Pharmaceutical Care Plan Research Articles

Functional disability among the older adult population in Kedah, Malaysia

BackgroundFunctional disability, defined as acquired difficulty in performing basic daily tasks or more complex tasks needed for independent living. Functional assessment among community dwelling elderly is critical due to the changes taking place during the normal aging process, acute illness, worsening chronic illness, and hospitalization which compromises their performances necessary to live independently. Measuring their functional ability can provide objective data to assist with targeting individualized care plan for older adults being the highest consumers of medications due to greater burden of medical conditions in addition to being vulnerable to the effects of medications. It is crucial for the pharmacists to be aware of the geriatric functional disability as pharmacies are often the first point-of-care this elderly group may encounter in community settings. MethodsThis study was conducted to estimate the prevalence of functional disability and the common difficulties in the daily task performance among elderly from a state in the Northern region of Malaysia. Besides, the differences in terms of functional disability in both genders were also explored. Among a total of 266 elderly participants. ResultsAround 42 % was estimated to face at least one difficulty with Activities of Daily Living while more than half, 57 %, had at least one difficulty with Instrumental Activities of Daily Living. The most common difficulties reported with Activities of Daily Living and Instrumental Activities of Daily Living were transferring (22 %) and transportation (33 %), respectively. ConclusionIn order to deliver effective pharmaceutical care plan emphatically, both senior-friendly pharmacy curricula and pharmacy settings are imperative to address the most common difficulties faced by this vulnerable group.

Evaluation of a novel clinical pharmacy tool in identifying and categorising drug-related problems in hospitalised patients: The MA2VER2ICK Tool Study

Abstract Introduction Literature searching has revealed a lack of high-quality research outlining the use of tools or checklists in hospitalised patients. Additionally, few tools identified relate directly to clinical pharmacy practice. The tools identified focus on specific disciplines (e.g. critical care) or specific tasks (e.g. handover). The MA2VER2ICK Tool is a novel clinical pharmacy tool which has recently undergone review and adaptation.[1] The tool is unique as it is comprehensive and applicable to all hospitalised patients, regardless of clinical discipline. The intended purpose of the tool is to assist clinical pharmacists in comprehensive pharmaceutical care planning. Aim Demonstrate the utility of the MA2VER2ICK tool in pharmaceutical care planning, by outlining the type and frequency of drug-related problems occurring in hospitalised patients. Methods A prospective, observational, cross-sectional study was conducted in a 560-bed acute university teaching hospital. Clinical pharmacists adopted the tool in their daily practice, in a mixed medical-surgical inpatient population, over four weeks. All drug-related problems identified were recorded and assigned to the applicable category within the tool, by the clinical pharmacist. Additionally, all drug-related problems were retrospectively assigned to applicable categories of the Pharmaceutical Care Network Europe Classification for Drug Related Problems Version 9.1,[2] for comparison, by two independent researchers. Results All identified drug-related problems identified were successfully categorised using the MA2VER2ICK Tool. In total, 753 drug-related problems were identified in 180 patients over four weeks, with 233 patient-pharmacist encounters occurring. The mean age of patients was 68.9±16 years, while 51.7% (93/180) were female and 48.3% (87/180) were male. The mean number of drug-related problems identified per patient was 4.2±3.6. The highest number of drug-related problems experienced by an individual was 20, while 17 patients experienced no drug-related problem. The majority of drug-related problems identified using the tool related to medication reconciliation (52.7%; 397/753), followed by prescription endorsement and administration (17.3%; 130/753) and pharmacotherapy optimisation (9.3%; 70/753). In comparison with the MA2VER2ICK Tool, the Pharmaceutical Care Network Europe classification system has a much larger range of categories for assigning drug-related problems. Despite this, a proportion of identified drug-related problems 1.6% (12/753) could not be categorised using this tool, while there were also several categories within the tool 43.2% (19/44) whereby no drug-related problems were assigned. Conclusion This study demonstrates that the MA2VER2ICK Tool is a robust clinical pharmacy tool, that is effective and practical in assisting clinical pharmacists with the identification of drug-related problems and thus is a useful guide to facilitate pharmaceutical care planning at the patient’s bedside. This is in comparison with the Pharmaceutical Care Network Europe classification system, which has less utility as a clinical pharmacy tool, but is better placed as a research instrument. Despite demonstrating the usefulness of the MA2VER2ICK Tool in identifying drug-related problems, the clinical significance of those identified was not assessed during this study. However, data collection occurred in real time, facilitating the identification of actual and potential problems, thus reducing the likelihood of underestimating the incidence rate.

