Access To Pharmacists Research Articles

Factors Influencing Older People's Intentions to Vaccinate.

Vaccination is crucial in reducing the spread of disease and improving overall patient mortality. Limited information exists regarding pharmacist accessibility outside traditional medical settings or impact on older patients' intention to vaccinate. This study aimed to examine patient perceptions regarding pharmacist accessibility and vaccination intention. Researchers used a quantitative research method of older people from Ohio, Kentucky, and Indiana. A survey was given to community-dwelling older people who attended different vaccine clinics. The survey included 10 questions describing reasons for not receiving vaccines in the past, how likely they are to receive vaccines if administered at community events, and the importance of having easy access to vaccines. For Likert-type items, a 5-point scale was used. The surveys were collected electronically and anonymously from several community events. Aggregate data were analyzed with descriptive and inferential statistics. One hundred seventy-eight responses were collected. The average age of participants was 75 years, and 70.8% were females. Of the respondents, 44.9% preferred to receive vaccines at a community center, 17.4% at the doctor's office, 4.5% at a clinic, and 9.6% at a sporting event like a boxing match. Men were more likely to receive a vaccine at a sporting event, while women were more likely to be interested in receiving a vaccine at a community center (P < 0.05). Respondents somewhat agreed (median = 4, interquartile range = 3-5) that they do not have transportation to places with vaccines. Age was significantly and negatively correlated with educational attainment (P < 0.001). However, as participants' ages increased, they were significantly more likely to have a belief that vaccines do not work (P = 0.011). The study addressed how pharmacists should consider more community outreach events in convenient locations, like community centers, for older people to improve vaccination rates.

Interprofessional Staffing Pattern Clusters in U.S. ICUs.

To identify interprofessional staffing pattern clusters used in U.S. ICUs. Latent class analysis. Adult U.S. ICUs. None. None. We used data from a staffing survey that queried respondents (n = 596 ICUs) on provider (intensivist and nonintensivist), nursing, respiratory therapist, and clinical pharmacist availability and roles. We used latent class analysis to identify clusters describing interprofessional staffing patterns and then compared ICU and hospital characteristics across clusters. We identified three clusters as optimal. Most ICUs (54.2%) were in cluster 1 ("higher overall staffing") characterized by a higher likelihood of good provider coverage (both intensivist [onsite 24 hr/d] and nonintensivist [orders placed by ICU team exclusively, presence of advanced practice providers, and physicians-in-training]), nursing leadership (presence of charge nurse, nurse educators, and managers), and bedside nursing support (nurses with registered nursing degrees, fewer patients per nurse, and nursing aide availability). One-third (33.7%) were in cluster 2 ("lower intensivist coverage & nursing leadership, higher bedside nursing support") and 12.1% were in cluster 3 ("higher provider coverage & nursing leadership, lower bedside nursing support"). Clinical pharmacists were more common in cluster 1 (99.4%), but present in greater than 85% of all ICUs; respiratory therapists were nearly universal. Cluster 1 ICUs were larger (median 20 beds vs. 15 and 17 in clusters 2 and 3, respectively; p < 0.001), and in larger (> 250 beds: 80.6% vs. 66.1% and 48.5%; p < 0.001), not-for-profit (75.9% vs. 69.4% and 60.3%; p < 0.001) hospitals. Telemedicine use 24 hr/d was more common in cluster 3 units (71.8% vs. 11.7% and 14.1%; p < 0.001). More than half of U.S. ICUs had higher staffing overall. Others tended to have either higher provider presence and nursing leadership or higher bedside nursing support, but not both.

Oncology stewardship practice in the United States: A Hematology/Oncology Pharmacy Association national survey.

