Pharmacy Support Research Articles

An Update on the Progress Toward Gender Equity in US Academic Pharmacy

Objective. To evaluate the status of gender equity in US pharmacy education since the two previous publications on the topic in 2004 and 2014.Methods. Data were gathered from existing national databases, internal American Association of Colleges of Pharmacy (AACP) databases, AACP meeting minutes, published reports, scholarly articles, pharmacy association websites, individual school websites, and LinkedIn profiles. Differences between men and women were evaluated on degree completion, discipline, rank, tenure status, research, leadership development, leadership positions, salaries, and professional awards. Comparisons were also made to academic medicine and dentistry.Results. Fifty-one percent of full-time faculty members across all academic pharmacy disciplines are women. The percentage of women at the rank of professor was 36.6%, compared to 25% in 2014. Of the 2992 tenured or tenure track pharmacy faculty, 39.2% were women. Out of 388 department chairs, 146 were women. Throughout 2014-2021, there were 121 chief executive officer (CEO) dean permanent appointments, with men holding 91 (75.2%) and women holding 30 (24.8%). Women received 29.7% of the National Institutes of Health grants awarded to pharmacy schools compared to men (70.3%), although women's funding amount was higher. In both the pharmacy practice discipline and all sciences disciplines, the total salary across all ranks and years in rank was significantly higher for men than women, even for department chairs, but there were no differences for CEO deans. To date, women have received 13% of four national pharmacy organizations' top 13 awards.Conclusion. Since 2014, some achievement gaps have narrowed, but areas of concern still exist and need continued attention and resources so inequities can be eliminated. Women in academic pharmacy need mentoring and support to extend throughout the trajectory of their careers in areas such as academic advancement, grant applications, salary negotiation, leadership pursuit, and award applications.

Systematic review of facilitators and barriers to community pharmacists’ role in licit opioid misuse prevention

Abstract Introduction The prescribing rate of Opioids is increasing and is perceived as main contributor to opioid misuse.1,2 Community pharmacists can help reduce opioid misuse rates by carrying out licit opioid misuse prevention services.3 Understanding and reviewing the barriers and facilitators to community pharmacists’ involvement in the prevention of licit (over-the-counter and prescription) opioid misuse prevention services have the potential to significantly improve these services. Aim To identify, collate and synthesise existing evidence of stakeholders’ views regarding barriers and facilitators to community pharmacists’ role in licit opioid misuse. Methods A systematic review of original studies was carried out in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO using search terms for community pharmacy, opioid misuse interventions and opioid misuse. Titles, abstract and full text were independently reviewed by two researchers and consensus on eligibility of included studies was reached. Studies were included if they were: either qualitative or mixed methods studies of community pharmacy and licit opioid misuse; published in English; either over-the-counter or prescription opioids. Quantitative, non-English studies; and studies on illicit opioids were excluded. Narrative synthesis was carried out by: developing a theory of change model, data extraction and thematic analysis, discussing relationship and robustness of studies. Quality assessment was carried out by the Joanna Briggs Institute critical appraisal checklist. Ethical approval was obtained from Newcastle University Faculty of Medical Sciences Research ethics committee. Results A total of 1,234 articles were retrieved from all database searches. After deduplication, title, abstract screening and data extraction, 10 studies were included. Barriers and facilitators identified are knowledge and skill, pharmacists’ attitude, relationship with prescribers, time, number of support staff, remuneration of service, scheduling of over-the-counter opioids, corporate pharmacy support, private counseling room and electronic programmes. The factors grouped as: capabilities are knowledge and skill; opportunities include relationship with prescribers, time, number of support staff, remuneration of services, scheduling of over-the-counter opioids, corporate pharmacy support, private counseling room and electronic programmes while motivation was Pharmacists’ attitude. Discussion/Conclusion Overall, Study opines that: (1) improving capabilities and opportunities will improve motivation of the Community Pharmacists; (2) improved motivation of Community Pharmacists will improve their involvement in the prevention of licit opioids misuse. (3) Improved capability could be achieved by implementation of policies that focus on: improving opioid misuse education at the undergraduate level and routine training of community pharmacists; while (4) improved opportunity could be achieved by implementing integrated pharmacy care model (a health system in which community pharmacists and prescribers collaborate), increased number of pharmacy support staff, remuneration for service, upscheduling of OTC opioids, pharmacy managers’ support, modifying the community pharmacy setting to include a private consultation area and efficient electronic systems. Findings of this study may not be generalized to developing countries because majority of the studies included in the review were carried out in developed countries. However, implementation of these factors (by policy makers, pharmacy managers) will improve community pharmacists’ attitude towards the provision of licit opioid misuse prevention services resulting in improved community pharmacists’ involvement in these services.