A mixed-methods review and adaptation of a novel clinical pharmacy tool: The MA2VER2ICK Tool Study

Abstract Introduction The MA2VER2ICK Tool[1] (see Figure 1) is a clinical pharmacy mnemonic developed in 2016 by the pharmacy department of Tallaght University Hospital, through a combination of literature searching and local expert consensus opinion. The intended purpose of the tool was to guide clinical pharmacists in pharmaceutical care planning. Since inception, the tool has not been formally evaluated. Locally, users report the tool as useful; although, there is scope for improvement, to better support clinical pharmacists. Aim Identify and gain consensus on suggestions to adapt the existing tool. Methods A two-stage mixed-methods approach was adopted. This comprised focus groups to facilitate idea generation and appraise contents of the existing tool, followed by a nominal group technique process[2] to agree the content and structure of the final tool. A purposive sample of clinical pharmacists were selected to participate in the focus groups and nominal group technique panel, based on responses to a screening questionnaire pre-circulated to all clinical pharmacists employed at the study site. Thematic analysis of the focus group transcripts was conducted by two independent researchers, with key themes and related recommendations to improve the tool identified. These recommendations were presented to the nominal group technique panel via an anonymous survey, where numerical rating scores were assigned over two rounds, with an intervening panel discussion. An increase in the mean rating score and convergence of the standard deviation indicated consensus for a recommendation. Results Two focus groups (5 participants each) of 45 minutes duration took place. Both focus groups resulted in similar findings, with seven major themes identified relating to adapting the tool. Overall, eight recommendations were formulated, with suggestions to adapt the content, structure, usability and application of the tool. Consensus agreement was reached on seven recommendations, each receiving a panel rating score > 90%. One recommendation was rejected, receiving a panel rating score < 30%. Conclusion This study demonstrates that the MA2VER2ICK Tool is a comprehensive clinical pharmacy resource. Few amendments were required to the original tool, indicating user satisfaction with and the utility of the tool, together with a high degree of consensus for the adaptations made. VTE: venous thromboembolism; Rx: prescription; CRP: C-reactive protein.

A call to strengthen medication therapy management training in the Kenyan pharmacy undergraduate curriculum: Feedback from a snapshot of the knowledge and practices among pharmacists in diverse disciplines

Background: The role of the pharmacist has continued to evolve, placing the profession at the fulcrum of holistic patient care, including offering medication therapy management (MTM), a critical component of any effective pharmaceutical care plan. Objective: This study was conducted to assess the knowledge, attitudes, and practices of Kenyan pharmacists regarding MTM. Methods: A cross-sectional study was performed whereby Google Form questionnaires were distributed among pharmacists working at hospitals and community pharmacies between 1st October 2022 and 30th November 2022. Results: Slightly over half (62, 52.5%) of the pharmacists rated themselves as knowledgeable about MTM, with most participants (55, 46.6%) stating that the undergraduate pharmacy curriculum was insufficient to prepare one to offer MTM services competently. Notably, online courses and workshops were the most popular channels (72%) for accessing MTM-related continuous professional development among the respondents. Conclusion: This study revealed some gaps in the knowledge and competence of undergraduate-level Kenyan pharmacists in their quest to offer MTM services. Therefore, embedding MTM in the undergraduate curriculum can bridge this gap and empower Kenyan pharmacists to provide holistic pharmaceutical care.

Clinical pharmacy services in cancer patients with hypertension

Abstract Clinical pharmacy services aim to ensure the rational use of drugs and resolve disease/health conditions with a multidisciplinary approach. Pharmaceutical care plans need to be created to effectively provide clinical pharmacy services in the treatment of hypertension which is one of the common chronic diseases in cancer patients. In this mini-review, we examine which drugs can cause or worsen hypertension in patients receiving cancer treatment, potential drug-drug interactions between drugs used in cancer treatment and antihypertensive drugs, pharmacological and clinical studies for the treatment of hypertension in patients with hypertension before cancer diagnosis or newly diagnosed hypertension due to cancer treatment. Non-pharmacological treatment approaches are presented. We think that our study will be a resource that can be used to solve possible drug-related problems in the practice.

