Mobile Pharmacy Research Articles

Toward Educating the New Generations of Pharmacist-Scientist Based on the New Six-Year System

Based on its founding spirit of "Strong, Correct and Clear" Gifu Pharmaceutical University (hereinafter referred to as "the University") has adopted the human and environmentally friendly Pharmacy (Green Pharmacy) as its basic philosophy. As the University fulfills its social mission to enrich and strengthen education, research, and social activities, it faces many challenges. These include incorporation, fostering academia-industry-government collaboration, life-science center development and expanding the role of the affiliated pharmacy. The University will continually strive to recognize trends in the social environment and make the effort to respond to challenges when they arise. This effort will allow the University faculty and staff to maintain a sustainable institution that can respond to social challenges while continuing to share the benefits of education, research, and drug discovery/development with the community. The University is committed to train world class Pharmacist-Scientist. This review explains the rationale for the University's transition to a single six-year program. It also gives an update on the current status of education, research, and the mobile pharmacy (MP) since its introduction. Furthermore, it highlights advancements in academic-industry-government collaboration.

Mathematical programming methods for reducing inequity due to stock-outs of pharmaceuticals in low-resourced regions using a mobile pharmacy

Delivering essential pharmaceuticals to consumers in low- and middle-income countries (LMICs) is a complex global challenge that requires equitable solutions in the last mile of pharmaceutical supply chains. This paper proposes using a mobile pharmacy to alleviate the burden due to pharmaceutical stock-outs among rural communities from an equity lens. The Stock-out Severity Index (SSI) is used to assess inequity and is used as the equity objective in a mobile facility routing model. We develop two mathematical programming approaches for routing of the mobile pharmacy so as to minimize the mean absolute deviation of the SSI. The first is a mixed integer program (MIP) modeling approach, based on an approximation of the SSI. The second is an implicit enumeration approach that is implemented within a chronological decomposition heuristic. To help establish its applicability potential, the paper describes a case study that demonstrates how a mobile pharmacy can effectively reduce inequity in a section of rural Uganda. In the case study, costs associated with improving equity are evaluated. This paper finds that optimizing for equity only is associated with high operational costs, and demonstrates approaches that achieve equitable solutions though constrained cost increases.

Mobile Pharmacies Throughout History.

Background:Mobile pharmacies are special organizational units or infrastructures that serve to supply medicines to remote communities or are stationed on ships or as such exist during war conflicts on the battlefields to provide first aid to the wounded and to provide the necessary medicines. The establishment of mobile pharmacies is regulated by the law of each state and only preparations approved by law can be found in it. There are also regulations for the good storage and warehousing of these drugs.Objective:The aim of this article was to provide an overview of the available literature on the topic “Mobile pharmacies through history”, which shows the development and progress in the structure and function of mobile pharmacies throughout history.Methods:This is an descriptive study based on the searched available literature from the on-line databases regarding to present a historical overview of mobile pharmacies during the most significant war events in Europe and the USA.Results and Discussion:Mobile pharmacies were first mentioned in Egypt and the Roman Empire, but it was not until 1500 that military and ship’s doctors began using them, and wealthy nobles had their own boxes of medicines, which they carried on long voyages. Mobile pharmacies became more and more popular, so in the 18th century, practical manuals on the use of the contents of the box began to be published. The importance of a mobile pharmacy was shown in the wars, where people, before their appearance, died due to the impossibility of providing first aid on the battlefield. The advanced medicine and pharmacy that developed on land, greatly affected the health care at the sea. The constant incidence of infectious diseases, poverty and inadequate nutrition, insecurity of navigation and long voyages are the main reasons why sailors often fell ill and were exposed to injuries at work. A situation like that required that the problem of health protection on ships gets solved in accordance with the then principles of medicine and pharmacy.Conclusion:Authors demonstrated the importance of mobile pharmacies in treating and providing medical protection on boat trips. Regarding the ship’s pharmacies, pharmacists have the role of supplying ships with medicines, conducting training for captains and ship staff, advising shipping companies and captains on equipping ship pharmacies and advising on the preparation of national regulations and national ship pharmacy supply policy.

