Pharmacy Support Research Articles

Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project

Discharge summaries are important medical documents that summarise a patient’s hospital admission. The Royal College of Physicians provides standardised guidance on the content of discharge summaries, given their important role...

Exploring career advancement of pharmacy support staff within two Queensland hospitals: a qualitative study

AbstractBackgroundInternationally, pharmacy assistants and technicians have expanded their roles to allow pharmacists to concentrate on more clinical duties. The Australian model of care is currently exploring avenues for strategic role expansion for these support staff.AimTo qualitatively explore pharmacist and support staff views on the training needs of Australian pharmacy support staff.MethodsEthics approval was obtained from both Metro South Human Research Ethics Committee and UnitingCare HREC prior to the commencement of the study. Semi‐structured interviews were conducted with personnel from the private and public settings to explore key issues identified in the literature. Interviews were conducted either face‐to‐face or via telephone between October 2017 and August 2018, with a mean duration of 39.85 min. NVivo® 11 qualitative software was used to consolidate the data. The general inductive approach was used for thematic data analysis, which allowed for the emergence of new themes and sub‐themes within the research topic.ResultsA total of 25 participants consisting of 10 pharmacists and 15 pharmacy support staff were recruited from a private (n = 13) and a public (n = 12) hospital in South‐East Queensland. Participants across both pharmacist and pharmacy support staff expressed inadequacy in current certification level, resulting in a need for further on‐the‐job training. The main reported facilitators to pursue further training were organisational support, career progression and remuneration. The main reported barriers were training cost and lack of time.ConclusionsThis exploratory study provides critical insights into the evolving needs of support staff that can inform innovative strategic role expansion for efficient and sustainable training.

Health boards given £80m to offer more pharmacy support in general practice

GP practices across Scotland have been allocated £82.6m, which will partly be used to provide greater pharmacy support for repeat prescriptions and medication reviews, the Scottish government has said. In an announcement made on 7 February 2022, the Scottish government said the funding would “expand teams within GP practices”, enabling GP practices to provide increased […]

Quality of prehospital fixed components of the Brazilian Emergency and Urgent Care Network: a study based on data from PMAQ-AB and PNASS

The organization and management of integrated health systems is complex and challenging. As a strategy to improve the quality and access to urgent services, the Brazilian Ministry of Health implemented the Emergency and Urgent Care Network (RUE), comprised of care facilities with different technological levels. Assess the quality of prehospital fixed components of the RUE in health macroregions. A cross-sectional study using data from the Brazilian National Health Services Evaluation Program (PNASS) and the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB) was carried out. A typology was built for the quality of the emergency care units (UPAs) and the first visit by health macroregion, correlating it with socioeconomic variables. A cluster analysis was performed. In total, 280 UPAs, 21,182 basic health units (UBSs), and 27,335 family health teams from 74 health macroregions were evaluated. The general indicator of the quality of the components presented an average of 0.687 (reference score: 1.00). UPA quality (0.61) was positively influenced by the indicators Pharmacy support and Immediate emergency and urgent care, with worse results in Contract management, Planning and organization, and Organizational model. In primary healthcare (PHC) quality (0.78), the dimensions with better evaluations were Articulation with the network, Reception and procedures, unlike Exams and medications. Health macroregions were allocated to three clusters. Cluster 3 obtained a much higher overall average score (0.81) than the others (0.64 and 0.63). A lower quality of PHC was observed in Cluster 1, which showed the highest level of social vulnerability.

Verification of the Effectiveness of the Health Support Pharmacy “Toyonaka Model,” an Industry-Government-Academia Collaboration Project Aiming to Promote Community Health through the Information from Community Pharmacies via Digital Signages

Verification of the Effectiveness of the Health Support Pharmacy “Toyonaka Model,” an Industry-Government-Academia Collaboration Project Aiming to Promote Community Health through the Information from Community Pharmacies via Digital Signages

Impact of the COVID-19 pandemic: Community and hospital shared pharmaceutical care model. Satisfaction and acceptability of patients with HIV infection on antiretroviral treatment.