Abstract 14777: Poor Utilization of Sodium Glucose Cotransporter-2 Inhibitors in Diabetic Patients With Coronary Artery Disease

Introduction: Sodium glucose cotransporter-2 inhibitors (SGLT2is) are antihyperglycemic agents found to significantly reduce cardiovascular mortality and heart failure hospitalizations for type 2 diabetics with cardiovascular disease. Despite guidelines from international and national societies recommending the initiation of SGLT2is in this patient population, there are many at-risk patients who have not received this life-saving therapy. We examined this at-risk population at Scripps Health and aimed to address potential barriers to the prescribing of SGLT2is. Methods: SlicerDicer, a data analysis tool in Epic the electronic health record, was utilized to assess population data. With the support of the hospital pharmacy and therapeutics committee, SGLT2is, Empagliflozin and Dapagliflozin, were put on formulary and available for inpatient initiation in April 2022. Results: From January to December 2021 across all Scripps Health campuses, there were 1050 type 2 diabetics with hemoglobin A1c > 5.7%, the majority of whom were treated with antihyperglycemic agents, with GFR > 30 mL/min/1.73m 2 , who underwent PCI for coronary artery disease. Of those patients, more than 75% were not on an SGLT2i. After SGLT2is were available for initiation in the inpatient setting, informational and educational sessions were provided to health care providers, including physicians, nurses, and other allied health professionals. These sessions reviewed current guidelines, how to prescribe the medication, and the side effects to monitor. New workflow was created such that inpatient prescription of SGLT2is would trigger pharmacy support with the submission of prior authorizations and patient counseling. Conclusions: Despite strong guideline recommendations for the use of SGLT2is from cardiology and diabetes societies, a minority of diabetic patients with coronary artery disease, free of contraindications, receive this therapy. This represents an important opportunity to improve patient outcomes. We used a multi-pronged approach to address foreseeable barriers to the prescription of SGLT2is in this at-risk population.

Public views of community pharmacy services during the COVID-19 pandemic: a national survey

ObjectiveTo assess public opinion about community pharmacy services in Lebanon during the COVID-19 pandemic.MethodA cross-sectional study using an online questionnaire was conducted between April and August of 2021. A link was shared randomly among the Lebanese population using WhatsApp and Facebook. Public perceptions were explored within 3 different indicators: general services (B) dispensing (C), and storage (D). Chi-square, Student’s test and ANOVA tests were used. p < 0.05 was considered statistically significant.ResultsOut of 491 responses, only 9.6% scored above the 75th percentile (19.3% for the general services, 2.4% for dispensing indicator and 12.6% for storage indicator). The main concerns focused on lack of medication and reduced opening hours; however, 67.1% of respondents preferred consulting the community pharmacist instead of visiting primary health care centers, doctor’s private clinic and hospitals. Higher mean values of indicators B, C and in the overall indicator were significantly found in the presence of a pharmacist compared to the support pharmacy workforce.ConclusionThe overall public perception was inadequate. Significant difference in terms of quality of services was detected in the presence and absence of a community pharmacist during the crisis. It is recommended that the Order of Pharmacist of Lebanon (OPL) and the Ministry of Public Health (MOPH) undergo further steps mainly to enforce the laws concerning dispensing and storage indicators, improve the services in terms of extending the opening hours, ensure the availability of medicines and increase public awareness.

160 A CLOSED-LOOP AUDIT EXAMINING THE USE OF PROPHYLACTIC ANTI-COAGULATION IN OLDER ADULTS ADMITTED TO A SPECIALIST GERIATRIC SERVICE

