Pharmaceutical Committee Research Articles

What are the priorities for improving quality for community pharmacy professional services? Nominal group technique discussions with multiple stakeholders

BackgroundHealthcare systems globally are expanding community pharmacy services to meet patient needs and reduce healthcare costs. In England this includes helping community pharmacies to provide integrated professional services but concerns persist over quality of care. This study aimed to identify priorities from key stakeholders for improving the quality of professional community pharmacy services.MethodsSix homogenous nominal group (NG) discussions (face-to-face and online) involved 36 participants from diverse stakeholder backgrounds. Participants included patients (n = 10), community pharmacists (n = 7), general practitioners, a general practice-based pharmacist (n = 4), community pharmacy service regulators (n = 5), Community Pharmacy England members (n = 4), and Local Pharmaceutical Committee members (n = 6), both responsible for negotiating services. Delbecq’s NG technique included silent idea generation, round-robin feedback, discussion, and ranking for consensus building. Discussions were audio-recorded and verbatim transcripts analysed thematically using NVivo12. Emerging themes across all NGDs were analysed by thematic analyses. Individual discrete ranking within each NGD were then combined by summing the mean scores of the categories within each theme.ResultsFive key themes emerged from qualitative analysis across all NGDs: quality service design, sustained funding, integration with the wider healthcare system, positioning community pharmacy as a hub for patient needs, and adequate workforce training, optimising staffing and retention. Participants emphasised the need for long-term commitment to quality service design centred on addressing local patient need, sustained and predictable funding. Community pharmacy staff having some access to patient records for making informed clinical decisions was discussed. Scoring priorities ranked as follows (highest to lowest): ensuring quality service design, sustained funding, integration with healthcare systems, community pharmacy as patient hubs, and workforce training and retention, reflecting different stakeholder priorities in these areas.ConclusionThis study highlighted core priority areas for a framework to improve the quality of community pharmacy professional services within a more responsive and integrated primary care led healthcare system.

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

The place of tadalafil in the treatment of PAH in the light of new clinical guidelines of the Eurasian Association of Cardiologists

Pulmonaryarterialhypertension(PAH)isalife-threateningcardiovascular disease that is characterized by a marked increase in pulmonary vascular resistance and pulmonary artery pressure due to obstructive remodeling of the pulmonary vascular bed with the development of right ventricular heart failure as a cause of premature mortality. Impaired synthesis and reduced bioavailability of nitric oxide is one of the key pathophysiological mechanisms of the development and progression of the disease. The review paper presents key data from the evidence base on the clinical use of tadalafil, a phosphodiesterase type 5 inhibitor (PDE5), which in August 2023 approved by the Pharmaceutical Committee of the Russian Ministry of Health for the indication – treatment of patients with PAH. Tadacardil from Canonpharma Production is the first and only drug in Russian practice today with the active substance tadalafil with the registered indication “PAH”, approved in the Eurasian Guidelines for the diagnosis and treatment of pulmonary hypertension 2023 and available on the territory of the Russian Federation and the EAEU. Tadacardil is indicated for use in adult patients with PAH functional class II and III according to the WHO classification to increase exercise tolerance. The efficacy of tadalafil has been shown in idiopathic PAH and PAH associated with connective tissue diseases. The recommended dose is 40 mg (2 tablets of 20 mg) once a day. The paper describes the mechanism of action and pharmacological effects of PDE5 inhibitors, features of the pharmacokinetics of tadalafil in comparison with other drugs of the class. The advantages of Tadacardil from Canonpharma Production are the proven effecacy of use in patients with PAH, ease of use due to a single dose of 2 tablets of 20 mg once a day in a standard dose; good tolerability and favorable safety profile; proven bioequivalence to the reference drug. In light of the new Eurasian recommendations for the diagnosis and treatment of PH, tadalafil has a wide field for clinical use, which will improve the treatment options for patients with PAH both in mono- and combination therapy.