BackgroundThe health crisis due to the COVID-19 pandemic is a challenge in the dispensing of outpatient hospital medication (OHM). Models of Antiretroviral Therapy (ART) based on community pharmacy support (ARTCP) have proven to be successful. The aim was to evaluate the degree of satisfaction, acceptability and limitations of the implementation of ARTCP, in the context of a pandemic, in our environment.MethodsDescriptive cross-sectional study carried out in a Barcelona hospital, during the months of July-November 2020. A telephone survey was carried out via a questionnaire on the quality dimensions of the model (degree of satisfaction, acceptability) and associated inconveniences. Data collected: demographics, antiretroviral treatment (ART), concomitant medication, drug interactions (DDIs), CD4 lymphocyte count and plasma viraemia. Data analysis included descriptive statistics.ResultsA total of 533 (78.0%) HIV patients receiving ART were included. 71.9% (383/533) of these patients were very satisfied and 76.2% preferred attending the community pharmacy rather than the hospital. The mean satisfaction rating was 9.3 (DS: 1.4). The benefits reported were: 1) proximity to home (406: 76.1%); 2) lower risk of contagion of COVID-19 (318: 59.7%); 3) shorter waiting time (201: 37.1%); 4) time flexibility (104: 19.5%); 5) reduction of financial expenses (35: 6.57%). A total of 11 (2%) patients reported no benefit. Only 22.9% reported disadvantages associated with ARTCP: 1) lack of privacy (65: 12.2%); 2) lack of coordination-organization (57: 10.7%).ConclusionThe COVID-19 pandemic has had an impact on the provision of pharmaceutical care for HIV patients. The ARTPC model has proved efficient, with patients reporting a high degree of satisfaction.

Short‐term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID‐19

Background and AimPatients with refractory ascites have frequent hospital admissions, which pose exposure risks in the context of the COVID‐19 pandemic. The aim of this study was to investigate the safety and efficacy of a novel 12‐week, multidisciplinary ambulatory care program allowing frequent low‐volume ascitic drainage through a tunneled, intraperitoneal catheter (IPC).MethodsAdult patients with cirrhosis complicated by refractory ascites were recruited through a liver clinic in a tertiary health service in Melbourne, Australia from April to December 2020. All patients were enrolled in a 12‐week multidisciplinary program including medical, nursing, dietetics, and pharmacy support. A Rocket Medical IPC was inserted on day 1 with 1–2 L of ascitic fluid drained over 1–3 sessions per week either at the patients' homes or at the hospital day ward. Patients' demographics, death, complications, and self‐reported outcomes were recorded.ResultsTwelve patients were enrolled with a median of 65‐day (interquartile range [IQR]: 16.5–93) IPC duration between April and December 2020 across two periods of COVID‐related lockdown in Melbourne, Australia. There were no IPC‐related deaths. Early removal was necessitated in three patients due to leakage, nonadherence, and bacteremia. On day 30, the median self‐reported health score increased from 50 (IQR: 50–70) to 78 (IQR: 50–85), attributable to a reduction in symptom burden.ConclusionA multidisciplinary IPC program including the use of short‐term IPC was safe and associated with a self‐reported improvement in perceptions of health. In the context of the COVID‐19 pandemic, the program aimed to reduce patient and clinician exposure, which is maintaining engagement and management of decompensated cirrhosis.

Support Pharmacy Infrastructure to Strengthen US COVID-19 Vaccination Efforts and Beyond.

AffiliationsKathryn K. Marwitz is with the College of Pharmacy, Natural and Health Sciences, Manchester University, Fort Wayne, IN. Candace Haugtvedt is with the Department of Healthcare Administration, St. Mary of the Woods College and the Chicago School of Professional Psychology, Westerville, OH. Audrey B. Kostrzewa is with the School of Pharmacy, Concordia University Wisconsin, Mequon, WI.

Status of Cancer Care at Network Sites of the Nation's Academic Cancer Centers.

Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care. A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018. Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center's EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks. The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

Significant Published Articles in 2020 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 2020 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 169 articles were identified; 5 from the primary literature were voted by the group to be of high importance. An additional 17 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.

Development, implementation, and evaluation of a clinical decision support tool to improve naloxone coprescription within Military Health System pharmacies.

To describe the development, implementation, and evaluation of a pharmacy clinical decision support tool designed to increase naloxone coprescription among people at risk for opioid overdose in a large healthcare system. The Military Health System Opioid Registry and underlying presentation layer were used to develop a clinical decision support capability to improve naloxone coprescription at the pharmacy point of care. Pharmacy personnel use a patient identification card barcode scanner or manually enter a patient's identification number to quickly visualize information on a patient's risk for opioid overdose and medical history related to pain and, when appropriate, receive a recommendation to coprescribe naloxone. The tool was made available to military treatment facility pharmacy locations. An interactive dashboard was developed to support monitoring, utilization, and impact on naloxone coprescription to patients at risk for opioid overdose. Initial implementation of the naloxone tool was slow from a lack of end-user awareness. Efforts to increase utilization were, in part, successful owing to a number of enterprise-wide educational initiatives. In early 2020, the naloxone tool was used in 15% of all opioid prescriptions dispensed at a military pharmacy. Data indicate that the frequency of naloxone coprescription to patients at risk for opioid overdose was significantly higher when the naloxone tool was used than when the tool was not used.

Evolution of haemophilia integrated care in the era of gene therapy: Treatment centre's readiness in United States and EU.

Evolution of haemophilia integrated care in the era of gene therapy: Treatment centre's readiness in United States and EU.

Implementing Clinical Practice Guidelines for Tobacco Cessation in a Women's Residential Substance Use Treatment Facility.

Tobacco is the leading cause of preventable death, and over 200,000 women die each year of diseases caused by tobacco. Women with substance use disorders (SUDs) are disproportionately affected. Smoking prevalence among individuals enrolled in SUD treatment is 2-4 times higher than that of the general population, yet less than half of all treatment facilities offer tobacco treatment services. However, when individuals combine treatment, they have a greater likelihood of long-term abstinence from alcohol and other substances of use. A quality improvement project was undertaken to implement the U.S. Public Health Service guideline for tobacco cessation in a women's residential substance use treatment facility. Tobacco users were advised on their health risk and recommended to cut down or quit. They were advised that help was available using nicotine replacement therapy, behavioral counseling, or both. Upon admission, 67% of clients received brief advice to quit, and 30% participated in an intensive treatment aimed at reducing or eliminating cigarette use. At discharge, counseling participants (n = 21) smoked an average of nine cigarettes per day, reduced from 23, which was statistically significant. Interventions reduced cigarette smoking in a population at a high risk for adverse outcomes related to use. Results suggest that more clients are interested in tobacco treatment than previously estimated. Increased administrative, clinical, and pharmacy support can sustain and further assist clients with cessation efforts.

Less is more: Deprescribing anticholinergic medications in persons with severe mental illness.

Long-term prescribing of anticholinergic medications (ACM) for antipsychotic-associated extrapyramidal symptoms (EPS) is not recommended, yet is widely prevalent. Adverse effects of ACM include memory impairment, dry mouth, constipation, blurred vision, urinary retention, and tachycardia, which can seriously impact quality of life. This quality improvement deprescription project sought to reduce chronic ACM use in patients with serious mental illness (SMI). Education directed at psychiatrists combined with clinical pharmacy support for deprescription was used to target clinically stable patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with no EPS and ACM prescriptions of ≥6 months. Scales were used to assess anticholinergic adverse effects, memory impairment, and quality of life. ACMs were tapered and discontinued over 1 to 6 months. More than 75% of targeted patients successfully tapered or discontinued ACM, which coincided with significant improvements in anticholinergic adverse effects, memory impairment, and quality of life. Approximately 10% of patients were restarted on ACM for re-emergent EPS. For most clinically stable patients with SMI without EPS, our findings suggest that gradual deprescription of chronic ACM is clinically appropriate, well tolerated, and improves quality of life. A randomized trial could provide more definitive answers.