The treatment of cancer is associated with high risk for toxicity and high cost. Strategies to enhance the value, quality, and safety of cancer care are often managed independently of one another. Oncology stewardship is a potential framework to unify these efforts and enhance outcomes. This landscape survey establishes baseline information on oncology stewardship in the United States. The Hematology/Oncology Pharmacy Association (HOPA) distributed a 38-item survey composed of demographic, institutional, clinical decision-making, support staff, metrics, and technology sections to 675 HOPA members between 9 September 2022 and 9 October 2022. Most organizations (78%) have adopted general pharmacy stewardship practices; however, only 31% reported having established a formalized oncology stewardship team. More than 70% of respondents reported implementation of biosimilars, formulary management, and dose rounding as oncology stewardship initiatives in both inpatient and outpatient settings. Frequently cited barriers to oncology stewardship included lack of clinical pharmacist availability (74%), lack of oncology stewardship training (62%), lack of physician/provider buy-in (32%), and lack of cost-saving metrics (33%). Only 6.6% of survey respondents reported their organization had defined "value in oncology." Lack of a formalized stewardship program was most often cited (77%) as the rationale for not defining value. Less than one-third of respondents have established oncology stewardship programs; however, most are providing oncology stewardship practices. This manuscript serves as a call to action for stakeholders to work together to formalize oncology stewardship programs that optimize value, quality, and safety for patients with cancer.

Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study.

Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Łs 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..

Organizational Context and Facilitation Interactions on Delirium Risk in Long-Term Care: A Cross-Sectional Study

ObjectivesOrganizational context (eg, leadership) and facilitation (eg, coaching behaviors) are thought to interact and influence staff best practices in long-term care (LTC), including the management of delirium. Our objective was to assess if organizational context and facilitation—individually, and their interactions—were associated with delirium in LTC. DesignRetrospective cross-sectional analysis of secondary data. Setting and ParticipantsWe included 8755 residents from 281 care units in 86 LTC facilities in 3 Canadian provinces. MethodsDelirium (present/absent) was assessed using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0). The Alberta Context Tool (ACT) measured 10 modifiable features of care unit organizational context. We measured the care unit's total care hours per resident day and the proportion of care hours that care aides contributed (staffing mix). Facilitation included the facility manager's perception of RAI-MDS reports' adequacy and pharmacist availability. We included unit managers' change-oriented organizational citizenship behavior (OCB) and an item reflecting how often care aides recommended policy changes. Associations of organizational context, facilitation, and their interactions with delirium were analyzed using mixed-effects logistic regressions, controlling for covariates. ResultsDelirium symptoms were prevalent in 17.4% of residents (n = 1527). Manager-perceived adequacy of RAI-MDS reports was linked to reduced delirium symptoms [odds ratio (OR) = 0.63]. Higher care hours per resident day (OR = 1.2) and an available pharmacist in the facility (OR = 1.5) were associated with increased delirium symptoms. ACT elements showed no direct association with delirium. However, on care units with low social capital scores (context), increased unit managers' OCB decreased delirium symptoms. On care units with high vs low evaluation scores (context), increased staffing mix reduces delirium symptoms more substantially. Conclusions and ImplicationsUnit-level interactions between organizational context and facilitation call for targeted quality improvement interventions based on specific contextual factors, as effectiveness may vary across contexts.

Critical Care Nurses’ Perception of Medication Administration Errors in Kelantan, Malaysia: A Cross-Sectional Study

Background. The study investigates critical care nurses’ perceptions of medication administration errors (MAEs) in a tertiary hospital in Kelantan, Malaysia, within the unique sociocultural context of East-Coast Malaysia. The research aims to understand the causes and underreporting of MAEs and assess the proportion of reported incidents according to MAE types. Methods. A cross-sectional study involving 424 critical care nurses from Hospital Raja Perempuan Zainab II (HRPZII), Hospital Sultan Ismail Petra (HSIP), and Hospital Tanah Merah (HTM) was conducted. Nurses in administrative roles or unavailable during the survey period were excluded. The study utilized a validated Medication Administration Errors Survey questionnaire to gauge nurses’ perceptions on the causes of MAEs, reasons for underreporting, and the percentage of reported incidents based on MAE types. Results. Results indicate that illegible medication orders from doctors were identified as the primary cause of MAEs, while a lack of 24-hour pharmacist availability received the lowest score. The most common reason for not reporting MAEs was identified as the nursing administration’s focus on individuals rather than systemic issues when errors occur. The majority of MAEs were non-intravenous, with incorrect timing of administration being the leading cause. Conclusion. The study sheds light on critical care nurses’ perspectives on MAEs in a Malaysian hospital setting, highlighting key factors contributing to these errors and barriers to their reporting. Understanding these perceptions is crucial for developing strategies to mitigate MAEs and enhance patient safety in critical care environments.

