Pharmaceutical Care To Patients Research Articles

Priorización de iniciativas 2024–2027 del mapa estratégico de atención farmacéutica al paciente externo de la Sociedad Española de Farmacia Hospitalaria

ObjectiveTo prioritize the initiatives to be developed for the development of the Strategic Map of Outpatient Care (MAPEX) project to improve the quality of care and Pharmaceutical Care for patients seen in Hospital Pharmacy outpatient clinics in the period 2024–2027 in Spain. MethodThe study was carried out in 4 phases between January and December 2023.For phase 1, a literature review of the evolution of the project was carried out by the coordinating committee with the aim of establishing a basis on which to define a new proposal for initiatives. In addition, an analysis was made of the health trends that will have an impact in the coming years.In phase 2, a working group of 19 specialists from all the autonomous communities was created, who were called regional ambassadors. They all made a preliminary proposal of initiatives and established revisions for their adjustment and final version both online and in telematic meetings.In phase 3, a consensus was established based on the Delphi-Rand/UCLA methodology with two rounds of online voting to select the initiatives classified as: priority and key or breakthrough.Between the first and second round of voting, a face-to-face “Consensus Conference” was held, where the results of the first round were presented.In phase 4, a public presentation was made in scientific forums and through the web. ResultsTen trends in the health sector were identified. A list of 34 initiatives grouped into five lines of work was established. A total of 103 panelists participated in the first round and 76 in the second. Finally, five initiatives were established as priority and 29 as key. Among those prioritized were external visibility, adaptations to the CMO methodology, strengthening certification and improving training. ConclusionsThe initiatives agreed upon as priorities were aimed at improving professional visibility, broadening the methodology of care work, expanding the quality of care, enhancing the training of professionals and the voice of patients.

The Influence of Pharmaceutical Care in Patients with Breast Cancer Receiving Adjuvant Endocrine Therapy

Objectives: Our objective was to explore the effect of a pharmaceutical care program on adherence to adjuvant endocrine therapy (AET) in breast cancer patients. Methods: Female breast cancer patients taking AET (N=429) were enrolled in the study; the pharmaceutical care program was implemented and the effect of this intervention was evaluated. The primary outcomes were scores on an 8-item medication adherence scale Chinese version (MMAS), beliefs about medicines questionnaire specific (BMQ), 5-level EuroQol 5 dimensions questionnaire (EQ-5D-5L) and a patient satisfaction questionnaire (PSQ-18). Results: We found statistically significant difference in scores on MMAS and BMQ-concern (p < .05) before and after intervention. The MMAS score was 6.12 (±1.21), 7.15 (±0.92) and 7.18 (±0.96) at baseline, 6 months and 12 months, respectively. The BMQ-concern score was 15.64 (±2.14), 12.26 (±2.85), 11.56 (±2.27) at baseline, 6 months and 12 months separately. Conclusion: The pharmaceutical care program significantly improved medication adherence and reduced patients' medication concerns to adjuvant endocrine therapy in Chinese breast cancer patients.

Post-Traumatic Stress Disorder: Administration, Clinical and Pharmacological, Organizational and Legal, Pharmaceutical Management, Recent Case Studies

Administered post-traumatic stress disorder based on ICD-11. The organizational and legal management of post-traumatic stress disorder’s pharmacotherapy based on evidence-based medicine and evidence-based pharmacy was studied. The use of medications to reduce post-traumatic stress disorder’s symptoms is indicated. Analgesics, anxiolytics, antidepressants, anticonvulsants, and drugs from other clinical-pharmacological groups can be used for analgesia, mood improvement, anxiety reduction, and control of hypergaining. Areas of professional reintegration (support in job search, skills training, education, employment, and adaptation to civilian life) have been determined. Legal support in the system of legal relations "doctor-patient-pharmacist-lawyer" indicated in order to achieve a comprehensive and multidimensional approach to the medical and pharmaceutical care of patients with post-traumatic stress disorder. Clinical and pharmacological management in the pharmacotherapy of post-traumatic stress disorder was studied. The further pharmaceutical development of the composition of the new drug based on the known active pharmaceutical ingredients of an analgesic and an antipsychotic is substantiated. Mentioned about the organizational and legal management of social patient-oriented pharmacotherapy, recent case studies of post-traumatic stress disorder in conflict conditions.