Effectiveness of a mobile antiretroviral pharmacy and HIV care intervention on the continuum of HIV care in rural Uganda

ABSTRACT Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conducted at two district hospitals, among patients who lived >5 km from the hospital. For each hospital, we identified 4 health centers in the catchment area to serve as site for the mobile pharmacy. Each site was visited once a month to provide ART refills and adherence counseling. We measured patient waiting time, adherence and viral load suppression before and after the intervention. The proportion of patients who missed an ART dose in the last 30 days dropped from 20% to 8.5% at 12 months post-intervention (p = 0.009) and those with detectable viral load dropped from 19.9% to 7.4% (p = 0.001), however, mean waiting time increased from 4.48 to 4.76 h (p = 0.13). Mobile pharmacy intervention in rural Uganda is feasible and resulted in improvement in adherence and viral load suppression. Although it did not reduce patient waiting time at the clinic, we recommend scale-up in rural areas where patients face transportation challenges.

SMART PHARMACY MONITORING SYSTEM BASED ON MQTT PROTOCOL USING RFID AND RASPBERRY PI

Smart mobile pharmacy has become a necessary requirement in improving the quality of healthy life in the last five years. Determining the type of medication and calculating the dose for each patient according to the patient's condition, monitoring the patient at the post and how to take the doses on time have a great effect on improving the patient's condition as soon as possible. In this paper, a system of monitoring, monitoring, and guidance based on potency management have been designed to contain a cloud data storage platform and its implementation to solve the above problem. The system is achieved by connecting each item (Medicine bottle) to a device (RFID) to verify that the patient has arrived in the bottle the correct medicine and is equipped with suppression of the treatment of the drug contains the sensors of weight to be sent all information to the control unit to be over the Internet through the routing portal. All data is stored in the first two data folders, which are static and the second is mobile. Synchronization between the two stations is performed to update the information and will be executed on a server that uses an MQTT protocol to register and integrate messages on the platform. The results of the experiment show the speed of guidance and reduce cost and reduce energy.

Pharmaceutical Relief Activities at Western Japan Torrential Rain Disaster

Introduction:The torrential rain triggering massive flooding and hundreds of landslides was the worst weather disaster in Western Japan. A temporary pharmacy was established in the Kurashiki health center, which provided medicine to victims.Aim:To evaluate the supply status of prescription under the health insurance system during a disaster.Methods:When the enormous disaster occurred, victims get a prescription in the hospital or community pharmacy under the Disaster Relief Act or Health Insurance Act. Under the Disaster Relief Act, prescriptions that are given at a first aid station are able to be filled at the mobile pharmacies at no cost to the patient from the local government. Prescriptions that are issued by a medical institution, and are in accordance with the Health Insurance Act or National Health Insurance Act, can be dispensed at hospitals or community pharmacies. Patients may be exempt from the co-payment by being covered by their health insurance. Here, we investigated the supply status of prescription to affected people.Results:The good points of the supply status were as following: 1) dispensing out of disaster area was a good system to relieve a pharmacist2. ) J-SPEED was also a good reporting system to provide appropriative medicine inventory management, and 3) sending prescription using a mobile phone was very useful for pharmaceutical activities. On the other hand, the points for improvement were as following: 1) more time to learn the medical insurance system during the disaster was needed, and 2) the mobile pharmacy is better to make the rounds of shelters including health care consultation.Discussion:In case of a disaster, two different medicine supply systems cause confusion to medical relief teams. It is considered that collaboration relief activities with relief teams that included a pharmacist was very important.

After hurricane, mobile pharmacy helps Florida veterans.

When the U.S. Department of Veterans Affairs (VA) activated its all-volunteer clinician force to respond to Hurricane Michael, Sheryl Dezellem correctly guessed she would be serving on one of the department’s mobile pharmacy units in Panama City, Florida. “It is exciting. You have to kind of be ready for anything,” Dezellem said of her weeklong deployment with VA’s Disaster Emergency Medical Personnel System (DEMPS). Dezellem, a clinical pharmacy specialist at William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, was part of a relief team that staffed the mobile pharmacy during the final days of a 3-week deployment that ended in early November. Also on that team was Robert Cyparski, clinical pharmacy specialist at the VA Medical Center in Martinsburg, West Virginia. Both pharmacists, reached after they returned from Florida, said this was their second DEMPS deployment and their first time working in one of VA’s mobile pharmacy units. The pharmacy units are part of a fleet of customized vehicles that provide medical and supportive services to veterans during large-scale disasters and localized events that disrupt normal access to care.