Improving pharmacy practice in relation to complementary medicines: a qualitative study evaluating the acceptability and feasibility of a new ethical framework in Australia

BackgroundThere is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines.ObjectiveEvaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy.MethodsAustralian community pharmacists were invited to participate in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis.ResultsSeventeen community pharmacists participated in the study (11 in 4 focus groups and 6 in individual interviews). There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff.ConclusionThe ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support.

Family medicine-directed hepatitis C care and barriers to treatment: a mixed-methods study.

Background:Antivirals for the treatment of hepatitis C virus (HCV) infection are effective, but many patients remain untreated and treatment is not yet routine in primary care. We evaluated the characteristics of patients who engaged in HCV treatment, and clinician perspectives on the barriers and facilitators to treatment.Methods:Our mixed-method, parallel-design study was conducted at a multisite primary care centre in downtown Toronto. In a retrospective chart review, we searched records from 2011 to 2017 to collect quantitative data, including HCV infection status and HCV treatment status. To contextualize the data, we conducted in-depth interviews with select physicians between Aug. 1 and Nov. 1, 2017, and analyzed the transcripts using content analysis.Results:Of the 40 381 charts reviewed, 727 patients (1.8%, 95% confidence interval [CI] 1.7%–1.9%) were infected with HCV, and 542 (74.6%) had HCV infection requiring treatment. Of those, 255 patients (47.0%) had engaged in treatment. Patients who had engaged in treatment were more likely to be male (odds ratio [OR] 1.63, 95% CI 1.10–2.42), older (OR 1.04 per year increase in age, 95% CI 1.02–1.05) and housed (OR 2.2, 95% CI 1.36–3.75), and they were more likely not to have engaged in injection drug use (OR 1.87, 95% CI 1.33–2.63). Based on interviews with 8 physicians, treatment barriers included a lack of knowledge about HCV treatment, concerns that patients would not adhere to medications and challenges related to medication access. Facilitators of treatment included access to specialist consultation, pharmacist support and primary care treatment guidelines. Common themes that emerged in both quantitative and qualitative components were the roles of unstable housing and intravenous drug use as barriers to engaging in and completing treatment.Interpretation:Our study captured provider-identified barriers to HCV care and the key factors related to retention in HCV care, including gender, age, housing status and experience with drug use. Successful primary-care-led HCV treatment programs may incorporate specialist and pharmacy support and focus on younger, female, underhoused populations and people who use drugs.

Telemedicine in Community Cancer Care: How Technology Helps Patients With Cancer Navigate a Pandemic.

COVID-19 places unprecedented demands on the oncology ecosystem. The extensive pressure of managing health care during the pandemic establishes the need for rapid implementation of telemedicine. Across our large statewide practice of 640 practitioners at 221 sites of service, an aggressive multidisciplinary telemedicine strategy was implemented in March by coordinating and training many different parts of our healthcare delivery system. From March to September, telemedicine grew to serve 15%-20% of new patients and 20%-25% of established patients, permitting the practice to implement safety protocols and reduce volumes in clinic while continuing to manage the acute and chronic care needs of our patient population. We surveyed practice leaders, queried for qualitative feedback, and established 76% were satisfied with the platform. The common challenges for patients were the first-time use and technology function, and patients were, in general, grateful and happy to have the option to visit their clinicians on a telemedicine platform. In addition to conducting new and established visits remotely, telemedicine allows risk assessments, avoidance of hospitalization, family education, psychosocial care, and improved pharmacy support. The implementation has limitations including technical complexity; increased burden on patients and staff; and broadband access, particularly in rural communities. For telemedicine to improve as a solution to enhance the longitudinal care of patients with cancer, payment coverage policies need to continue after the pandemic, technologic adoption needs to be easy for patients, and broadband access in rural areas needs to be a policy priority. Further research to optimize the patient and clinician experience is required to continue to make progress.