Development and Implementation of an Integrated Pharmaceutical Care Program for patients with COPD in a Rehabilitation Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with airflow limitation and prolonged respiratory problems. The treatment requires an interdisciplinary approach with a holistic view of the patient. A cornerstone of the treatment consists of inhalation therapy. Inhalation errors are abundant and medication adherence towards inhalation therapy is low. We aimed (1) to develop a standardized pharmaceutical care protocol for hospitalized patients with COPD and (2) to evaluate the effect and feasibility of protocol implementation.
 Methods: This study took place at the rehabilitation hospital Koningin Elisabeth Instituut (RH-KEI) in Oostduinkerke, Belgium from January 2021 to April 2022. The protocol was based on the PHARMACOP protocol, tailored to the specific setting using in-depth interviews with all HCPs involved in the pharmaceutical care of patients with COPD (physicians, pharmacists, pharmacy technicians, nurses, physiotherapists and an occupational therapist). The finalized protocol consisted of six additional patient contacts (3 evaluation moments, 2 educational moments and 1 evaluation moment two weeks after discharge), mainly between the hospital pharmacist and the patients. Consequently, from January 2022 to April 2022, adult patients with COPD were included to follow the complete protocol. Patient outcomes were evaluated using standardized questionnaires (i.e. mMRC, BMQ, CAT, EQ-D and EQ-VAS). The feasibility was assessed during a focus group discussion with all involved HCPs and a patient survey after discharge.
 Results: Before the start of the study, the hospital pharmacist in RH-KEI had no patient contact and there were no (recurrent) training sessions about inhaler use. The in-depth interviews elucidated that most involved health care providers (HCPs) had insufficient knowledge of the correct use of inhalers. This is however needed as 37% of included patients made at least one critical inhalation error at hospitalization. The adapted PHARMACOP protocol was tested in 13 patients, after which a significant improvement was noted in mMRC (p = 0.047), BMQ concerns (p = 0.011) and CAT score (p = 0.002). A trend towards improvement was noted in the EQ-5D and EQ-VAS score (resp. p = 0.065, p = 0.590). Finally, mean inhalation technique scores had significantly improved (p = 0.003). Transferring information to primary care HCPs seemed difficult as only a third of patients had handed over their discharge letter to their community pharmacist. The in-hospital HCPs concluded that the protocol was feasible for implementation with some adjustments, such as a more prominent role of the (hospital) pharmacist, the possibility to tailor the program to the patient and a set timing for interdisciplinary (patient) discussions. 
 Conclusion: An interdisciplinary pharmaceutical care program can improve outcomes in patients with COPD. Additional attention should be given to the inclusion of primary care HCPs to guarantee continuity of care concerning inhalation therapy for COPD management.

PAUSATE Study: Prevalence and appropriateness of the use of antimicrobials in Spanish hospitals