Abstract Background Guidelines recommend prescription of Prophylactic Anticoagulation (PA) to all hospitalized older adults unless a contraindication exits. In many cases this does not happen at the time of admission increasing the risk of thromboembolic events. We aimed to assess the use of PA across the medicine for the geriatric service of a level 3 hospital (average daily census of service 120) then use quality improvement to achieve our goal of 95% prescription of prophylactic anticoagulation when appropriate. Methods Medication kardexes and clinical notes were reviewed to collect variables including age, length of stay, creatinine clearance, weight, mobility status, use and dose of antithrombotic medications and documentation of reason if not prescribed. Following initial data collection, cause and effect analysis was performed to identify reasons for under-prescription and small tests of change were conducted across 4 PDSA cycles before data collection was repeated. Results Initial data collection revealed that only 80% of older adults admitted to the service were receiving prophylactic anticoagulation. Cause and effect analysis identified many reasons for failure to prescribe PA including inadequate history taking, lack of clinician education and training, poor documentation, lack of handover between clinicians, failure to complete medication reconciliation on admission and lack of pharmacy support on some wards. Each of these contributory factors were addressed in turn. After a month of QI activities prescription of PA improved to 83% and by 3 months 98.1% (104/106) of patients were receiving PA with only 2 patients for whom PA was not prescribed without clear documentation of the reason. Conclusion Sustained quality improvement resulted in a culture change across our service improving rates of appropriate prescription of PA and raising the quality of care delivered to older adults. This model of quality improvement is now being replicated across our department to address other gaps in service delivery.

Implementing the pharmacy technician role in existing pharmacy settings: Stakeholders views of barriers and facilitators.

The field of pharmacy will benefit from pharmacy technicians, a higher educated mid-level support workforce. They support pharmacists in providing pharmaceutical patient care through delegated roles and responsibilities. Empirical research on pharmacy technicians within pharmacy practice community and hospital pharmacy practices tends to focus on the practical outcomes of this workforce addition. It mostly addresses the 'WHAT' of service delivered by pharmacy technicians. Literature on the 'HOW' of their role development in practice is scarce. Furthermore, it seems difficult for most pharmacy technicians to effectively fulfil this professional role. This qualitative study explored factors influencing role development of pharmacy technicians in community and hospital pharmacies. On site, individual and small-group interviews were conducted with pharmacy technicians (n=10), and two colleagues: pharmacists (n=7) and pharmacy assistants (n=6). Interviews were based on a semi-structured interview guide. Participants were asked to describe specific incidents and organisational, relational and pharmaceutical care perspectives, illustrative of the process of developing and implementing the pharmacy technician role. Template analysis was used to develop a list of codes representing themes identified in the data. Five interrelated themes influenced development and implementation of the pharmacy technician role. Two of them were at a more contextual level: (a) experiencing a lack of vision on added value of the new role within the field of pharmacy and (b) learning climate. The other three were related to personal interactions between staff members: (c) role expectations and organisational fit, (d) personal traits of pharmacy technicians and (e) support of pharmacy technicians through task delegation and role enhancement. The data showed that development and implementation of pharmacy technician roles is a complicated process. A detailed plan for addressing and remediating the five identified themes is important to promote role development of pharmacy technicians.

Evaluating the safety and efficiency of robotic dispensing systems

BackgroundAlthough automated dispensing robots have been implemented for medication dispensing in Japan, their effect is yet to be fully investigated. In this study, we evaluated the effect of automated dispensing robots and collaborative work with pharmacy support staff on medication dispensing.MethodsA robotic dispensing system integrating the following three components was established: (1) automated dispensing robot (Drug Station®), which is operated by pharmacy support staff, (2) automated dispensing robot for powdered medicine (Mini DimeRo®), and (3) bar-coded medication dispensing support system with personal digital assistance (Hp-PORIMS®). Subsequently, we evaluated the incidences of dispensing errors and dispensing times before and after introducing the robotic dispensing system. Dispensing errors were classified into two categories, namely prevented dispensing errors and unprevented dispensing errors. The incidence of dispensing errors was calculated as follows: incidence of dispensing errors = total number of dispensing errors/total number of medication orders in each prescription.ResultsAfter introducing the robotic dispensing system, the total incidence of prevented dispensing errors was significantly reduced (0.204% [324/158,548] to 0.044% [50/114,111], p < 0.001). The total incidence of unprevented dispensing errors was significantly reduced (0.015% [24/158,548] to 0.002% [2/114,111], p < 0.001). The number of cases of wrong strength and wrong drug, which can seriously impact a patient’s health, reduced to almost zero. The median dispensing time of pharmacists per prescription was significantly reduced (from 60 to 23 s, p < 0.001).ConclusionsThe robotic dispensing system enabled the process of medication dispensing by pharmacist to be partially and safely shared with automated dispensing robots and pharmacy support staff. Therefore, clinical care for patients by pharmacists could be enhanced by ensuring quality and safety of medication.

