Medication Management Services Research Articles

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.

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...

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.

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<0.001). Many participants (>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.

Perancangan Sistem Informasi Peminjaman dan Pengembalian Berkas Rekam Medis Rawat Jalan dengan Metode Waterfall

Wiyung Sejahtera Hospital in recording the borrowing and returning of outpatient medical records still uses expedition books which are recorded manually. The research aims to design and develop an information system to facilitate the process of borrowing and returning outpatient medical record files using the Waterfall method approach. The Waterfall method was chosen because of its ability to divide system development into structured stages, starting from requirements analysis to maintenance. The needs analysis stage involves an in-depth study of existing processes and user needs. Next, system design is carried out by building a design plan that includes database structure, user interface design, and system workflow. System implementation is carried out by developing applications based on previous designs, while system testing is carried out thoroughly to ensure quality and performance before full implementation. The maintenance stage is carried out to ensure system operation and carry out continuous repairs and improvements. As a result, it is hoped that this system can improve the efficiency and quality of outpatient medical record file management and health services as a whole. The conclusion of this research is the successful design and development of a computer-based information system for borrowing and returning outpatient medical records at Wiyung Sejahtera Hospital using the waterfall method.

Perceptions about the COVID-19 disease and the vaccination of those arriving at a vaccination center are correlated with medical public health services management

<b>Background:</b> Perceptions of COVID-19 and vaccination depend on personal beliefs, experiences, and trust in health authorities’ information. Cultural and social factors also influence perceptions. Effective government messaging can minimize barriers to vaccination.<br /> <b>Methodology:</b> This cross-sectional research examines socio-demographic parameters related to risk factors, conducted using questionnaires at the vaccination center of Hippokrateio General Hospital of Athens, Greece (n=167), in the last quarter of 2022. Participants were asked to answer questions regarding the impact of the COVID-19 pandemic, a measurement tool for assessing good health status developed by the World Health Organization. The data were analyzed using IBM SPSS v26.<br /> <b>Results:</b> The study found that women perceive vaccines to cause more harm than men, with younger individuals viewing the infection as harmless. Educational level also influences vaccine side effects and long-term harm. Perceptions of COVID-19 differ based on vaccination status.<br /> <b>Conclusions:</b> This research confirms the link between socio-demographic variables and pandemic severity perception, emphasizing the importance of correlated with medical public health services management in enhancing communication strategies and creating effective vaccination campaigns.

Inappropriate Polypharmacy and the Need for Comprehensive Medication Management Service

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Healthcare Public Relations – A Pilot Study in Romania

Communication is a critical component in the process of providing quality healthcare services and products. The role of public relations (PR), as a strategic, proactive, and responsible type of communication, is to establish and maintain a positive reputation and relationships with the public, based on trust and mutual understanding. Given the complex approach and process of this activity, when properly applied, PR can bring benefits to all stakeholders in the healthcare sector, contributing positively to its overall realities and outcomes. This paper presents the results of an exploratory pilot study aimed at identifying the coordinates of PR in the Romanian health sector by investigating perceptions on health public relations (HPR), its potential, challenges and opportunities, and stakeholders in healthcare. It is based on qualitative research, using interviews with a mixed group of professionals from the public and private sectors (doctors, medical service coordinators, medical professors, managers, and owners of entities that provide health services and products, and strategic communication professionals working for companies in healthcare). The results are discussed alongside relevant findings provided by previously published studies. In the final part of the article, the author proposes a PR model for entities in the medical area. It emphasizes that HPR should not only be used as a tactical tool or alternative to marketing efforts, nor only intended to manage an undesirable image or deliver damage control after an inconvenient situation or crisis. Instead, HPR services are at their true potential when a strategic approach is applied proactively, based on complex research and planning, designed to engage stakeholders and motivate them towards collaborative communication and sustained effort, based on partnership, for efficient and effective results in the health sector.

