Patient-centered Pharmaceutical Care Research Articles

Historical background and current situation of pharmacy education in Mongolia.

In Mongolia, the medical education system with a long history has developed with its characteristics since ancient times. Modern medical education, including pharmacy education, began to grow in 1921. Before modern pharmaceutical science developed in Mongolia, pharmacy and pharmacy education were part of Traditional Mongolian Medicine and education. Medical knowledge and experience were transferred from generation to generation through simple teaching. From the sixteenth century, Manba Datsan was established in religious temples to teach Mongolian medicine through discipleship. Modern pharmacy education in Mongolia began in 1926 with the course training of pharmacy technicians, and pharmacist training started in 1961. Pharmacy technician training with a 3-year and pharmacist training with 5-year programs oriented on patient-centered pharmaceutical care are implemented in Mongolia. Pharmacy technicians can also study towards a B. degree in Pharmacy with an additional 3 years of training. As of 2023, seven state-owned and private higher education institutions offer pharmacy education and the number of institutions and students of pharmacy is expected to increase. The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends.

Students' Feedback on the Development of a Competency-Based Pharmacy Education (CBPE) at the University of Tartu, Estonia.

Increasing need in society to provide collaborative and patient-centered pharmaceutical care has to be addressed in curriculum development. Principles of competency-based pharmacy education (CBPE) could be seen as one solution to the new professional challenges of pharmacists. At the University of Tartu (UT), the Pharmacy curriculum was updated in 2019 to introduce principles of CBPE. The aim of this study was to gather initial students’ feedback on the development of CBPE at the UT. The survey was conducted in the spring semester of the 2019/2020 academic year to collect feedback about all curricula at the UT. All 1st, 3rd, and 5th year pharmacy students (n = 67) were invited and 70.1% (N = 47) of them also participated in this study in order to evaluate the Pharmacy curriculum. Pharmacy students were more complacent with the content and less with the fixed structure of the Pharmacy curriculum. Students emphasized more theoretical knowledge and less practical and transferable skills of the competencies developed over the studies. Initial student feedback on the development of CBPE in Estonia demonstrated that theoretical knowledge needs to be more integrated with practice throughout the curriculum. In the future, more attention should be paid to the development of transferable skills, including digital skills.

Association between Personality Traits and Metacognition among Pharmacy Students: Implication for Pharmaceutical Education

Abstract: Background: The importance of pharmacy practitioners’ personality traits in their professional development and future patient-centered pharmaceutical care practice has been widely recognized. Metacognitive skills in critical thinking, self-directed learning as a critical part of pharmacy training has been emphasized in the new pharmacy education accreditation standard. Correlation between metacognition and personality has been demonstrated in patients with personality pathology. Objectives: This work aimed to study the association between personality and metacognition among Chinese pharmacy students. Materials and Methods: A total of 130 pharmacy students voluntarily completed the 30-item Metacognitions Questionnaire (MCQ-30) and NEO Five-Factor Inventory (NEO-FFI) to measure their metacognitions and personality traits, respectively. Results: Pearson Correlations showed a strong association between metacognition and NEO-FFI conscientiousness personality trait. NEO-FFI neuroticism was found weakly but significantly positively associated with overall MCQ-30 scores, strongly positively associated with metacognitive factors “Negative beliefs about worry” and “Cognitive self-consciousness”, moderately negatively associated with “Positive beliefs about worry” or “Cognitive confidence” subscales of MCQ-30. Scores on the NEO-FFI extraversion, openness or agreeableness and the metacognitive factor “Positive beliefs about worry”, “Cognitive confidence” or “Negative beliefs about worry” were highly correlated. Conclusion: This study firstly linked pharmacy students’ personality traits to their metacognition levels, suggesting that educational interventions to develop metacognitive skills might contribute to the improvement of students’ personality traits. Key words: Personality, Metacognition, Association, Pharmacy students, Pharmaceutical education.

