Pharmacists Research Articles

Medications for community pharmacists to dose adjust or avoid to enhance prescribing safety in individuals with advanced chronic kidney disease: a scoping review and modified Delphi

BackgroundCommunity pharmacists commonly see individuals with chronic kidney disease (CKD) and are in an ideal position to mitigate harm from inappropriate prescribing. We sought to develop a relevant medication list for community pharmacists to dose adjust or avoid in individuals with an estimated glomerular filtration rate (eGFR) below 30 mL/min informed through a scoping review and modified Delphi panel of nephrology, geriatric and primary care pharmacists.MethodsA scoping review was undertaken to identify higher risk medications common to community pharmacy practice, which require a dose adaptation in individuals with advanced CKD. A 3-round modified Delphi was conducted, informed by the medications identified in our scoping review, to establish consensus on which medications community pharmacists should adjust or avoid in individuals with stage 4 and 5 CKD (non-dialysis).ResultsNinety-two articles and 88 medications were identified from our scoping review. Of which, 64 were deemed relevant to community pharmacy practice and presented for consideration to 27 panel experts. The panel consisted of Canadian pharmacists practicing in nephrology (66.7%), geriatrics (18.5%) and primary care (14.8%). All participants completed rounds 1 and 2 and 96% completed round 3. At the end of round 3, the top 40 medications to adjust or avoid were identified. All round 3 participants selected metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin and rivaroxaban as the top ranked medications.ConclusionMedications eliminated by the kidneys may accumulate and cause harm in individuals with advanced chronic kidney disease. This study provides an expert consensus of the top 40 medications that community pharmacists should collaboratively adjust or avoid to enhance medication safety and prescribing for individuals with an eGFR below 30 mL/min.

A comprehensive rabies vaccination program led by community pharmacists

A comprehensive rabies vaccination program led by community pharmacists

Navigating Burnout: Exploring Pharmacists’ Attitudes toward Patient Care

Abstract Background The study aimed to investigate the link between pharmacists’ burnout levels and their attitudes toward patient care, crucial for addressing burnout’s impact on service quality and fostering positive patient interactions. Methods The study utilized the Shirom-Melamed Burnout Questionnaire (SMBQ) to assess burnout levels among 442 community pharmacists. Additionally, the five-point Likert Scale of General Attitudes and Beliefs of Pharmacists about their Work with Patients (SOSUF), developed by the authors, was employed to measure pharmacists’ cognitive, affective, and behavioral attitudes toward patient care. Statistical analyses involved correlation and regression procedures. Results Moderate burnout levels among pharmacists observed (mean SMBQ score: 4.18 ± 0.96, range: 1.45 to 6.55), alongside generally positive attitudes toward patient care (mean SOSUF score: 3.44 ± 0.37). Regression analysis revealed a moderate positive correlation between burnout and attitudes toward patient care (R = 0.336, R Square = 0.113, Adjusted R Square = 0.111, p < .001). Burnout impacted pharmacists’ attitudes, notably in perceptions of patients not appreciating their efforts (r = -0.317, p < 0.001), finding patient interactions challenging (r = -0.409, p < 0.001), and disregarding their advice (r = -0.333, p < 0.001). Conclusions Despite generally positive attitudes toward patient care, burnout moderately correlates with negativity, notably impacting perceptions of patient appreciation, interaction challenges, and adherence to advice. Addressing burnout is crucial for maintaining positive patient care attitudes and ensuring quality service delivery. Key messages • Burnout impacts pharmacists’ patient care attitudes, emphasizing the need for intervention to enhance healthcare delivery. • Implementing strategies to reduce burnout among pharmacists can improve patient care outcomes.