Exploring the implementation of a novel community pharmacist-led support service for people living with severe and persistent mental illness

BackgroundCommunity pharmacists are well-placed to promote and provide mental health medication management services. However, literature evaluating the impact of pharmacy services in supporting people living with severe and persistent mental illness (SPMI) is currently limited. An individualised, goal-oriented pharmacist-led support service that focused on improving the physical and mental health of consumers living with SPMI, namely the PharMIbridge intervention, was provided to consumer participants as part of the PharMIbridge Randomised Controlled Trial (RCT). Objective(s)To explore the experiences of the participants who delivered and supported the implementation of the PharMIbridge intervention and propose ideas and supports needed for broader implementation and sustainability of pharmacist-led support services for people living with SPMI. MethodsInterviews and focus group discussions were undertaken with PharMIbridge pharmacists and mentors, respectively. Audio-recordings were de-identified and transcribed verbatim. Data analysis was conducted using an iterative, inductive approach. The key themes identified were furthered divided into subthemes. Subthemes were then mapped to the EPIS (Exploration, Preparation, Implementation and Sustainment) framework. ResultsData were collected from one focus group involving six RCT mentors and 16 semi-structured interviews with community pharmacists. Five overarching themes emerged: “Training needs”, “Pharmacist integration within the healthcare system”, “Environmental factors”, “Attitudes and behaviour” and “Pharmacy operations”. Twelve subthemes were mapped to EPIS phases “Preparation”, “Implementation” and “Sustainment” and EPIS constructs “Outer” context, “Inner” context and “Bridging” factors. ConclusionAdequate remuneration and supports to encourage healthcare professional collaboration are necessary to establish and sustain functioning, integrated pharmacy mental health services. A shift in pharmacy business and workflow models is necessary to support community pharmacies to implement mental health services. In addition, there is a need to promote psychological support services to ensure that pharmacists are well supported while delivering pharmacy mental health services.

Internet of Things (IoT) in healthcare: A systematic review of use cases and benefits

This paper presents a systematic review of the Internet of Things (IoT) in healthcare, exploring its use cases, benefits, and challenges. Through an analysis of diverse sources, including journal articles, conference proceedings, and white papers, we identify critical applications of IoT in patient monitoring, medical supply chain management, clinical operations, and telehealth services. Our findings highlight the transformative impact of IoT on healthcare, offering improved patient care through personalized treatments and early detection, enhanced operational efficiency, and facilitated evidence-based decision-making. Despite the promising benefits, challenges such as privacy, security, and interoperability persist, necessitating further research and technological advancements. This review underscores the potential of IoT to revolutionize healthcare delivery, making it more efficient, accessible, and patient-centered.

Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil.

Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.

Change management strategy in the implementation of electronic medical record system in the era of digital transformation: Case study at Rahman Rahim Hospital

Change management strategy in the implementation of electronic medical record system in the era of digital transformation: Case study at Rahman Rahim Hospital

Availability of Mental Telehealth Services in the US

Telehealth utilization for mental health care remains much higher than it was before the COVID-19 pandemic; however, availability may vary across facilities, geographic areas, and by patients' demographic characteristics and mental health conditions. To quantify availability, wait times, and service features of telehealth for major depressive disorder, general anxiety disorder, and schizophrenia throughout the US, as well as facility-, client-, and county-level characteristics associated with telehealth availability. Cross-sectional analysis of a secret shopper survey of mental health treatment facilities (MHTFs) throughout all US states except Hawaii from December 2022 and March 2023. A nationally representative sample of 1938 facilities were contacted; 1404 (72%) responded and were included. Data analysis was performed from March to July 2023. Health facility, client, and county characteristics. Clinic-reported availability of telehealth services, availability of telehealth services (behavioral treatment, medication management, and diagnostic services), and number of days until first telehealth appointment. Multivariable logistic and linear regression analyses were conducted to assess whether facility-, client-, and county-level characteristics were associated with each outcome. Of the 1221 facilities (87%) accepting new patients, 980 (80%) reported offering telehealth. Of these, 97% (937 facilities) reported availability of counseling services; 77% (726 facilities), medication management; and 69% (626 facilities) diagnostic services. Telehealth availability did not differ by clinical condition. Private for-profit (adjusted odds ratio [aOR], 1.75; 95% CI, 1.05-2.92) and private not-for-profit (aOR, 2.20; 95% CI, 1.42-3.39) facilities were more likely to offer telehealth than public facilities. Facilities located in metropolitan counties (compared with nonmetropolitan counties) were more likely to offer medication management services (aOR, 1.83; 95% CI, 1.11-3.00) but were less likely to offer diagnostic services (aOR, 0.67; 95% CI, 0.47-0.95). Median (range) wait time for first telehealth appointment was 14 (4-75) days. No differences were observed in availability of an appointment based on the perceived race, ethnicity, or sex of the prospective patient. The findings of this cross-sectional study indicate that there were no differences in the availability of mental telehealth services based on the prospective patient's clinical condition, perceived race or ethnicity, or sex; however, differences were found at the facility-, county-, and state-level. These findings suggest widespread disparities in who has access to which telehealth services throughout the US.