Exploring pharmacists’ perception of medicines waste and how they can help reduce the burden

Abstract Introduction Medicines waste can occur due to a variety of reasons and lead to financial and environmental implications. Previous studies have investigated how patients manage medicines waste and have identified that the reasons for incorrect disposal could be due to patient convenience, lack of awareness or safety concerns with children1. In this study we have explored the pharmacist's perception of medicine waste to inform future polices that could be introduced to reduce medicines waste. Aim To explore the knowledge and views that pharmacists have about medication waste, and the methods that they use to reduce it, to inform how medication waste is managed. Methods Following ethical approval, a two-phased study was conducted among pharmacists from various sectors in England, 20 of whom had their independent prescribing qualification. In phase one a questionnaire was developed to explore the perceptions of the pharmacists. This included how much of an impact methods such as deprescribing and the education of patients could have on the reduction of medicines waste. The electronic questionnaire was emailed through local and regional networks such as pharmaceutical committees and affiliates of the university. In the questionnaire we asked respondents if they would like to participate in phase two of the study, which involved an interview to gain in-depth knowledge and further perspective. The interviews were recorded and transcribed and then coded into the four themes by the researchers; causes of waste, barriers preventing the reduction of waste, systems in place to reduce waste and patient education. Results When pharmacists were asked how high of a priority reducing waste was in there practice they worked at on a scale of 1 (high priority) to 5 (low priority). It was found that most ranked it to be a low priority, with 12 respondents choosing one and over half (55.9%) choosing 1 or 2, indicating that to pharmacists reducing waste is not currently prioritised in practice. When asked about how often they educate patients on medicine waste disposal, most gave the response either often (32.4%) or sometimes (38.2%) suggesting most patients are not educated about medicine waste disposal. During interviews, the reasons for medicine waste not being a priority was due to time constraints and lack of incentives. Discussion/Conclusion Whilst a small scale study only, the findings suggest that whilst pharmacists seem to see medicine waste as a big issue in the UK, they may not see medicine waste as a high priority in practice. This may be due to a lack of incentives and needing more spare time to perform activities to reduce waste in practice. Schemes and incentive programs need to be implemented to encourage pharmacists to reduce medicine waste in practice before pharmacists are likely to actively try and reduce waste. Further research needs to be done to evaluate for possible schemes or incentive programs and the cost-effectiveness of the schemes in terms of money saved and total medicine waste reduction.

Pharmacy and Genomic Medicine: A UK-wide survey of pharmacy staff assessing their prior education, confidence and educational needs

Abstract Introduction Pharmacy teams are key in helping patients to get the most from genomic medicine.1,2 However, genomics has only recently been included in undergraduate curricula, and it has been suggested that all healthcare professionals could benefit from education in pharmacogenomics2. We surveyed pharmacy staff to gather information on previous education, current practice and future educational needs in genomics and pharmacogenomics. Aim This survey aimed to establish existing levels of education and confidence in genomics and pharmacogenomics in pharmacy staff working in any role, in any sector, across the UK, and to investigate respondents’ preferences in delivery of genomic education. Methods The survey was based on a 2021 survey of genomic knowledge among medical staff by Health Education England (HEE)3, and amended to reflect pharmacy roles and practice following discussion with pharmacy leads from the 7 NHS Genomic Medicine Service Alliances in England, and from Scotland, Wales and Northern Ireland. SmartSurvey software was used to host the survey, with data held securely. The survey was open between 1st March and 16th May 2022, and was publicised via pharmacy groups including the Royal Pharmaceutical Society, National Pharmacy Association, Local Pharmaceutical Committees, chief pharmacists networks in primary and secondary care, and social media. This work was assessed using the NHS Health Research Authority Research screening tool and judged as ‘not research’; therefore ethical approval was not required. Results 1,552 responses were received from pharmacists, pharmacy technicians, dispensers and other pharmacy staff across the UK; 68% of responses were from England, 13% from Scotland, 10% from Northern Ireland and 9% from Wales. The majority of responses (69%) were from Pharmacists, with 24% from Pharmacy Technicians and 4% from Pharmacy support workers. Only 13% of respondents had received any formal training in genomics. Most respondents felt unprepared to use genomic testing in their practice; just 8% of pharmacists (including trainees), and 1% of pharmacy technicians (including trainees) felt prepared. However, 65% of respondents thought that genomics would change their practice within the next 5 years, and over 70% of pharmacists, and 56% of pharmacy technicians, could envisage ordering, advising on, or counselling patients on genomic testing in the future after appropriate training. 29% of respondents (mainly pharmacy managers) did not currently see patients and therefore might not train personally in genomics. Discussion/Conclusion This work suggests that pharmacy teams are likely to require educational support to embrace the opportunities of genomic medicine. High survey engagement suggested that respondents were keen to make their voices heard. Pharmacists appeared more confident in their ability to advise patients on genomics than Technicians, however both groups seemed keen to receive training. One limitation is that respondents were likely interested in genomics; those with no interest may not have completed the survey. Additionally, pharmacy managers who do not see patients might not train personally in genomics, but may influence strategy for pharmacy genomics service development and delivery. National bodies should capitalise on enthusiasm across the sector to help drive pharmacy genomics services forward through education and training.