Assessment of Knowledge, Attitude and Practice of Community Pharmacists towards Adverse Drug Reactions Reporting in Pokhara

Introduction: The pharmacovigilance activities were initiated since 2004 AD which promote Adverse Drug Reactions (ADRs) reporting in hospital-based set-up in Nepal. But the system lacks robust activities related to ADRs and its reporting on community-based pharmacy. The role of pharmacist is very essential in preventing harmful effects of medicine. Objective: The main objective of the research is to assess the knowledge, attitude and practice of community pharmacists towards ADR reporting and to correlates the KAP scores with the demographic distribution of the respondents. Methods: A cross-sectional study was carried out by using a self-administered structured questionnaire. During the study period 132 pharmacists working at community pharmacies in Pokhara were selected and they were interviewed. Results: Out of 132 pharmacies visited, with an overall response rate of 65.33%, only 87 pharmacists agreed to response. There were 56 males and 31 females. The pharmacists with post-graduation degree had a high KAP score (21.00) followed by PharmD (19.5), graduate pharmacists (19.35), and then assistant pharmacists (13.8). Conclusion: Majority of the pharmacist had relatively better attitude but good knowledge towards ADRs and pharmacovigilance. In spite of that the knowledge and attitude could not reflected on the practice of ADR reporting. The majority of respondents emphasize the reporting of ADR from ground level is essential, so that the outcome-based treatment can enhance the patient’s safety.

The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study.

In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19-related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19-related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19-testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises.

Bridging PrEP Access Gaps: Mapping Geospatial Accessibility Across the US and Leveraging Community Pharmacies for Expansion

Pre-exposure prophylaxis (PrEP) is key to ending the US HIV epidemic, but uptake remains low. Federal legislation permitting community pharmacists to initiate PrEP nationwide could expand access to PrEP services. This study aimed to evaluate census tract-level geospatial access to PrEP facilities and community pharmacies across the US and characterize geographic areas and populations where community pharmacies could help bridge the gap in care. We identified census tracts with limited or no access ("deserts") to PrEP facilities and community pharmacies in 2022 using two primary definitions: 1) a tract with no PrEP facilities or pharmacies within a 30-minute drive of the tract centroid; and 2) a tract with low income and low access (no PrEP facilities or pharmacies within one mile of the centroid for low vehicle access tracts, two miles in urban tracts, 10 miles in suburban tracts, 20 miles in rural tracts). Tracts with access were "oases," and "PrEP desert, pharmacy oasis" tracts represented areas without PrEP facilities where community pharmacies could expand access. We characterized the social determinants of health associated with desert status and conducted sensitivity analyses exploring additional access definitions. Of the 82,729 census tracts in our analysis, most were classified as dual PrEP and pharmacy oases. We categorized 13.3% as PrEP deserts under the 30-minute definition, and 94.3% of these tracts were pharmacy oases. Under the low income and low access definition, 17.0% of all tracts were PrEP deserts, 78.2% of which were pharmacy oases. PrEP deserts were predominantly located in the Midwest and South and associated with higher poverty, social vulnerability, and uninsurance. Our analysis confirmed inequitable access to PrEP facilities across the US. Federal recognition of pharmacists as health care providers empowered to initiate PrEP nationwide has the potential to substantially bridge access gaps for underserved communities.

Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.

Collaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working. We conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King's Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022. A total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient's trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships. Our research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.

Assessment of the first 5 years of pharmacist-administered vaccinations in Australia: learnings to inform expansion of services.

