Pharmacists Research Articles

Pharmacist prescribing – perspective of German community pharmacists

Pharmacist prescribing – perspective of German community pharmacists

Determinants affecting the collaborative professional practice between community pharmacists and general practitioners in primary care in Spain.

Determinants affecting the collaborative professional practice between community pharmacists and general practitioners in primary care in Spain.

Burnout and Competency Development Among Community Pharmacists: Exploring Patterns

Burnout and Competency Development Among Community Pharmacists: Exploring Patterns

Pharmacist prescribing in primary care: a Dutch citizen perspective

Pharmacist prescribing in primary care: a Dutch citizen perspective

Assessing community pharmacists' thoughts on telepharmacy in Bali province

Telepharmacy describes the use of technology in interactions between pharmacists and patients. Given that telepharmacy is the most recent development in the delivery of digital pharmacy services, the question of how prepared pharmacists are to provide high-quality services frequently comes up and receives attention. The purpose of this study was to determine the viewpoints of pharmacists in telepharmacy services. From February to April 2023, a cross-sectional survey was done using a Google form. The study population included 111 pharmacists in charge of network pharmacies in Bali Province. Their thoughts were assessed using a credible and reliable questionnaire created by the researchers. The questions were split into two sections: a professional demographic items, and a section describing the perspectives, benefits, and challenges of telepharmacy. To get a more detailed or comprehensive response, open-ended questions were added. In general, especially during a pandemic, pharmacists were aware of being involved in remote services (non-face-to-face interaction) and telepharmacy services. This study makes clear that pharmacists' involvement is essential for creating a long-distance relationship between them and their patients. Therefore, pharmacists should learn how crucial communication is to increase patient satisfaction.

Evaluating the education provided by community pharmacists to municipal staff about medication handling using recently developed quality indicators

Evaluating the education provided by community pharmacists to municipal staff about medication handling using recently developed quality indicators

Exploring community pharmacists’ practices and clinical reasoning after hospital discharge

Exploring community pharmacists’ practices and clinical reasoning after hospital discharge

Pharmacist perspective on the potential introduction of pharmacist prescribing – a nationwide survey study

Pharmacist perspective on the potential introduction of pharmacist prescribing – a nationwide survey study

Community Pharmacists’ Knowledge in Managing Minor Ailments: A Focus on Childhood Gastroenteritis in Saudi Arabia Using a Simulated Patient Approach

Background: Community pharmacists are frequently approached by patients seeking health advice for minor ailments, particularly for common childhood diseases like diarrhea. Globally, approximately two million children under five years of age die each year due to diarrhea, which remains a significant health concern, especially in developing countries. Objectives: The purpose of this study was to assess the skills of community pharmacists in addressing and prescribing for simple viral diarrhea in children. Methods: A hundred community pharmacies were visited by simulated clients following a standard scenario of inquiring about simple childhood diarrhea. Subsequently, they filled out a standardized form after each visit to assess the skills of the community pharmacists. Results: It was found that 98% of the pharmacists were males. Approximately 80% of them inquired about the child’s age, while only 29% asked about the presence of fever. Around 2–6% of them only asked about the stool nature, child’s feeding behavior, and family symptoms. Around 10% of them suggested a potential bacterial origin, and 24% recommended the use of antibiotics. Only 43% of the community pharmacists suggested the use of oral rehydration solution, while 15–56% recommended using antidiarrheals, anti-emetics, and spasmolytics. The mean knowledge score of the pharmacists was 9.06 out of 17. Conclusions: The results indicated a relatively low level of knowledge about managing simple viral childhood diarrhea, which may reflect a similar level of knowledge about dealing with minor ailments in general.

A Systematic Review of Controlled Trials: Can Patient Adherence to Antibiotics Be Improved Through Pharmaceutical Communication-Based Interventions?

