Pharmacist Participation Research Articles

Clinical and economic impact of comprehensive medication management implementation by clinical pharmacists in an intensive care unit: a cost–benefit analysis

Abstract Objectives Critically ill patients are at risk of drug-related problems (DRPs) and healthcare-related cost. Clinical pharmacists are specifically trained in pharmacotherapy evaluation; they can identify and prevent DRPs. We aim to evaluate clinical and economic impact of clinical pharmacist by cost–benefit analysis in intensive care unit. Methods This was a prospective, interventional study from healthcare provider perspective which conducted over 6 months in a neurosurgery intensive care unit (ICU) of a university hospital on 162 patients. A clinical pharmacist was dedicated to implement comprehensive medication management. All pharmacotherapy problems were categorized and economic impact of clinical pharmacist’s interventions including cost–benefit ratio and net benefit in the ICU was assessed. Key findings A total of 1524 interventions were done. The top five pharmacotherapy-related problems were defined as, drug selection (33.3%), dose adjustment (17.32%), fluid and electrolyte management (12.99%), drug discontinuation (12.07%) and therapeutic drug monitoring (6.75%). The minimum and maximum benefit–cost ratio was 8.4:1 to 12.7:1 and net benefit was $169,205 to $266,633, respectively over the 6-month period. Conclusions The participation of a clinical pharmacist in a multidisciplinary ICU team by implementation of comprehensive medication management may reduce healthcare expenditures and improve drug safety.

The Role of Key Performance Indicators in Improving the Performance of Clinical Pharmacist in Hospitals

Key performance indicators are a way to improve performance, including in the hospital sector. In this study,the hospital used was private hospital, Central Java, especially in the field of Clinical Pharmacy services. Thisresearch is motivated by the low achievement of clinical pharmacy services. The purpose of this researchis to measure the performance of the clinical pharmacy service before and after the intervention with theapplication of clinical pharmacy Key Performance Indicators (cpKPI). This study is an observational studyby observing differences in the achievement of clinical pharmacist performance indicators before and afterthe implementation of cpKPIs. This studywas conducted using clinical pharmacist visit data for all inpatientsat the hospital in September 2019-February 2020. Data analysis used a paired t-test.The use of cpKPI wasable to significantly improve the performance of clinical pharmacists (p<0.05) related to drug reconciliationindicators, drug therapy services, pharmacist participation in patient management, patient education duringhospitalization, and comprehensive direct pharmacists’ care. The result proves that cpKPI can improve theperformance of clinical pharmacists at Private hospital so that this method can be used by other hospitals toimprove the performance of clinical pharmacy services.

Public Perception Toward Ministry of Health Regulations for Antibiotic Dispensing and Its Impact on Pharmacy and Family Physician Visits.

IntroductionAntibiotic dispensing regulations have been implemented in most countries worldwide. Saudi Arabia’s Ministry of Health (MOH) recently implemented a policy for dispensing antibiotics, in which pharmacies in Saudi Arabia are strictly prohibited from dispensing antibiotics without a medical prescription. Failure to adhere to the regulations will result in a fine and may lead to the revoking of the pharmacy's license. The aim of this study was to investigate public perception among the Saudi population toward the recently implemented policy, to examine the effect of antibiotic dispensing regulations on consumers’ request for non-prescribed antibiotics at retail pharmacies, and to elucidate the implications of the recent policies on patient visitation to family physicians.MethodA cross-sectional study was conducted using three questionnaires targeting the general public in Saudi Arabia in addition to pharmacists and family physicians working in Saudi Arabia. ResultsA total of 380 participants completed the questionnaire for the general public, 299 for the pharmacist questionnaire, and 94 for the family physician questionnaire. Most participants in the general public questionnaire obtained their antibiotics using a prescription after consulting with a family physician (72.4%). Most of these individuals also agreed with the strict regulations for antibiotic dispensing (82.1%). Most pharmacist participants either always or frequently received requests to dispense antibiotics without a prescription from customers (71.5%). In addition, most physicians (59.6%) acknowledged that patient demand increased after the implementation of the new policies.ConclusionOur assessment of public perception towards the recent regulation for dispensing antibiotics indicates that most participants who participated in the General Public questionnaire supported the MOH’s strict regulations for antibiotic dispensing. However, customer requests for antibiotics without a prescription from pharmacists were a bit high, which could be attributed to customers' lack of awareness of the regulations. The results also indicate an increase in the number of family physician visits after the regulations were implemented.