S1371 High SVR Rates, Regardless of Race or Socioeconomic Class, in Patients Treated With HCV DAAs in Community Practice Using a Specialized Pharmacy Team

Introduction: Approved HCV DAA regimens can cure nearly all patients; however, socioeconomic disparities may impact access and outcome. This study assesses socioeconomic factors, differences in insurance coverage and the drug prior auth process in HCV-infected patients managed in community practices partnered with a dedicated pharmacy team with expertise in liver disease. Methods: This IRB-approved, ongoing study captures data on a cohort of 2480 patients from community practices. Patients had chronic hepatitis C and were treated with DAA regimens selected by their physician. Median income is based on home zip code. The HCV Health Outcomes Centers (HOC) Network provides comprehensive patient management including a dedicated pharmacy support team with expertise in the prior auth process. Results: In this cohort, 60.1% were male, 49% were Hispanic Whites (HW), 37% were Non-Hispanic Whites (NHW), and 14% were Black. Eighty-seven percent of patients were treatment naïve, 74% were infected with genotype 1 virus and 63% had advanced fibrosis/cirrhosis (F3/F4=68.2% HW, 65.6% Blacks, 55.4% NHW). Figure depicts the distribution of socioeconomic characteristics by racial group. Forty percent of patients were on disability with the highest % in the Black group and less than 1/3 were employed full time, regardless of race/ethnicity. Medicare covered 42% of Black patients vs 32% of HW and NHW. The vast majority of HW (80%) and Blacks (75%) had a median income below the median income of Texas residents. Additionally, 75% of HW and 71% of Blacks had median income below the poverty level in Texas. Despite the above socioeconomic factors, 92% of all prior authorizations were approved upon first submission and patients received DAAs an average of 17 days from prescription. DAA therapy resulted in cure in 95.3% of patients (SVR=94.8% HW, 94.0% Blacks, 96.5% NHW). Conclusion: Despite having more advanced disease and more negative socioeconomic factors, > 94% of HW and Blacks patients were cured. Continued patient education and communication with the healthcare team can lead to high adherence and > 94% HCV cure rates regardless of race/ethnicity or underlying socioeconomic factors in the community setting.Figure 1.: Distribution of socioeconomic characteristics by racial group.

What do preceptors want? A mixed methods study exploring pharmacist preceptor perceptions of their training and support needs at a regional Australian University

Background: Global demand for work-ready pharmacy graduates has highlighted the role of pharmacy preceptors and the need for training and support from universities. There remains a lack of consensus on the ideal requirements for preceptor training programmes. Objective: To assess community pharmacy preceptor training and support requirements at a regional Australian University. Method: A mixed method study using an online survey of community pharmacy preceptors of James Cook University, followed by qualitative semi-structured interviews. Result: 55 preceptors completed the survey, and ten interviews were conducted. Preferred programme content included role clarification, a curriculum outline and management of poorly performing students. Demands on individuals’ time and workloads support a flexible online approach to training and highlight the importance of institutional support for optimal preceptor engagement and retention. Conclusion: Good teaching and communication skills were considered by preceptors to be essential for their primary role in linking theory to practice for pharmacy students during experiential placements.

Developing pharmacists' competencies in Saudi Arabia: A proposed national competency framework to support initial education and professional development

IntroductionWith the currently accelerating changes in pharmacists' roles in Saudi Arabia, evidence-based developmental tools are required to guide initial pharmacy education and define competencies for early career (foundation level) pharmacists' progression. This study aimed to develop a profession-wide competency framework for foundation level pharmacists in Saudi Arabia using the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) as the source framework. MethodsAn online nominal group technique was used to develop consensus on a profession-wide national competency framework in Saudi Arabia. Purposive sampling was used to recruit experts from local various pharmacy sectors. A combination of self-administered surveys and online meetings was used to measure and develop consensus. The survey items were adopted from the FIP GbCF version 2. ResultsNine pharmacy experts participated in five iterative rounds of consensus measurement and development between July and November 2021. Consensus was achieved on appropriateness to Saudi pharmacy practice for all the behaviours in the “Pharmaceutical Public Health,” “Pharmaceutical Care,” and “Professional/Personal” clusters. The “Organisation and Management” cluster caused most differences of opinion. The final consensus generated a list of 125 behavioural statements for inclusion in the national competency framework. ConclusionThis study proposes the first competency framework for foundation level pharmacists in Saudi Arabia. The developed framework represents a consensus on competencies for foundation level pharmacists working across all pharmacy sectors and is eligible for supporting further improvement of initial pharmacy education and support excellence in pharmacists' performance to address the country's needs from pharmaceutical services.

