Optimize Medication Use Research Articles

Pharmacist-Patient Relationship: Commitment to Care

Pharmacist-Patient Relationship: Commitment to Care

Pharmacogenomics Testing in Directing the Optimal Use of Supportive Care Medications in Patients With Stage III-IV Cancer

Pharmacogenomics Testing in Directing the Optimal Use of Supportive Care Medications in Patients With Stage III-IV Cancer

Significance and Role of Academic Detailing for Optimal Medication

"Academic detailing" is used to clearly explain scientific issues. In the field of clinical practice, "academic detailing" is a form of interactive educational outreach to physicians in order to provide unbiased, non-commercial, evidence-based information about medications and other therapeutic modalities, with the goal of improving patient care. It is necessary to provide proper information about prescription drugs for their appropriate use in clinical practice. However, this requires of physicians significant time and labor to comprehensively collect and summarize all necessary information for the proper clinical application of pharmaceutical products, a task which may be both difficult and prohibitive to a busy physician. However, if clinical experience and other pharmaceutical or treatment information is derived solely from the commercial entities, this may lead to improper prescription practices. In western countries, public funds are used to support universities and other research institution programs. In Canada, clinical pharmacists act as "detailers". Their mission and role is to listen to the needs of the physician or health care professional, to provide objective, evidence-based drug information on selected drug therapy topics, to educate physicians on the optimal use of medications, to provide practical alternatives, and to extend the physician's usable knowledge base. The importance of this "academic detailing" activity is also recognized in Japan, and pharmacists can be expected to act as detailers in the future. We hope that this will lead to improvement in the quality of medical care.

Attitudes and practices of community pharmacists and barriers to their participation in public health activities in Yemen: mind the gap

BackgroundPatients in Yemen commonly visit community pharmacies to obtain consultation or treatment for common ailments. Community pharmacists have an opportunity to optimize medication use and improve patient outcomes. This study aimed to evaluate the attitudes and practices of community pharmacists regarding their participation in public health activities and barriers to their participation in these activities.MethodsThis cross-sectional study was carried out among community pharmacists working in pharmacies located in urban areas of the Aden governorate of Yemen from March to June 2017 using a self-administered questionnaire. We selected pharmacies from a line list using proportional sampling according to the number of pharmacies in the urban areas of each district. The questionnaire contained four sections: demographic characteristics, attitudes, practices, and barriers encountered. Data were analyzed descriptively, and the Chi-square test was used for analyzing the association of variables (alpha = 0.05).ResultsThe questionnaire was distributed to 200 community pharmacists working in community pharmacies. Of the 200 respondents, 62% (n = 124) were male. Overall, the mean age (sd) was 30.0 years (8.6) with the number of years of work experience between 2 and 9.9 years (n = 158, 79%). On average, 62.3% of the pharmacists had a positive attitude toward participation in public health activities. Providing education to stop tobacco chewing, smoking, alcohol drinking and improve oral hygiene was an important activity of the community pharmacists. Blood pressure measurements (86%, n = 172) and glucose tests (45%, n = 90) were commonly conducted for clients. Lack of time (71%, n = 142) and lack of teamwork (70%, n = 140) were mentioned as common barriers to participation in public health activities.ConclusionsCommunity pharmacists had a positive attitude toward public health activities. Health education and routine health tests were important practices of the community pharmacists. Barriers need to be overcome to enable more active participation by community pharmacists in public health activities by consulting with all stakeholders, assessing the situation, considering alternatives and taking action.