A pilot study to assess the impact of the Discharge Medicines Service for paediatric patients

Abstract Introduction The Discharge Medicines Service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework from February 20211,2. Aim The pilot study aimed to evaluate this service for paediatric patients and to identify if there are any barriers to referrals. Methods The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 – February 2023. All paediatric in-patients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed the referrals through PharmOutcomes, and can accept, complete, refer, or reject referrals on this platform. A survey was also sent to community pharmacists, through the Local Pharmaceutical Committee, to better understand how comfortable community pharmacists felt completing referrals for paediatric patients. The study was deemed as a service evaluation by the Clinical Audit Department and Research and Development Department and therefore did not require ethical approval. Results Out of the 149 referred patients, 63 (42.3%) had completed referrals, 19 patients (12.8%) had their referrals rejected, and the remaining 67 patients (44.9%) either had their referrals accepted or referred. Younger children (less than 2 years) were more likely to have their referral rejected compared to older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%), and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation and only nine community pharmacists (42.9%) survey answered as either somewhat comfortable or very comfortable about completing a referral for a paediatric patient. In addition, one community pharmacist reported they did not know how to complete a referral for a paediatric patient. Discussion/Conclusion This pilot study demonstrates the value of completing referrals for paediatric patients as well as the potential barriers. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals. As this was a pilot study, the number of patients included was small, and a larger scale study is required to further investigate the implications of DMS referrals for paediatric patients and reasons for non-completion of referrals. Although the numbers of respondents to the community pharmacist survey were very small, this did give an insight into how community pharmacist colleagues felt about receiving paediatric referrals and potentially highlights the need for ongoing training and support. More research is required to explore how community pharmacists can be supported to complete DMS referrals for paediatric patients.

Reply to the letter to the editor on the statement of Rauch et al. (2023) on the guidelines of the Pharmaceutical Committee of the German Medical Profession (AkdÄ)

Reply to the letter to the editor on the statement of Rauch et al. (2023) on the guidelines of the Pharmaceutical Committee of the German Medical Profession (AkdÄ)

Pharmacies save 1,700 GP appointments through NHS-funded walk-in consultation service

Just under 100 community pharmacies in Humber and North Yorkshire are piloting a ‘walk-in’ minor ailment consultation service, saving “over 1,700” GP appointments in 11 weeks, according to the local pharmaceutical committee (LPC). The ‘Walk-in consultation service’ (WiCS), which was commissioned on 1 September 2022, pays pharmacists in Humber and North Yorkshire £14 per patient […]

A qualitative evaluation of an online training package for the provision of a new pharmacy osteoarthritis service