ObjectiveTo determine the prevalence and appropriateness of antimicrobial use in Spanish hospitals through a pharmacist-led systematic cross-sectional review. MethodA nationwide multicenter cross-sectional study was conducted on 10% of the patients admitted to the participating hospitals on one day in April 2021. Hospital participation was voluntary, and the population was randomly selected. The study sample was made up of patients who, on the day of the study, received at least one antimicrobial belonging to groups J01, J02, J04, J05AB, J05AD or J05AH in the Anatomical Therapeutic Chemical Classification System. The pharmacist in charge made a record and carried out an evaluation of the appropriateness of antimicrobial use following a method proposed and validated by the Pharmaceutical Care of Patients with Infectious Diseases Working Group of the Spanish Society of Hospital Pharmacy. The evaluation method considered each of the items comprising antimicrobial prescriptions. An algorithm was used to assess prescriptions as appropriate, suboptimal, inappropriate and unevaluable. ResultsOne-hundred three hospitals participated in the study and the treatment of 3,568 patients was reviewed. A total of 1,498 (42.0%) patients received antimicrobial therapy, 424 (28.3%) of them in combination therapy. The most commonly prescribed antimicrobials were amoxicillin-clavulanic acid (7.2%), ceftriaxone (6.4%), piperacillin-tazobactam (5.8%), and meropenem 4.0%. As regards appropriateness, prescriptions were considered appropriate in 34% of cases, suboptimal in 45%, inappropriate in 19% and unevaluable in 2%. The items that most influenced the assessment of a prescription as suboptimal were completeness of medical record entries, choice of agent, duration of treatment and monitoring of efficacy and safety. The item that most influences the assessment of a prescription as inappropriate was the indication of antimicrobial agent. ConclusionsThe method used provided information on the prevalence and appropriateness of the use of antimicrobials, a preliminary step in the design and implementation of actions aimed at measuring the impact of the use of antimicrobials within the antimicrobial stewardship programs.

Mental health: current trends in pharmacy and new concepts

The implementation of the National Mental Health Gap Action Program (mhGAP), which aims to broaden the management of patients with mental disorders in primary care, should involve not only primary care physicians but also pharmacists. Pharmacists play a crucial role by providing medications within the expanded Medical Guarantee Program for drug reimbursement in outpatient treatment of mental and behavioral disorders. Additionally, they offer pharmaceutical care for patients dealing with stress disorders and insomnia, adhering to the Good Pharmacy Practice (GPP) standards. The aim of the work is the study of national information, scientific databases, and scientometric databases of Scopus, Web of Science, PubMed, Cochrane Library in order to identify, generalize, and systematize the source based on providing pharmaceutical care in the field of mental health care of patients and predicting the future vector of research on the specified topic. Materials and methods. General scientific methods such as analysis, synthesis, comparison, and data generalization from domestic information and scientific databases were employed in this study. To search for scientific publications, the VOS viewer visualization program, the PubMed search engine, and the Cochrane Library were used. The keywords “mental health” and “pharmacy” were used for the search within the scientometric databases of Scopus and Web of Science. Results. The analysis of the main strategies for the development of pharmaceutical care for mental health care in pharmaceutical practice was carried out. The most researched clusters of mental health care were singled out. Modern trends in the development of pharmaceutical care for mental health care were summarized. Conclusions. The initiative for enhancing mental health care for the country’s population hinges on the principles of a novel, sustainable, patient-centered pharmacy model. This approach necessitates the realization of an expanded role for pharmacists, aligning with the standards outlined in Good Pharmacy Practice.

Intelligent MONitoring System for antiviral pharmacotherapy in patients with chronic hepatitis C (SiMON-VC)

Two out of six strategic axes of pharmaceutical care in our hospital are quality and safety of care, and the incorporation of information technologies. Based on this, an information system was developed in the outpatient setting for pharmaceutical care of patients with chronic hepatitis C, SiMON-VC, which would improve the quality and safety of their pharmacotherapy. The objective of this paper is to describe requirements, structure and features of SiMON-VC. Requirements demanded were that the information system would enter automatically all critical data from electronic clinical records at each of the visits to the Outpatient Pharmacy Unit, allowing the generation of events and alerts, documenting the pharmaceutical care provided, and allowing the use of data for research purposes. In order to meet these requirements, 5 sections were structured for each patient in SiMON-VC: Main Record, Events, Notes, Monitoring Graphs and Tables, and Follow-up. Each section presents a number of tabs with those coded data needed to monitor patients in the outpatient unit. The system automatically generates alerts for assisted prescription validation, efficacy and safety of using antivirals for the treatment of this disease. It features a completely versatile Indicator Control Panel, where temporary monitoring standards and alerts can be set. It allows the generation of reports, and their export to the electronic clinical record. It also allows data to be exported to the usual operating systems, through Big Data and Business Intelligence. Summing up, we can state that SiMON-VC improves the quality of pharmaceutical care provided in the outpatient pharmacy unit to patients with chronic hepatitis C, increasing the safety of antiviral therapy.