Comprehensive medication management – part I

Comprehensive medication management (CMM) is a standard of patient-centered pharmaceutical care, through which the clinical pharmacist simultaneously achieves several goals (ensures better clinical outcomes and improves the patient experience, lowers healthcare costs and increases professional satisfaction through the obtained results and by good integration in the medical team), by optimizing medication use. The components of CMM are the philosophy of practice, the care process and the management of practice. The identification, solution and prevention of drug therapy problems are done during CMM in order to achieve the clinical and personal goals of the patient.

Medication-Related Needs and Humanistic Impact of Patient-Centered Pharmaceutical Care at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.

PurposeTo assess patients’ medication-related needs and the humanistic impact of patient-centered pharmaceutical care.Patients and MethodsA hospital-based cross-sectional study was conducted using self-administered structured questionnaires from February 4 to 28, 2019, on patients attending ambulatory care for chronic non-communicable diseases at the University of Gondar specialized teaching hospital, North-west Ethiopia. Data were entered to SPSS version 22 for analysis. Descriptive statistics was used to describe the socio-demographic characteristics and medication-related needs of study participants. Independent sample t-test and one-way ANOVA analysis were performed to check for possible associations between dependent and independent variables.ResultsInformation about what to do if patients missed doses and the potential side-effects or abnormal conditions caused by the prescribed medicines were not explained for most of the 425 patients studied. The majority of the study participants reported that they felt worried about adverse medicine effects, drug interactions, and long-term medicine use. Patients who were older than 50 or those receiving two or more medications were less satisfied with the effect of their medicine as compared to younger ones and those on monotherapy, respectively. People who were illiterate or had attended only primary schools thought that they received less disease and medicine information from health professionals than people who attended tertiary education.Conclusion and RecommendationMost of the participants were particularly unhappy with the amount of information received about side-effects and what to do if doses were missed. Special emphasis should be given to patients with a low level of education as they were not satisfied with medicine and disease information obtained from health professionals, experienced more psychological impacts of medicine use, and had poor overall quality-of-life.

Alignment of Community Pharmacy Foundation Grant Funding and the Evolution of Pharmacy Practice in the United States of America.

The Community Pharmacy Foundation is a non-profit organization dedicated to the advancement of community pharmacy practice and patient care delivery through grant funding and resource sharing. Since 2002, CPF has awarded 191 grants and over $9,200,000 (US dollars) in research and project grants. The purpose of this manuscript is to highlight the evolution of pharmacy practice and pharmacy education in the United States through the presentation of exemplary cases of Community Pharmacy Foundation funding that is aligned with new care delivery models and approaches to the advancement of patient-centered pharmacy care. Pharmacy began in colonial America as the United States of America was just beginning to form with apothecary shops and druggists. Over time, the pharmacy industry would be revolutionized as America became urbanized, and drug products became commercially produced. The role of the pharmacist and their education evolved as direct patient care became a clear expectation of the general public. By the 1990s, the pharmacy profession had carved out a new path that focused on pharmacist-led, patient-centered pharmaceutical care and medication therapy management services. The Community Pharmacy Foundation grant funding has aligned with this evolution since its founding in 2000, and multiple exemplary grants are presented as support. As the role of pharmacists again transitions from a fee-for-service model to a value-based model, the Community Pharmacy Foundation continues to provide grant funding for research and projects that support the advancement of community pharmacy practice, education, and expanded training of pharmacists.