Cross-sectional study. We analysed data on pharmacist-administered vaccinations that were reported to the Australian Immunisation Register (AIR) between 2016 and 2019, categorised by gender, jurisdiction, age group and vaccine type. We conducted a national survey of community pharmacists providing vaccination services during June and July 2020 to understand how pharmacists record and report vaccinations to the AIR. We assessed data completeness by comparing the number of vaccinations reported by surveyed pharmacists to the number recorded on the AIR. 576 780 pharmacist-administered vaccinations were recorded on the AIR between 2016 and 2019, of which 94.7% were influenza vaccines. The proportion of vaccinations given by pharmacists increased each year, from <0.001% in 2016 to 2.7% in 2019. Between 2017 and 2019, rates of pharmacist-administered vaccinations were highest among people aged 60-64 years (2046 per 100 000 people) and those living in regional areas (1074 per 100 000 people). Among 243 survey respondents, 57.8% (126/223) reported vaccinations to the AIR automatically via software, 27.8% (62/223) manually entered data and 13.5% (30/223) used both methods. Of the 87 665 vaccination encounters recorded by 121 respondents, 82.2% (72 045/87 665) were recorded on the AIR. There were more AIR-recorded encounters from those who reported automatically via software (84.8% [49 309/58 134]) than from those who manually entered data (68.3% [12 127/17 746]). Pharmacists have an increasing role in providing vaccination services in Australia, with great potential to improve coverage among adults and populations in regional locations. Measures introduced during the COVID-19 pandemic may have increased the uptake of electronic methods of recording and reporting data, which can improve data completeness. Our results provide an assessment of the first 5 years of pharmacist vaccination services in Australia, against which future evaluations of the impacts of policy changes during the COVID-19 pandemic can be compared.

Randomized controlled trial parallel-group on optimizing community pharmacist's care for the elderly: The influence of WhatsApp-Email delivered clinical case scenarios.

Drug-related problems (DRPs) significantly threaten the safety of the elderly. In order to improve pharmacists' ability to minimize these events, novel educational interventions that consider the current challenges in clinical practice are crucial. The primary objective is to assess the impact of two unique educational interventions on pharmacists' ability to identify DRPs. A total of 127 community pharmacies in the United Arab Emirates (UAE) were recruited and randomly allocated to one of three arms using a 1:1:1 allocation ratio. While a series of clinical case scenarios (N = 24) related to elderly care were established and validated and sent to pharmacists in Active Group A over a 3-month period, lengthy research articles focused on medication safety in elderly were emailed to pharmacists in Active Group B. The control group pharmacist received no intervention. Then, pharmacists self-reported the number, categories, and severity of DRPs and pharmacist recommendations. The incidence of DRPs identified by pharmacists was 10.8% in Active Group A, 2.0% in the Control Group (p = 0.011), and 3.8% in Active Group B (p = 0.014). A significant difference was observed in the proportion of DRP types between Active Group A and the Control Group. The most common DRPs in Active Group A were avoidable medication (14.7%) and untreated disease (9.2%). Pharmacists in Active Group A (37.2%) and Active Group B (32.3%) most commonly intervened by recommending the cessation of medication, while the most common intervention in the Control Group was recommending a decrease in dose (29.8%). The mean cost reduction per patient was highest in Active Group A (31.3 ±11.8 $), followed by Active Group B (20.8 ±8.6 $) and the Control Group (19.6 ±9.5 $). The mean time needed to resolve a DRP was shortest in Active Group A (7.3 ±3.5 minutes), followed by Active Group B (9.8 ±4.2 minutes) and the Control Group (9.8 ±5.7 minutes). Using WhatsApp to deliver clinical scenarios was effective in improving pharmacists' ability to identify and address DRPs in elderly patients, resulting in faster resolution and higher cost savings.

A Realistic Case Confirming the Significance of Clinical Pharmacist Role Inside Community Pharmacists

The Article Abstract is not available

Pharmacist-Prescribed Hormonal Contraception: A Survey of Perceptions of Georgia Community Pharmacists and Non-Community Pharmacists.