Background: Patient adherence to antibiotics is vital to ensure treatment efficiency. Objective: To evaluate the impact of pharmacist communication-based interventions on patients’ adherence to antibiotics. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for systematic review (PRISMA) checklist and flow diagram. Controlled trials were included. Databases: PubMed, Cochrane Library, SciELO, and Google Scholar. Quality, risk of bias, and confidence in cumulative evidence were evaluated. Results: Twenty-one trials were selected, with better patient adherence for the intervention than the control group. However, statistically significant differences were only found in two-thirds of these trials. The use of educational leaflets, personalized delivery of antibiotics, follow-up measures, and structured counseling were among the most impactful and significant interventions. The fact that community and/or hospital pharmacists were required to intervene in both groups (e.g., intervention vs. control/usual care) may explain that statistically significant differences were not achieved in all trials. Moderate quality issues and/or risk of bias were detected in some of the evaluated trials. The cumulative evidence was classified as high to moderate, which was considered acceptable. Conclusion: It seems that more intense and structured pharmacist interventions can improve patient adherence to antibiotics.

Development of a Frailty Screening Tool Using Electronic Community Pharmacy Records.

Frailty is associated with increased susceptibility to medication-related harm, highlighting the importance of medication review for frail older adults. Community pharmacists are increasingly involved in the initiation of medication reviews. Yet, current frailty measurement methods are impractical in this setting. Alternative approaches, leveraging routinely collected data, are needed. To develop a frailty screening tool utilising routine electronic pharmacy records. Community-dwelling older adults (≥ 70 years) using ≥ 5 chronic medications were recruited in 196 Belgian community pharmacies. Frailty was assessed using SHARE-FI75+ (based on Fried's frailty phenotype). Model development was on the basis of a two-stage approach using multivariable logistic regression with split-sample internal validation. Stage 1 considered only electronic pharmacy record variables, while stage 2 also included other variables that can easily be collected in the community pharmacy. Model performance was evaluated for discrimination, calibration and predictive accuracy. We recruited 875 participants [mean ± standard deviation (SD) age 79.3 ± 5.9 years], with 14.8% identified as frail. At stage 1, the frailty screening model included age, sex, reimbursement level of medical expenses, number of chronic medications and medication-derived comorbidities (anxiety, congestive heart failure, hypertension) [area under the receiver operating characteristic curve (AUC) 0.77, 95% confidence interval (CI) 0.69-0.85; sensitivity 78.0%; specificity 60.1%]. At stage 2, additional information on difficulties with basic activities of daily living or pharmacist's intuitive frailty assessment further improved the model (AUC 0.81, 95% CI 0.74-0.88 and AUC 0.82, 95% CI 0.75-0.89, respectively). We developed a screening tool for frailty using data from electronic pharmacy records. This tool offers the opportunity for frailty screening in community pharmacy and to identify individuals that may benefit the most from medication review. External validation is warranted.

Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study)

Background Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs. Objective This study aims to develop and test an intervention to improve the use of POCTs in managing RTIs involving GPs and CPs in Irish primary care, following the UK’s Medical Research Council’s (MRC) framework for complex intervention development, involving five work-packages (WPs). Methods WP1 involves creating best practice guidance for using POCT in managing RTIs, informed by a scoping review and validated with an expert Delphi panel. This guidance will be used to define target behaviour(s) for GPs and CPs related to POCT use. WP2 explores GP and CP perceived barriers and facilitators to these behaviours using the Theoretical Domains Framework, mapping influential domains to Behaviour Change Techniques to develop draft interventions. WP3 gathers patients’ perspectives on using POCTs for RTIs. In WP4, a task group will review and finalise the intervention(s). They will consider patients’ perspectives from WP3 and assess feasibility of the intervention(s). WP5 involves a proof-of-concept study to test the feasibility of the newly developed intervention(s). Conclusion A theoretically informed intervention(s) for using POCT(s) in the management of RTIs in primary care in Ireland will be developed and tested in a proof-of-concept study, following MRC guidance. Further refinement and larger studies will be needed to determine its effectiveness before widespread implementation.