의료기관 종사자들의 전자의무기록 인증제 시행 목적에 대한 인식

This study was conducted to examine the perceptions of employees at tertiary and general hospitals, which have passed the certification of Electronic Medical Record (EMR) systems, regarding the objectives of the EMR certification program. The study was conducted from the perspectives of the public, medical institutions, and the industry. Data collection spanned from August 1 to October 31, 2022, involving responses from 1,187 employees across 11 or more accredited hospitals. The analysis included descriptive statistics, mean analysis, regression analysis, and Scheffé's analysis to understand the perceptions from the three different perspectives. The results revealed that from the public's perspective, the highest recognition was for “enhanced information security in medical information leading to the prevention of personal data breaches and security incidents” (t=-3.827, p<.01). From the perspective of medical institutions, the highest but not statistically significant recognition was for “improved clinical decision support such as medication warnings and effective history management of medical information, enabling safer and higher quality medical services” (f=-1.612). From the industrial perspective, there was high recognition for “the capability to meet market quality demands due to national recognition of EMR system quality standards” (f=-3.154, p<.01). Linear regression analysis was conducted to identify factors influencing the recognition of the objectives of the EMR certification system. The results showed that the model explained 27.4% of the variance for the public perspective, 26.9% for the medical institution perspective, and 28.6% for the industrial perspective, with all models being significant (P<.05). Following the implementation of the EMR certification system, medical institution employees positively perceived it from the perspectives of the public, medical institutions, and the industry. Future efforts should focus on enhancing system functionality awareness among employees, improving quality, and government and medical institutions should work together to enhance user interoperability of the system.

Predictors of mortality in heart failure patients with reduced or mildly reduced Ejection Fraction: The CASABLANCA HF Study.

Heart failure(HF) poses a significant public health challenge throughout the world and Morocco. Our objective was to delineate the epidemiological characteristics of Moroccan patients living with chronic heart failure and to identify prognostic factors correlated with CHF mortality. A total of 1344 patients participated in this study, with survival rates at 3, 6, and 10years recorded at 75.2%, 60%, and 34%, respectively. During the follow-up, 886 patients succumbed, representing a mortality rate of 65.9%. A Cox regression model, utilizing baseline candidate variables, was developed to predict cardiovascular (CV) mortality. Predictors all of which had a P value less than 0.05 included age, left ventricular ejection fraction (EF) at commencement (< 35%), hypertension, male sex, anemia, creatinine levels, and the number of hospitalizations due to HF decompensation. Notably, the frequency of hospitalizations emerged as the most potent predictor of mortality, with an HR of 2.5 (95% CI [2-2.9]). Almost 90% of patients with three or more readmissions for HF decompensation experienced mortality by the follow-up's conclusion. This study offers valuable insights into risk factors and clinical outcomes in HF patients in Morocco. Factors such as male gender, advanced age, a history of hypertension, lower systolic blood pressure, rehospitalizations for HF decompensation, low left ventricular ejection fraction, anemia, and elevated creatinine levels were associated with increased mortality. Medical and health services managers should be aware of the substantial burden and future challenges posed by HF in Morocco, prompting the adoption of multidisciplinary strategies for its management and care.