Pharmacist-prescribed hormonal contraception (HC) is supported by a majority of pharmacists and pharmacy students; however, few studies have evaluated perceptions of non-community pharmacists, or differences in geographic areas. The primary objective of this study is to assess differences between community and non-community pharmacists in perceptions of pharmacist-prescribing HC in Georgia, a state that does not currently permit this practice. Secondary objectives include assessment of community pharmacist interest in prescribing HC, and differences in perceptions between pharmacists in metropolitan and nonmetropolitan areas. A survey was emailed in early 2022 to 2592 Georgia pharmacists, with Likert questions assessing interest, perceptions, comfort, and perceived barriers regarding pharmacist-prescribed HC. Chi square testing identified differences between groups. The completed survey response rate was 11.8%. Regardless of practice site, a majority agreed that pharmacists are well trained to prescribe HC (community 61.8% vs. non-community 68.1%, p = 0.25) and provision of HC services is within pharmacists' scope (community 73.6% vs. non-community 74.2%, p = 0.90). Overall, metropolitan and nonmetropolitan community pharmacist perceptions were similar; however, more metropolitan pharmacists believed pharmacists are well trained to prescribe HC (66.7% vs. 48.7%, p = 0.049) and that it is within their scope of practice (78.1% vs. 61.5%, p = 0.045). In summary, the majority of pharmacists, regardless of practice type, believe that pharmacists are prepared to prescribe HC and that it is a part of pharmacists' professional scope of practice.

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study

BackgroundMedication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia.MethodsA multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of &amp;lt;0.05 was considered statistically significant.ResultsAmong three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients’ non-adherence to medications.ConclusionThe medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

A decision tree approach for investigating the background of research activity of community and hospital pharmacists in Mie Prefecture: a retrospective questionnaire-based survey

BackgroundThe support system for research activities has not been sufficiently established in clinical settings. A survey should be conducted to identify the causes of low research activity among pharmacists and the characteristics of pharmacists who could serve as mentors to build a support system at the regional level.MethodsA retrospective cross-sectional survey was conducted with 156 pharmacists, including hospital and community pharmacists, who attended a webinar on research ethics held once a year in Mie Prefecture. Decision tree (DT) analysis was performed to extract the low research activities and pharmacists who could serve as mentors in research activities using independent factors identified by multivariate logistic regression analysis.ResultsThe questionnaire response rate was 72.4% (113/156), and most respondents were community pharmacists (81.4%). In the DT model, pharmacists who did not belong to academic societies (78%, 46/59) or those who belonged to one or two academic societies but had no certifications (100%, 5/5) had low research activities. Pharmacists who read papers more than once a month and had a nearby mentor (73%, 11/15) were more likely to become mentors in research activities.ConclusionsThe combination of the number of academic societies and the presence of certifications determines the efforts in research activities. In addition to reading at least one paper monthly, the presence of a mentor for writing research papers may also be a crucial factor in becoming a mentor. The proposed DT model may be helpful in building a support system for research activities at the regional level.

Pharmacists' empathy after a postgraduate course in narrative medicine: an observationalstudy.

Narrative medicine is a recent cross-disciplinary approach which through aesthetic activities such as reading fiction and creative writing aims to encourage empathy, reflection, professionalism, and trustworthiness in the encounter between patients and health care professionals. The aim of this study was to evaluate changes in level of empathy after a postgraduate course in narrative medicine among pharmacists conducting medication counselling. During 2020-2021, three courses in narrative medicine among pharmacists with the aim to enhance empathy were held in Odense, Denmark. The primary outcome was the pharmacists' self-reported level of empathy before and after the course measured with Jefferson Scale of Empathy (JSE), which is a validated 20 item scale with higher scores indicating higher levels of cognitive empathy. A total of 33 community and hospital pharmacists participated in the three courses. The pharmacists' median age was 41 years, 91% were female, 76% were working in community pharmacy, and 47% were, according to themselves, rare readers. The pharmacists completed the JSE scale before and after the course. A statistically significant increase was found in mean total JSE score from 109.9 ± 17.1 before the course to 115.7 ± 14.6 after the course (p = 0.0362). Following the course in narrative medicine the level of empathy for the pharmacists according to JSE was enhanced. We recommend that future studies also use patient-reported outcomes to explore if the self-experienced enhanced empathy among pharmacists affects the patients' experience of their encounters.