[Translated article] Checklist for the pharmaceutical care of patients with interstitial lung disease (CheckEPID): A Delphi-based consensus

ObjectiveTo develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs. MethodFive hospital pharmacists developed an initial list of 37 items divided into 4 blocks: (1) First visit, which included general patient data and data from the first treatment; (2) follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; (3) telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; (4) non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, 2 rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its “utility”, which was the determining criterion for its inclusion, and its “applicability”. ResultsForty-eight hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi, the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the 2 rounds of the Delphi, there were 2 that, based on utility, the participants did not reach consensus for inclusion in the checklist: the one referring to “History of surgical intervention, specifically abdominal surgery in the last 4 weeks” (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on “Relaxation”. No consensus was reached on their applicability for 2 of the items: “Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model” and “Collection of Results Reported by the Patient”. ConclusionsThe management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.

Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms

ObjectiveWe aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. MethodThe risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. ResultsThe participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16–27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of “clinical and health services utilization” and “treatment-related.” Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. ConclusionThis stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Community pharmacists' perspectives on cardiovascular disease pharmaceutical care in the United Arab Emirates: a questionnaire survey-based analysis.

Background: Community pharmacists play an intermediary role between prescribing physicians and patients in the United Arab Emirates (UAE) and thus are responsible for ensuring that patients receive optimal cardiovascular disease (CVD) pharmaceutical care. Methods: we used a cross-sectional design to assess the perceptions and practices of community pharmacists concerning pharmaceutical care for patients with CVD. A trained researcher visited randomly selected community pharmacies and used a structured questionnaire to conduct in-person interviews with pharmacists. The questionnaire collected demographic data and information on perceptions and practices regarding CVD pharmaceutical care. Results: Five hundred and fifty-one participants were recruited. The average participant age (mean ± SD) was 35 ± 2.7years. The average perception score regarding CVD prevention and management was 75.6% (95% confidence interval [CI] 77.1%-74.2%), and the average practice score for CVD prevention and management was 87.1% (95% CI 76.5%-79.6%). Bivariate analysis revealed that gender (p = 0.001), education level (p < 0.001), pharmacy position (p = 0.004), work experience (p < 0.001), number of patients served per day (p < 0.001) and being trained on CVD prevention and management (p < 0.001) were significantly associated with perceptions about the prevention and management of CVD. Better practice scores were seen among older participants (OR 1.01; 95% CI 1-1.019), postgraduates (OR 1.77; 95% CI 1.66-1.89), workers at chain pharmacies (OR 1.24; 95% CI 1.11-1.39), pharmacists in charge (OR 1.22; 95% CI 1.01-1.47), pharmacists with >10years of experience (OR 11.3; 95% CI 6.01-15.62), pharmacists with 6-10years of experience (OR 4.42; 95% CI 3.90-5) and pharmacists trained on CVD prevention and management (OR 1.29; 95% CI 1.15-1.46). Conclusion: Pharmacy practitioners working in community pharmacies in the UAE actively engage in delivering pharmaceutical care to patients, playing a role in CVD management and prevention. However, they showed low levels of involvement in other healthcare services, specifically in screening and measuring patients' weight, glucose levels, and blood pressure, monitoring treatment responses, maintaining medical records, and reviewing medication refill histories. Activities such as educating patients, providing medication counseling, offering support for treatment adherence, and fostering collaborative relationships with other healthcare providers should be encouraged among UAE community pharmacists to ensure the provision of high-quality patient care.