ASSESSMENT OF WHO/INRUD CORE DRUG USE INDICATORS AT PUBLIC AND PRIVATE HEALTHCARE CENTRES IN LAHORE, PAKISTAN: A MULTICENTRE CROSS-SECTIONAL STUDY

Background: A key element of the pharmaceutical care plan is the appropriate use of medications. Objectives: Using the WHO/INRUD core drug use indicators, this study sought to evaluate medication usage trends at both public and private healthcare centres in the Lahore district of the Punjab province of Pakistan. Methodology: A cross-sectional and descriptive study design was adopted. For data collection, 399 prescriptions (199 prescriptions from public and 200 prescriptions from private healthcare facilities) were systematically sampled written from February to July 2022. To evaluate the prescription indicator, patient-care and facility-specific indicators, patients randomly selected from both public and private hospitals were examined and interviewed. For each of the WHO/INRUD indicators, we considered ideal criteria that have been published. Results: The average number of medicines prescribed each encounter was reported to be 6.26% in public hospitals and 4.14% in private hospitals among the prescribing indicators, generic medication, antibiotics, and the number of times patients received injections were prescribed, respectively, in 54%, 84%, and 89% of public hospitals and 19%, 61.7%, and 78% of private hospitals. In the public and private sectors, respectively, 71% and 97% of prescription drugs were from the list of essential drugs. The average consultation time was found to be 2.1 minutes in public hospitals and 3.2 minutes in private hospitals, while the average dispensing time was reported to be 37 seconds in public hospitals and 39 seconds in private hospitals. Of the total prescribed medicines, 84% and 97 % were dispensed in public and private hospitals respectively and the percent medicine adequately labelled was 100% in both healthcare facilities. Regarding patient awareness, 69% of patients in private hospitals and 42.5% of patients in public hospitals were aware of the proper dosage, frequency, and duration of the medications that were prescribed. In terms of facility-specific data, both public and private hospitals had 100% availability of the EDL copy and 82% stock of the important medications, respectively. Conclusion: Irrational use of drugs was observed in both public and private healthcare facilities. WHO/INRUD proposed 12 key initiatives to encourage rational use of medications must be put into practice as a result of present study.

The Implementation and Evaluation of Pharmaceutical Care Plan in Stroke Patients at Tertiary Care Hospital

Objective: To assess the pattern and prevalence of adverse drug reactions (ADRs) reported by the neurology department and review the benefits of the pharmaceutical care plan. Materials and Methods: A total of 148 stroke cases with previous medication history correlated with current complaints leading to hospitalization were included in the prospective study for one year in the neurology department. Results: This study identified non-adherence (50%) and ADRs (38%). Ignorance of the disease, its complications, and the possible adverse effects of self-medication have been identified as risk factors. The medication-related problems were mainly observed with antimicrobials, central nervous system (CNS), central venous system (CVS), and inflammatory and immune modulators. Conclusion: The risk factors involved are illiteracy regarding prescribed therapy benefits. In the patient’s medication therapy, warfarin has more adverse events, and an observation of the patient’s plasma concentration levels increased.

Effect of pharmacist interventions on pulmonary function parameters of Iraqi asthmatic patients: A comparative study

Background: Despite the fact that asthma is a long-term disease that may be treated, many people are unable to control their symptoms due to a lack of knowledge about their condition. The study's purpose was to find out if a pharmacist intervention improved asthma management because of this.
 Objective: this study designed to assess the effect of pharmaceutical care on pulmonary functions test.
 Method: The study was completed in three months. The patients who were enrolled were divided into two groups: Group 1 consists of 23 asthma patients who were randomly assigned to receive conventional therapy for chronic bronchial asthma based on disease stage and severity, as well as a pharmaceutical care plan that includes patient care and education, for three months. Group 2: Included in the study were 21 asthma patients who were randomly randomized to receive only conventional therapy for chronic bronchial asthma based on illness stage and severity for three months. All individuals included in this trial had their ACT and PFT levels checked at the start and three months later.
 Result: the conclusion of the study, patients who received a verbal and written pharmaceutical implementation plan significantly improved their asthma control by increasing medication adherence, which was accompanied by an improvement in mean ACT and PFT scores for the interventional group when compared to the control group after 3 months of follow up.
 Conclusion: The results of the study approved the important role of the pharmacist in asthma control to improve medication adherence and enhancing PFT and this mean increase asthma control

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.