Pharmacists’ role in maternal immunization

Maternal immunization is an important strategy to safeguard infants against vaccine-preventable diseases such as pertussis, which poses a significant economic burden on the health care system. Although the Tetanus, Diphtheria, and Pertussis vaccine has been recommended for pregnant individuals since 2018, uptake varies widely across Canadian provinces. As 4.5 million Canadians do not have access to a regular physician, there is a need to find alternate ways of informing pregnant individuals about maternal immunization schedules. Given the wide accessibility of pharmacists across Canada, they should have a leading role in informing pregnant individuals about maternal vaccines. Training guidelines for pharmacists would ensure informative and effective conversations about vaccinations and promote vaccine safety and benefits, facilitating administration. Increased participation from pharmacists can significantly contribute to improving maternal and child health outcomes, with the goal of reducing the burden of vaccine-preventable diseases in Canada.

Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

Preparing community pharmacy teams for health information exchange (HIE)

BackgroundHealth information exchanges (HIEs) facilitate health care professionals’ electronic sharing of patient information across different organizations. When community pharmacists have access to HIE, they can further contribute to improved patient outcomes. However, several implementation challenges are noted, which impede sustained pharmacist access to HIE. To our knowledge, no bidirectional HIE interface design and pharmacy team-informed implementation process has been documented. In response, our research team designed and developed an HIE interface prototype for use specifically by community pharmacy teams to access local HIE data through their pharmacy dispensing software. ObjectivesTo 1) identify barriers, facilitators, and recommendations for using HIE data in community pharmacies and 2) create a curated list of resources addressing identified implementation needs to aid future implementation of a fully functional, bidirectional HIE interface by community pharmacy teams. MethodsPharmacists, pharmacy technicians, and patients from three pharmacy sites within the Community Pharmacy Enhanced Services Network of Indiana participated in individual semi-structured interviews. Interview questions were mapped to select constructs across all domains of the Consolidated Framework for Implementation Research. Interview transcripts were deductively coded. A subset of participants participated in Evidence-Based Quality Improvement sessions to iteratively update planned resource items needed to support future HIE implementation. ResultsWe interviewed 23 total participants: 8 pharmacists, 8 pharmacy technicians, and 7 patients. Five facilitators, four barriers, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE; guidance on workflow and team roles; resources that are patient-facing; and resources that are provider-facing, resulting in 16 planned implementation resources. ConclusionOur study provides the first-of-its-kind list of pharmacy team-informed resources to facilitate sustainability and scalability of HIE implementation in community pharmacies.

Determinants t of patient satisfaction with pharmacy services at Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia

Background: Patients have explicit desire for quality services when they visit health institutions. Patient satisfaction is a primary means of measuring the effectiveness of healthcare delivery. However, inadequate discovery of their needs may result in patient dissatisfaction. Patients who are satisfied with pharmaceutical care are likely to adherence, seeking for medical attentions and take medications properly. Providing better access to quality pharmacies is a way to improve patient satisfaction with healthcare services. Study objective: The study was aimed to assess patient satisfaction with pharmacy services at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). Methods and materials: An institution-based cross-sectional study design was conducted at FHCSH from 1 May 2021 to 30 October 2021. Data were collected by interview with structured questionnaires. Then the data were coded, entered, and then analyzed by SPSS version 23. The association between predictors and outcome was measured using bivariate logistic regression. Result: In this study, 384 study participants were included. Majority of the participants were males (55.37%, N=227). The overall satisfaction score of the participants of this study was 65.37%. In our study, clients showed greater satisfaction towards pharmacists’ commitment to correct myths (92%), pharmacist availability (88.78), and cleanliness (87.8%). Multivariate analysis indicated physical restriction [adjusted odds ratio (AOR)=6:95%; 95% CI (2.98, 25.9)] and rural residence [AOR=2.43; 95% CI (1.71, 9.6)] had significant association with pharmacy service dissatisfaction. Among the quality pharmacy service indicators, counselling on how medications work [AOR=9; 95% CI (1.48, 8.85)], keeping to dosage regimen [AOR=7.3; 95% CI (5.49, 11.06)], and advice on the current medical condition had greater odds of client dissatisfaction. Conclusion: The findings of the current study showed that patients’ satisfaction towards outpatient pharmacy services provided by FHCSH is very low as it is indicated in their perception towards revealing written information about medication use, medication availability, medication storage, and instructions about medication side effects.