Abstract Introduction Community pharmacies are well-placed to support patients in the management of long-term conditions such as osteoarthritis (OA). In Staffordshire there are approximately 75,000 people with knee OA and 45,000 with hip OA.1 Community pharmacists in the area were invited to be part of an osteoarthritis service pilot scheme. This new service links to an ongoing international project, Joint Implementation of Guidelines for Osteoarthritis in Western Europe (JIGSAW-E,) which supports healthcare professionals to aid patients in self-management of their OA.2 In preparation for delivery of the service, an online training package was distributed to the participating pharmacists to increase their knowledge of the condition. Aim This study aimed to evaluate the osteoarthritis training package and to establish improvements which could be implemented if the service is rolled out. Methods All pharmacists who had completed the training package were identified by the Local Pharmaceutical Committee Chief Operating Officer. An email was sent detailing the evaluation with an invitation to be interviewed. Those interested responded with proposed dates and times. An interview guide was developed based on the study aims and objectives and knowledge of the training package. Semi-structured telephone interviews were conducted and digitally recorded with verbal consent. Recordings were transcribed verbatim and analysed thematically by applying the Framework Approach.3 As this was a service evaluation, no ethical approval was required. Results Twelve pharmacists were invited to be interviewed and six agreed. Three participants were female, three worked for a multiple pharmacy chain, two in independent pharmacies and one in a distance-selling pharmacy. Five themes emerged from the data, namely, baseline knowledge, format of the training package, appropriateness of the content, views on the specific resources and provision of the service. Most pharmacists reported having limited prior knowledge of OA although they were aware of pharmacological treatment options. The online training format was seen as convenient, although some would have liked a face-to-face element so that they could interact and learn from others. Time spent on the training package ranged from less than one hour up to five, with most mentioning a lack of time during the working day to review it. Regarding content, the materials were generally considered relevant and at an appropriate level. Some felt the detail provided was adequate, whilst others wanted to do further research themselves. Views on the included resources were generally positive. Participants liked that the JIGSAW videos were of short duration and easy to understand, and downloadable resources from Keele University, NICE guidelines and charity websites were highlighted as particularly useful. All pharmacists stated that they felt they had enough knowledge to begin providing the service and planned to (or already had) encouraged staff to complete relevant parts of the training too. Discussion/Conclusion Although this was a small study in a single geographical area there was representation across pharmacy types. The study found that the online OA training package was generally well-received but a face-to-face element would be desirable. Further research would be useful to gauge its impact on service delivery.

Evaluation of a pilot community pharmacy-led discharge medicines service

Abstract Introduction The risk of miscommunication and unintended changes to medicines is a significant problem when patients transfer between care settings.1 Medicines reconciliation is recommended at each transfer of care to reduce the risk of these errors occurring.2 Whilst common practice on admission to hospital, medicines reconciliation was not routinely undertaken for patients after discharge. One local pharmaceutical committee piloted a discharge medicines service (DMS) provided by community pharmacists within the area. The pilot took place prior to commissioning of the essential service, NHS DMS3. It involved a person-centred consultation with each patient and reconciliation of the patient’s post-discharge medicines using the electronic discharge summary received via PharmOutcomes. Any issues were resolved by the community pharmacist where possible, or the GP surgery if necessary. Aim This study aimed to evaluate the impact of the pilot DMS. Methods A mixed-methods approach was taken to comprehensively evaluate the service. Nine community pharmacies provided DMS for patients discharged from hospital. Quantitative data were collected by community pharmacists for each DMS, then collated and analysed using descriptive statistics by an independent researcher. Qualitative, semi-structured telephone interviews based on the quantitative findings were conducted after the pilot with pharmacists from each of the pilot pharmacies. Interview recordings were transcribed and used to contextualise the quantitative findings. Ethical approval was granted by LJMU research ethics committee. Results 56 DMS were carried out a four-month period. 43% (24/56) of patients had at least one medicines-related discrepancy. A total of 40 discrepancies were identified by community pharmacists, 50% (20/40) of which involved high-risk medicines known to cause hospital readmission. 63% (25/40) of the discrepancies identified prevented the dispensing of unnecessary medicines requested, and consequently reduced medicines wastage with an estimated cost saving of £229.06. Community pharmacists from each of the pilot pharmacies found the service worthwhile, perceiving that it helped to improve communication between healthcare professionals, increase patient involvement in their care and cut the medicines waste associated with unnecessary dispensing and returned medicines. Whilst overall beneficial, community pharmacists did report some difficulties, including examples of unclear discharge information documented by hospitals and the time spent trying to contact GP surgeries to resolve some prescribing discrepancies. Discussion/Conclusion This small-scale pilot demonstrated that the impact of DMS could be wide-reaching. A reduction in medicines waste was seen, resulting in a positive impact on sustainability and cost savings for the NHS. The savings reported are due to medicines waste alone and do not take into account any other potential cost savings incurred, for example preventing the costs associated patient harm from medication errors, re-admission to hospital or wasted healthcare professionals’ time. Whilst lessons can be learned from the pharmacists’ feedback to improve efficiency, DMS has a positive impact on various healthcare providers in terms of efficiency and cost savings: GPs, hospitals and pharmacists. Patients will benefit from the efficient provision of appropriate post-discharge medicines and reduced risk of medicines-related issues or hospital readmission. The person-centred approach involves patients throughout to highlight any issues and supports them to more effectively manage their own care.

