard EMS management). The primary efficacy end point was the utility-weighted modified Rankin Scale (UW-mRS) score. The secondary efficacy end point was independent ambulation status. The coprimary safety end points were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality. Of 19 433 patients (median [IQR] age, 73 [62-83] years; 9867 female [50.8%]) treated at 106 hospitals, 1237 (6.4%) received prehospital management in an MSU. Prehospital management in an MSU was associated with a better score on the UW-mRS at discharge (adjusted mean difference, 0.03; 95% CI, 0.01-0.05) and a higher likelihood of independent ambulation at discharge (53.3% [468 of 878 patients] vs 48.3% [5868 of 12 148 patients]; adjusted risk ratio [aRR], 1.08; 95% CI, 1.03-1.13). There was no statistically significant difference in sICH (5.2% [57 of 1094] vs 4.2% [545 of 13 014]; aRR, 1.30; 95% CI, 0.94-1.75]) or in-hospital mortality (5.7% [70 of 1237] vs 6.2% [1121 of 18 196]; aRR, 1.03; 95% CI, 0.78-1.27) between the 2 groups. Among patients with acute ischemic stroke potentially eligible for intravenous thrombolysis, prehospital management in an MSU compared with standard EMS management was associated with a significantly lower level of global disability at hospital discharge. These findings support policy efforts to expand access to prehospital MSU management.

Management of Emergency Department Services at a Secondary Level Hospital

Background: The primary purpose of the Emergency Department (ED) is to provide immediate medical attention and resuscitation to seriously ill patients. Prompt treatment and efficient service management play crucial roles in preventing fatalities and disabilities. Objective: To evaluate the management of emergency department services at a secondary-level hospital in Bangladesh. Methodology: A descriptive cross-sectional study was carried out in the emergency department at Narayanganj General Hospital from January to December 2018. The study involved 229 participants, including both service recipients and providers. Data was collected using a pre-tested, semi-structured questionnaire administered through face-to-face interviews. Results: The majority of participants easily identified the ED room (82.3%) and waited ≤15 minutes (91.2%) to see a doctor. They also felt that doctors listened attentively to their complaints (88.9%) and behaved well (92.5%). Service providers' behavior was also positively rated by patients, with 90.8% expressing satisfaction. Most patients did not receive all prescribed medicines from the pharmacy (81.4%), expressed dissatisfaction with the cleanliness of the environment (52.1%), and facilities in the waiting room (60.0%). Despite these concerns, they mostly stated satisfaction with the treatment received (51.6%) and the overall management of the ED (45.1%). Service providers identified several shortcomings across multiple areas, such as laboratory facilities (78.6%), staffing levels of doctors (78.6%), nurses (64.3%), and supporting staff (85.7%). Despite these challenges, they expressed satisfaction (64.3%) with their roles. Conclusion: The study demonstrated that both service recipients and service providers were satisfied with the management of medical services. However, hospital administration and health service providers should prioritize resolving deficiencies in order to improve patient satisfaction more substantially. Journal of Monno Medical College June, 2024; 10 (1):36-42

Complexity of patient encounters within a clinically integrated community pharmacy network Medicaid payer program

BackgroundCommunity pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals. ObjectivesThe objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies. MethodsThis qualitative programmatic case study utilized data from semistructured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors. ResultsThirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination, (2) behavioral health support, and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors. ConclusionPharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.