Correlations to and potential implications of resilience among certified pharmacy technicians

ObjectivesTo assess resilience among a sample of certified pharmacy technicians in the United States and evaluate associations between resilience and various personal and work-related characteristics and conditions, including coworker support and pharmacist leadership behaviors, and to assess the relationship between technicians’ resilience and support from coworkers and commitment to their organization. MethodsThis study employed the use of a self-administered questionnaire survey electronically in a cross-sectional design. The questionnaire was delivered with a response portal open for approximately 6 weeks during the spring of 2022 to a sample of 3000 technicians certified through the National Healthcareer Association. The questionnaire consisted of items comprising the Brief Resilience Scale, an adapted version of the Multifactorial Leadership Questionnaire (A-MLQ), and items measuring aspects of coworker support, future uncertainty, commitment, and turnover, in addition to demographic and practice site–related questions. ResultsUsable responses were acquired from 822 respondents, who reported relatively high levels of resilience. Resilience was observed to be positively correlated with pharmacy transformative leadership behaviors measured on the A-MLQ and with coworker support and negatively correlated with future uncertainty. Respondents indicating the highest level of profession commitment reported a statistically higher level of resilience than did others. There were very few relationships observed between resilience and technicians’ personal characteristics. ConclusionsImmutable characteristics (e.g., race/ethnicity, sex, and age) played a very small role in describing resilience among pharmacy technicians. Instead, organizational characteristics of the workplace were shown to be highly associative with resilience of technicians, adding further evidence that organizations and the profession can help facilitate resilience among these important pharmacy support personnel.

Advancing a global pharmacy support workforce through a global strategic platform.

The pharmacy support workforce (PSW) is the mid-level cadre of the global pharmacy profession, referring to pharmacy technicians, assistants and other cadres that assist in the delivery of pharmaceutical services in a variety of practice contexts. The PSW undertake technical tasks delegated under the supervision of a pharmacist or performed collaboratively. The PSW are not intended to replace pharmacists, but rather work side-by-side with the pharmacist to achieve a shared goal. However, extensive variation in the PSW exists globally, ranging from an educated, regulated, and highly effective workforce in some countries to unrecognized or non-existent in others. Vast differences in education requirements, specific roles, regulatory oversight, and need for pharmacist supervision, inhibit the development and advancement of a global PSW. As clinical care providers, pharmacists worldwide need for a competent support workforce. Without the confidence to delegate technical responsibilities to a well-trained and capable PSW, pharmacists will be unable to fully deliver advanced clinical roles. A clear vision for the role of the PSW in the expanding scope of pharmacy practice is needed. One organization working to unite global efforts in this area is the International Pharmaceutical Federation (FIP). The FIP Workforce Development Hub Pharmacy Technicians & Support Workforce Strategic Platform was established to address the pharmacy workforce shortage in low and middle-income countries. Further developments were made in 2019, with the creation of a representative global PSW advisory panel, to provide guidance towards the development of the global PSW. Provision of frameworks and strategic input to support quality in education, development of legislative frameworks, guidelines for registration and licensure, and advice on appropriate role advancement are critical to move the PSW forward. In order to produce substantial advancement of roles and recognition of the PSW and advancement of pharmacists as patient care providers, global collaborative work is needed.

Evaluation of a pharmacy supported e-cigarette smoking cessation intervention in Northwest England

BackgroundCigarette smoking cessation has been described as the world’s most important public health intervention. Electronic cigarettes are a relatively new tool for assisting smoking cessation but there is a lack of data on their efficacy. This article reports on a pharmacy supported e-cigarette smoking cessation intervention undertaken in a metropolitan area in the north of England.MethodsLongitudinal mixed-methods evaluation incorporating analysis of secondary data, interviews with service users, and interviews with service providers at 3-month and 12-month follow-up, with an additional text message survey of service users at 12-month follow-up.ResultsThe four-week follow-up data suggest that for every twenty people given an e-cigarette, six quit smoking tobacco and three people cut their cigarette intake by more than five cigarettes per day. Long-term follow-up results were positive but only a small number of participants were still engaged with the study at 12 months. Service users and providers spoke positively about the combination of e-cigarettes and pharmacy support.ConclusionsE-cigarette distribution combined with pharmacy support appears to be an agreeable and effective intervention for smoking cessation, but further data are needed on long-term quit rates and health effects.