Preemptive pharmacogenetic testing: exploring the knowledge and perspectives of US payers

PurposePreemptive pharmacogenetic testing aims to optimize medication use by having genetic information at the point of prescribing. Payers' decisions influence implementation of this technology. We investigated US payers' knowledge, awareness, and perspectives on preemptive pharmacogenetic testing. MethodsA qualitative study was conducted using semistructured interviews. Participants were screened for eligibility through an online survey. A blended inductive and deductive approach was used to analyze the transcripts. Two authors conducted an iterative reading process to code and categorize the data. ResultsMedical or pharmacy directors from 14 payer organizations covering 122 million US lives were interviewed. Three concept domains and ten dimensions were developed. Key findings include clinical utility concerns and limited exposure to preemptive germ-line testing, continued preference for outcomes from randomized controlled trials, interest in guideline development, importance of demonstrating an impact on clinical decision making, concerns of downstream costs and benefit predictability, and the impact of public stakeholders such as the Food and Drug Administration and Centers for Medicare and Medicaid Services. ConclusionBoth barriers and potential facilitators exist to developing cohesive reimbursement policy for pharmacogenetics, and there are unique challenges for the preemptive testing model. Prospective outcome studies, more precisely defining target populations, and predictive economic models are important considerations for future research.Genet Medadvance online publication 26 October 2017

Associations Between Chronic Disease, Polypharmacy, and Medication-Related Problems Among Medicare Beneficiaries.

Mismanaged polypharmacy among older adults costs the health care system approximately $2 billion each year. Medication therapy management (MTM), a service designed to optimize medication use, improve health outcomes, and reduce associated costs, is available to eligible Medicare beneficiaries. Yet, it remains unclear which beneficiaries benefit most from this service. To assess associations between patient characteristics, chronic disease, polypharmacy, and medication-related problems (MRPs) in a sample population of Medicare beneficiaries. This study was a retrospective cross-sectional analysis of 1 Medicare Part D plan provider for the year 2015. Medicare beneficiaries were included if they were eligible to receive MTM services and excluded if they were aged under 65 years or the dataset had no count of MRPs for the beneficiary. A negative binomial regression assessed the relationship between age, sex, and chronic health conditions with MRPs. Second and third negative binomial regressions assessed the relationship between age, sex, and polypharmacy with MRPs. A sample of 27,765 Medicare beneficiaries had a mean (SD) age of 76 (±7) years, were predominantly female (59%), and used a mean (SD) of 11 (±4) chronic medications. Beneficiaries with certain conditions were more likely to incur an MRP than those without, including depression (OR = 1.58; 95% CI = 1.51-1.64), congestive heart failure (OR = 1.26; 95% CI = 1.20-1.31), diabetes (OR = 1.24; 95% CI = 1.18-1.29), end-stage renal disease (OR = 1.38; 95% CI = 1.25-1.52), respiratory conditions (OR = 1.25; 95% CI = 1.19-1.31), and hypertension (OR = 1.09; 95% CI = 1.01-1.18). Medicare beneficiaries with polypharmacy (11 or more medications) were 1.86 (95% CI = 1.80-1.93) times more likely to experience an MRP than those taking fewer medications. For every additional medication, the odds of incurring an MRP increased by 10% (OR = 1.11; 95% CI = 1.10-1.1.11). The diagnosis of depression presented with the strongest association with MRPs. Diabetes, congestive heart failure, end-stage renal disease, respiratory conditions, and hypertension also presented with significant associations with MRPs. Beneficiaries with polypharmacy (11 or more medications) were almost 2 times more likely to experience an MRP than those taking fewer medications. Addition of a chronic medication resulted in a 10% increase in the odds of incurring an MRP. MTM programs may find a greater number of MRPs among those diagnosed with depression in their MTM-eligible patient populations. No outside funding supported this research. Silva Almodóvar reports fees from SinfoniaRx, outside the submitted work. Nahata has nothing to disclose.

Evaluating Pharmacy Practice in Hospital Settings in Jeddah City, Saudi Arabia: Prescribing and Transcribing-2018.