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial

ObjectiveTo estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes.DesignCluster randomised controlled trial, with clusters based on triads of a pharmacist...

Connecting Pharmacists and Other Health Care Providers (HCPs) towards Drug Therapy Optimization: A Pharmaceutical Care Approach.

Pharmaceutical care services offered by pharmacists rationalize drug therapy, improve patient quality of life, and save patients' lives. This study was designed to optimize patient drug therapy through pharmaceutical care services offered by a pharmacist in consultation with other health care providers (HCPs) at a tertiary care hospital. This descriptive study was conducted to assess the role and effectiveness of pharmacists in optimizing drug therapy outcomes. The study was carried out at an internal and pulmonary medicine unit of a tertiary care hospital in Srinagar, Jammu and Kashmir, India, with a total of 50 health care providers (HCPs) (24 doctors, 16 nurses, and 10 pharmacists). A total of 182 patients (males and females) of all age groups were recruited into the study over a period of nine months. Patient-specific pharmaceutical care plans initiated by the pharmacist based on drug therapy-related needs and problems were used to address and optimize drug therapy outcomes in consultation with other HCPs. A total of 388 drug-related problems (DRPs) with an average of 2.29 DRPs per patient were identified, for which 258 pharmaceutical care plans as interventions were proposed, out of which 233 (90.31%) were accepted and implemented. Preassessment and postassessment by HCPs on services rendered by the pharmacist showed a positive change in attitude among HCPs with respect to their endorsement and acceptance of the pharmacist's services in providing direct patient care. Pharmaceutical care services offered by pharmacists helped in optimizing drug therapy and patient care.

Prospective Study on Identification of Risk Factors, Assessment of Respiratory Distress in Pediatrics

Introduction: Respiratory tract infection (RTI) is defined as any upper or lower respiratory tract infectious disease. Globally, respiratory infections are the leading cause of infant and child mortality and a substantial burden of morbidity. Proper use of antibiotics is crucial and should be incorporated into the pharmaceutical care plan. Aim: The present study aimed to identify risk factors, and assess respiratory distress in pediatrics by using the ReSVinet scale. Materials and Methods: A prospective observational study was conducted for the age of < 2 years over 6 months with a sample size of 250 in the pediatrics department. Results: The Majority of the patients were from the age group of 0-1 year (81.6%). Female patients are more (56%). Out of 250 cases, most of the patients are from rural (69.2%). Most of the patients are found to be undernourished (72.4%). Cold, cough (78%), and breathing difficulty (19.6%) are more commonly occurring symptoms in patients with pulmonary infections. Respiratory distress (25.6%), and pneumonia (20.8%) are found to be more prominent diseases in pediatrics. Every preterm patient is affected with respiratory distress syndrome (74.8%). In our study uppermiddle and lower-middle socioeconomic classes were affected by RTI. Conclusion: The study concludes that they are multiple aetiological factors in this group, which include Age, Gender, Residence, Gestation, and Nutrition can cause ARI. The ReSVinet Scale was found to have substantial reliability.

Feasibility of a collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: a preliminary study.

Pharmacists working in general practices provide medication reviews with recommendations to general practitioners (GPs) to optimise medications. We describe a model where the pharmacist is empowered with increased responsibility to implement agreed recommendations through collaborative prescribing. To assess a collaborative pharmacist prescribing model incorporating increased pharmacist responsibility, for patients with chronic diseases in general practice. This was a pre-test-post-test quasi experimental pilot study using a pharmacist embedded in three Australian general practices. A pharmaceutical care plan was developed with patients and their GP to identify drug related problems (DRPs). The pharmacist discussed recommendations to manage DRPs with the GP and implemented recommendations agreed by the GP and patient over the six-month study period. Outcome measures included acceptance and implementation rate of recommendations made by the pharmacist. The pharmacist made 135 recommendations to optimise medicine use of which 126 (93.3%) were accepted by the GP. There were 105 (83.3%) implemented by the end of the study of which the pharmacist implemented 62 (49.3%). Compared to other Australian studies using a general practice pharmacist model, this study suggested increased pharmacist responsibility through collaborative prescribing led to high acceptance and implementation rates of recommendations to manage DRPs.