[Artículo traducido] Modelo de atención farmacéutica en medicina de precisión en China

Pharmacy service is to provide individualized pharmaceutical care for patients, which should follow the current evidence-based pharmacy, and constantly verify the evidence and then produce new evidence. In pharmaceutical care, differences are often found in the efficacy and adverse reactions of drugs among individuals, even within individuals, which are closely related to patients’ genetics, liver and kidney functions, disease states, and drug interactions. Back in the 1980s, therapeutic drug monitoring (TDM) has been applied to routinely monitor the blood drug concentration of patients taking antiepileptic drugs or immunosuppressants after transplantation to provide individualized dosage recommendations and accumulate a large amount of pharmacokinetic (PK)/pharmacodynamic (PD) data. As individualized pharmaceutical care proceeds, the concept of precision medicine was introduced into pharmacy services in combination with evidence-based pharmacy, PK/PD theories, and big data to further promote the TDM technology and drugs, and carry out pharmacogenomics analysis. The TDM and pharmacogenomics have been applied gradually to the fields of antimicrobial, antitumor, and antipsychotic drugs and immunosuppressants. Based on the concept of precision pharmacy, we adopted approaches including PK/PD, quantitative pharmacology, population pharmacokinetics, and big data machine learning to provide more personalized pharmacy services, which is mainly for special patients, such as critical patients, patients with interaction risk of multiple drugs, patients with liver and renal insufficiency, pregnant women, children, and elderly patients. As the service pattern of precision pharmacy has been constructed and constantly improved, better evidence in clinical practice will be produced to provide patients with better precision pharmacy service.

Dispensing metformin with other drugs and dietary supplements in pharmaceutical care in patients with multimorbidity

Pharmaceutical care is an activity aimed at protecting the patient’s health. The purpose of this benefit is to provide assistance in receiving and safely using the drug. The idea of pharmaceutical care originated in the United States in the 70s’ of the 20th century although the issue had already been discussed in the interwar period. The definition in force in Poland is contained in the Act on the Profession of Pharmacist (Act of September 10, 2020). The program includes pharmaceutical consultations, performing medications reviews, developing pharmaceutical care plans considering the patient’s drug-related problems, performing diagnostic tests and issuing prescriptions that are a continuation of a medical order(1). This paper reviews the current literature on the use of metformin in patients with multimorbidity. Special attention was given to the studies on probability of occurrence potential drug-related problems in the treatment of these diseases. The analysis shows that the most difficulties are caused by the lack of knowledge about the treatment used by patients. The result is often a reduction in the regularity of therapy or even resignation from it. The obtained observations related to the combined use of drugs from different therapeutic groups should help to systematize knowledge about the current needs and expectations of patients. Properly conducted pharmaceutical care, including the preparation of drug reviews and education, can significantly improve the effectiveness of treatment. The article emphasizes the importance of the cooperation of the patient, doctor and pharmacist in achieving and maintaining the proper quality of life of the patient.

Lista de comprobación para la atención farmacéutica del paciente con enfermedad pulmonar intersticial (CheckEPID): un consenso basado en el método Delphi

ObjectiveTo develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs. MethodFive hospital pharmacists developed an initial list of 37 items divided into 4 blocks: 1) First visit, which included general patient data and data from the first treatment; 2) Follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; 3) Telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; 4) Non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, two rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its “utility”, which was the determining criterion for its inclusion, and its “applicability”. Results48 hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the two rounds of the Delphi, there were two that, based on utility, the participants did not reach consensus for inclusion in the checklist: The one referring to “History of surgical intervention, specifically abdominal surgery in the last 4 weeks” (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on “Relaxation”. No consensus was reached on their applicability for two of the items: “Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model” and “Collection of Results Reported by the Patient”. ConclusionsThe management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.