Knowledge, attitudes, and practices of community pharmacists providing over-the-counter emergency hormonal contraception: a scoping review.

Reducing the rate and impact of unintended pregnancy through effective contraception is a public health goal. Since deregulation, globally, ease of access to community pharmacists has enabled them to play a key role in the provision of emergency hormonal contraceptive pills (ECP). The aim of this scoping review is to explore pharmacists' overall knowledge of and attitudes and practices towards the provision of emergency contraception. A systematic literature search for the period from 1999 to 2023 was conducted using Scopus, Medline (Ovid), CINAHL, Emcare, Web of Science, and Google Scholar. Keywords such as emergency contraception, emergency contraceptive, morning after pill, plan B, pharmacist, community pharmacist, and pharmacy were applied. Articles published only in English that described the knowledge, attitudes, and practices of community pharmacists providing emergency contraception were included in this review. Twenty studies met the inclusion criteria. Despite positive attitudes towards the provision of ECP, there is a clear deficit in both the knowledge and counselling practices of pharmacists, with some pharmacists lacking an open attitude towards the supply of ECP to adolescents and third parties. Usage of a private counselling area ranged from 0% to 90% highlighting privacy for patients seeking ECPs is lacking during consultations. In countries where practice guidelines are available, these are often not being optimally utilized. This review has highlighted gaps in pharmacists' knowledge and counselling practices, demonstrating shortcomings in pharmacists' education, training, and application of professional practice guidelines. Future research on ECP guidelines is recommended to improve implementation and usability in practice.

Factors Associated with the Practice of Assessing Drug-Drug Interactions Among Pharmacists in Saudi Arabia.

Drug-drug interactions (DDIs) occur when two or more drugs are administered concomitantly, changing the pharmacokinetics or pharmacodynamics of a drug's characteristics. Despite the advances in health technology, DDIs remain a concern to patient safety. This study aimed to (1) assess the knowledge, attitude, and practice of hospital and community pharmacists toward DDIs in Saudi Arabia and (2) examine factors associated with their practice. A cross-sectional study was conducted using an online self-administered questionnaire targeting hospital and community pharmacists working in Saudi Arabia. The study questionnaire consisted of five sections: demographics, knowledge, attitude, and practice toward DDIs, as well as pharmacy characteristics. Descriptive statistics were used to summarize the characteristics of participants as count and percentage. Chi-square tests were used to examine associations between practice variables and other independent variables. A total of 131 pharmacists participated in the study. The majority were males (81.7%), aged 26-35 years (64.9%), and worked in community pharmacies (81.7%). Nearly half of the participants reported optimal practice regarding checking drug interactions before dispensing any drug. Factors associated with the practice of checking DDIs were found to be gender, perceived workload, perceived knowledge, and attitude variables. Regarding the practice of asking patients about their prescription and OTC drugs, there were statistically significant differences between hospital and community pharmacists. Our findings on both community and hospital pharmacists in Saudi Arabia reveal that pharmacists' attitudes and perceived knowledge might influence the practice of pharmacists toward DDIs.

Opportunities and challenges associated with the launch of nirmatrelvir/ritonavir (Paxlovid) in British Columbia during the COVID-19 pandemic: A qualitative study to explore community pharmacists' perspectives.