Case study of hospital extending new connotation of pharmaceutical services

Objective To understand the extensions of pharmaceutical at medical institutions in China. Methods From June to October 2018, 196 cases were collected regarding exploring new areas of pharmaceutical care , which ranks one of the ten innovative medical services under China Healthcare Improvement Initiative(2018-2010). By means of statistics on the frequency of the subject words in the cases, the authors identified hotspots of these hospitals in this regard, and used descriptive analysis to study the data. Results The 196 cases covered 23 items of pharmaceutical care, including three traditional guaranteed drug services, i. e., drug supply, drug dispensing and drug storage management; one traditional Chinese medicine supply service, namely decoction and delivery of traditional Chinese medicine decoction; 19 pharmaceutical professional technical services, namely, prescription(doctor′s advice)review, patient education and guidance, and prescription(doctor′s advice)comment among others. Conclusions The connotation of pharmaceutical is extending rapidly.Therefore we should enhance the professional value of pharmacists, establish training programs for pharmaceutical talents, establish incentive mechanism for pharmaceutical care, and promote the rapid development of patient-centered pharmaceutical care. Key words: Pharmaceutical care; Development; Medical institution; Cases

Development and psychometrics of a short-form pharmaceutical care-specific measure for quality of life.

Background The validated patient-reported outcomes measure of pharmaceutical therapy for quality of life (PROMPT-QoL) contains 43-items, and can be too lengthy for some applications. Objectives To develop a brief version called the PROMPT, and test its psychometric properties. Setting Four public hospitals in Bangkok, Thailand. Method Secondary analysis of three databases used to develop and evaluate the original PROMPT-QoL. Items for the short-form PROMPT were selected based on expert and patient evaluations of content and importance, and lack of redundancy. All domains of the original version are represented in the PROMPT. Main outcome measures Psychometric properties (internal consistency and test-retest reliability, criterion, convergent and discriminant validity, and responsiveness), and indicators of practicality (e.g., administration time, missing data). Results Analyses of the PROMPT and its domain subscales demonstrated good internal consistency and fair-to-excellent test-retest reliability. Correlations between the original and short-form, overall and by domain, were high. Expectations for convergent and discriminant validity were met as correlations between the PROMPT and generic health-related quality of life measures (WHOQoL-BREF domains and summary scores of the SF-12v2) were modest (< 0.40). Based on data from a trial of pharmaceutical care, the PROMPT short-form was very responsive to reductions in medication related problems. Administration time for the PROMPT is estimated to be about 5min, and across all datasets used, no missing data were found amongst the 16 items of the PROMPT. Conclusion The 16-item PROMPT appears to be a practical, reliable, valid, and responsive instrument to identify patient's drug-related needs and to assess the humanistic impact of patient-centered pharmaceutical care.

Interdisciplinary Care Team with Pharmacist in a Community-based HIV Clinic

BackgroundHuman immunodeficiency virus (HIV) infection presents a significant burden, especially in the Washington, DC area. Literature is limited in describing the role of pharmacists in the outpatient clinic setting to provide patient-centered pharmaceutical care for patients with HIV. ObjectiveOur study aims to describe an interdisciplinary HIV care model including a clinical pharmacist at a community-based transcultural clinic in the Washington, DC area, and to describe the role of the pharmacist as indicated by an association between non-adherence to antiretroviral therapy (ART) and an ART regimen change. MethodsUsing the electronic health record at the clinic from May 2011 through July 2013, 53 patients were identified who were referred to the clinical pharmacist. ResultsThe average age of the patients with HIV was 46.57 years in the clinic. About 28% of patients had documented non-adherence to ART and 30% of patients had one or more ART regimen changes during the study period. Medication non-adherence was a significant predictor of ART regimen change (ORadj 8.44; 95% CI 1.91–37.29). Substance use was a strong predictor of ART regimen change (ORunadj 3.47; 95% CI 1.02–11.81), but the relationship disappeared in the multivariate analysis. ConclusionsA strong association between pharmacist's evaluation of non-adherence to ART and a regimen change was demonstrated and the role of the pharmacist as the interdisciplinary team member was described. A follow-up study should be made to assess the services provided by the pharmacist on clinical, economic, and humanistic outcomes in the community-based clinical setting.

A randomized controlled trial of the impact of pharmacist-led patient-centered pharmaceutical care on patients' medicine therapy-related quality of life.