Effect of Restricted Caloric Intake and Bariatric Surgery on PCSK9 Concentrations in Plasma

PCSK9 is a major modulator of LDLc through internalization and endosomal degradation of LDL receptor. It has been shown that PCSK9 plasma levels predict CVD risk. Bariatric surgery is known to reduce both LDLc and CVD. However, its exact effect on circulating PCSK9 levels has not been fully investigated. We have now investigated the effect of strict caloric restriction and Roux-en-Y bariatric surgery (RYGB) in 15 morbidly obese patients on plasma PCSK-9 levels. Subjects were instructed to follow a regimen of 4 liquid shakes (up to 16g carbohydrate, 0g fat, and 33g of protein, total daily intake was 550-785 calories) during the 2-weeks strict caloric restriction period prior to surgery and the usual dietary regime after surgery. Blood samples were obtained at 2 weeks before, at the time of surgery and 6 months after RYGB. There was a significant weight loss of 7.8±2.4 Kg during the 2 weeks prior to surgery and of additional 26.6±5.3 Kg 6 months after surgery. At completion of strict caloric restriction, subjects had a significant reductions in glucose, insulin and HOMA-IR (7.1±1.1 to 4.5± 1.0) which continued following surgery (HOMA-IR (4.5±1.0 to 2.1± 0.3). LDL(c) fell significantly by 11±7% (from 120±6 to 109±7mg/dl) following the strict caloric restriction and by 15±8% (from 109±7 to 95±6mg/dl) following surgery. There was a reduction of 38±11% (from 227±25 to 139±15 ng/ml) in plasma PCSK9 concentration in the 2 weeks of caloric restriction. Thereafter, PCSK9 levels increased to 166±22ng/ml over the next 6 months. Our data show that there is an impressive and concurrent fall in PCSK9, LDL(c) concentrations and insulin resistance following strict caloric restriction. The marked weight loss over 6 months has only a marginal effect on PCSK9 concentrations while metabolic improvements persisted. This reduction in PCSK9 may contribute to the known benefit in cardiovascular outcomes following bariatric surgery. Disclosure H. Ghanim: None. S. Abuaysheh: None. S. Monte: Stock/Shareholder; Self; Mobile Pharmacy Solutions (Community Pharmacy). Employee; Self; Synergy Bariatrics, a Department of ECMC. P. Dandona: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca.

The Effect of Bariatric Surgery on Neprilysin and Vasoactive Factors

Objective: Since morbid obesity is associated with congestive cardiac failure and hypertension, and gastric bypass surgery is followed by a reduction in blood pressure and a reduction in the risk of congestive cardiac failure, we hypothesized that weight loss following bariatric surgery in morbidly obese patients is associated with a decrease in plasma concentrations of neprilysin, mediators of renin angiotensin system, catecholamines and endothelin-1 with an increase in the concentrations of vasodilators. Method: Fasting blood samples were obtained from fourteen patients with morbid obesity and diabetes prior to and 6 months after Roux-en-Y gastric bypass (RYGB) surgery. Plasma and serum were separated for the measurement of neprilysin; vasoconstrictors, angiotensinogen, renin, angiotensin II, endothelin-1, epinephrine and norepinephrine; and vasodilators, ANP, BNP, cGMP, and cAMP. The mRNA expression of angiotensin converting enzyme (ACE) and adenylate and guanylate cyclases in circulating mononuclear cells (MNC) was also measured. Results: Six months after RYGB, BMI fell from 52.1±4.8 to 40.4±4.0 kg/m2 and there were significant improvements in the HbA1c. Plasma concentrations of neprilysin, angiotensinogen, angiotensin II, renin and endothelin-1 fell significantly by 27±16%, 22±10% 22±8%, 35±13% and 17±6% (p<0.for all) respectively, while ANP concentrations increased significantly by 24±13% at 6 month following surgery. There was no significant change in aldosterone, BNP, cAMP or cGMP concentrations and ACE mRNA expression. Conclusion: RYGB suppressed neprilysin concentrations, which may contribute the observed increase in plasma ANP concentrations. In addition, RYGB resulted in a reduction in plasma angiotensinogen, angiotensin II, renin and endothelin-1 concentrations. These changes may contribute to the reduction in the risk of congestive cardiac failure and blood pressure after RYGB. Disclosure P. Dandona: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. H. Ghanim: None. S. Monte: Stock/Shareholder; Self; Mobile Pharmacy Solutions (Community Pharmacy). Employee; Self; Synergy Bariatrics, a Department of ECMC. K. Green: None. J.A. Caruana: None.