Antimicrobial Stewardship Programs in Northwest China: A Cross-Sectional Survey of Perceptions, Involvement, and Perceived Barriers Among Hospital Pharmacists.

Background: Antimicrobial stewardship (AMS) is a key prevention strategy in addressing the global concern of increasing antimicrobial resistance (AMR). Pharmacists are one of the integral members of AMS hospital teams around the world. Toward reducing AMR, a major strategy in China is to improve the capacity and participation of pharmacists in the AMS framework. However, little is known about how hospital pharmacists perceive their position and participation in AMS work, and the barriers to this work in China, especially in the Northwest region. Methods: Region this work describes a cross-sectional, anonymous, online survey study. Hospital pharmacists from five provinces/autonomous regions in northwest China were invited to participate in June and July 2020. Participants completed the survey by using WeChat, a popular social application in China. We purposefully distributed the questionnaire link and QR code to hospital pharmacists through the hospital antimicrobial resistance surveillance network, hospital antimicrobial consumption surveillance network, provincial and city pharmaceutical associations, and hospital pharmacist WeChat groups. Results: Out of 1032 respondents, 93.1% believed that AMS programs promote the judicial prescribing of antimicrobials, 95.5% strongly agreed that AMS could reduce the widespread use of antimicrobials, and 92.3% believed that AMS could improve medical services. Pharmacists were most likely to be involved in AMS through reviewing prescriptions of antimicrobials, intervening in inappropriate prescriptions, and providing feedback on antimicrobial prescriptions and medical orders. Barriers to participating in AMS included workload (59.5% of respondents), ineffective communication between pharmacists and doctors (57.7%), and inadequate knowledge of AMS (47.0%). Differences in responses were found between the five surveyed provinces. A significant association was found between median involvement scores and gender, age, education, level of superiority, experience, and type of hospital (p < 0.05). Conclusion: Pharmacists perceived that AMS programs are important, but that their involvement in related activities is limited in all provinces. Further studies and strategies should consider how to overcome the identified barriers to optimize the participation of pharmacists in AMS programs.

Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: A retrospective observational study.

Even if total joint arthroplasty (TJA) patients have received conventional antithrombotic therapy, the incidence of thrombosis remains high. Clinical pharmacists have been involved in the multidisciplinary team of orthopaedics, but their roles and functions are not yet defined. The objective of this study was to assess the impact of clinical pharmacist services on the use of anticoagulant drugs, the rationality of medication and the incidence of thrombosis in patients with TJA. This retrospective, observational cohort study was conducted for patients undergoing TJA procedures. Study variables were collected for a baseline period of 1 January 2016 to 30 June 2017 and an intervention period of 1 January 2018 to 30 June 2019, allowing for a 6-month run-in period. For demographic characteristics, the use of anticoagulant drugs and the incidence of thrombosis between the baseline and intervention periods, the data were statistically analysed. During the 36-month study timeframe, a total of 591 TJA procedures were performed. A total of 577 participants were included in the study (240 in the baseline group and 377 in the intervention group). After clinical pharmacist participation, the prevention rate of anticoagulant drugs (p<0.05), the proportion of oral anticoagulants (p=0.000) and the course of preventive treatment (p=0.004) increased significantly. The time of administration was shortened from after 24h to within 24h post-surgery (p=0.000). Although the incidence of symptomatic DVT reduced in the intervention period, there was no statistical difference in either the hospital, 1-month follow-up, or 3-month follow-up after surgery (all p>0.05). Within the limitations of a retrospective study, clinical pharmacist intervention was associated with improvements in anticoagulation management of TJA procedures, likely conferring beneficial effects.

A Cross-Sectional Study on Pharmacy Students' Career Choices in the Light of Saudi Vision 2030: Will Community Pharmacy Continue to Be the Most Promising, but Least Preferred, Sector?