Self-efficacy of community pharmacists and associated factors in counselling to support self-medication in Japan: A cross-sectional study.

Background:In 2016, the Ministry of Health, Labour and Welfare established the Health Support Pharmacy Certification System. The certification requirements include a track record of counseling regarding the use of over-the-counter drugs (OTC). Therefore, pharmacists must increase their self-efficacy for counseling.Objectives:To determine pharmacists’ self-efficacy for OTC counseling and related factors.Methods:A web-based survey was conducted. Multivariate analysis was conducted to test the relationship among the mean scores of self-efficacy for OTC counselling for 25 symptoms, pharmacist attributes, years of work, psychosocial factor, job satisfaction, and level of trust from the community and patients.Results:We received responses from 250 people. The overall self-efficacy was 5.8 (SD= 2.4) but varied depending on the symptoms. Self-efficacy was relatively high for allergic symptoms (6.9), cold/influenza (6.9), and constipation (7.1), but relatively low for contraceptive drugs (3.8), palpitation/shortness of breath (4.6), and abnormal taste/smell (4.2). In bivariate analysis, items related to self-efficacy included “age” (Spearman correlation= 0.276, P<0.001), “academic background” (-0.208, P=0.001), “number of years of work” (0.267, P<0.001), “level of trust from the community” (0.155, P=0.014), “level of trust from patients” (0.271, P<0.001), “job satisfaction” (0.236, P<0.001), “role clarity” (0.181, P=0.004), and “positive challenge at work” (0.271, P<0.001). Multivariate analysis indicated that the number of years of work (Standardizing Coefficient: 0.22), trust from patients (0.13), and positive challenge at work (0.25) had a positive effect on self-efficacy.Conclusions:Years of work, recognition that they are trusted by patients, and positive challenge at work were important for the counseling self-efficacy of pharmacists. These results provide implications for pharmacy management and lifelong education strategies to promote self-efficacy in pharmacist counseling.

Pharmacist-managed multistep order transmittal for electronic specialty prescriptions reduces represcribing burden in ambulatory clinics: A retrospective cohort pilot study.

BACKGROUND: Specialty medications pose unique prescribing challenges, including complexities with drug dosing and safety monitoring, need for prior authorization and patient financial assistance, use of payer-mandated specialty pharmacies, and special requirements for storage and handling. These challenges can lead to higher rates of represcribing for specialty clinic providers, who may be operating with inadequate information or limited resources. Multistep order transmittal (MSOT) is an electronic medical record (EMR) prescription work queue functionality used by a specialty pharmacy service to support select ambulatory clinics. OBJECTIVE: To explore the relationship between an MSOT specialty pharmacy support service and represcribing burden of specialty medications for providers in an ambulatory care setting. METHODS: A retrospective cohort pilot study was performed before and after MSOT implementation. Prescription data were queried from Sanford Health's EMR for patients who were electronically issued at least 1 prescription for an injectable biologic medication at a dermatology and rheumatology clinic. The pre-intervention group included index prescriptions prescribed between October 1, 2017, and June 20, 2018. The post-intervention group included index prescriptions prescribed between October 1, 2018, and June 20, 2019. Retrospective EMR review was completed to identify any prescriptions that were represcribed and the reason for represcribing. The primary outcome was the rate of represcribing. Secondary endpoints explored reason for represcribing, when it occurred. Nominal data were compared using Pearson's chi-square tests. Regressions were performed to account for potential confounders. RESULTS: The pre-intervention group included 880 index biologic prescriptions, and the post-intervention group included 941 index biologic prescriptions. The aggregate represcribing rate decreased from 12.73% in the pre-intervention group to 9.56% in the postintervention group (P = 0.03). Represcribing directly by providers as a result of needing to modify the destination pharmacy decreased significantly from 6.25% of the pre-intervention group to 0.64% of the post-intervention group (P < 0.01). However, represcribing due to patient preferences and prescribing errors increased significantly between the pre- and post-intervention groups, with patient preferences increasing from 0.91% to 2.55% (P = 0.01) and prescribing errors from 0.68% to 1.70% (P = 0.05), respectively. Represcribing due to provider preferences and payer restrictions remained similar between groups. CONCLUSIONS: Within 2 ambulatory care clinics in an integrated health care system, the use of pharmacist-managed MSOT reduced overall represcribing burden. The need to represcribe owing to wrong destination pharmacy was nearly eliminated, while appropriate represcribing to accommodate patient preferences and correct prescribing errors increased. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to disclose.