Development of Health Management Through History

Background: One of the main goals of any organization is to achieve certain success, in fact it is the reason for the existence of any organization. Management provides the framework and basis for the control system required to maintain each organization. Management theorists believe that the knowledge and management skills are universal and apply equally to all business processes. Objective: The aim of this article is to present development of health management through history based on facts from appropriate literature as sources. Methods: The method is systematic review of the facts described in the published scientific papers about general and health management stored in scientific databases PubMed Central, Hinari, Scopus, EBSCO, etc., which are relevant to be used in the praxis. Results and Discussion: Management as a method or management skills traces its roots back to the original creation of the human society. In primary community, a human was performing its duties intuitive, and later taught preceding experience, began to plan and organize work activities to help them to more efficiently perform it. That is why it is claimed that management, as a complex activity, is old as human civilization itself. Health management plays a key role in providing a good health care quality, ultimately improving the health of an entire population. Therefore, it is important to provide good education in management to physicians who aspire to be managers and to lead hospitals, clinics and different health institutions. Management in the health care system is an area of scientific management which in terms of economic, socio-economic and socio-political change, crisis and political change, crisis and extraordinary circumstances requires more attention. The world clearly shows a significant interest in the role of all managers in the health sector and highlights the importance of a good and professional managers to solve problems in the functioning of health institutions and their services. At the same time, in the developed countries, the schools of management flourishing by training the managers in managerial skills. Efficiency refers to doing things in a right manner. Scientifically, it is defined as the output to input ratio and focuses on getting the maximum output with minimum resources. Effectiveness, on the other hand, refers to doing the right things. It constantly measures if the actual output meets the desired output. Therefore, efficiency is generally an internal measure and effectiveness an external measure. Conclusion: Health care services, like any other business, need effective managers. Medical and health service managers are either specialists, supervising a clinical department, or generalists, overseeing an entire facility. All management theory in one way or another were good, but could never be uniform for all organizations. That is why today the new theory is based on the fact that each organization requires specific that and that every requires form of management appropriate for it.

Smartphone AI vs. Medical Experts: A Comparative Study in Prehospital STEMI Diagnosis.

Prehospital telecardiology facilitates early ST-elevation myocardial infarction (STEMI) detection, yet its widespread implementation remains challenging. Extracting digital STEMI biomarkers from printed electrocardiograms (ECGs) using phone cameras could offer an affordable and scalable solution. This study assessed the feasibility of this approach with real-world prehospital ECGs. Patients suspected of having STEMI by emergency medical technicians (EMTs) were identified from a policy research dataset. A deep learning-based ECG analyzer (QCG™ analyzer) extracted a STEMI biomarker (qSTEMI) from prehospital ECGs. The biomarker was compared to a group of human experts, including five emergency medical service directors (board-certified emergency physicians) and three interventional cardiologists based on their consensus score (number of participants answering "yes" for STEMI). Non-inferiority of the biomarker was tested using a 0.100 margin of difference in sensitivity and specificity. Among 53 analyzed patients (24 STEMI, 45.3%), the area under the receiver operating characteristic curve of qSTEMI and consensus score were 0.815 (0.691-0.938) and 0.736 (0.594-0.879), respectively (p=0.081). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of qSTEMI were 0.750 (0.583-0.917), 0.862 (0.690-0.966), 0.826 (0.679-0.955), and 0.813 (0.714-0.929), respectively. For the consensus score, sensitivity, specificity, PPV, and NPV were 0.708 (0.500-0.875), 0.793 (0.655-0.966), 0.750 (0.600-0.941), and 0.760 (0.655-0.880), respectively. The 95% confidence interval of sensitivity and specificity differences between qSTEMI and consensus score were 0.042 (-0.099-0.182) and 0.103 (-0.043-0.250), respectively, confirming qSTEMI's non-inferiority. The digital STEMI biomarker, derived from printed prehospital ECGs, demonstrated non-inferiority to expert consensus, indicating a promising approach for enhancing prehospital telecardiology.

Improvement of access to mental health care through implementing telehealth services by clinical pharmacist practitioners

AbstractThe nationwide shortage of psychiatric providers delays patients from receiving vital mental health (MH) treatments. Mental Health clinical pharmacist practitioners (CPPs) are qualified to provide comprehensive medication management (CMM) services and expand care; however, many MH interdisciplinary teams have not incorporated MH CPPs or have not optimized their role. The purpose of this paper is to highlight how MH CPPs leveraged telemedicine to provide CMM to outpatient MH clinics requiring provisional coverage for other prescribing providers. This paper also reviews supplemental services and barriers to implementation. The Veterans Integrated Services Network (VISN) 6 Clinical Resource Hub‐Telemental Health (CRH‐TMH) is a centralized interdisciplinary team that provides telemental health services to veterans through coordination with their local Veterans Health Administration Health Care Systems located in North Carolina and Virginia. The MH CPPs serve as advanced practice providers with a scope of practice that authorizes prescriptive authority including controlled substances. The VISN 6 CRH‐TMH program was initiated in 2020 and expanded from one MH CPP to include three MH CPPs and a MH CPP supervisor. Since initiation, the MH CPPs have supported 10 outpatient MH clinics. From October 2021 to March 2023, the MH CPPs have completed 5080 clinical encounters. The MH CPPs decreased phone appointments and increased the percentage of video‐to‐home encounters from 56% in fiscal year 2021 to 91% by March fiscal year 23. Virtual same‐day access was implemented at three locations and the substance use disorder program provided timely access to life‐saving treatments. The joint intake clinic optimized veterans' intake into the MH clinic by the therapist providing diagnostic services and the CPP performing CMM during the same appointment. The telehealth learning experience increased training opportunities for residents. The success of this initiative further supports the expansion of MH CPPs as advanced practice providers.