Enhancing Enrollment in Acute Stroke Trials: Current State and Consensus Recommendations.

The Stroke Treatment Academic Industry Roundtable (STAIR) convened a session and workshop regarding enrollment in acute stroke trials during the STAIR XII meeting on March 22, 2023. This forum brought together stroke physicians and researchers, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss the current status and opportunities for improving enrollment in acute stroke trials. The workshop identified the most relevant issues impacting enrollment in acute stroke trials and addressed potential action items for each. Focus areas included emergency consent in the United States and other countries; careful consideration of eligibility criteria to maximize enrollment and representativeness; investigator, study coordinator, and pharmacist availability outside of business hours; trial enthusiasm/equipoise; site start-up including contractual issues; site champions; incorporation of study procedures into standard workflow as much as possible; centralized enrollment at remote sites by study teams using telemedicine; global trials; and coenrollment in trials when feasible. In conclusion, enrollment of participants is the lifeblood of acute stroke trials and is the rate-limiting step for testing an exciting array of new approaches to improve patient outcomes. In particular, efforts should be undertaken to broaden the medical community's understanding and implementation of emergency consent procedures and to adopt designs and processes that are easily incorporated into standard workflow and that improve trials' efficiencies and execution. Research and actions to improve enrollment in ongoing and future trials will improve stroke outcomes more broadly than any single therapy under consideration.

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial.

Introduction: Drug-related problems (DRPs) incidence is higher in neonatal intensive care units (NICUs), compared to other pediatric wards due to aspects like off-label medications, pharmacokinetic/dynamic variability, or organ dysfunction/immaturity. This study aimed to determine whether and to what extent a clinical pharmacist intervention improves medication safety and prevents DRPs [medication errors (MEs), adverse drug reactions (ADRs), drug-drug interactions (DDIs)]. Methods: A prospective, randomized, double blind, controlled study in NICU-admitted neonates was conducted. NICU patients were randomly assigned to the intervention (clinical pharmacist-led) (IG) or control group (standard care such as clinical diagnosis, pharmacotherapy) (CG). The clinical pharmacist was involved in the IG to identify-prevent-intervene MEs, or identify and monitor ADRs and DDIs. The primary outcome was the number of neonates who developed at least one DRP compared with those seen across IG and CG. Secondary outcomes included length of hospital stay, total number of drugs or DRP type. Results: Neonates were randomly assigned to CG (n = 52) or IG (n = 48). In total, 45%, 42%, and 16% of patients had at least 1MEs, ADRs, and clinically significant DDIs, respectively. The number of patients with at least 1ME was 28 (53%) and 17 (35%) in the CG and IG (p>0.05). The median (range) number of ME was higher in CG [1 (0-7)] than in IG [0 (0-4)] (p = 0.003). Applying regression analysis, the CG had 2.849 times more MEs than the IG (p<0.001). Furthermore, the number of patients (CG to IG) with at least one detected ADR or clinical DDI was 19 (36%) to 23 (47%) (p>0.05) and 4 (7%) to 12 (25%), respectively (p = 0.028). Conclusion: Clinical pharmacist availability to systematically and standardized identify, prevent and resolve DRPs among NICU patients is effective. Daily detailed clinical pharmacist observations and interventions enables prevention and monitoring of DRPs. Clinical Trial Registration ClinicalTrials.gov, identifier NCT04899960.

Current Practices and Perceived Role of Community Pharmacists in Type 2 Diabetes Services in Pakistan.