A Study on the Assessment of Knowledge and Awareness towards Drug-Food Interactions among Pharmacy Students

Aim: To evaluate the knowledge and awareness towards the drug-food interactions among the Indian pharmacy students.
 Materials and Methods: A total of 132 pharmacy students were participated in this study by filling the knowledge and awareness questionnaire. In this study the questionnaire was divided into 2 categories that include the evaluation of knowledge and awareness. The knowledge of study participants were graded into good (8-10) moderate (5-7) and poor (> 4).
 Results: A total of 132 pharmacy students were participated in the study and among the 43 (32.6%) were found to be males and 89 (67.4%) were found to be females. In this study, 43.2% of the study participants were having good knowledge 53.8% of the study participants were having moderate knowledge and the remianing 3% of the study participants were having poor knowledge about drug-food interactions. About 71 (53.3%) of the study participants had the awareness regarding the usage of the hand book on software programme in order to check the drug interactions before taking them. About 130 (98.5%) of the study participants, felt that the doctors and the pharmacists should update their knowledge about the drug interactions.
 Conclusion: Pharmacy students should have enough knowledge in the aspect of drug-food interactions as they are directly or indirectly involving in the pharmaceutical care plan of the patients once they become professionals. They should take the responsibility in creating the awareness regarding the drug-food interactions among the patients and should work efficiently in providing the better patient care.

A Pharmaceutical Care Plan to Minimize the Incidence of Potential Drug-Related Problems in Cancer Patients

A Pharmaceutical Care Plan to Minimize the Incidence of Potential Drug-Related Problems in Cancer Patients

Protocol for systematic review and meta-analysis of randomized controlled trials, cost-benefit analysis and interrupted time-series interventions on pharmacist's prescribing.

Shortening the process of prescribing via permitting the pharmacist to select the most appropriate pharmaceuticals for each particular patient may provide great opportunities for pharmacists to develop suitable pharmaceutical care plan, monitor and follow up prescribed medications, communicate and consult physicians for more confirmations. The objective of the current protocol for the systematic review and meta-analysis of pharmacists prescribing interventions was to explore, investigate the evidence, assess and compare PICO in patients with medical conditions (population), receiving pharmacist's prescribing care services (interventions) versus non-pharmacist's prescribing (comparators), and identify how it will impact the clinical, humanistic, and economic patient's outcomes (outcomes). The necessary elements of PRISMA will be strictly followed to report the systematic review. The meta-analysis will be reported in line with the Cochrane guidelines for synthesis of trials and all forms will be based on quality measures as per the validated Cochrane templates. We will present the results of the systematic review and the meta-analysis based on PICO comparison between the included trials. We have identified four models of pharmacist prescribing interventions (independent, dependent [collaborative], supplementary, and emergency prescribing). The results will contain a systematic critical evaluation of the included trials in terms of the sample number of the population (characteristics), the type of interventions and the comparators, and the main outcome measures. This protocol will report the evidence and explore the magnitude of impact of pharmacist prescribing interventions, on clinical, humanistic, and economic outcomes. .

Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews

Regular clinical medication reviews (CMRs) are recommended for monitoring and addressing potential drug-related problems, especially in elderly people. Interprofessional collaborative practice (ICP) by general practitioners, community pharmacists, and nurses in a CMR is recommended and expected to produce more efficient CMRs. Involving home care nurses in ICP is not yet well implemented, and their perspectives are unclear. This study explores how they perceive their role in ICP in CMRs and the requirements to assume that role. Structured interviews were performed, using case-vignettes; data were analyzed with a thematic analysis approach. Twelve home care nurses were interviewed. Three themes regarding the nurses' role were identified: (1) observing, recognizing, and communicating information for a CMR to prescribers and community pharmacists (2); helping to provide patient information and education about implemented changes in the pharmaceutical care plan; and (3) the nurses’ level of involvement in ICP. Three themes regarding requirements were identified: (1) nursing competences, (2) periodic interprofessional consultation and ad hoc interprofessional communication, and (3) guidelines describing the role of nurses. Home care nurses could provide additional support in a CMR. Nursing competences, periodic interprofessional consultation and ad hoc interprofessional communication, and guidelines describing the role of home care nurses are required.