Validation of the JH-SEFAC Questionnaire on Knowledge on Insulin Management by Patients with Diabetes in Community Pharmacies

To review and validate a questionnaire on knowledge of injectable insulin management (JH-SEFAC) by patients with diabetes for use in community pharmacies. Study design: cross-sectional observational in Spanish community pharmacies during the first half of 2023. Inclusion criteria: patients with diabetes, of legal age, on insulin treatment. Questionnaire design: a nominal group of community pharmacists reviewed and piloted the initial questionnaire to determine its feasibility. It was approved by the CEIC of Aragón (PI22/375). Content validation: by a multidisciplinary group of experts in diabetes, using an ad hoc evaluation questionnaire of 10 questions (Likert scale of 1-5). Reliability: by means of the internal consistency index (Cronbach's alpha) and the intraclass correlation coefficient (ICC). Reproducibility (test/retest): the results of the questionnaire administered twice 2-3 weeks apart to the group of patients were compared. Pharmacists members of the SEFAC Diabetes Working Group collaborated. Sample: calculated in 127 subjects (95% CI and precision of 10%). 20 community pharmacies from 13 autonomous communities included 131 patients. The expert assessment was 4.52 out of 5 (90.4%). The Keiser-Meyer-Olkin test was 0.626 and Bartlett's test was significant (p<0.001). The Cronbach's alpha of the global questionnaire was 0.804 and the ICC was 0.902. The mean score of the questionnaire was 15.98 out of 31 points. The JH-SEFAC questionnaire was validated to evaluate the management of insulin injectables, providing community pharmacists with a valuable tool for therapeutic education.

Informing community pharmacists on COPD case-finding methods: A scoping review

Background: Early detection of chronic obstructive pulmonary disease (COPD) is a strategy to address the increasing human and economic costs of this condition. This study aimed to inform pharmacists’ case-finding strategies by providing an overview of case-finding approaches by health care practitioners. Methods: A scoping review was conducted based on the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA ScR) guidelines. Included studies were analyzed under the following themes: population characteristics, inclusion and exclusion criteria, setting, case-finding strategies and yield, health care practitioners involved, interprofessional collaboration and the provision of preventive services. Studies were then characterized by highest yields (the weighted average of each approach expressed as a percentage of the total number of new COPD cases divided by the total number of patients screened using the same approach). Results: The screening process produced 170 eligible studies. Twenty case-finding approaches with average yields of new COPD cases ranging from 3.8% to 29% were identified. The approach with the highest yield involved the use of a questionnaire, peak flow meter and pre–post spirometry. In 14 of these approaches, the process was initiated with the use of questionnaires. In many of the studies, case-finding was targeted at high-risk and/or symptomatic patients. Characteristics of studies with the highest case-finding yields included provider education/training, patient education, active screening, multistep approaches to case-finding, provider engagement, diagnostic criteria by guidelines and engagement of other health care practitioners. Conclusion: In our scoping review of case-finding methods for patients with COPD, we found the greatest yield from pre–post spirometry following initial screening with a peak flow meter and questionnaire. Pharmacists and health researchers can use these approaches to identify high-risk patients for interventions.

Nausea and vomiting in pregnancy: a cross-sectional study of community pharmacists in the UK.

To assess the content and frequency of advice community pharmacists (CPs) provide to pregnant women with nausea and vomiting, their confidence in providing advice, and their knowledge of the safety of medication used to manage the condition. An online questionnaire of closed- and open-ended questions was distributed to CPs in the UK in May 2023. Closed-ended questions were analysed quantitatively, and conventional content analysis was utilised for open-ended responses. One hundred and eighty-one respondents completed the questionnaire, 24 responses were excluded, leaving data from 157 available for analysis. The majority (90.4%) of participants reported having experience in providing advice on nausea and vomiting with varying levels of confidence. Advice provided included using over-the-counter products, lifestyle modifications, reassurance, medication advice, and referring to other healthcare professionals. Knowledge of first-line antiemetics considered safe in pregnancy varied; cyclizine was correctly identified as safe during pregnancy by 57.3%, followed by 37.6% for promethazine and 31.2% for prochlorperazine. Self-reported confidence and having experience providing advice were related to higher medication safety identification rates. Five percent of participants reported previous training on the condition, while 70% reported wanting further education, preferably delivered via an online medium. This study showed that although 90% of CPs provide advice on nausea and vomiting in pregnancy, their medication safety knowledge varied. The majority of CPs reported wanting further education that would ensure women could access reliable information and evidence-based advice to optimise management of the condition.