Purpose: The aim of this study was to evaluate the prescription and transcription processes in hospital settings in Jeddah city, Saudi Arabia. Method: A customized version of the original American Society of Health-System Pharmacists (ASHP) survey was distributed to a total of 26 hospitals in Jeddah city that fits our criteria starting from December 2017. Hospitals' names were adopted from the Ministry of Health and Jeddah Municipality websites. All questionnaires were collected in June 2018. After that, they were classified according to the type of care provided by the hospital, size, ownership, teaching affiliation, and accreditation. Data were entered electronically using Google forms, and then Microsoft Excel was used to conduct descriptive statistics. Results: The survey had a response rate of 57%. A strict formulary system was adopted in 53.3% of hospitals, and clinical practice guidelines were used to optimize medication use in 86.7% of hospitals. Pharmacists do not have the authority to write medication orders in about 86.7% of hospitals and only 40.0% of hospitals have pharmacists routinely assigned to patient care units. However, Pharmacists actively provided consultation, mostly in drug information (80.0%). Computerized prescriber order entry (CPOE) is used to receive medication orders electronically in 80.0% of hospitals, and electronic health record (EHR) is used in about 53.3% of hospitals and 50.0% of those hospitals have pharmacists who document their clinical intervention in EHR. Conclusion: Survey results suggest that pharmacists in hospital settings have not yet been positioned to improve the prescribing and transcribing components of the medication-use process.

CHALLENGES IN 21ST CENTURY INPATIENT GERIATRIC PSYCHIATRY AND LONG TERM CARE PRACTICE.: Session 112

With the increase in life span, there has been a rise in the number of older adults. In 2010, approximately 40 million persons aged 65 years and older lived in the United States and this statistic is projected to increase to 88.5 million by 2050, accounting for 20.2% of the population. The number of older adults with psychiatric disorders is also expected to increase to 15 million by 2030. A significant proportion of these older adults will also have co-morbid medical issues, which may pose challenges. In this session, we will provide an overview of how nursing home facilities and inpatient geriatric psychiatry units are adapting to changes and challenges to provide care for this vulnerable population. In the last 20 years, the number of elderly patients cared for in nursing homes has increased, with facilities expanding to include more beds to respond to this need. The average resident age has also increased, with a corresponding increase in functional limitations, disabilities, cognitive and mental disorders requiring advanced care. Additionally, policy and industry changes over the years have affected the way we provide care for these residents. There has been rapid growth in assisted living facilities in order to provide an alternative care setting for these individuals who require more assistance with activities of daily living. This has led to the development of specialized units that will meet the needs of these residents. Since the implementation of the minimum data set (MDS) system, many prevalence reports have relied on either recorded diagnoses or scales derived from MDS to identify residents with psychiatric conditions. These have also been used as screening tools to identify residents in need of treatment. Available data indicates that there are an inadequate number of geriatric psychiatrists in the USA to care for these older adults with mental illness. The unfortunate consequence has been providers without specialist training or oversight attempting to provide care for residents. This often includes prescribing multiple psychotropic medications that are inappropriate for their symptoms and their age, which can ultimately lead to substantial psychological and functional morbidity. Additionally, these medication side effects and undertreated psychiatric disorders have a significantly negative impact on the residents’ quality of life, disability, and cost of care. Approximately 75-80% of residents in long- term care have a neurocognitive disorder. Although most major neurocognitive disorders are incurable, appropriate comprehensive treatment can substantially improve the quality of life of a resident, their family, and their caregivers. Routine provision of evidence-based care by a mental health care team with expertise in long-term care is essential for maintaining dignity and reducing suffering for these patients. This includes ongoing staff education, discontinuation of inappropriate medications, optimal use of appropriate psychotropic medications and other behavioral interventions. We will review how the geriatric psychiatrist, along with other allied health care professionals, can work as a team in today's highly regulated environment of long term care to improve patient outcomes. With the projection that the older adult population will swell over the next several decades, inpatient geriatric psychiatry facilities have arisen to address the need to provide acute services for these patients. These units appear to have distinct clinically relevant assessment and treatment advantages. They are more comprehensive in their diagnostic assessment of patients, are more likely to provide cognitive assessments and are more cognizant of potential side effects of psychotropic medications. They are also more likely to provide more age-specific aftercare recommendations, which is important in maintaining success after the hospitalization. However these specialized units are limited, expensive, and may encounter a unique set of challenges as the landscape changes for healthcare delivery, reimbursement and managed care. In this session, we will describe key characteristics of a typical geriatric psychiatry unit, discuss advantages of such a unit over a general psychiatry unit, discuss different models of geriatric psychiatry facilities, outline standard admission screening criteria for appropriate patient selection, address treatment challenges associated with the need for rapid improvement in patient psychopathologies and discuss the increased pressures in providing high quality care in the context of reduced length of stays with scarce resources for aftercare. At the end of our presentation, we will briefly showcase the unique characteristics of our inpatient geriatric psychiatry unit.