Background Diabetes mellitus is a chronic illness which is becoming more prevalent in developing countries, and it is being managed mostly in hospitals or clinics in underdeveloped nations. Other strategies for treatment delivery in emerging nations must be considered as the number of diabetic patients grows.Community pharmacists are a valuable choice for diabetes care. However, only developed countries have data on community pharmacists' diabetes treatment practices. Methodology A non-probability consecutive sampling strategy was used to gather a self-administered questionnaire from 289 community pharmacists. Six points Likert scale was employed to score current practices and pharmacists' perceived role. A response rate of 55% was attained. Characteristics associated with present behaviors and perceived roles were analyzed using Chi-square and logistic regression. Results The majority of the respondents were males, 234 (81.0%). Out of 289, 229 (79.2%) were of 25-30 years of age and were pharmacists as well as qualified persons (QP) 189 (65.4%).A QPis one who has the legal authority to sell drugs to customers. The majority had <5 years of working experience as a community pharmacist, 268 (92.7%), and did not have diabetes training, 237 (82.0%). Most community pharmacies were stand-alone, 110 (38.1%), and had a single or a group of proprietors, 248 (85.8%). Openhours of most of the pharmacies were 16-20 hours per day, 202 (69.8%), and most had one pharmacist, 243 (84.1%), i.e., working as a pharmacist as well as a qualified person. Approximately 203 (70.2%) of the pharmacies had customers >2000 in a month and >100 customers purchased anti-diabetes medications per month. Only 44 (15.2%) community pharmacies had a designated roomor spacefor patient counselling. The majority of pharmacists were also in favor of providing services other than dispensing such as counselling the patients about prescribed medicines, direction of use, use of devices for insulin administration, training on self-monitoring of glucose, and healthy lifestyle and diet practices. Pharmacy setting, ownership, patient counseling area, and the number of customers per month were key factors in the provision of diabetes services. The main obstacles identified were a lack of pharmacist availability and academic competency. Conclusion In Rawalpindi and Islamabad, most community pharmacies only provide a basic dispensing service for diabetes patients. Most of the community pharmacists agreed to extend their duties. The expansion of pharmacist professional responsibilities would help control the rising diabetes burden. The facilitators and hurdles identified would serve as a foundation for the introduction of diabetic care in community pharmacies.

Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

IntroductionCritical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update.MethodsThe 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level.Main findingsData were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043–0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited.ConclusionsAvailability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.

Assessment of Understanding and Practices of Community Pharmacy Personnel to Tackle COVID-19 Pandemic.

The skill, accessibility, and knowledge of community pharmacists have been paramount in managing pandemics. This study was conducted to assess the knowledge, attitude, and practice of community pharmacy personnel towards tackling COVID-19 pandemic which might help concerned authorities to take effective actions to eliminate the gaps for the management of such pandemic in an efficient way. A cross-sectional study was conducted among 428 community pharmacy personnel from different community pharmacies in Kathmandu, Nepal from December 2021 to February 2022. Statistical analysis was done through SPSS® v21 and MedCalc for Windows v12.3.0. Most of the participants (42.76%) had certificate-level degrees in their respective fields and one to five years of working experience (48.84%). Only 29.67% of the respondents had good knowledge towards tackling COVID-19, whereas good attitude and practice were demonstrated by 59.11% and 42.29% respectively. The participants with higher degrees and more working experience had better knowledge, attitude, and practice. Education level bachelor and above was independent predictor of good knowledge (OR 20.69, 95% CI 11.30-37.90). Knowledge and practice (Spearman's rho: 0.135; P ≤0.005) and attitude and practice (Spearman's rho: 0.095; P = 0.049) scores were positively correlated. The significant association of community pharmacy personnel's educational level with knowledge, attitude, and practices demands the necessity of policy-making bodies' involvement for the mandatory presence of well-qualified pharmacists and regular training at the community pharmacy level. Furthermore, it is high time to reinforce the drug regulatory acts, regulations, and codes all over the nation.