EUROPEAN INTEGRATION AS A CATALYST FOR THE DEVELOPMENT OF MEDICAL TOURISM IN UKRAINE IN THE POST-WAR PERIOD

This article explores the potential of medical tourism as a key component of Ukraine’s economic recovery strategy after the war, emphasizing the role of European integration in this context. Medical tourism, known for its ability to attract significant foreign investment and improve the economic indicators of the country's development, is seen as a strategic sector that can significantly contribute to the socio-economic recovery of Ukraine after a long conflict. The object of the research is the post-war reconstruction of the health care industry, where Ukraine faces the dual challenge of reviving its economy and enhancing the global competitiveness of its medical sector. Despite a well-established foundation in medical education and the affordability of medical services attractive to international patients, Ukraine encounters several barriers. The article identifies key problems, such as underdeveloped infrastructure, low level of certification of medical institutions, and ineffectiveness of regulations, which are currently inhibiting the full-scale development of medical tourism. The article focuses on the impact of European integration processes on the medical tourism sector. It asserts that closer alignment with European standards could lead to the modernization of medical services, enhancing quality and trust in Ukraine's medical tourism market. This integration promotes the adoption of best practices in medical service provision and management, ensuring that Ukrainian medical institutions can meet and exceed international patients' expectations. Various aspects of medical tourism are explored, from the development of medical services before the war, which predominantly attracted patients from Europe, to the dramatic consequences of the war, including infrastructure damage and professional brain drain. Legal reforms aimed at streamlining and improving the regulatory framework for medical tourism are discussed as critical to creating a conducive environment for the sector. The role of the strategic partnerships with European medical institutions is highlighted as a crucial factor. Such partnerships could lead to technology transfer, joint research, and educational opportunities, which not only improve service quality but also enhance the international image of Ukraine's medical tourism sector. Additionally, these collaborations can help to standardize medical procedures and protocols to match European norms, thereby increasing the safety and appeal of medical services offered in Ukraine. The article underscores the need for continued reforms, investment in modern medical technologies, and marketing strategies for the international promotion of Ukraine as a leading provider of medical tourism services. It notes that addressing outlined challenges and effectively leveraging European integration could enable Ukraine to tap into the growing global market for medical tourism, offering comprehensive, high-quality, and cost-effective medical solutions to international patients. Overall, the article provides a deep analysis of the catalytic role of European integration in advancing medical tourism in Ukraine, noting that with the right policies and international cooperation, Ukraine can significantly improve its economic landscape and health care standards in the post-war period.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.

Reduced Cost Sharing and Medication Management Services for COPD

High out-of-pocket costs and improper use of maintenance inhalers contribute to poor outcomes among patients with chronic obstructive pulmonary disease (COPD). There is limited evidence for how addressing these barriers could improve adherence and affect COPD exacerbations, spending, or racial disparities in these outcomes. To examine the effect of a national program to reduce beneficiary cost sharing for COPD maintenance inhalers and provide medication management services that included education on proper technique for inhaler use. This randomized clinical trial included individuals with COPD. All individuals were enrolled in Medicare Advantage. Data were collected from January 2019 to December 2021, and data were analyzed from January 2023 to May 2024. Invitation to enroll in a program that reduced cost sharing for maintenance inhalers to $0 or $10 and provided medication management services. The random assignment of the invitation was used to estimate the effects of the invitation and program enrollment, overall and by race. Inhaler adherence measured as proportion of days covered (PDC), moderate-to-severe exacerbations, short-acting inhaler fills, total spending, and as an exploratory outcome, out-of-pocket spending. Of 19 113 included patients, 55.2% were female; 9.5% were Black, 81.1% were White, and 9.4% were another or unknown race; and the median (IQR) age was 74 (69-80) years. Program enrollment was higher in the invited group (29.4%) than the control group (5.1%). The PDC for maintenance inhalers was higher in the invited group than the control group (32.0% vs 28.4%; adjusted invitation effect, 3.8 percentage points; 95% CI, 3.1-4.5); the adjusted effect of the program (the local average treatment effect) was 15.5 percentage points (95% CI, 12.8-18.1), a 55% relative increase in adherence. Mean (SD) out-of-pocket spending for prescriptions was lower in the invited group ($619.5 [$863.1]) than the control group ($675.0 [$887.3]; adjusted invitation effect, -$49.5; 95% CI, -68.9 to -30.0; adjusted program effect, -$203.0; 95% CI, -282.8 to -123.2), but there was no statistically significant difference in exacerbations, short-acting inhaler fills, or total spending. Among Black individuals, the adjusted invitation effect on maintenance inhaler PDC was 5.5 percentage points (95% CI, 3.3-7.7), and the adjusted program effect was 19.5 percentage points (95% CI, 12.4-26.7). Among White individuals, the adjusted invitation effect was 3.7 percentage points (95% CI, 2.9-4.4), and the adjusted program effect was 15.1 percentage points (95% CI, 12.1-18.1). The difference between the invitation effects by race was not statistically significant (1.8 percentage points; 95% CI, -0.5 to 4.1; P = .13). Individuals in Medicare Advantage who received an invitation to enroll in a program that reduced cost sharing for maintenance inhalers and provided medication management services had higher inhaler adherence compared with the control group. The difference in the program's effect on inhaler adherence between Black and White individuals was substantial but not statistically significant. ClinicalTrials.gov Identifier: NCT05497999.