Due to a lack of pharmaceutical care (PC)-specific measures for health-related quality of life, a novel generic questionnaire "Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was developed. Little was also known about an impact of pharmaceutical care on medicine therapy-related quality of life. First, evaluate the impact of PC on medicine therapy-related QoL using the PROMPT-QoL in Thai patients. Second, compare the outcomes of drug-related problems (DRPs) between usual care (UC) and PC groups. Third, assess the responsiveness of the PROMPT-QoL. A randomized controlled trial was conducted at a tertiary public hospital in Bangkok, Thailand from March to October 2016. A total of 514 patients were randomly allocated into the UC (N=255) and pharmacist-led patient-centered PC (N=259) groups. The follow-up period was three months. A split-plot ANOVA showed that the PC group significantly improved four domain scores and total score of the PROMPT-QoL than the UC group (all p < 0.01). For improved patients in the PC group (N=164), the responsiveness of these four domains and the total score was moderate-to-high with standardized effect sizes between 0.23 and 3.01. The PC group also significantly yielded higher proportion of patients with better DRP outcomes than the UC group (p<0.01). Pharmacist-led patient-centered PC could improve patients' medicine therapy-related QoL and DRP outcomes. Four out of eight domains and the total score of the PROMPT-QoL were responsive to assess a humanistic impact of PC. More research can be conducted in longer follow-up periods.

EXTEMPORANEOUS MANUFACTURING OF INTRAVENOUS ADMIXTURES IN HOSPITAL PHARMACIES OF RUSSIAN FEDERATION

The provision of patient-centered pharmaceutical care is carried out through pharmaceutical organizations and is accompanied by such necessary functions as counseling, provision of information on drugs, monitoring of drug therapy. It also includes ensuring quality, effective and safe drugs. In this case, the role of pharmacies is reduced to providing the population with ready-made products of industrial production. The problem of improving the technology of infusion solutions assigned in stationary conditions, including combined drugs of individual manufacture is especially acute. The aim of this work was to study and analyze the options for the extemporaneous manufacture of combined drugs for infusion introduction in hospital pharmacies. Materials and methods. The methodological basis of the study was a systemic approach, which makes it possible to identify the key elements of two different options for the extemporaneous manufacture of combined drugs for infusion administration. The research uses methods of logical and functional analyses. Results and discussion . The analysis of scientific sources on the issues of manufacturing of combined infusion solutions for the needs of stationary patients showed that manufacturing is carried out according to the traditional scheme for the Russian Federation, i.e. in the conditions of the procedural room of the department. In pharmacies of medical organizations, two variants of small-scale extemporal manufacture of combined infusion solutions are permissible using pharmaceutical substances and using sterile drugs of industrial production. The presence of a number of critical points of the first variant shows the irrationality and limitations of the use of such a scheme for the manufacture of combined infusion solutions in the pharmacy of a medical organization. The second version of the extemporal manufacture of combined infusion solutions is characterized by the simplicity of the technological scheme, the absence of complex calculations, a number of preparatory operations, filtration and sterilization steps, a simplified version of quality control, and the lack of complex equipment. This allows the rapid and large-scale production of various combinations of drugs for infusion. Conclusion. Manufacturing intravenous admixtures from commercial medicines allows the rapid and large production of various combinations of drugs for infusion introduction, does not contradict the current legislation, which makes it possible to consider it as the main variant of manufacturing of combined infusion solutions in hospital pharmacies.

Medication monitoring and optimization: a targeted pharmacist program for effective and cost-effective improvement of chronic therapy adherence.