Introduction: The Saudi Arabian healthcare divisions that recruit and hire pharmacists include hospital pharmacy, community pharmacies, universities, and research centres. Local studies showed that hospital pharmacy is the most preferred sector, while community pharmacy is the least preferred. However, jobs in hospital pharmacy are limited compared to community pharmacy. Hence, to accommodate the increasing numbers of pharmacy graduates and to facilitate the implementation of Saudi Vision 2030, which promotes primary healthcare and the participation of both private and non-governmental organisations in healthcare delivery, community pharmacy ought to be Saudised. This study was conducted to assess the career choices made by Saudi pharmacy students and the enablers that influence their career choice, especially in community pharmacy. Methods: A prospective cross-sectional approach was used. A total of 437 final year pharmacy students were recruited from 15 pharmacy schools around the country. Results: Salary and advancement opportunities as well as geographical location, benefits, and work environment were found to be “very important” enablers when making career decisions. Hospital pharmacy was selected as the most preferred sector by 242 (55.4%) of the participants, while community pharmacy was the least favoured pharmacy sector (17% or 6.2%). The enablers that might influence the consideration of a job in community pharmacy included career aspiration and social accountability. On the other hand, the barriers were personal beliefs about the sector and the nature of the work. Conclusions: The community pharmacy sector was found to be the least preferred sector to work in. The study revealed a list of enablers that the participants found to be relevant or of high relevance when choosing community pharmacy as a career pathway. Some of the enablers contribute to the role of the pharmacist towards the local community, social accountability, and towards the country’s Vision, such as interaction with the general public and educating them. Other enablers are related to the pharmacists’ career aspirations, such as owning a business. Some of the barriers that were found relevant include high workload, inflexible working hours, and limited opportunities for professional development. Localisation of community pharmacies would help to create more jobs for national pharmacists, increase the participation of female pharmacists in the workforce and support the achievement of Vision 2030. The barriers should be tackled on several levels: undergraduate curriculum, regulatory, and actual practice. Undergraduate education needs to include primary pharmaceutical care services in its curriculum. Regulatory changes include enforcing the renationalisation of the community pharmacy sector and permitting females to work in community pharmacies without location restrictions.

The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives

Abstract Objectives Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS). Methods The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken. Key findings Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers. Conclusions Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.

Factors influencing the involvement of doctor of pharmacy students in research and scholarship projects

IntroductionThe study objective was to determine factors that stimulate or hinder student pharmacist participation in research and scholarship, to determine factors faculty believe are motivators or barriers for student pharmacist participation, and to compare student and faculty responses. MethodsAn electronic questionnaire was developed and emailed to all students enrolled in the doctor of pharmacy program and to all program faculty. To increase response rate, students were provided class time to complete the survey. Responses were collected anonymously. ResultsA total of 404 students (69% response rate) and 35 faculty (78% response rate) participated. Motivational factors rated highly by both students and faculty were interest in the topic, comfort level in working with faculty, energetic quality of faculty, and becoming more competitive for post-graduate training. Students indicated that projects benefiting the profession/medical community was an important motivator, while faculty believed that pursuing a position that requires research/scholarship was a key motivational factor. The most highly rated barrier was lack of time. ConclusionsStudent pharmacist participation in research and scholarship with faculty is variable in our program and little was known previously about factors that led student pharmacists to engage in research and scholarship. There was general agreement among student and faculty regarding several motivating factors; however, some important differences did exist. Addressing these differences may help increase student involvement in research and scholarship in the future.

The effectiveness of an independent anti-neoplastic medication therapy management system in ambulatory cancer patients.