PENGARUH LINGKUNGAN KERJA, MOTIVASI KERJA DAN DISIPLIN KERJA TERHADAP KINERJA KARYAWAN KOMITE FARMASI NASIONAL

This study aims to determine: (1) The effect of work motivation on the performance of the Secretariat Of The National Pharmaceutical Committee Of The Republic Of Indonesia, (2) The effect of work discipline on employee performance.. National Pharmaceutical Committee Of The Republic Of Indonesia. This research is a survey research with a quantitative approach. The sample of this research is the employees of the Secretariat of the National Pharmacy Committee of the Ministry of Health, totaling 60 employees with a proportional random sampling technique. Data collection used a questionnaire while data analysis was performed using multiple regression analysis.The results of the study found that: (1) Work motivation has a t value of 2.551 with a significance level of 0.015 so that it is known that tcount> ttable (2.551> 2000), and a significance level of 0.015 <0.05. Which means that work motivation (X1) has a significant effect in a positive direction on employee performance at the National Pharmacy Committee of the Ministry of Health of the Republic of Indonesia (Y). (2) Work Discipline has a t value of 2.119 with a significance probability level of 0.039 So that it is known that tcount> ttable (2119> 2000), and a significance level of 0.039 <0.05, which means that Work Discipline (X2) has a significant effect in a positive direction on performance. Employees at the National Pharmacy Committee of the Indonesian Ministry of Health. (3) The work environment has a value of t count 13,000 with a probability level of significance of 0.000 So that it is known that tcount> ttable (13,000> 2000), and a significance level of 0,000 <0.05, which means that the Work Environment (X3) has a significant effect in a positive direction on performance. Employees at the National Pharmacy Committee of the Indonesian Ministry of Health.

Pharmacognostic and Phytochemical Evaluation of Bellente Gida (Mussaenda Belilla Buch.Ham.) A Folklore Claim

Traditionally used medicinal plants have recently received the attention of the pharmaceutical and scientific committees. Hence there is a need to develop new effective traditional drugs with scientific validation. One such plant is Mussaenda belilla Buch-Ham which belongs to Rubiaceae family locally called as Bellante gida in south canara district Karnataka. It is a climbing shrub. Local people use the leaf juice as shampoo for hair as it is good for hair.
 The present study deals with the pharmacognostic and phytochemical study, analytical parameters, organoleptic tests, macroscopic and microscopic study,p hysical tests. Taste with tongue method showed kashaya madhura rasa.The drug contains carbohydrates, proteins, alkaloids, tannins and phenolic compounds in Aqueous and alcoholic extracts. HPTLC study showed total 9 peaks at 254nm and 10 peaks at 366nm. It also contains calcium, iron, sulphates, chlorides like In-organic compounds.
 It contains the mucilage which is soothing to eyes, hairs. It contains proteins, tannins, phenol, calcium, iron acts as Raktha sthambhaka, Raktha vardhaka, Vrana roopana, and Tvak prasadaka. So it need further experimental and clinical study.