Research on Public Management Strategy of Optimizing the Service Efficiency of NHS System in Britain

In this paper, the optimization of the service efficiency of the National Health Service (NHS) in Britain is deeply discussed, and the corresponding public management strategies are put forward. In order to improve the service efficiency of NHS system, this paper puts forward a number of public management strategies. First of all, improve the management system, introduce performance evaluation mechanism and strengthen cross-departmental cooperation to motivate medical service providers and managers to improve their work efficiency. Secondly, optimize the allocation of resources, dynamically adjust the allocation of medical personnel and beds according to seasonal and regional needs, and improve the efficiency of human resources. Finally, strengthen information construction, promote electronic medical record system, and use big data and artificial intelligence technology to improve the accuracy and efficiency of medical services. By drawing lessons from successful public management strategy cases at home and abroad, this paper provides practical reference for optimizing the service efficiency of NHS system. The British government and relevant institutions should formulate detailed implementation plans to ensure that these strategies are effectively implemented, so as to improve the overall service level and patient satisfaction of the NHS system. The research in this paper provides valuable insights and strategic suggestions for optimizing the service efficiency of NHS system in Britain, which is of great significance for improving the quality and efficiency of medical services.

Telehealth Availability for Mental Health Care During and After the COVID-19 Public Health Emergency

Telehealth services expanded rapidly during the COVID-19 public health emergency (PHE). To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE. In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024. Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared. During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics. Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.

Implementación piloto de la gestión integral de la farmacoterapia a pacientes hospitalizados con enfermedades cardiovasculares

Context: Comprehensive medication management service provides comprehensive pharmaceutical care to patients to meet their pharmacotherapeutic needs and improve their quality of life in terms of health. Aims: To describe the results of the pilot implementation of the comprehensive medication management service provided to inpatients with cardiovascular diseases. Methods: Longitudinal, prospective and intervention study was carried out, with qualitative research elements. The sample included patients with cardiovascular diseases and more than five days from the Cardiology Service of the “Saturnino Lora” Provincial Hospital in Santiago de Cuba. The care process was developed according to the OFIL's Guide for the implementation of Comprehensive Medication Management. The patients’ medication experiences were evaluated according to Ramalho de Oliveira et al. The evaluation of drug-related problems and the clinical outcomes was carried out according to the Pharmacotherapy Work-up Method. Results: Twenty patients were included, 65% male. The mean age was 66.2 ± 13.1 years. Eighty percent of the patients had hypertension. One hundred percent received antihypertensive and antithrombotic drugs. Forty percent reported body as a pharmacotherapeutic experience. One hundred and thirty-three drug-related problems were detected and 45.1% corresponded to safety problems. One hundred and fifty-five pharmaceutical interventions were performed and 89% were accepted. Ninety percent of the patients achieved positive clinical outcomes. Conclusions: The pilot implementation of the comprehensive medication management service contributed to the resolution of drug-related problems and showed positive clinical outcomes in patients with cardiovascular diseases.

Barriers and Challenges in Implementing Clinical Pathway of Sectio Caesarea for Health Workers in a Private Hospital

Clinical pathway (CP) is one of the requirements required in hospital accreditation standards. It has an important role in controlling quality, and costs and supporting patient safety, especially in cases that have the potential to consume large amounts of resources, one of which is a sectio cesarean (SC). Apart from being able to reduce maternal mortality due to normal childbirth, SC procedures can also cause post-operative injuries. This research explores the barriers and challenges to implementing the sectio caesarean clinical pathway among health workers in hospitals. This qualitative case study research recruited 10 informants consisting of 3 obstetricians, 2 executive nurses, the head of the inpatient room, the head of the operating room, the deputy director of medical services, and 2 patients who had undergone SC at the hospital purposively. In-depth interviews were conducted in March 2024 at a private hospital in Bandar Lampung, Indonesia. Thematic analysis was used for data analysis. Several themes emerged as obstacles to the implementation of CP SC in this research, namely: 1) individuals, 2) patients, 3) infrastructure, and 4) hospital management support. Apart from that, the challenges faced include the need to carry out socialization, monitoring, and evaluation activities, as well as collaborative activities between health workers and hospitals to share experiences to increase compliance in implementing CP SC. Hospital management is expected to provide regular outreach, training, and personal approaches to health workers regarding the implementation of CP SC. Collaboration between professionals and hospitals is also needed to share experiences regarding the implementation of sectio caesarean clinical pathways in hospitals.