BackgroundCancer has always been a serious health threat for human. Patients with cancer are at high risk of drug-related problems (DRPs) due to multi-morbidity associated polypharmacy. However, data is lacking in identifying and addressing potential DRPs in cancer patients in China. This study aims to investigate the prevalence of DRPs and evaluate the effectiveness of an independent anti-neoplastic medication therapy management (MTM) system in ambulatory cancer patients.MethodsThis is a retrospective study. An independent anti-neoplastic MTM system in Shanghai Jiao Tong University affiliated sixth People's Hospital was established in 2018 with the collaboration of oncologists, clinical pharmacists and software engineers. The system contains an independent clinic of pharmacy and MTM software. The software consisted of six modules to help clinical pharmacists serve the tumor patients. The six modules include medication therapy review, intervention plan, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up.ResultsA total of 173 eligible tumor patients visited the anti-neoplastic pharmaceutical clinic and were recorded in the independent anti-neoplastic MTM system from Jun 2018 to May 2019. The average clinic visits were 2.4 times of the study participants. Two thirds patients (117/173) had one or more identified DRPs in medication therapy review. Adverse drug reaction, potential drug interaction and non-adherence were the leading DRPs. 85.8% of DRPs could be resolved (cured or improved) in four weeks. Tumor patients showed medication adherence reached 84–100% after three or four times of follow-up and intervention.ConclusionsThe participation of clinical pharmacists in managing polypharmacy tumor patients, with the independent anti-neoplastic MTM system, facilitated the identifying and solving DRPs, especially improving medication adherence of patients, and thus enhancing the effectiveness, safety and rational use of medication.

Clinical pharmacist participation in the treatment of a pregnancy complicated with Clostridium difficile infection

Objective To explore the clinical pharmacist participation in the treatment of pregnancy complicated with Clostridium difficile infection. Methods From the perspective of medications, clinical pharmacists followed evidence-based medical practice, combined pharmaceutical theory with clinical evidence and provided individualized pharmacy care in drug selection, dose adjustment, medication regime and liver protection treatment. Results Clinical pharmacists integrated into the treatment team to ensure the effectiveness and safety of medication in the patient with pregnancy. Conclusion The individualized pharmacy care improved the effectiveness of drug treatment.

Health Emergency with COVID-19 and Supporting Role of Community Pharmacists in Pakistan

Background: The infection (COVID-19) inflicted via newly discovered strain of the virus was first spotted in Wuhan in December 2019 and established as a worldwide public health emergency on 30th January, 2020 demanding support from all healthcare sectors, on urgent basis.&#x0D; Objective: The objective of this review is to highlight and appreciate roles of community pharmacists during COVID-19 pandemic.&#x0D; Methodology: For literature review various databases were used such as Google Scholar, Springer Link, PubMed, MEDLINE and Science Direct.&#x0D; Results: The proposed provisions such as social distancing and lockdowns to quite an extent aided in restricting the dispersion of the virus. In addition, wearing face mask, washing hands, using sanitizer with periodic disinfection of surrounding was recommended. These measures were registered to provide protection to all and positively influence the life of special population i.e., those suffering from chronic diseases, as they don't approach the healthcare facilities on a regular basis for their everyday care and supervision, in terms of medication. However, the easiest approach to gain access to sophisticated health facilities in such conditions remained and is through retail pharmacy outlets.&#x0D; Conclusion: The existing healthcare system with surging stress and fear can be profoundly reduced by participation of community pharmacists and their thorough involvement in managing chronic illnesses and strengthening medication adherence.

The marketing research of the level of promoting the rational use of medicines by pharmacists in Ukraine

Aim. To conduct the marketing analysis of the frequency and causes of the irrational use of medicines according to the assessment of the Ukrainian pharmacists, participation of pharmacists in promoting the rational use of drugs, and identifying appropriate measures to improve the situation.&#x0D; Materials and methods. To achieve this goal, a survey of pharmacists from different regions of Ukraine was conducted, 420 questionnaires were selected and processed.&#x0D; Results. According to pharmacists, such types of the irrational use of drugs as false self-medication, polypharmacy, and the use of expensive drugs in the presence of cheaper alternatives are the most common in Ukraine. The most important reasons for this phenomenon are uncontrolled self-medication, the impact of advertising and the availability of many over-the-counter medicines. The Ukrainian pharmacists take certain measures to influence on the rational use of drugs: refusal to dispense medicines, supplement to the doctor’s prescription, correction of the duration of treatment, and others. When counseling pharmacy visitors the largest number of respondents provide information on the way, frequency and duration of taking a medication, the smallest part – recommendations for a healthy lifestyle or non-pharmacological recommendations for the treatment. The respondents consider compliance with the rules of dispensing prescription medicines, training and advanced training of pharmacists throughout their professional career, and limitation of excessive advertising of medicines as the most appropriate measures to promote the rational use of medicines.&#x0D; Conclusions. The results of the research reflect the peculiarities of the Ukrainian pharmacy practice regarding the participation of pharmacists in promoting the rational use of medicines.&#x0D; Key words: rational use of medicines; pharmaceutical care; pharmaceutical consulting; good pharmacy practice.