Optimizing medication use through a synergistic technology testing process integrating implementation science to drive effectiveness and facilitate scale

Objectives1) To describe a synergistic technology testing process (STTP) that integrates traditional technology assessment with implementation science principles to drive uptake, enhance outcomes, and facilitate scaling of medication optimization health information technology solutions; and 2) to illustrate the application of the STTP using an example that involves designing and testing a medication therapy problem (MTP) platform for use by pharmacists in primary care. SummaryOptimizing medication services requires supportive technologies that have been fully tested before release. Current testing approaches are not sufficient to produce the information needed to accelerate uptake and drive impact. Implementation science principles can supplement the traditional testing process by broadening its focus to include designing a truly usable technology, attending to contextual influences, studying the implementation process, and assessing the technology for its scalability. The STTP is an early attempt at outlining the integration of traditional technology testing with implementation science for pharmacy practice. ConclusionThe potential impact of technology-supported medication optimization solutions to improve patient outcomes, enhance quality of care, and reduce costs could be substantial. Accelerating uptake, driving impact, and facilitating scaling will require innovative testing paradigms that result in evidence-based technologies that can feasibly be implemented in real-world settings.

Consumer tradeoff of advertising claim versus efficacy information in direct-to-consumer prescription drug ads.

Consumers' decision making about prescription drugs may be influenced by more than thoughts about drug efficacy and the potential for side effects. Choices may be based on tradeoffs among multiple factors, for example, medical condition, risk severity, risk likelihood, product efficacy, and resources. Some information used in tradeoff choices might be derived from marketing efforts by drug manufacturers. How market claims, such as "#1 Prescribed" may affect this tradeoff is an area that has yet to be explored fully. Using conjoint analysis techniques, this research examined the tradeoff of market claim and efficacy information in direct-to-consumer (DTC) print advertising for prescription drugs. Two hundred fifteen adult participants with a self-reported diagnosis of diabetes were recruited through an online consumer panel. Participants were presented a series of choices. Each choice pair represented a prescription diabetic nerve pain drug with a different efficacy level and one of the two had a market claim of "#1 Prescribed". Participants indicated which drug they would prefer if they had to choose one. Results showed an advantage of #1 Prescribed. A drug without this claim needed at least 1.23% greater efficacy to be chosen over a drug with this claim. Study findings align with previous research which found that extrinsic cues can influence consumer product choice, which has implications for optimal medication use.

Pharmacoepidemiology in older people: Purposes and future directions

Knowledge of the benefit/risk ratio of drugs in older adults is essential to optimise medication use. While randomised controlled trials are fundamental to the process of drug development and bringing new drugs to the market, they often exclude older adults, especially those suffering from frailty, multimorbidity and/or receiving polypharmacy. Therefore, it is generally unknown whether the benefits and harms of drugs established through pre-marketing clinical trials are translatable to the real-word population of older adults. Pharmacoepidemiology can provide real-world data on drug utilisation and drug effects in older people with multiple comorbidities and polypharmacy and can greatly contribute towards the goal of high quality use of drugs and well-being in older adults. A wide variety of pharmacoepidemiology studies can be used and exciting progress is being made with the use of novel and advanced statistical methods to improve the robustness of data. Coordinated and strategic initiatives are required internationally in order for this field to reach its full potential of optimising drug use in older adults so as to improve health care outcomes.