An analysis of the impact on total cost of care within a pharmacist‐led comprehensive medication management program

AbstractIntroductionThe rise in health care expenditures continues to pose a significant concern regarding the longevity of the current health care system design. The literature has demonstrated a positive return on investment (ROI) when pharmacists perform medication management services. Building upon positive ROI literature, a clinically integrated network (CIN) in Michigan developed an approach to patient targeting for comprehensive medication management (CMM) services in existing alternative payment model (APM) Medicare Advantage, Medicaid, and Commercial contracts.ObjectivesThe primary objective of this study was to examine the real‐world impact of an advanced ambulatory care pharmacy model, inclusive of embedded clinic‐based ambulatory pharmacists, centralized ambulatory pharmacists, centralized population health pharmacists, and specially trained pharmacy technicians, on the total cost of care (TCOC) within a large integrated health system.MethodsFor CMM dates of service occurring in calendar year 2022, pharmacy and medical claims were evaluated during the 6‐month period prior to and following the initial CMM patient encounter. Upon completion of the study period, data were evaluated to assess TCOC and utilization trends for the study population.ResultsStatistically significant differences in median TCOC ($1427.84, p &lt; 0.001), prescription drug costs ($222.82, p &lt; 0.001), and medical costs ($462.26, p &lt; 0.001) were observed between the pre‐CMM and post‐CMM timeframes for the study population. A 16% reduction in hospital admissions was observed between the pre‐CMM and post‐CMM timeframes.DiscussionThis study further supports that pharmacist intervention as part of a CMM program can favorably affect health care costs. Criteria such as a population's benchmark costs and utilization, insurance product types, and core conditions present can help determine whether expanding or initiating CMM services could be beneficial in improving care and health care costs.

Data management in Nepalese medical sector: An empirical study

This study attempted to examine the influence of data management in the Nepalese medical sector and the impact of big data in health care. Many nations have strict policies and guidelines of data management of medical services. Countries with good ranking in health sector are the instances of this. Contemporary medical literatures have answered many issues, but the level of intensity or impact of unmanaged data in the medical sector and mechanisms to utilize EDI in the data management of the Nepalese medical sector are yet to be answered which is the quest of this article.

Nursing Staff in a Large Hospital System Underutilize Insurance-Based Mental Health Services.

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services.

Pharmacist-community-based organization collaboration to address health-related social needs

BackgroundCommunity-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use. ObjectivesTo develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications. MethodsTwo different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses. ResultsThe CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel. ConclusionBoth pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.

The value of health service-based research to health service organisations: a qualitative study with senior health service executives

BackgroundResearch evidence has demonstrably improved health care practices and patient outcomes. However, systemic translation of evidence into practice is far from optimal. The reasons are complex, but often because research is not well aligned with health service priorities. The aim of this study was to explore the experiences and perspectives of senior health service executives on two issues: (1) the alignment between local research activity and the needs and priorities of their health services, and (2) the extent to which research is or can be integrated as part of usual health care practice.MethodsIn this qualitative study, semi-structured interviews were conducted with senior health leaders from four large health service organisations that are members of Sydney Health Partners (SHP), one of Australia’s nationally accredited research translation centres committed to accelerating the translation of research findings into evidence-based health care. The interviews were conducted between November 2022 and January 2023, and were either audio-recorded and transcribed verbatim or recorded in the interviewer field notes. A thematic analysis of the interview data was conducted by two researchers, using the framework method to identify common themes.ResultsSeventeen health executives were interviewed, including chief executives, directors of medical services, nursing, allied health, research, and others in executive leadership roles. Responses to issue (1) included themes on re-balancing curiosity- and priority-driven research; providing more support for research activity within health organisations; and helping health professionals and researchers discuss researchable priorities. Responses to issue (2) included identification of elements considered essential for embedding research in health care; and the need to break down silos between research and health care, as well as within health organisations.ConclusionsHealth service leaders value research but want more research that aligns with their needs and priorities. Discussions with researchers about those priorities may need some facilitation. Making research a more integrated part of health care will require strong and broad executive leadership, resources and infrastructure, and investing in capacity- and capability-building across health clinicians, managers and executive staff.