Views of independent prescribing pharmacists on the community pharmacy pilot independent prescribing service: a qualitative study

Abstract Introduction Independent Prescribing Pharmacists (IPPs) can prescribe autonomously within their scope of practice. Their role is increasing within the community setting (1). The Welsh Pharmaceutical Committee has a vision to have at least one IPP in every community pharmacy by 2030 (1). In 2020, an Independent Prescribers’ Service (IPS) pilot was delivered in 13 pharmacies across six of the seven Health Boards in Wales (2), via Choose Pharmacy (CP), an IT platform that provides access to patients’ General Practitioner (GP) medical record. IPS allowed patients to access advice, and, where relevant, be treated in the community pharmacy setting, rather than the GP surgery. The consultation is recorded on CP and the patient’s GP informed of the outcome. As the IPS is a recent development there is little research on this service. Aim To explore the views of community IPPs delivering the IPS. Methods A qualitative methodology was utilised with semi-structured interviews, via telephone or MS Teams. Only thirteen pharmacies were commissioned to deliver the service. Purposive sampling was used to identify IPPs in these premises, who had completed at least one IPS consultation. Participants were informed of the study and written; informed consent obtained. An interview schedule utilised open questions to explore participants’ experiences of the service. Interviews were recorded, transcribed and analysed via deductive and inductive thematic analysis. Analysis was quality assured through discussion with the research team. All identifiable information in the transcripts were removed to ensure anonymity. Results Nine interviews were conducted, including participants from all Health Boards in the pilot. Interviewees had varied prescribing experience with some only prescribing since the roll out of the pilot. The IPPs’ scope of practice included acute minor ailments, contraception, urinary tract infections and asthma. Four themes were identified: 1.Impact of the IPS: Participants believed the service had impacted on the wider healthcare setting, patients and themselves. Patients had improved convenience and accessibility to a healthcare professional to manage their condition. Patient safety was of a high standard with access to patient notes ensuring informed, appropriate clinical decisions. 2.Relationship with GP: Positive relationships with local GPs was believed to be critical to the pilot’s success. 3.Future delivery: This will rely on support, funding, and ongoing review. A ‘blended approach’ whereby patients are seen with or without an appointment was believed to provide the flexibility that patients want. 4.Remote consultations: Can have an impact on patient safety, making non-verbal communication and language barriers more challenging. After nine interviews, no new information was gathered. Conclusion Participants were supportive of the service which will potentially benefit IPPs, patients and GPs, and improve patient care. Pharmacists, by providing a high quality, accessible service, ensures that forward thinking healthcare is delivered in a manner which makes use of the skills of those working in the community. The study, albeit small scale, explored the thoughts of the majority of IPPs conducting the IPS service at that time. More information is needed to understand the impact of the service and effect on practice, from the practitioner and patient perspective. References (1) Walsh A. All Welsh pharmacies to have independent prescribers. Wales; 2019 [accessed 5 February 2021]. Available from: http://www.pharmacymagazine.co.uk/all-welsh-pharmacies-to-have-independent-prescribers (2) NHS Wales Informatics Service. Choose Pharmacy. Wales; 2021 [accessed 5 Feb 2021]. Available from: http://www.nwis.nhs.wales/systems-and-services/in-the-community/choose-pharmacy/

Disclosure, transparency, and accountability: a qualitative survey of public sector pharmaceutical committee conflict of interest policies in the World Health Organization South-East Asia Region

BackgroundWeak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharmaceutical committees, relationships with the private sector can result in conflicts of interest, which may introduce commercial biases into decision-making, potentially compromising public health objectives and health system sustainability. We conducted a descriptive, qualitative study of conflict of interest policies and practices in the public pharmaceutical sector in ten countries in the World Health Organization (WHO) South-East Asia Region (SEAR) (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste) between September 2020 and March 2021.ResultsWe identified 45 policy and regulatory documents and triangulated documentary data with 21 expert interviews. Key informants articulated very different governance priorities and conflict of interest concerns depending on the features of their country’s pharmaceutical industry, market size, and national economic objectives related to the domestic pharmaceutical industry. Public sector pharmaceutical policies and regulations consistently contained provisions for pharmaceutical committee members to disclose relevant interests, but contained little detail about what should be declared, when, and how often, nor whether disclosures are evaluated and by whom. Processes for preventing or managing conflicts of interest were less well developed than those for disclosure except for a few key procurement processes. Where processes for managing conflicts of interest were specified, the dominant strategy was to recuse committee members with a conflict of interest from relevant work. Policies rarely specified that committee members should divest or otherwise be free from conflicts of interest.ConclusionsRobust processes for conflict of interest prevention and management could ensure the integrity of decision-making and build public trust in pharmaceutical processes to achieve public health objectives. Upstream approaches including supportive legislative frameworks, the creation of oversight bodies, and strengthening regulatory institutions can also contribute to building cultures of transparency, accountability, and trust.