Pharmacy students’ perceptions and attitudes towards experiential training in Jordan and United Kingdom

Purpose: To examine the quality of pharmaceutical experiential training by developing an experiential training survey.
 Methods: An online survey was placed on E-learning platforms in Jordan and UK to develop a validated instrument that can assess pharmacy students' perceptions of the experiential program implemented in their curricula.
 Results: A total of 377 students from Jordan (250 students) and the UK (127 students) completed the survey. Principal component analysis was used to conduct exploratory factor analysis and to assess the factor structure for the data. A two-factor model was applied to the data obtained from the students. These factors included students’ feelings toward experiential training (Perceiver Feelings; PF) and their ability to conduct a full Pharmaceutical Care Plan (PCP). Students from both Jordan and the UK showed a higher satisfaction PF score toward the experiential training program compared to PCP. Being female and not having prior practice experience led to significantly lower PCP scores compared to males and having a prior practice experience, respectively.
 Conclusion: The availability of a validated questionnaire will help in investigating the effectiveness of experiential training courses.
 Keywords: Experiential training; Factor Analysis; Survey development; Pharmacy

Pharmacist-led transitions of care between hospitals, primary care clinics, and community pharmacies.

Pharmacist-led transitions of care (TOC) interventions have been described as some of the most promising interventions to reduce medication-related harm (MRH) in older adults. This study analyzed the feasibility of pharmacist-led TOC interventions between hospitals, multidisciplinary primary care clinics (PCC), and community pharmacies. Adults aged 65 years and older at risk of MRH in three regions of Quebec, Canada, with contrasting contexts of care based on university affiliation were recruited in this multicenter, single arm, and prospective intervention cohort. The hospital pharmacist developed the pharmaceutical care plan in collaboration with the hospital physician and transferred this plan with the hospitalization summary, at hospital discharge, to the PCC family physician and to the community and PCC pharmacists. A consultation with the community pharmacist was scheduled within seven days of hospital discharge and with the PCC pharmacist when appropriate. Feasibility outcomes included the time to complete the interventions and their location. The 123 eligible patients had a mean age of 78.5 years, and 63.4% were females. The most frequent inclusion criterion was 10 medications or more, including one high-risk medication for 90 patients (73%). Recruitment in one region was stopped after three months due to unsuccessful recruitment of key PCC. The hospital pharmacist interventions took a median of 165 min. The first consultations of the PCC and community pharmacists took a median of 15 and 50 min. Among the 96 patients with a post-discharge pharmacist follow-up, 23 (24.0%) had a consultation with a PCC pharmacist, with 65.2% of the consultations conducted at the PCC. The community pharmacists conducted a consultation with 88 patients (93%), with more than 70% of consultations conducted by phone. Our study showed the feasibility of pharmacist-led TOC interventions between hospitals, PCC, and community pharmacies and detailed the novel role that PCC pharmacists played in optimizing TOC interventions.

Pharmacist-led interventions during transitions of care of older adults admitted to short term geriatric units: Current practices and perceived barriers

BackgroundDuring transitions of care, older adults are at risk of adverse drug events which could lead to avoidable hospital visits. Pharmacists are increasingly involved in care teams at various stages of the continuum of care. The types and frequency of clinical interventions performed by pharmacists in the geriatric practice setting remain poorly documented. ObjectivesThis study aimed to describe the current integration of pharmacist interventions during transitions of care of older adults admitted in short-term geriatric units (STGUs) and to explore barriers and facilitators to their implementation in clinical practice. The secondary objective was to explore associations between certain patient characteristics and pharmacist-led interventions during transitional care. MethodsA mixed methods study was conducted with pharmacists practicing in STGUs in the Montreal area, Canada. The application of 8 pharmaceutical interventions was assessed using a self-administered questionnaire, along with as a retrospective chart review. Four semi-structured group interviews were conducted in order to identify perceived barriers and facilitators. ResultsThirteen pharmacists participated in the study. In the questionnaire, medication reconciliation on admission and at discharge was reported as being performed at least half the time by 12 (92%) and 7 (54%) pharmacists, respectively. The retrospective chart review revealed that these interventions were documented in 95 (98%) and 25 (26%) files, respectively. While 35% of patients had a documented pharmaceutical care plan on admission, none was documented at discharge. Several barriers to implementing clinical interventions were identified such as lack of time, technical support, communication and standardization. ConclusionsPharmacists are involved at different periods of transitional care; however, certain barriers should be addressed in order to expand their role in discharge planning. Providing guidelines on what is expected at discharge and post-discharge, and having a practice focused on delegation and collaboration would help pharmacists increase their role throughout the transition of care of older adults.