Caregivers\u2019 perspectives and experiences of withdrawing acetylcholinesterase inhibitors and memantine in advanced dementia: a qualitative analysis of an online discussion forum

BackgroundThere is considerable uncertainty surrounding the medications used to delay the progression of dementia, especially their long-term efficacy and when to withdraw treatment with these agents. Current research regarding the optimal use of antidementia medication is limited, contributing to variability in practice guidelines and in clinicians’ prescribing practices. Little is currently known about the experiences encountered by caregivers of people with dementia after antidementia medication is withdrawn.AimTo investigate the experiences and perspectives of carers and family members when antidementia medications (cholinesterase inhibitors and/or memantine) are stopped, by analysing archived threads and posts of an online discussion forum for people affected by dementia.MethodsArchived discussions from Talking Point, an online discussion forum hosted by the Alzheimer’s Society UK, were searched for threads discussing antidementia medication withdrawal and relevant threads were analysed thematically using the Framework method. Participant demographics were not established due to usernames which ensured anonymity.ResultsFour key themes emerged: (1) expectations about withdrawal, (2) method of withdrawal, (3) clinical condition on withdrawal, and (4) the effect of withdrawal on caregivers.ConclusionsOnline discussion forums such as Talking Point provide dementia carers with an outlet to seek help, offer advice and share experiences with other members. The study findings highlight the complexity surrounding optimising dementia pharmacotherapy and antidementia medication withdrawal, highlighting the need for treatment to be person-centred and highly individualised.

Impact of pharmacist care provision in value-based care settings: How are we measuring value-added services?

ObjectivesTo discuss the current state of measuring value-added services in emerging value-based payment practice models and their impact on the pharmacy profession. SummaryValue-based care models require a focus on population health. In value-based care settings, providers are held accountable for risk that goes beyond the clinic encounter, and payment is tied to quality measures that reflect clinical and humanistic outcomes across the health care spectrum. This creates opportunities for pharmacist integration into value-based care settings through addressing gaps in care, optimizing medication use, and developing physician-pharmacist team-based care practice models. ConclusionScalable and sustainable pharmacist integration into value-based care settings should involve expansion of preventive care into the community. The need for measurement of the value added by pharmacy services is a priority.

Implications of the opioid epidemic for critical care practice

The purpose of this paper is to consider the implications of the opioid epidemic for the critical care practitioner and provide recommendations to try to reduce the likelihood of opioid over‐prescribing. The medical literature pertaining to the current opioid epidemic has focused on opioid overdose and deaths associated with the chronic use of opioids, but the issue has implications for the critical care pharmacist because excessive prescribing during hospitalization and at discharge may lead to chronic use. Guidelines are available concerning pain assessment and control in the critical care setting, but the evidence base supporting these recommendations is limited and often based on extrapolations from postoperative pain studies. While current pain management guidelines pertaining to critically ill patients place more emphasis and recommendations on nonopioid agents as adjuncts to opioids for severe pain, the recommendations for these adjuncts are tempered by a lack of higher‐level evidence supporting their use and concerns related to adverse effects. Efforts to control opioid over‐prescribing begin in the intensive care unit (ICU) with implementation of recommendations from current clinical practice guidelines that recommend appropriate assessments. After the ICU stay, attention should be focused on prescribing practices associated with patients' transition of care from hospital to home or other care facility, because this is where acute‐to‐chronic use is most likely to occur. Clinical pharmacist involvement in follow‐up clinics postdischarge has the potential to improve patients' pain control by optimizing medication use.

Update on Medication Use Quality and Safety in Older Adults, 2017

Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. We selected four important articles from 2017 that address these issues to annotate and critique, and we discuss the broader implications for optimizing medication use. A longer list of articles is given in an online appendix. The first study provides national data on the prevalence of central nervous system-active medication polypharmacy in older adults and how this has changed over a 9-year period (2004-2013). The second study characterizes prevalence of and factors associated with nonadherence to antiepileptic drugs in 36,912 older adults with epilepsy, with an emphasis on minorities. The third study describes the extent of antibiotic use in residents of 381 long-term care facilities (LTCF) in British Columbia, Canada, from 2007 to 2014. Finally, we discuss a meta-analysis of 42 studies that evaluated the prevalence of hospital admissions caused by adverse drug reactions in older adults. This article is intended to provide a narrative review of important publications on medication use quality and safety for clinicians and researchers committed to optimizing medication use in older adults. J Am Geriatr Soc 66:2254-2258, 2018.