Repurposing of Medicines in the EU: Launch of a Pilot Framework.

Repurposing of authorised medicines has been under discussion for a long time. Drug repurposing is the process of identifying a new use for an existing medicine in an indication outside the scope of the original approved indication. Indeed, the COVID-19 health crisis has brought the concept to the frontline by proving the usefulness of this practise in favour of patients for an early access to treatment. Under the umbrella of the Pharmaceutical Committee and as a result of the discussions at the European Commission Expert Group on Safe and Timely Access to Medicines for Patients (STAMP) a virtual Repurposing Observatory Group (RepOG) was set up in 2019 to define and test the practical aspects of a pilot project thought to provide support to “not-for-profit” stakeholders generating or gathering data for a new therapeutic use for an authorised medicine. The group's initial plan was impacted by the outbreak of the SARS-CoV-2 pandemic and the launch of the pilot needed to be postponed. This article describes the progress and the activities conducted by the group during this past and yet extraordinary 2020–2021 to keep the project alive and explores on the background of this topic together with the obvious opportunities this health crisis has brought up in terms of repurposing of medicines.

Pharmacies to offer point-of-care test and treatment for acute cough

Community pharmacies in Liverpool will be able to supply antibiotics to patients with an acute cough following a rapid point-of-care test, the local pharmaceutical committee (LPC) has said. The service — part of a wider ‘Pharmacy First’ service running in the city — will enable pharmacists to supply doxycycline under a patient group direction (PGD) […]

RPS Wales asks for views on 2025 strategy

The Royal Pharmaceutical Society (RPS) in Wales is asking pharmacy professionals for their input as it plans the next phase of the nation’s vision for pharmacy in 2030. In 2018, the Welsh Pharmaceutical Committee asked RPS Wales to manage the development of the vision, called ‘Pharmacy: Delivering a Healthier Wales‘. A document encompassing the full […]

Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa

BackgroundSouth Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector.MethodQualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed.ResultsThis study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly.ConclusionThis was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.

Evaluation of a collaborative pharmacy service initiative for people with intellectual disabilities in residential care homes