P28.01 The Clinical Pharmacist as a Member of a Multidisciplinary Team for Lung Cancer Patients Assistance

The recent finds related to molecular biology have been modifying treatment scenarios for lung cancer patients. Along with better understanding of different genetic changes and signalling pathways, new drugs have been developed for that kind of cancer treatment. Due to broad type of clinic protocols and oncological drug combinations, the participation of clinic pharmacists working as a multiprofessional team member has increased. In this article we will describe the caregiving model developed for patient treatment by a specialized clinical pharmacist. This article aims to provide a real case of a multiprofessional team that have been acting in specialized pharmaceutical patient monitoring. All patients were diagnosed with lung cancer and treated between november of 2018 and July of 2020, in a private oncologic clinic in the city of Rio de Janeiro, Brazil. We developed a pharmacist assistance model for lung cancer patients in order to improve its experience, safety and quality of life during all treatment scope (figure 1). 273 patients and 23 types of different oncological drugs were identified for lung cancer treatment, with 4 different types of pharmaceutical classes: 40% oral target-therapy; 30% conventional chemotherapy; 22% immunotherapy and 8% intravenous target-therapy. All patients were conducted by a previous clinical pharmacist query before begginning of treatment. Were evaluated: degree of treatment understanding of patient and caregiver; distress levels through assessment “thermometer”; identification and registration of allergies; smoking; social habits; comorbidities and drug reconciliation. Each patient received an individualized care plan, education material with guidance for drug administration and packaging of oncological medicines for home use, telephone follow-up to assess adherence and schedule of laboratory tests. Of the patients consulted by the clinical pharmacist, 67% needed pharmaceutical intervention, being referred for assessment of nutrition, psychologist or reassessment by the oncologist. 97% of pharmaceutical interventions were accepted by the multidisciplinary team. All identified drug toxicities were recorded and no patient abandoned treatment. With new oncological drugs for lung cancer treatment available on the market, it has been necessary a better understanding of protocols and monitoring plans for intravenous administration or for oral administration. The clinical pharmacist is a key factor for correct patient monitoring for each different types of protocols, by helping reduce drug interactions risks, toxicity identification and developing better treatment adherence. For this method of assistance to succeed, the presence of the pharmacist is fundamental on the “tumor board” and its inclusion as a member of multidisciplinary team.

Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions

Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.

Impact of Structured Diabetes Pharmaceutical Care Training on Practices of Community Pharmacist

Objectives: The diabetes epidemic in India has placed it in the second position in having the largest number (77 million) of adults with diabetes, worldwide. Diabetes is a chronic progressive disease that can be effectively controlled by medication adherence, monitoring and managing well on regular basis. A well-trained pharmacist can help the patients to achieve good glycaemic control by providing them pharmaceutical care. This study aims to evaluate the effect of tailored diabetes pharmaceutical-care training on the practices of pharmacists and the subsequent impact on patients’ clinical outcomes. Methods: A prospective interventional quantitative study was conducted to assess the impact on Knowledge, Attitude and Practice (KAP) levels of community pharmacists after providing diabetes pharmaceutical care training. The selected trained pharmacists enrolled type-2 diabetes patients to assess the practice component further, by observing patients’ outcomes in terms of knowledge, attitude, practices along with clinical outcomes in terms of glycemic control, post pharmaceutical care provision. A descriptive analysis and statistical evaluation, using SPSS Version 21. Key Findings: Significantly improved outcomes were observed across all the pharmacist participants in terms of KAP levels, from baseline to post-interventional training (p<0.0001). Also, a considerable impact on patients' knowledge, awareness, practices and clinical outcomes was noted in the intervention group. Clinically there was a significant reduction in fasting blood glucose levels, postprandial blood glucose levels, HbA1c and control in systolic and diastolic blood pressure (p<0.05) was also observed. Conclusion: Community pharmacists who had completed structured training in diabetes care could practice pharmaceutical- care well and help patients with type-2 diabetes in achieving good glycemic control.