[Artículo traducido] Consenso de la Sociedad Española de Farmacia Hospitalaria sobre el manejo fármacoterapéutico óptimo de la dermatitis atópica

AimThis study’s aims are: 1) To use the Delphi method to determine the level of consensus among HPs as regards the factors involved in the current approach to patients with AD; 2) To identify potential areas for improvement in hospital pharmacy in terms of dealing with patients with severe AD; and 3) To contribute to adequate pharmaceutical care for patients with AD by drawing up recommendations. MethodsA two-round Delphi survey with participation from HPs from all over Spain. Three theme-based blocks were set out: 1) AD; 2) Management of patients with severe AD in the Hospital Pharmacy setting; and 3) Unmet needs (pathology, patient, treatment and management). ResultsThe 42 HPs participating reached a consensus in recognizing the impact of severe AD on the patients suffering from it, the need to encourage adherence and the recommendations to use scales that take into account the patient's quality of life and indicators of the patient’s experience. It has also been demonstrated that it is worthwhile evaluating the results in real clinical practice in consensus with other specialists from the multidisciplinary team. Finally, it is advisable to use drugs that have demonstrated long-term effectiveness and safety for patients with severe AD, given the disease´s chronic nature. ConclusionsThis Delphi consensus highlights the impact of severe AD on patients, the importance of a multidisciplinary and holistic approach, in which HP play a major role. It also highlights the importance of increased access to new drugs to improve health outcomes.

ОБОСНОВАНИЕ МЕТОДИЧЕСКИХ ПОДХОДОВ К ОПТИМИЗАЦИИ ЛЕКАРСТВЕННОГО ОБЕСПЕЧЕНИЯ ПАЦИЕНТОВ С РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

The health of the population is one of the priorities of the state. Particular attention of the Russian healthcare system is focused on preventing the spread and reducing human and financial losses in socially significant diseases, which are formed on the basis of the structure of morbidity and causes of death. Prostate cancer is the one of the most common socially significant diseases among the male population, which specify in the difficulty of diagnosing in the early stages and rapidly progressing complications that significantly reduce the quality of life and working capacity of patients, leading to disability in the future. Today, there is sufficient attention to the issues of preventive measures, disease detection, prevention of the development and / or progression of complications, therapy, rehabilitation and palliative care for patients with prostate cancer, however, the involvement of pharmaceutical segment structures in the process of providing drug care to patients with prostate cancer is insufficiently studied. The course of the study determined: medical and social characteristics and information needs of oncourological patients in the prevention of cancer and drug supply; analysis of the information field of drugs recommended for the treatment of prostate cancer, registered in the State Register of Medicines, as well as included in the Standards of medical care and Clinical guidelines; assessment of the level of knowledge of pharmacists on the issues of prevention and provision of drug care to patients with prostate cancer, including the interaction between pharmaceutical and medical specialists, made it possible to determine possible directions for expanding drug supply for patients with prostate cancer at the regional level. There are presented the following results of the substantiation of methodological approaches: optimization of the choice of drugs used for the treatment of prostate cancer, with selection criteria; improvement of pharmaceutical care for patients with prostate cancer, based on the development of an algorithm for pharmaceutical counseling such patients, with organizational technologies; development of information and methodological technologies for the formation of cancer awareness among pharmaceutical specialists and visitors to pharmacy organizations, professional special competencies of pharmaceutical specialists in the prevention and organization of drug supply for patients with prostate cancer, pharmaceutical support technologies for medical specialists in the rational use of drugs and proper prescribing of drugs used in the treatment of prostate cancer.

Consensus of Spanish Society of Hospital Pharmacy on optimal medication therapy management of atopic dermatitis