Abstract Introduction People with Intellectual Disabilities (ID) often have complex care needs and increased likelihood of premature death.1 The NHS has committed to improving the use of psychotropic medicines in people with ID with the Stopping the Over-Medication of People with Learning Disabilities (STOMP) programme.2 In the Wirral a cross-sector, collaborative service initiative involving community pharmacists and a specialist mental health pharmacist was developed to provide pharmaceutical care reviews for ID care home residents, which included an evaluation of the initiative. Aim This study aimed to determine the number and type of pharmacists’ interventions and GP recommendations in this service initiative. Methods Pharmacists provided pharmaceutical care reviews for ID care home residents using a framework and where applicable made interventions or recommendations to residents’ GPs or consultant psychiatrist. The framework was devised by the lead Consultant, Mental Health Trust lead pharmacist and Local Pharmaceutical Committee representatives to align with national ID priorities.1 Pharmacists were recruited via expressions of interest and direct recruitment by the mental health trust. Using anonymised, aggregated, Clinical Commissioning Group data, an Oversight Group divided all ID care homes in the locality into two groups: homes with residents with low psychotropic medicines use were primarily assigned to community pharmacists, whilst those with higher psychotropic use were assigned to the specialist mental health pharmacist. Pharmacists contacted care home managers and arranged reviews with all residents, sharing learnings in weekly reviews. Community pharmacists identified residents who would benefit from specialist mental health pharmacist review and referred them. Data collected included patient demographic details, medication history, results of assessments completed and interventions/recommendations. Following institutional ethical approval, this data was downloaded from PharmOutcomes into Microsoft Excel and personally identifiable data removed. The data underwent descriptive statistical analysis in SPSS, including frequency counting interventions by type. Results The pharmacists conducted reviews with 160 residents (76 by community pharmacists and 84 by the specialist mental health pharmacist) from November 2019 – May 2020, reflecting all residents in visited care homes. These residents were prescribed 1207 medicines, 74% were prescribed 5 or more medicines (i.e. polypharmacy) and 507 interventions or recommendations were made, averaging 3.3 per resident. Table 1 shows that the highest proportion (30.4%) of these were public health related, whilst changing and stopping medicines accounted for 17.9% and 12.8% respectively. The majority (63%) of interventions made by community pharmacists were public health related, whilst those made by the mental health specialist pharmacist most frequently concerned changing medicines (25%), stopping medicines (18%), and blood monitoring (13%). Conclusion The study findings indicate a high level of polypharmacy among the ID residents and a high number of interventions / recommendations were needed to improve care, in line with national priorities.1,2 The small scale of the study is acknowledged, and further research is warranted. However, the findings suggest that this service model may be an effective use of the respective skill sets of the pharmacists involved and suitable for wider adoption, with community pharmacists focusing on holistic care and specialist mental health making specialist medicines interventions.

Exploring the independent prescribing role of the community pharmacists in Wales

Abstract Introduction Since 2019, the role of independent pharmacist prescribers (IPPs) in primary care has extended to community pharmacies in Wales [1]. This was in response to a Welsh Pharmaceutical Committee report in 2019 that outlined a plan to include an IPP in each community pharmacy in Wales by 2030. This aimed to relieve pressure on general practices, enhance patient care and reduce referral and admission rates to secondary care [2]. As funding was provided by the Government, the number of community pharmacists completing the independent prescribing course increased and many have implemented their prescribing role. Aim To explore the views of community IPPs regarding their prescribing role within community pharmacies in Wales. Methods Semi-structured face-to-face and telephone interviews were conducted with community IPPs from all seven health boards (HBs) in Wales. Ethical approval was obtained from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University and the School of Pharmacy and Bioengineering at Keele University. Purposive sampling was used to identify potential participants. Gatekeepers (HB community pharmacy leads and directors of IPP courses in Wales) sent invitation emails, participant information sheet and consent form to potential participants. Written consent was obtained. Interviews were audio-recorded and transcribed ad verbatim. Thematic analysis was used to analyse the data. Results Thirteen community IPPs across Wales participated. Six themes were identified, including the utilisation of their role as community IPPs, their experiences with their independent prescribing training, motivation to obtain their prescribing qualification and utilise it, the impact, barriers and facilitators to implement and utilise their role. Participants practised as IPPs in the management of minor ailments and some other conditions, such as respiratory and sexual health. The course and training for community IPPs was helpful, but there was a need to focus more on therapeutic and clinical examination skills. The main impact of the role was that it helped to improve communication between community pharmacies and general practices and relieved some pressure on general practices. The main barriers were the lack of appropriate funding by the Government to develop the role, lack of access to patients’ medical records, lack of support and high workload. “One of the areas identified as high risk is for pharmacy prescribers is the lack of access to clinical records. How can you [as community IPPs] make any sensible decisions with half the information?” IPP6 Facilitators included that some services were already in place and the drive from the 2030 vision. Conclusion This is the first study that explored the views of community IPPs regarding their prescribing role in community pharmacies in Wales. It provided an insight into this new role that can be considered by the Welsh Government to achieve the 2030 vision for this role. A limitation to this study was that the role is still new in community pharmacies, which may affect the views of the community IPPs. Many of them have obtained their prescribing qualification but have not started to utilise it yet. Further work is needed to explore a wider population of community IPPs’ experiences as the role develops.