Good practices for physical restraint in intensive care units: integrative review.

to describe the available evidence on indications, complications, care and alternative strategies in the use of physical restraint in adult patients in Intensive Care Units.Methods: an integrative review conducted in the LILACS, Nursing Database, Índice Bibliográfico Español en Ciencias de la Salud, Scopus and CINAHL databases and the PubMed portal, in the period from June to August 2018. the final selection was of 19 articles, from which the indications, complications, care and alternative strategies were extracted. The studies were conducted between the years 2003 and 2018, with a predominance of the United States; they were mostly classified (58%) in level 6 evidence, being performed by nurses, with multi-professional participation of psychologists, pharmacists, physicians, and nurses. the most common practices regarding physical restriction were described, and the need for the elaboration and implementation of protocols on intervention to support decision making was observed.

81. Physicians’ Knowledge, Attitude, and Practice regarding Prolonged Antimicrobial Use

BackgroundTo reduce unnecessary long-term antibiotic therapies, pharmacist-led intervention followed by the involvement of infectious diseases (ID) specialist was implemented. In addition, a survey for the prescribers was conducted to find the gaps for improvement.MethodsThe “less is better” intervention was implemented between August 1, 2018 and February 28, 2019, which was focused on those to whom antibiotics had been administered for over 15 days. However, the following patients were excluded: patients having hematologic diseases, patients in the neonatal intensive care units, and patients who were recommended to maintain antibiotics by ID specialist. Treatment duration according to the indications was compared between pre-intervention period (Aug to Sep 2017) and post-intervention period. A questionnaire based on clinical vignettes was distributed among 140 prescribers.ResultsAmong 500 prescriptions assessed as a prolonged treatment, 475 (95%) were stopped after intervention. Over the pre- and post-intervention period, pneumonia was the most common indication of prolonged antibiotic use (43.8 versus 43.0%). The treatment durations decreased from 21.0 (interquartile range [IQR], 27.3-18.0) days pre-intervention to 16.0 (IQR, 20.0-15.0) days post-intervention (p=0.000).The survey response rate was 76.4% (107/140). Regarding community-acquired pneumonia, there was a significant difference between knowledge and practice, showing that 53% were aware of the standard duration, but 72% actually prescribed for a longer duration. There was a similar trend for the treatment of urinary tract infection (30% versus 83%, p=0.024). The reasons why the physicians prescribed antibiotics of a prolonged duration in spite of adequate knowledge were not only the lack of symptom alleviation in patients but also organizational factors.ConclusionThe duration of long-term antibiotic treatment was shortened by active participation of pharmacist as well as ID specialists. However, gaps between the knowledge and practice on the duration of antibiotic treatment were also found. Therefore, it is necessary to implement appropriate feedback and education based on clinical scenario in order to improve the physicians’ antibiotic prescription.Disclosures All Authors: No reported disclosures

Does an encounter with the ambulatory clinical pharmacist in the transitional setting play a role in clinic attendance and patient engagement?