The Role of Susceptibility-Weighted Imaging and Dedicated MRI Protocols in the Diagnostic Evaluation of Patients with Drug-Resistant Epilepsy

Background: Near one-third of epileptic cases never achieve remission, despite optimal medication use. In these patients, various surgical procedures can be helpful. However, surgical success is directly associated with the ability to localize precisely the region of seizure onset. Objectives: The goal of this study was to evaluate the role of susceptibility weighted imaging (SWI) in detecting intracerebral lesions and localizing epileptogenic zones in addition to conventional MRI with routine epilepsy protocol in drug-resistant epileptic patients. Methods: The study was carried out at an academic medical center in a major metropolitan city, and all participants underwent conventional MRI assessment with seizure protocol and SWI evaluation. Results: During the study period, 59 cases met the criteria. Thirty-four were male (57.6%) and twenty-five were female. Mean age of participants was 30 years, and mean age at the time of epilepsy onset was 11. In 50 cases (85%), there was evidence of brain abnormalities in conventional MRI and/or SWI. Brain abnormalities were also evident in conventional MRI evaluation of 47 cases (79%). In three out of twelve cases with normal conventional MRI with routine epilepsy protocol, SWI showed brain abnormalities. In 20 cases (40%), the same lateralization or localized lesions were detected in EEG and MRI. More information from SWI was reported in 13 patients (22%). In two cases, in which EEG showed evidence of partial seizures, conventional MRI showed no abnormality while SWI showed abnormal vascular cluster. In one of these two cases, caput medusa, in agreement with developmental venous anomaly, was reported. In one case, conventional MRI was normal while SWI showed evidence of cavernoma. In another patient, in addition to the lesion detectable in conventional MRI, SWI found two other lesions in agreement with cavernomas. Conclusions: Susceptibility weighted imaging can be helpful in localizing epileptogenic zones, which are not detectable by conventional MRI with routine epilepsy protocol, in patients with drug-resistant epilepsy.

Cultural Competence Considerations for Health-System Pharmacists.

Purpose: An introduction to cultural competency is provided for health system pharmacists, including communication tools and considerations to personalize care for diverse patient populations. Summary: Disparities in patient outcomes, health care utilization, and treatment adherence exist across diverse patient populations in the United States. Cultural competence of health system pharmacists is important to optimize medication use in diverse patient populations. The LARA (Listen, Affirm, Respond, and Add) methodology, Kleinman's explanatory model, and the teach-back method are communication tools to facilitate culturally integrated discussions with patients. Health system pharmacists should be cognizant of cultural considerations that may emphasize spiritual care, nonpharmacologic therapy, patient privacy, and potential distrust of health care professionals. Conclusion: Health system pharmacists should strive to increase awareness of the impact that cultural beliefs and traditions have on patient care.

Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta-analysis.

AimsDeprescribing interventions safely and effectively optimize medication use in older people. However, questions remain about which components of interventions are key to effectively reduce inappropriate medication use. This systematic review examines the behaviour change techniques (BCTs) of deprescribing interventions and summarizes intervention effectiveness on medication use and inappropriate prescribing.MethodsMEDLINE, EMBASE, Web of Science and Academic Search Complete and grey literature were searched for relevant literature. Randomized controlled trials (RCTs) were included if they reported on interventions in people aged ≥65 years. The BCT taxonomy was used to identify BCTs frequently observed in deprescribing interventions. Effectiveness of interventions on inappropriate medication use was summarized in meta‐analyses. Medication appropriateness was assessed in accordance with STOPP criteria, Beers' criteria and national or local guidelines. Between‐study heterogeneity was evaluated by I‐squared and Chi‐squared statistics. Risk of bias was assessed using the Cochrane Collaboration Tool for randomized controlled studies.ResultsOf the 1561 records identified, 25 studies were included in the review. Deprescribing interventions were effective in reducing number of drugs and inappropriate prescribing, but a large heterogeneity in effects was observed. BCT clusters including goals and planning; social support; shaping knowledge; natural consequences; comparison of behaviour; comparison of outcomes; regulation; antecedents; and identity had a positive effect on the effectiveness of interventions.ConclusionsIn general, deprescribing interventions effectively reduce medication use and inappropriate prescribing in older people. Successful deprescribing is facilitated by the combination of BCTs involving a range of intervention components.