Significant Published Articles in 2021 for Pharmacy Nutrition Support Practice.

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2021 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 211 articles were identified; 8 from the primary literature were voted by the group to be of high importance. An additional 18 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

Using content analysis software to compare pharmacy support qualifications in South Africa

The training of pharmacy support personnel (PSP) differs considerably across the world; however, the question of whether the training of PSP meets the needs of the scope of practice in each country must be considered. This article considers a methodology employed to determine if qualifications for PSP in South Africa provided the knowledge and practical skills required by the prescribed scope of practice. A content analysis was performed in three steps, using Atlas Ti software to manage the textual information. The same basic format used in all qualitative content analysis was utilised, including preparing and organising, exploring, developing themes, reporting, and interpreting data. Content analysis can be a helpful tool in analysing large volumes of information. Despite the process being time-consuming, it allows for the trustworthiness of data. Breaking the analysis into three steps made the process more manageable, allowing a single researcher to do the analysis.

P004 A quality improvement project at Bradford Teaching Foundations Hospital to reduce high-cost medication waste and improve medicines optimisation

Abstract Background/Aims Biologics and methotrexate are high-cost medications delivered to patients through pharmacy homecare services prescribed and dispensed at 8-weekly intervals in our Trust. It is estimated nationally, £300 million of NHS prescribed medicines are wasted annually. The aim of this quality improvement project (QiP) was to investigate the extent and reasons for high-cost medication waste within the rheumatology department at BTHFT and develop a service to overcome these issues thereby improving medicine optimisation and reducing waste. Methods Homecare data was reviewed over 12 months from Jan 2020- 21 looking at high-cost medication waste within rheumatology at BTHFT. Two hundred and sixty-seven rheumatology patients were initiated on therapy in this period. Forty-four (16%) patients stopped therapy within a year of initiation. Of the 44 patients, 32 patients stopped within their first 8-week delivery resulting in £17,362 in wastage of medications. On further analysis, reasons for treatment cessation included: adverse effects, non-adherence due to lack of response or patient choice, lack of information and change in treatment plan by overseeing consultant. To overcome some of these issues we changed initial prescribing methods and dispensed 4 weeks supply of medication. We set up a pilot pharmacy telephone clinic between 9th April and 18th June 2021. Patients were phoned 8 weeks after nurse counselling when patients should have been 3 weeks into treatment with their new biologic and provided with further information and reassurance. Any clinical queries outside the pharmacist’s remit were directed to the rheumatology team. If patients were continuing medications, a further appropriate length prescription was dispensed. Results Over the 10-week period of the pilot study, 83 new patients started on therapy, 46 of these were provided with reassurance/support and of those, 9 held/stopped treatment. Through the pharmacy support line, £2,612 of medication cost was saved as these patients had received 4 weeks of medication rather than the usual 8 weeks supply. This translates to approximately a potential of £13,500 of medication waste which can be saved annually through reduced initial prescription of biologics together with implementation of a pharmacy support line through the rheumatology department alone. Another unexpected benefit of the pharmacy support line was improved compliance and adherence to treatment through further counselling and guidance that was delivered to patients who may have stopped treatment without the additional support provided by the pharmacist. Conclusion The introduction of a pharmacy-led telephone support service together with a change in prescribing practice can reduce waste, save money and improve patient outcomes through medicine optimisation. This service could be rolled out to other specialties using high-cost medication with similar intended benefits. Enhancing roles of pharmacists in this way will help meet increasing demand and improve services for patient as recommended by the recent rheumatology GIRFT review. Disclosure P. Sidhu: None. G. Quinn: None. K. Nadesalingam: None.

P116 A quality improvement project at Bradford Teaching Foundations Hospital to reduce high-cost medication waste and improve medicines optimisation