In February 2022, a novel antiviral for the treatment of COVID-19, nirmatrelvir/ritonavir (Paxlovid), was approved by Health Canada and made available to patients in British Columbia (BC). BC community pharmacists did not prescribe nirmatrelvir/ritonavir, but dispensing involved a detailed assessment with close attention to drug-drug interactions and patient monitoring. As the nirmatrelvir/ritonavir service was unique in BC, and not all pharmacists participated in the program, it is important to evaluate the perspectives of all the pharmacists who were affected so that lessons learned from the program can inform future pandemic planning and government initiatives. A qualitative research study using key informant semistructured interviews was conducted. Community pharmacists with varying degrees of experience with nirmatrelvir/ritonavir were recruited using multiple methods of recruitment through e-mail and fax invitations and social media posts. Open-ended questions explored pharmacists' experiences with the nirmatrelvir/ritonavir program, including barriers and facilitators to dispensing it, and recommendations for future pharmacy initiatives. Forty-three community pharmacists participated in the study. Most participants were between the ages of 30 and 39 years and had practiced for less than 10 years. Thematic analysis yielded 36 codes that were organized into 3 overarching themes related to the following: learning; in-process experiences, supports, difficulties; and perceptions about the expanded scope of practice. The following strategies may be helpful to consider including in future initiatives: preprinted forms, a hotline for peer support, slower rollouts, a single source for communicating changes, a patient portal, addressing the divisions between dispensary and clinical work, and having specialized positions to support future rollouts. Lessons learned from the nirmatrelvir/ritonavir service included a slower approach to program initiation with additional training opportunities and more streamlined prescription options. Pharmacists also wished for better communication support and involvement in the planning of future initiatives.

Lyme disease chemoprophylaxis prescribing before and after pharmacist prescriptive authority in Nova Scotia.

Lyme disease is a bacterial infection transmitted to humans through bites from infected Ixodes species of ticks. Prophylaxis with a single dose of oral doxycycline following a bite from an infected tick reduces the risk of developing Lyme disease. Pharmacists in Nova Scotia (NS) were among the first in Canada to prescribe for this indication. The primary objective of this study is to describe experiences with pharmacist prescribing of prophylaxis after tick bites in NS. A retrospective cohort study was performed using health administrative data 16 months before and after pharmacists were authorized to prescribe Lyme disease chemoprophylaxis (August 1, 2021). All dispensations of a single dose of oral doxycycline from a community pharmacy in NS were included. Data collected included prescriber type, date, and county of dispensation. Comparisons of dispensations were completed before and after pharmacists gained prescriptive authority and relative to other prescribers. Dispensations were described descriptively. Over the study period, 12,549 single-dose doxycycline prescriptions were dispensed in NS: 3900 prescriptions were dispensed before pharmacist prescribing authorization for this indication occurred and 8649 were dispensed after. Pharmacists prescribed 61.3% of all single-dose doxycycline prescriptions following implementation of prescribing authority. An increase in single-dose doxycycline prescriptions was observed in NS. Pharmacists have become the primary prescribers for Lyme disease chemoprophylaxis in the province. Patients were willing to be assessed for chemoprophylaxis after tick exposure by pharmacists, and pharmacist prescribing for this indication suggests increased access to post-tick exposure care.

Regulation of mark-up on medicine prices in Zimbabwe: a pilot survey from 92 community pharmacies in the metropolitan area of Harare

BackgroundMedicine pricing in the community pharmacy sector in Zimbabwe significantly influences accessibility to health care. In this pilot survey, we investigated how community pharmacies in Zimbabwe apply various mark-up strategies to essential and non-essential medicines, and gathered community pharmacists’ perspectives on mark-up regulation.MethodsUsing an adapted methodology endorsed by the World Health Organization and Health Action International for studying medicine prices and availability, we conducted a quantitative cross-sectional pilot survey for 46 medicines (31 essential and 15 non-essential) identified using the Zimbabwe Essential Medicines List and classified according to the Vital, Essential, and Non-essential (VEN) tool. We conducted the pilot survey in 92 community pharmacies in the metropolitan area of Harare, Zimbabwe. ResultsWe gathered a total of 92 responses from 167 distributed questionnaires. The most prevalent mark-up strategy was the cost-plus fixed percentage.The median mark-up for all medicines in the community pharmacies was 60% (interquartile range 50- 82%). We found a statistically significant difference in the median mark-up by essentiality of medicines (p < 0.001), essential medicines had a median mark-up price of 62% while non-essential medicines had a mark-up of 56%. Antipsychotics had the highest mark-up at 82%, while anti-neoplastic medicine had the lowest at 36%. Overall, 55% of the community pharmacists did not support mark-up regulation.ConclusionMark-up strategies varied across community pharmacies in the metropolitan area of Harare. Without mark-up regulation, essential medicines remain significantly expensive in Zimbabwe. We recommend mark-up regulation in Zimbabwe’s community pharmacy sector and emphasize the effective use of multiple pricing strategies to reduce medicine prices. .