Association of Pharmacy Services with Patient Satisfaction in Public and Private Tertiary Care Hospitals of Rawalpindi And Islamabad

Background: The healthcare system in Pakistan is facing a shortage of human resources and appropriate and sustainable financial measures and therefore fails to provide optimum services to the population of Pakistan. Furthermore, research is limited in the healthcare institutes; therefore, there is a scarcity of information about patient satisfaction with pharmacists and pharmacy services in Pakistan. As evident from the inadequate information in the literature, patients’ opinions about the pharmacy services in Pakistan are important. Therefore, the current study was designed to assess patient satisfaction with the pharmacy performance of the outpatient pharmacy and its variation with socio-demographic characteristics in twin cities of Pakistan (Rawalpindi and Islamabad). Method: A cross-sectional study design was used to assess the patient satisfaction through convenience sampling technique. Minimum sample size of 250 respondents who visit pharmacy department of public and private hospital for pharmaceutical care were included in this study. A pre-validated tool was used to assess the patient satisfaction. Data was clean coded and import into spss for analysis. Descriptive and inferential statistic was applied to calculate frequency, standard deviation, mean deviation and p value to find the association among different domain of patient satisfaction with different demographic characteristics of respondents. Result: Current study shows overall patients were satisfied from pharmacy services provided by government and private hospitals. Furthermore, patient satisfaction towards pharmacist medication advice was very good however patient satisfaction towards pharmacist approach was good while patient perception with pharmacy setting, drug availability and cost were underrated. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. No significant difference (p ≥ 0.05) was observed in pharmacy setting drug availability and cost with different gender, age groups and marital status of respondents. However, Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with different level of education patients with less education had better satisfaction as compared to highly educated respondents. Furthermore, Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with occupation. Self-employee and government employee had low satisfaction score while other had better satisfactory score. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. Females had better satisfactory score as compared to female. Younger age group had better satisfaction as compared to elderly. Patients belong to higher educational groups had better satisfaction toward pharmacist approach as compared to low qualification groups respondents. Furthermore, no significant difference (p ≥ 0.05) was observed in pharmacist’s approach with marital status and number of visits Conclusion: Current study concluded that overall patient had average satisfaction score. Patients shows a better satisfaction towards pharmacist behavior/ way of handling the patients, information provided by pharmacist regarding medicine. Patient had less satisfaction towards the location of pharmacy, Availability and affordability of medicine. Patient shows negative satisfaction regarding waiting area and counselling area at indoor patient pharmacy. It has been observed that educated respondents shows high level of satisfaction towards pharmacist availability and information provided by the pharmacist.

Implementation outcomes associated with a value-based care model of comprehensive medication management in community pharmacies

Although the delivery of comprehensive medication management (CMM) in community pharmacies has been shown to improve health outcomes, inconsistent adoption hinders the benefit patients receive. Our objective was to examine the implementation of a novel value-based care model and the impact of educational and coaching support for pharmacists on patient access to CMM. The underlying care model provides a payment for CMM services combined with incentives to document and improve clinical outcomes and patient engagement. Cross-sectional study. In addition to fee-for-service payments, performance-based incentives were provided to 12 participating pharmacy organizations to promote pharmacist documentation of clinical values (blood pressure and tobacco status for patients with vascular disease and additionally hemoglobin A1c [HbA1C] for patients with diabetes). To promote patient engagement, pharmacies that engaged a higher proportion of attributed patients received additional incentives. Implementation outcomes included penetration (the proportion of eligible patients who received CMM), adoption (variation in penetration across organizations), and fidelity (documentation of all required clinical values). Comparisons were made using t-tests and chi-square testing. Among 1240 eligible patients, 478 (35.8%) had documentation of any service by a participating pharmacist during a one-year implementation period. Using diabetes as an example, documentation was consistently highest for tobacco status (38.1%), followed by blood pressure (29.7%), and HbA1C (38.1%). CMM recipients on average were older, used more medication, and were more likely to have at least one comorbid condition than non-recipients. 41.8% of patients with vascular disease had documentation of both blood pressure and tobacco status while 24.4% of patients with diabetes had blood pressure, tobacco, and HbA1C documentation. Improving pharmacist access to a patient's medical records could help improve access to CMM services for patients under value-based care models that rely on patient targeting and clinical measurements.