AimThis study's aims are: 1) To use the Delphi method to determine the level of consensus among hospital pharmacists (HPs) as regards the factors involved in the current approach to patients with atopic dermatitis (AD); 2) To identify potential areas for improvement in hospital pharmacy in terms of dealing with patients with severe AD; and 3) To contribute to adequate pharmaceutical care for patients with AD by drawing up recommendations. MethodsA two-round Delphi survey with participation from HPs from all over Spain. Three theme-based blocks were set out: 1) AD; 2) Management of patients with severe AD in the Hospital Pharmacy setting; and 3) Unmet needs (pathology, patient, treatment and management). ResultsThe 42 HPs participating reached a consensus in recognising the impact of severe AD on the patients suffering from it, the need to encourage adherence and the recommendations to use scales that take into account the patient's quality of life and indicators of the patient's experience. It has also been demonstrated that it is worthwhile evaluating the results in real clinical practice in consensus with other specialists from the multidisciplinary team. Finally, it is advisable to use drugs that have demonstrated long-term effectiveness and safety for patients with severe AD, given the disease's chronic nature. ConclusionsThis Delphi consensus highlights the impact of severe AD on patients, the importance of a multidisciplinary and holistic approach, in which HP play a major role. It also highlights the importance of increased access to new drugs to improve health outcomes.

Pharmaceutical care model in precision medicine in China

Pharmacy service is to provide individualized pharmaceutical care for patients, which should follow the current evidence-based pharmacy, and constantly verify the evidence and then produce new evidence. In pharmaceutical care, differences are often found in the efficacy and adverse reactions of drugs among individuals, even within individuals, which are closely related to patient's genetics, liver and kidney functions, disease states, and drug interactions. Back in the 1980s, therapeutic drug monitoring (TDM) has been applied to routinely monitor the blood drug concentration of patients taking antiepileptic drugs or immunosuppressants after transplantation to provide individualized dosage recommendations and accumulate a large amount of pharmacokinetic (PK)/pharmacodynamic (PD) data. As individualized pharmaceutical care proceeds, the concept of precision medicine was introduced into pharmacy services in combination with evidence-based pharmacy, PK/PD theories and big data to further promote the TDM technology and drugs, and carry out pharmacogenomics analysis. The TDM and pharmacogenomics have been applied gradually to the fields of antimicrobial, antitumor and antipsychotic drugs and immunosuppressants. Based on the concept of precision pharmacy, we adpoted approaches including PK/PD, quantitative pharmacology, population pharmacokinetics, and big data machine learning to provide more personalized pharmacy services, which is mainly for special patients, such as critical patients, patients with interaction risk of multiple drugs, patients with liver and renal insufficiency, pregnant women, children and elderly patients. As the service pattern of precision pharmacy has been constructed and constantly improved, better evidence in clinical practice will be produced to provide patients with better precision pharmacy service.

451 A systematic review exploring cultural competence in pharmacy education

Abstract Introduction There is an increased need for a healthcare workforce that is culturally competent to improve health outcomes and reduce health disparities for patients from diverse cultural backgrounds. This is important in the context of pharmaceutical care for patients, as the inability to recognise a patient’s health beliefs, which could be influenced by their cultural background, can lead to reduced medication adherence and poor treatment outcomes (1, 2). This review is registered with PROSPERO (Reference number CRD42021295875). Aim This systematic review aims to explore cultural competence teaching and training in pre-qualification pharmacy education. Methods This study is reported using the PRISMA Checklist. Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were systematically searched for studies that explored cultural competence in pharmacy education and were published in English from January 2012 to December 2021. Methodological quality of studies were assessed using the Mixed Methods Appraisal Tool (MMAT). Data from included studies were thematically analysed. Results Overall, 47 papers (46 studies) were included in the review. Of these, 40 papers focused on interventions for teaching cultural competence to pharmacy students only, the remaining studies included students from pharmacy and other health discipline programmes. Half of the studies focused on cultural competence in general (n = 20, 50%), while the remaining studies focused on competence on specific aspects e.g. cultures, religions and disabilities. Most studies (n = 24, 60%) report implementation of interventions that took place over a week. Twenty-one studies reported that cultural competence interventions were compulsory. There were variations in how cultural competence is conceptualised in studies; some studies focused on the need to increase knowledge about different cultures or ‘knowing how’; other studies focused on behavioural aspects that would help students while they work with patients from diverse backgrounds, or ‘showing how’; some studies described cultural competence as a continuum that includes both ‘doing’ knowledge and behavioural aspects. Conclusion There is variation in how cultural competence is taught in pharmacy education programmes, which could be a consequence of differences in how authors conceptualised cultural competence. It is also challenging to know whether or not current interventions improve ‘cultural competency’ due a range of outcome measures used in the studies. Therefore, it is important to develop a set of key principles that underpin the understanding and operationalisation of the concept of cultural competence into the pre-qualification pharmacy curricula – this forms our future work. A limitation of the study was the inclusion of only papers written in English, which may therefore have inadvertently excluded relevant papers published in other languages. Additionally, grey literature was not included, which often is a key step in the dissemination of pedagogical research and scholarship.