Pandemic preparedness of Egyptian community pharmacists and potential facilitators to the successful implementation of a community pharmacy coronavirus disease 2019 referral service: a cross-sectional survey.

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased need for essential community services including new roles for pharmacists. Globally, community pharmacists are a highly accessible point of contact for referral. To assess the preparedness of and facilitators to community pharmacists referring patients with suspected COVID-19 symptoms for testing. A cross-sectional survey was administered using a structured questionnaire to 1023 pharmacists (one respondent in each pharmacy) in Egypt between 17 and 30 May 2020. Pharmacists who had received pandemic referral training were significantly more familiar with the referral system in comparison to those who had not (n = 180; 17.6% vs. n = 841; 82.4%, P = .014). Case referral was significantly associated with the referrer (n = 161, 15.8%), demographics of region (P = .001), graduation year (P = .035), and gender (P = .015). The vast majority of respondents identified facilitators to referring, namely university-level teaching (n = 984, 96.7%), continuing professional development (n = 958, 94.3%), smartphone app (n = 809, 80.5%) or telephone hotline (n = 933, 91.5%), IT access (n = 861, 84.7%), and managing patients' attitudes through the media in terms of the importance of declaring symptoms to (n = 998, 97.7%) and cooperating with (n = 977, 96.2%) referrers. Pharmacists' lack of preparedness to engage with the referral process and related roles contributing to tracking the national COVID-19 infection rate could be mitigated by the provision of facilitators suggested by respondents. These included improved cooperation from local healthcare authorities, educational interventions, technological solutions, and the use of the media. Demographics associated with pharmacists' attitudes to referral, and hence the reliability and validity of the national infection rate, demand further investigation.

Prescription and nonprescription drug misuse and abuse in community pharmacies in Iraq: a cross-sectional survey.

There is little known regarding prescription and nonprescription medicine nonmedical use (abuse and misuse) in Iraq, with limited treatment. Pharmacists could be a valuable source of information in the absence of any national monitoring system. This study aimed to explore Iraqi community pharmacists' perspectives on prescription and nonprescription medicine abuse/misuse, including motives for use and how often they encounter people whom they think are misusing or abusing medicines. A cross-sectional survey was undertaken between November 2020 and February 2021. Community pharmacists in Iraq were asked to complete a prepiloted self-administered questionnaire, distributed through online social media platforms. 300 pharmacists completed the questionnaire. The most commonly reported nonprescription drugs suspected of abuse/misuse were cough and cold medications (n = 80, 26.6%), topical corticosteroids (n = 54, 17.9%), and allergy products (n = 33, 11%). The most common reported prescription drugs suspected of abuse/misuse were systemic antibiotics (n = 111, 36.9%), gabapentinoids (n = 56, 18.6%), and moderate-weak opioids (n = 34, 11.3%). The most commonly method used by pharmacists to limit access to such drugs was responding that the requested medication was unavailable (n = 273, 51.7%), followed by advising on risks (n = 152, 33.2%). Prescription/nonprescription medicine abuse and misuse are suspected in community pharmacies in Iraq. Current methods for controlling the problem are likely to be ineffective in the absence of prescription drug enforcement. Pharmacists could have a more proactive role in managing this issue, networking with other pharmacists, and referring suspected users to support.

Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change

ObjectivesExpanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government’s goals to eliminate new HIV acquisitions by 2030. Using the Capability,...