Abstract Background/Aims Biologics and methotrexate are high-cost medications delivered to patients through a pharmacy homecare service prescribed and dispensed at 8 weekly intervals in our Trust. It is estimated nationally, £300 million of NHS prescribed medicines are wasted each year. The aim of this QiP was to investigate the extent and reasons for high-cost medication waste within the rheumatology department at BTHFT and to develop a service to overcome these issues thereby improving medicine optimisation and reducing waste. Methods Homecare data were reviewed over 12 months from Jan 2020-21 looking at high-cost medication waste within rheumatology at BTHFT. Two hundred and sixty-seven rheumatology patients were initiated on therapy in this period. Forty-four (16%) patients stopped therapy within a year of initiation. Of the 44 patients, 32 patients stopped within their first 8-week delivery resulting in £17,362 in wastage of medications. The data were further analysed to assess reasons for treatment cessation. Reasons included adverse effects, non-adherence due to lack of response or patient choice, lack of information and change in treatment plan by overseeing consultant. To overcome some of these issues we changed initial prescribing methods and dispensed 4-weeks supply of medication. We set up a pilot pharmacy telephone clinic between 9th April and 18th June 2021. Patients were phoned 8-weeks after nurse counselling when patients should have been 3-weeks into treatment with their new biologic and provided with further information and reassurance. Any clinical queries outside the pharmacist’s remit were directed to the rheumatology team. If patients were continuing medications, a further appropriate length prescription was dispensed. Results Over the 10-week period of the pilot study, 83 new patients started on therapy, 46 of these were provided with reassurance/support and of those, 9 held/stopped treatment. Through the pharmacy support line, £2,612 of medication cost was saved as these patients had received 4-weeks of medication rather than the usual 8-weeks supply. This translates to approximately £13,500 of medication waste can be saved a year through reduced initial prescription of biologics together with implementation of a pharmacy support line through the rheumatology department alone. Another unexpected benefit of the pharmacy support line was improved compliance and adherence to treatment through further counselling and guidance that was delivered to patients who may have stopped treatment without the additional support provided by the pharmacist. Conclusion The introduction of a pharmacy-led telephone support service together with a change in prescribing practice can reduce waste, save money, and improve patient outcomes through medicine optimisation. This service could be rolled out to other specialties using high-cost medication with similar intended benefits. Enhancing roles of pharmacists in this way will help meet increasing demand and improve services for patient as recommended by the recent rheumatology GIRFT review. Disclosure P. Sidhu: None. K. Nadesalingam: None. G. Quinn: None.

Providing pharmacy support to housebound patients: learning from the COVID-19 pandemic

IntroductionHousebound patients may face challenges to their medicines management due to reduced household mobility and potential lack of access to healthcare services. Previous literature has explored the medication-related needs of housebound patients from pharmacists’ perspectives (1-2). However little work has focussed on the patient/family perspective. In this study, we used data obtained from those staying at home as much as possible during the COVID-19 pandemic to fill this gap.AimTo explore home medicine practices and safety for people who were housebound during the COVID19 pandemic and to create guidance, from the patient/family perspective, for enabling pharmacists to facilitate safe medicine practices for this population.MethodsInterviews were carried out with people who were taking at least one long term medication and met the criteria for ‘shielding’ and/or were over 70 years of age during the first wave of the COVID-19 pandemic in the UK and/or their family carers. Respondents were recruited through patient and public involvement representatives, the research team’s networks, and support groups. Potential participants were approached via personal contact and social media. Interviews were conducted by telephone or video conferencing and participants asked about their medicines management while staying at home. Inductive thematic analysis was carried out. Patient and public involvement representatives were involved in the data analysis alongside the researchers.ResultsFifty people were interviewed (16 males, 34 females; mean age 68 years, range 26–93 years). Interview data suggested diversity of experiences of medicines management while staying at home. Some respondents reported no or little change, others an initial crisis followed by re-stabilisation, and others that the pandemic was a tipping point, exacerbating underlying challenges and having negative effects on their health and wellbeing. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing medicine-related healthcare services. Key factors identified as facilitating a smooth transition included patients’ own agency, support from family, friends and community, good communication with pharmacy staff, continuity of pharmacy services and synchronisation of medicines supply so that a maximum of one collection/delivery was required each month.ConclusionThe study findings that we have presented relate to the UK only; this may limit the generalisability of our findings to other countries. Findings from Ireland are in the process of being analysed and will provide a basis of comparison. In addition, more females took part than males, despite efforts to address this. However, our findings suggest pharmacy staff can support medicines management for people who are housebound by synchronisation of medicines supply, delivering medicines where possible, developing/raising awareness of alternative means of communication, providing continuity of pharmacy services and signposting any community support available.References(1) Kayyali R, Funnell G, Harrap N, Patel A. Can community pharmacy successfully bridge the gap in care for housebound patients? Research in Social and Administrative Pharmacy 2019;15:425-439.(2) Latif A, Mandane B, Anderson E, Barraclough C, Travis S. Optimizing medicine use for people who are homebound: an evaluation of a pilot domiciliary Medicine Use Review (dMUR) service in England. Integr Pharm Res Pract 2018;7:33-40.