The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals.

This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China's day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.

The Impact of Smart Technologies on the Medicine 4.0 Transformation in the Context of the Technological Revolution

The article examines the impact of smart technologies on the transformation of healthcare 4.0 in the context of the technological revolution, which is defined by the introduction of telemedicine and mHealth, sensors and digital device technologies that have truly evolved in 4.0 and expanded, thanks to new technologies that have made wireless interaction between devices possible. The methodology includes the use of such methods as computer science, axiological, system analysis and synthesis, Agile method, as well as general philosophical methods, which allowed us to analyze the contradictory nature of the impact of smart technologies on the transformation of medicine 4.0. The article analyzes telemedicine and mHealth, which provide remote access and management of medical services. The directions of artificial intelligence and machine learning implementation that are changing the healthcare sector are identified. The place and role of the 3D printing industry for medical applications and nanotechnology are investigated. The essence of the Internet of Things (IoT) as a global network and technologies of interconnected devices and their application in the medical sector is clarified.

Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Pharmacist-led medication management services: a qualitative exploration of transition-of-care cardiovascular disease patient experiences

ObjectiveHospitalisation due to medication-related problems is a major health concern, particularly for those with pre-existing, or those at high risk of developing cardiovascular disease (CVD). Postdischarge medication reviews (PDMRs) may...

A survey on the perspectives of Irish pharmacists on the implementation of pharmacogenetics into pharmacy practice

Abstract Introduction Pharmacogenetics is the use of an individual’s genetic data to determine their response to a drug.[1] The incorporation of pharmacogenetic information into the prescribing process has the potential to improve patient outcomes by reducing adverse drug reactions and non-response to drugs.[1] Aim This study aims to evaluate the potential to implement pharmacogenetic testing and counselling into pharmacy practice in Ireland, by looking at the opinions of registered pharmacists on the potential new service. Methods A web-based survey, adapted from a previous survey,[2] was sent out to 6,236 pharmacists on the Pharmaceutical Society of Ireland’s mailing list using the software ‘Limesurvey’ in September 2019. Information was collected anonymously on demographics, knowledge, confidence, attitudes toward pharmacogenetic testing, and barriers and facilitators of pharmacogenetic testing. Quantitative analysis was undertaken using SPSS version 26, including descriptive analysis, correlations (Spearman’s Rho) and comparison of means (ANOVA). Knowledge scores were derived (number of correct questions out of 5), and converted to percentages. Responses to the open-ended question were analysed for recurring themes using qualitative content analysis. Results A response rate of 7.8% was attained with 486 analysable responses, 446 of which were full responses. Responses were submitted by 2.5 times more females than males and the majority came from pharmacists practising in community (56.4%) or hospital (25.3%). There was also a diversity of roles, ages and levels of experience represented. The mean knowledge score was 2.71 out of 5 (54.3%). However, the knowledge score of younger participants was significantly greater than those in the 61+ age bracket (p=0.007), with mean knowledge scores of 58% (20-30 years), 48% (41-50 years) and 40% (61+ years). A majority of respondents (60%) disagreed that their pharmacy education had prepared them sufficiently to counsel on pharmacogenetics. There was a significant relationship between a participant’s knowledge score and their self-reported confidence to discuss pharmacogenetics with other healthcare professionals (p&amp;lt;0.001). Many participants (&amp;gt;80%) agreed that pharmacogenetic testing had potential benefits for patient care. The open-ended question was answered by 17.4% of respondents. Barriers to introducing pharmacogenetic testing into pharmacy practice included ethical issues such as unauthorised access to private data and discrimination by insurance companies. A lack of resources including time and reimbursement were also noted as potential obstacles. Facilitators included an overall positive attitude towards the idea of pharmacogenetic testing. Conclusion Pharmacists already play an important role in medication management and health services. Given their knowledge and experience in the area, pharmacists are ideal candidates to introduce the idea of pharmacogenetic-guided prescribing into routine practice. From this study, it is apparent that for this implementation to occur, further education and training needs to be provided to pharmacists, as well as greater resources. While this study had the limitation of a low response rate, it was the first survey in Ireland to gather the perspectives of pharmacists on implementing pharmacogenetics in Ireland. As the survey was sent to all registered pharmacists, pharmacists from diverse settings and with varied years and types of experience answered this survey.