Community pharmacies provide a promising platform for monitoring and improving therapy adherence and providing pharmaceutical care. Structured methods and appropriate software are important tools to increase pharmacist effectiveness and improve health outcomes. In 2006, the Medication Monitoring and Optimization (MeMO) program was introduced in several community pharmacies in the Netherlands. MeMO facilitates targeted and continuous patient-centered pharmaceutical care around chronic medication, such as for osteoporosis, cardiovascular disease, and asthma/chronic obstructive pulmonary disease (COPD). To describe the MeMO program and summarize findings from publications on its effectiveness, patient satisfaction, and cost-effectiveness. In the first part of this article, the MeMO program is extensively described. In the second part, a review of the evidence of effectiveness, cost-effectiveness, and patient satisfaction of the MeMO program is provided. Evidence is based on 5 previously published articles. The MeMO program starts with structured counseling sessions with patients at the initiation and follow-up of chronic therapies. This process is followed by a continuous phase in which patients' therapy adherence is monitored on a monthly basis, using standardized search algorithms in the pharmacy database. When the algorithm detects a patient's discontinuation of therapy, tailored interventions are used to improve adherence and optimize pharmacotherapy. For osteoporosis patients, treatment discontinuation with bisphosphonates after 1 year dropped from 31.7% to 16.1% (P less than 0.001). This program was shown to be cost-effective in patients initiating osteoporotic therapy. Future scenarios with lower drug prices (e.g., from generic prescribing) result in cost savings for the MeMO program. For lipid-lowering drugs, the MeMO program has been shown to lower therapy discontinuation after 1 year from 25.9% to 13.6% (P less than 0.001). By extrapolating these results to patients' lifetimes, the intervention was estimated to be cost-effective, with gains for primary prevention of cardiovascular events, and even cost saving in secondary prevention. Results from the ongoing MeMO asthma/COPD program are promising, showing marked improvements in therapy control and quality of life for asthma and COPD patients. Almost all patients participating in MeMO programs are satisfied with the pharmacy team and have gained knowledge of the effectiveness and administration of their medications and the importance of therapy adherence. The MeMO program is an effective and structured method to improve patients' adherence to chronic medication in the field of osteoporosis, lipid-lowering drugs, and asthma/COPD and is well received by patients. By targeting the program toward nonadherent and high-risk patients, the program showed favorable cost-effectiveness.

Pharmacy practice in 2040

Pharmacy practice 50 years in the future is discussed. The practice of pharmacy in 2040 will be influenced by many trends and issues, such as increasing cultural diversity, the aging population, evolving drug and information technology, rising drug costs, and increasing third-party coverage. Pharmacy may take one of two paths. In the first scenario, institutional and community practice would drift further apart, with community pharmacy becoming more involved with retailing than with health care. In the second scenario, all pharmacists would become a vital component of an integrated, patient-centered system of health care; pharmacists, like physicians, would be salaried professionals, paid for by health-care programs financed through health insurance. The difference between the two scenarios is the degree to which pharmacists actively participate in their creation: The first will happen if pharmacists do not take action; the second will require a considerable amount of work. If pharmacists wish to see an active system of patient-centered pharmaceutical care in 2040, they must begin to create it now, regardless of their practice setting. Pharmacists must work to create a future in which they are an integral part of the health-care system.

Opportunities and responsibilities in pharmaceutical care

Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not yet been restored to its erst-while importance in medical care. It is not enough to dispense the correct drug or to provide sophisticated pharmaceutical services; nor will it be sufficient to devise new technical functions. Pharmacists and their institutions must stop looking inward and start redirecting their energies to the greater social good. Some 12,000 deaths and 15,000 hospitalizations due to adverse drug reactions (ADRs) were reported to the FDA in 1987, and many went unreported. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of ADRs, the length of hospital stays, and the cost of care. Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice. Changing the focus of practice from products and biological systems to ensuring the best drug therapy and patient safety will raise pharmacy's level of responsibility and require philosophical, organizational, and functional changes. It will be necessary to set new practice standards, establish cooperative relationships with other health-care professions, and determine strategies for marketing pharmaceutical care. Pharmacy's reprofessionalization will be completed only when all pharmacists accept their social mandate to ensure the safe and effective drug therapy of the individual patient.