Exit-Knowledge of Ambulatory Patients About Medications Dispensed in Government Hospital in Eastern Ethiopia: The Need for Focused Patient Counseling.

Background: In the counseling process, a multi-cultural competence of dispenser is among the key factors affecting his/her successful communication with patients for achieving optimal use of medications. For patients to use dispensed drugs appropriately, it is a must for them to understand the medication related information provided by the dispenser. Hence, the objective of this study was to identify parameters that likely affect ambulatory patients' knowledge of medication(s) provided at the exit of outpatient pharmacy of Federal Harar Police Hospital, Eastern Ethiopia.Methods: Cross-sectional study design was employed to conduct this study. An interview of patients was made at the exit of hospital pharmacy using a semi-structured questionnaire. The interview tool primarily assessed the knowledge of the patients for a maximum of three medications provided. Statistical Package for Social Sciences (SPSS), Version 20.0, was employed for analysis of the data. Chi-squared test was done to retain parameters with potential to have association; and the retained parameters were adjusted by performing bivariate and multivariate logistic regression analyses.Results: The result showed that only 37.2, 33.4 and 28.7% of the patients were able to recall the name of the drug(s), common side effects, and actions to be taken for missed doses, respectively. The likelihood of patients' knowledge for dispensed medications was high among patients aged 19–39 years (adjusted odds ratio [AOR]: 5.0; 95% CI: 1.04–24.2) and who thought their communication with dispenser had been polite (AOR: 4.62; 95% CI: 1.48–14.4). However, the knowledge status was found low among patients who were Afan Oromo speakers (AOR: 0.58; 95% CI: 0.35–0.95) and who came from rural residence (AOR: 0.48; 95% CI: 0.25–0.90).Conclusion: A high proportion of patients were unable to recall the drug (s) name, associated common toxicities, and actions to be taken in case of missed dose. In addition, patients who were at early adulthood and who were positive for the politeness of dispenser had better exit-knowledge of their medication. Therefore, for the patients' clear understanding of medications provided, it is mandatory to optimize patient–dispenser communication possibly by adapting multi-cultural communication skills and by providing focused training for dispensers to address factors that likely affect patient-dispenser interactions.

Pharmacists and patients sharing decisions about medicines: Development and feasibility of a conversation guide

In Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understanding, decision-making and information preferences, health priorities related to medicines, patient goals and fears, views on important activities and trade-offs. This study describes the development and feasibility testing of a Medicines Conversation Guide in HMRs with pharmacists and older patients. The Guide was developed using a systematic and iterative process, followed by testing in clinical practice with 11 pharmacists, 17 patients (aged 65+) and their companions. A researcher observed HMRs, surveyed and qualitatively interviewed patients and pharmacists to discuss feasibility. Transcribed recordings of the interviews were thematically coded and a Framework Analysis method used. Pharmacists found the Guide to be an acceptable and useful component to the HMR, especially among patients with limited knowledge of their medicines. The Guide seemed most effective when integrated with the HMR and tailored to suit the individual patient. Some questions were difficult for patients to grasp (e.g. trade-offs) or sounded formal. Most patients found the Guide focused the HMR on their perspective and encouraged a more holistic approach to the HMR. From the quantitative survey, pharmacists found the Guide easy to implement, balanced and understandable. Pharmacists and patients reported the Guide fits with the HMR encounter relatively easily and promoted communication about goals and preferences in relation to medications. This study highlighted some key challenges for communication about medicines and how the Guide may help support the process of involving patients more in the HMR.