BackgroundPatient engagement is an important aspect in improving patient outcomes. However, there is a paucity of literature regarding patient engagement in a nonresearch health care setting and the impacts of ambulatory clinical pharmacist interventions. Patient engagement has several definitions making it challenging to assess, but attendance to initial primary care provider (PCP) visits is an important aspect of patient engagement. ObjectiveThe study objective was to assess if improved patient engagement, defined as attendance to an initial PCP visit, was associated with differences in services provided or pharmacist participation during postdischarge clinic appointments. Practice descriptionThe site of this study was the Johns Hopkins After Care Clinic (JHACC), an interdisciplinary postdischarge, safety net clinic in Baltimore, MD. Practice innovationThrough an interdisciplinary health care team including pharmacists, patients received comprehensive care to assist with postacute disease-state management and transitions of care. Evaluation methodsInitial PCP visit attendance after a postacute visit in a high-risk population was evaluated for differing service delivery factors between groups who attended and did not attend their initial PCP visit. Descriptive statistics and chi-square tests were used for analysis. ResultsPatients were statistically significantly more likely to engage in primary care when clinical pharmacy specialists participated in their JHACC appointment (P = 0.02). Medication education and disease-state counseling improved initial PCP visit attendance, both of which are key pharmacist activities. ConclusionThis study suggests ambulatory clinical pharmacy specialists’ roles in an interdisciplinary clinic model correlates with increased attendance to initial PCP visits, a surrogate for patient engagement. Disease-state education and medication education are both important activities in improving this measure; however, additional research is necessary to determine specific pharmacist interventions associated with patient engagement. As research in patient engagement continues, the positive effects of pharmacist involvement in this area could support their value in ambulatory care services.

Percepção do farmacêutico analista clínico: da formação à atuação profissional

The work of the medical laboratory scientist is directly related to the study and diagnosis of the patient's health. This study aimed to understand the opinion of medical laboratory scientists regarding their academic training. The research had the participation of pharmacists who work as medical laboratory scientists. The collected data were analyzed using the content analysis technique and divided into two categories: academic training and clinical analysis training. The result shows that practical classes during the undergraduate course are of paramount importance, as they allow the future medical laboratory scientist to develop skills and attitudes linked to knowledge. It was also found that theoretical knowledge provides the basis for the practice and that the training of the medical laboratory scientist shall prioritize the context where he/she will be proactively inserted in the multiprofessional teams and in society.

PUBLIC HEALTH PROTECTION AS A PROFESSIONAL FUNCTION OF A PHARMACIST − ANALYSIS OF EXPECTATIONS AND PREFERENCES OF PHARMACEUTICAL SERVICES CONSUMERS

Implementation of state problems in the field of public health protection is impossible without the participation of phar- maceutical specialists, which requires a comprehensive assessment of existing practices in the field of health and social work from the consumers’ view. The purpose of the research is to study the expectations, preferences and consumers satisfaction with the level of participation of pharmacists in maintaining and improving the public health. Materials and methods. The assessment of consumer expectations and preferences was based on the analysis of the survey results using standard methods of statistical analysis (two-sample student test, nonparametric Mann-Whitney test with a significance level of p&lt;0.05, Friedman’s rank analysis of variance) in the software products Statistica 10 and Microsoft Excel. Results. Analysis of consumer expectations and their satisfaction regarding the participation of pharmacists in public health has allowed to define the portrait of the most competent and at the same time demanding visitor pharmacies. It’s a woman 36-50 years old with higher education that has got children up to 18 years and/or older relatives (friends), and/or with chronic diseases and receiving multiple medications on a regular basis. With increasing age, the number of chronic diseases and, consequently, the number of necessary medications, consumer expectations are also increase. The public reaction to the participation of pharmacists in public health protection is mostly positive, however the pharmaceutical specialist is more widely perceived in society as an expert on medicines, rather than on healthcare in general. For all consumers of pharmaceutical services, the most significant characteristic is the level of pharmacists’ professional compe- tence. Regular consumers of pharmacy services express a higher willingness to follow the pharmacists’ recommendations to pre- serve and promote health (such as healthy diet, physical activity, solving problems associated with quitting smoking). At the same time, consumers without any health problems are less motivated to receive health-saving recommendations from a pharmacist. Conclusion: The modern society is aware of the significant role of pharmacists in the implementation of health-saving technologies, although the range of their professional tasks rarely goes further than the sphere of medicines supply. This fact requires the phar- macy manager to focus on monitoring the compliance of specialists ‘ competencies with consumer expectations. The greatest interest in receiving health-saving recommendations from pharmacists is shown by older patients having chronic dis- eases and taking medicines on a regular basis, while the involvement of other categories of pharmacy’s visitors in preventive con- sultations remains low. This circumstance indicates the potential for strengthening the preventive component of pharmaceutical counseling, which will allow visitors to form a deeper understanding of pharmacists as full participants in the healthcare system.