The impact of pharmacist practice of medication therapy management in ambulatory care: an experience from a comprehensive Chinese hospital

BackgroudWith the reform of medical system in China, Beijing municipal hospitals explored a new pharmaceutical care model and set up medication therapy management services (MTMs) in ambulatory care since 2019. We were one of the first hospitals to set up this service in China. At the present, there were relatively few reports about the effect of MTMs in China. In this study, we summarized the implementation of MTMs in our hospital, explore the feasibility of pharmacist-led MTMs in ambulatory care and the impact of MTMs on patients’ medical costs.MethodsA retrospective study was conducted in a university-affiliated, tertiary comprehensive hospital in Beijing, China. The patients who received at least one MTMs and with complete medical records and pharmaceutical documents from May 2019 to February 2020 were included. Pharmacists provided pharmaceutical care for patients according to the MTMs standards issued by the American Pharmacists Association, identified the numbers and classification of the patients’ perceived medication-related demands, identified medication-related problems (MRPs), and developed the medication-related action plans (MAPs). All MRPs found by pharmacists, pharmaceutical interventions, and resolving recommendations were documented, and calculate the cost of treatment drugs that patients can reduce.ResultsA total of 112 patients received MTMs in ambulatory care, among them 81 cases with the completed record were included in this study. 67.9% of patients had five or more diseases, 83% of them co-took over 5 drugs. While performing MTMs, 128 patients’ perceived medication-related demands were recorded in all, monitoring and judgment of adverse drug reaction (ADR) (17.19%) was the most common demand. 181 MRPs were found, with an average of 2.55 MPRs per patient. Nonadherence (38%), excessive drug treatment (20%), and adverse drug events (17.12%) were the top three MRPs. Pharmaceutical care (29.77%), adjustment of drug treatment plan (29.10%) and referral to the clinical department (23.41%) were the top three MAPs. Whereby the MTMs provided by pharmacists, the cost-saving of each patient was about $ 43.2 monthly.ConclusionBy participating in the MTMs of outpatients, the pharmacists could identify more MRPs and develop personalized MAPs timely for patients, thereby promoting rational drug use and reducing medical expenses.

Multi-Lingual Mobile Application to Improve the Pharmaceutical Care of Patients in Ethiopia

Delivering essential information for patients concerning medication they’re taking is vital and improves healthcare services. Due to heavy burdens in every pharmacy, patients in Ethiopia do not get proper advice about the medicinal drugs they’re taking from the pharmacist. Moreover, it is far tough to recognize and interpret the various written instruction on remedy labels or package deal leaflet while not heaving the domain knowledge. As Ethiopia is an importer of many medicinal drugs from abroad, very often the package leaflets are not written in the local language. Therefore, due to language barrier, most of the patients cannot comprehend the information on medication labels and on package leaflet. In this regards most patients purchase the medication without a proper understanding of how to use the medication. This necessitates a technological based solution which serves patients in their language when they want an advice. This study demonstrates the design and implementation of a mobile-based solution to minimize such challenges and improve patient access to the medicinal drugs information. The requirements of the proposed system gathered using interview from pharmacist, doctors, technical expert, and client. Finally, a mobile application prototype is developed and evaluated for its effectiveness.