Organizational innovations related to Primary Care Access Points (GAP) for unattached patients in Quebec: a multi-case qualitative study

BackgroundBeing attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally.MethodsThis multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations.ResultsFive organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients.ConclusionsDescriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.

Potentially inappropriate prescription of medications to older adults who access a community pharmacy in Peru

Polypharmacy in older adults is associated with a higher incidence of medication-related problems, such as pharmacological interactions, adverse reactions, and medication errors. This study aimed to identify and evaluate potentially inappropriate prescription of medications (PIP) using the screening tool of older persons’ prescriptions/screening tool to alert doctors to right treatment (STOPP/START) criteria in a representative community pharmacy in Trujillo, Peru. The population sample consisted of 158 subjects, with 66.5% between 65 and 69 years old, 53.8% male, and 77.9% receiving between 3 and 4 medications. Medical prescriptions were analyzed using the explicit STOPP/START version 2 criteria, revealing that 93.7% of patients presented STOPP criteria (to stop medication) and 53.8% presented START criteria (to start medication). The most frequently identified STOPP criterion was the gradual withdrawal of benzodiazepines, while the most frequently identified START criterion was the initiation of antihypertensive treatment in patients with systolic blood pressure &amp;gt; 160 mmHg and diastolic blood pressure &amp;gt; 90 mmHg. Principal component analysis showed that the high prevalence of PIP was significantly associated (p &amp;lt; 0.05) with the number of prescribed medications and as age decreases, the number of medical diagnoses also decreases. It is concluded that there is a high prevalence of PIP in the studied population, posing a greater challenge in older adults, highlighting the importance of addressing prescribing practices with greater involvement of community pharmacists.

Addressing the second victim phenomenon among community pharmacists and its impact on clinical pharmacy practice: a consensus study.

The second victim phenomenon, denoting the harmful effects of patient safety incidents on healthcare practitioners, remains insufficiently examined within the pharmacy workforce. This study aimed to investigate the second victim phenomenon in community pharmacies, focusing on its triggers, impacts on pharmacists' well-being, and effects on pharmaceutical care and safety. This consensus study with the Nominal Group Technique involved 27 community pharmacists in three equal groups. The final ranks of the statements scored by participants from 5 to 1 were recalculated using the Van Breda method, combining three distinct data sets with higher values for a higher impact on the output evaluated. Statistics were applied to ascertain event distribution and investigate the potential relationships between event categories and outcomes for patients and pharmacists. "Patient-centric anxiety" (6.8) was the top mental health issue, followed by "Personal responsibility and resilience" and "Future concerns and career aspirations" (6.0 each). The dominant support was "Colleague/Peer support" (5.3). The most frequent patient safety incidents were "Inadequate pharmaceutical service" (8.0) and "Wrong drug dispensed" (7.8). Most errors (63%) were dispensing failures, primarily wrong drug dispensed (44.4%). Of these, 50% were near misses, 25.0% caused no harm, and 16.7% had serious consequences. Field notes suggest contributing factors like inadequate supervision, crowding, and storage issues. This study revealed the second victim phenomenon among pharmacists, which potentially stems from breaches in practice standards. The impact on the quality and safety of pharmaceutical care and its influence on pharmacists' well-being should be studied in further studies.