VA pharmacy goes mobile in Houston

The Department of Veterans Affairs (VA) activated its Disaster Emergency Medical Personnel System (DEMPS) in response to Hurricane Harvey and rolled out its mobile pharmacy unit to serve the urgent medication needs of Houston-area veterans affected by the storm. The mobile pharmacy is one of

Pharmacists' responses to natural disasters: Insights into the soul of pharmacists and our role in society.

In this issue, we feature an article from Denise A. Epp, a Canadian now living in Japan (and obtaining her PhD in pharmacy). She tells the stories of how pharmacists in Japan and Canada have responded to major disasters. After the Tohoku earthquake-tsunami-nuclear disaster, Yoshirou Tanno, despite his significant personal losses, immediately helped to set up the emergency evacuation centre in the local school, coordinated pharmacist volunteers to get people their medications and set up a temporary pharmacy. She also tells the story of Anita and Bob Brown in Okotoks, Alberta, and the services they provided to patients from nearby High River, which had been particularly hard hit by the floods of June 2013. Ms. Brown was one of the first Alberta pharmacists to receive her prescribing authorization, and the overrun local health centre began to direct patients to see her. The Browns courageously mobilized their staff to provide care to the many displaced patients who needed their help. Read the article—it’s heartwarming and inspirational. As a follow-up to this story, on April 14 to 16 of this year, the Kumamoto area of Japan was struck with several earthquakes and aftershocks. Ms. Epp emailed me in May to tell me that Mr. Tanno was there—1600 km from his home—providing emergency pharmacy services. Because he has lived through such a disaster, he has a unique rapport with the latest earthquake victims. Mr. Tanno’s vest and helmet, which identify him as a pharmacist at the disaster sites (photo credit: Yoshirou Tanno). As I write this, the tragic wildfires in Fort McMurray and surrounding area are ongoing. The evacuation of Fort McMurray has resulted in 40,000 people temporarily relocating to Edmonton, often with nothing but the clothes on their backs. I spoke to Deb Van Haaften, Executive Director, Pharmacy, Edmonton Zone, Alberta Health Services, who, along with Sandra Leung (the pharmacist in charge of home care services), are providing administrative leadership during the crisis. When I spoke to her, Ms. Van Haaften had just completed a shift at the evacuation centre set up at the Northlands Expo complex. The centre has been providing food, clothing, shelter and health care support for evacuees. She got the call last week—Alberta Health Services wanted pharmacists to be there 24 hours a day. Interestingly, they didn’t want pharmacists to dispense drugs but rather to assess patients and prescribe their medications. I repeat, Alberta Health Services wanted pharmacists for their ability to prescribe, not dispense. Pharmacists are also helping assess patients’ coverage of medications. For those unable to pay, they have set up a partnership with a community pharmacy, and Alberta Health Services is covering the costs. And they have even set up a shuttle bus to take patients from the evacuation centre to the pharmacy. They have also been asked to help patients requiring methadone and tuberculosis therapies. One of Japan’s 3 mobile pharmacy vans arrived in the Kumamoto area the day after the second earthquake struck (photo credit: Denise A. Epp). Yesterday, the first pharmacist (from the Royal Alexandra Hospital in Edmonton) was sent to the field hospital set up in Fort MacMurray. Her mission will be to serve the first responders’ needs. And the challenges continue: as of today, they have noted acute diarrheal illnesses in many evacuees, likely a Norwalk or similar virus. This is the scene at the Northlands Expo Centre where pharmacists are busy assessing and prescribing for victims of the Fort McMurray disaster (photo credit: Deb Van Haaften). In all of this, hospital pharmacists have volunteered to help, 24/7. The Royal Alexandra Hospital pharmacy is busy restocking emergency medical supplies. Many community pharmacies have also stepped up to meet the needs of patients. These are all very different tragedies. But I note a few strong themes: courage, selflessness, and above all, patient-centredness. This is an inspiring demonstration (and recognition) of the role that we play in society. Indeed, the actions of these and other pharmacists in the face of disasters could be a defining moment for pharmacy. ■

Creating a state medical response system for medical disaster management: the North Carolina experience.