Impact of Mobile Stroke Units on Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Prespecified BEST‐MSU Substudy

Background The impact of mobile stroke units (MSUs) on outcomes in patients with large vessel occlusions eligible for endovascular thrombectomy (EVT) has yet to be characterized. Methods We completed a prespecified substudy of patients with EVT‐eligible stroke with anterior and posterior circulation large vessel occlusions on computed tomography and/or computed tomography angiography who were enrolled in BEST‐MSU (Benefits of Stroke Treatment using a Mobile Stroke Unit). Primary outcome was 90‐day utility‐weighted modified Rankin scale. Groups were compared using chi‐square or Fisher's exact tests for categorical variables, and 2‐sample t ‐tests for continuous variables. Multiple logistic regression was used to assess the effect of MSU on binary outcomes after adjusting for other baseline factors. Results Of 1515 trial patients, 293 had large vessel occlusions eligible for EVT: 168 in the MSU group and 125 in the emergency medical services group. Baseline characteristics were comparable, with the exception of baseline National Institutes of Health Stroke Scale score (MSU median 19 [interquartile range 13, 23] versus emergency medical services 16 [11, 20], P = 0.002) and study site. The mean (±SD) score on the utility‐weighted modified Rankin scale at 90 days was 0.63±0.39 in MSU group and 0.51±0.41 in emergency medical services group (mean difference 0.13, 95% CI [0.03–0.22]). After adjustment, MSU had significantly higher odds of functional independence (odds ratio 2.60 [95% CI, 1.45–4.77], P = 0.002). Secondary outcomes also favored MSU: early neurologic recovery (30% improvement in National Institutes of Health Stroke Scale score at 24 hours) 68% versus 52%; adjusted odds ratio 1.98 [95% CI, 1.19–3.33]; time of tissue plasminogen activator bolus from symptom onset 65.0 minutes [50.5–92.0] versus 96.0 [79.3–130.0], P ≤0.001. The groups had similar onset to arterial puncture (169.0 minutes [133.5, 210.0] versus 162.0 [135.0–207.0], P = 0.83). Conclusions In patients with EVT‐eligible large vessel occlusion stroke, MSU management was associated with better clinical outcomes compared with standard emergency medical services management. MSU management sped thrombolysis but did not expedite EVT treatment times. Future MSU processes should include efforts to capitalize on the potential of MSUs to provide earlier EVT.

A Qualitative Evaluation of the Australian Community Pharmacy Agreement.

The Australian Federal Government's Community Pharmacy Agreement (Agreement), initiated in 1990 and renegotiated every five years with a pharmacy owners' organisation, is the dominant policy directing community pharmacy. We studied the experience with the Agreements of 38 purposively selected individual pharmacists and others of diverse backgrounds, using in-depth, semi-structured interviews. Although perceived to lack transparency in negotiation and operation, as well as paucity of outcome measures, the Agreements have generally supported the viability of community pharmacies and on balance, contributed positively to the public's access to medicines. There were, however, contradictory opinions regarding the impact of the policy's regulation of pharmacy locations, including the suggestion that they provide existing owners with an undue commercial advantage. A reported shortcoming of the Agreements was their impact on pharmacists' abilities to expand their scopes of practice and assist patients to make better use of medicines, in part due to the funding being almost totally focused on supply-related functions. The support for programs such as medication management services was perceived to be limited, and opportunities for diversification in pharmacy practice appeared constrained. Future pharmacy policy developed by the government could be more inclusive of a diverse range of stakeholders, seek to better utilise pharmacists' expertise, and have a greater focus on health outcomes.