955. Improving Pharmacist Access to Training in Antimicrobial Stewardship in Latin American Countries: Partnership between the Pharmaceutical Forum of the Americas (PFA) and the Society of Infectious Diseases Pharmacists (SIDP)

Abstract Background Antimicrobial stewardship programs (AMS) in Latin America have varying degrees of development. One significant barrier is the lack of clinical pharmacists with specialized training in infectious diseases, as there are no residency programs or certifications available to train pharmacists in AMS in Latin America. To overcome this limitation and based on the roadmap for antimicrobial resistance action from the International Pharmaceutical Federation (FIP), the PFA established a partnership with SIDP to support specialized training and mentoring in AMS for pharmacists working in Latin America. Herein, we describe characteristics of this innovative program and its initial participants. Methods Pharmacist members of associations belonging to the PFA (9 Latin American countries) were invited to apply for the SIDP AMS Certificate Program (SIDP-CP) with additional mentoring. Selection was based on current employment status, support from hospital leadership, and an intermediate level of English. A 14-item survey was disseminated to the participants of this program and responses were collected in March 2022, at the beginning of their SIDP-CP. The survey collected information on demographics, characteristics of the AMS at their hospital, experience with AMS to-date, and support requirements to finish the SIDP-CP. Results The description of the SIDP-CP can be found in Figure 1. Surveys were completed by 11/12 (91.7%) program participants: 6 (54.5%) from Costa Rica, 4 (36.4%) from Colombia, and 1 (9.1%) from Argentina. Seven (63.6%) pharmacists work in hospitals with a formally approved AMS, with 6 providing basic and 1 reporting intermediate AMS services. None of the pharmacists have positions dedicated exclusively to AMS, and the majority of those surveyed work ≤ 25% of their time on AMS-related activities. In addition to completing the SIDP-CP, participants indicated high interest in attending periodic virtual meetings to increase their knowledge of how to implement, strengthen, or begin research in AMS. Conclusion Incorporating antimicrobial stewardship in all healthcare institutions worldwide is vital in the fight to slow antimicrobial resistance. Partnerships like this one between PFA and SIDP can inform future planning for expansion of AMS training. Disclosures José Pablo Díaz-Madriz, PharmD, MSc, Eli Lilly: Stocks/Bonds|Pfizer: Advisor/Consultant Melissa D. Johnson, PharmD, MHS, AAHIVP, Charles River Laboratories: Grant/Research Support|Entasis: Honoraria|Merck: Grant/Research Support|Pfizer: Honoraria|Scynexis: Grant/Research Support|Theratechnologies: Honoraria|UpToDate: Honoraria Scott J. Bergman, PharmD, BCIDP, FCCP, FIDSA, Merck &amp; Co., Inc: Advisor/Consultant|Merck &amp; Co., Inc: Grant/Research Support|Merck &amp; Co., Inc: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.

Changes in pharmaceutical retail market and regional inequality of community pharmacists accessibility in mainland China: a retrospective cross-sectional study

ObjectivesTo describe the development of pharmaceutical retail market and community pharmacists in mainland China and identify challenges from both government and business perspectives.DesignA retrospective cross-sectional study.SettingCommunity pharmacies providing primary care...

Patient experiences and views on pharmaceutical care during adjuvant endocrine therapy for breast cancer: A qualitative study.

The use of adjuvant endocrine therapy (AET) after primary treatment of hormone receptor-positive breast cancer reduces the risk of recurrence and mortality. However, non-adherence is still common. Limited consideration has been given to how users deal with AET and the role of pharmaceutical care. Therefore, this study aims to obtain insight into the needs and wishes of women using AET regarding pharmaceutical care and eHealth. This is a qualitative explorative study comprising semi-structured interviews (n = 16) and a focus group (n = 5) among women who use or used AET after primary early-stage breast cancer (EBC) treatment using a thematic analysis approach. Three themes emerged from the interviews and focus group: (1) experiences with AET use, (2) experiences with provided information and (3) needs and wishes regarding pharmaceutical care. Most women were highly motivated to use AET and indicated to have received useful information on AET. However, many expressed a strong need for more elaborate tailored and timely provided information on AET. They acknowledged the accessibility of pharmacists but reported that currently, pharmacists are hardly involved in AET care. Several women considered eHealth useful to obtain counselling and reliable information. Women need more comprehensive information and follow-up in primary setting after initial cancer treatments. A more elaborate role for the pharmacy and eHealth/mHealth, especially with regard to counselling on side effects and side effect management, could potentially improve pharmaceutical care.