The purpose of this work was to examine the creation and evolution of the North Carolina state medical response system (SMRS). During the past 30 years, states and local communities have developed a somewhat incongruent patchwork of medical disaster response systems. Several local or regional programs participated in the National Disaster Medical System; however, aside from the Disaster Medical Assistance Teams, most of these local resources lacked national standards and national direction. The September 11, 2001 terrorist attacks in Washington, DC and New York, and the anthrax-laced letters mailed to prominent individuals in the US media and others (bioterrorism) in the months that followed were tragic, but they served as both a tipping point and a unifying factor to drive preparedness activities on a national level. Each state responded to the September 11, 2001 attacks by escalating planning and preparedness efforts for a medical disaster response. The North Carolina SMRS was created based on the overall national direction and was tailored to meet local needs such as hurricane response. This article reviews the accomplishments to date and examines future aims. From regional medical response teams to specialty programs such as ambulance strike teams, burn surge planning, electronic inventory and tracking systems, and mobile pharmacy resources, the North Carolina SMRS has emerged as a national leader. Each regional coalition, working with state leadership, has developed resources and has used those resources while responding to disasters in North Carolina. The program is an example of how national leadership can work with state and local agencies to develop a comprehensive and effective medical disaster response system.

Mobile phone text messaging for pharmaceutical care in a hospital in China

We have developed a mobile pharmacy service system (MPSS) to deliver individualized pharmaceutical care via text messages sent to the mobile phones of patients. The text messages were: (1) reminders about medication - from the day following discharge, reminder messages were automatically sent to patients approximately 10 minutes before their medication was due to be taken. The system stopped sending messages when the prescription ran out and suggested that patients should come to hospital to renew any prescribed medicines; (2) practical information about medicines, such as information about methods of administration; (3) information about adverse drug reactions. In a 3-month trial in a general hospital, 100 patients were provided with pharmaceutical care using the MPSS for an average of 3.5 medicines per patient (range 1-9). They received pharmaceutical care for an average of 12 days per patient (range 3-19). A survey was then conducted which indicated that most patients were satisfied with the pharmaceutical care provided by MPSS through text messages, and that they had positive attitudes despite some limitations. The use of the MPSS should improve pharmaceutical care, widen the knowledge of pharmacists, reduce the burden on pharmacy staff, improve pharmacist-patient interaction, and improve the effect and safety of medication.

VA pharmacy goes mobile

When Robert A. Grasso joined the Department of Veterans Affairs (VA) as director of Emergency Pharmacy Services in 2005, one of the first tasks assigned to him was to procure a new disaster-response vehicle. But VA was not looking for the kind of transportation available at an automobile dealership. Instead, the department needed a fully functioning mobile pharmacy, with a satellite link to VA’s consolidated mail-order pharmacy (CMOP) outpatient formulary database, to provide outpatient services to veterans affected by a hurricane or other disaster. The prototype, a 40-ft-long, custom-built shipping container dubbed the deployable pharmacy unit (DPU), was unveiled September 11 in front of VA’s Washington, D.C., headquarters building, along with the department’s new deployable medical unit. The DPU features solid steel construction that Grasso said can withstand winds from a category 3 storm, which can reach 130 mph. Inside, the unit is divided into five compartments, including pharmacy workspaces for drug preparation and dispensing and an entryway that can be made accessible to patients. Also inside is a sleeping area with six bunks and bathroom and shower for VA personnel who would staff the DPU during deployment.

Combination Medication Cart and Computer Terminal in Decentralized Drug Distribution

A decentralized unit dose distribution system using mobile pharmacy carts and computer terminals for filling inpatient and discharge medication orders is described. The system uses computer terminals mounted on mobile medication carts. Medication orders are collected from each nursing station by the pharmacist. Using the mobile combination decentralized medication cart/computer terminal (cart/CRT), the pharmacist examines and updates the patient's drug profile, checking for drug allergies and interactions, and bills the patient for drugs dispensed. Unit dose drugs requiring no additional labeling are dispensed from the decentralized cart to the patient's drawer in the unit dose medication cart. When a label is necessary, the pharmacist commands the computer to print a label in the central pharmacy. Discharge orders are entered at the cart/CRT, filled and recorded in the central pharmacy, and distributed to the patients by the pharmacist on the nursing unit. Turnaround time for routine inpatient orders and discharge orders decreased substantially using this system, and the system was perceived as beneficial by nurses, physicians, and pharmacists.