A day in the life of a pharmacist leading in health education

After working in several managerial positions in community pharmacy, I made the move to pursue my passion in learning and development. At first, I worked for several multiples, preparing preregistration pharmacists to become pharmacists and educating pharmacy support staff. However, after completing a postgraduate certificate in clinical pharmacy, I felt there was something missing in […]

981. Extended Adherence and Persistence to HIV PrEP in a Multidisciplinary PrEP Clinic

BackgroundMethods to identify and address barriers to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) persistence are needed to improve low PrEP persistence rates beyond 6 months. We evaluated PrEP adherence and persistence in a multidisciplinary clinic model with an integrated specialty pharmacist.MethodsWe conducted a single-center, retrospective, cohort study of patients initiating PrEP in the multidisciplinary Vanderbilt PrEP Clinic with prescriptions filled by Vanderbilt Specialty Pharmacy between 9/1/2016 and 3/31/2019. In this model, integrated clinical pharmacists manage PrEP access, affordability, and therapy monitoring. Clinical data were collected from the electronic health records and pharmacy claims data. Adherence was calculated from fill data using proportion of days covered (PDC). Persistence at 6, 12 and 18 months was measured using patient-reported discontinuation date or the date of the last fill plus the fill’s days’ supply for patients lost to follow-up. The Kaplan-Meier estimation method was used to estimate persistence probabilities.ResultsMost of the 63 patients included were male (97%), white (84%), commercially insured (94%) with a median age of 38 years, and men who have sex with men at high risk for acquiring HIV (97%); Table 1. The majority of patients with at least one follow-up visit (n=58) reported no adverse effects (78%), no missed doses (71%), and had a median PDC of 99% (IQR 97% – 100%). Persistence at 6, 12 and 18 months was 0.87 (95% confidence interval, CI, 0.80 – 0.96), 0.81 (95% CI 0.72 – 0.91), and 0.74 (95% CI 0.64 – 0.86), respectively; Figure 1. Of the 18 patients who discontinued PrEP, 9 discontinued due to perceived lack of risk for acquiring HIV, 6 were lost to follow up, 1 moved, transferring PrEP care to a new provider, 1 had worsening depression, and 1 had renal function decline.Table 1 Patient Characteristics Figure 1 Persistence on HIV PrEP ConclusionPatients receiving PrEP treatment in a multidisciplinary clinic with an integrated clinical pharmacist had high rates of adherence and persistence up to 18 months. Patients reported few side effects and reasons for therapy discontinuation were appropriate. Efforts to incorporate pharmacy support in managing PrEP patients could be beneficial in increasing patient adherence and persistence.Disclosures All Authors: No reported disclosures

Patients' Attitudes, Awareness, and Opinions About Community Pharmacies in Japan: Next Steps for the Health Support Pharmacy System.

PurposeDespite the formal establishment of the Health Support Pharmacy system, few community pharmacies have transitioned to this new designation in Japan. Moreover, patients’ perspectives on the usefulness of health-support pharmacies and community pharmacies have not yet been investigated. In this work, we investigated patients’ attitudes, opinions, and awareness as users of member pharmacies of the Japan Federation of Democratic Medical Institutions (Min-Iren), with respect to two essential functions provided by community pharmacies—primary care and health support—to identify modern challenges facing community pharmacies.MethodsRegular visitors to participating Min-Iren community pharmacies were asked to complete an anonymous questionnaire. Responses were compared between users of health-support pharmacies and other pharmacy types, as well as between members and non-members of “collaborating organizations” (CO). CO is organizational partners of Min-Iren whose activities support affiliated facilities. Logistic regression analysis was performed to explore the predictive value of different factors on pharmacies’ primary-care and health-support functionality.ResultsA total of 181 Min-Iren community pharmacies (51.7%: 181/350) participated in this study, and most patients answered the questionnaire (97.7%, n=2623). Relatively few patients recognized the term “Health Support Pharmacy” (12.2%). CO members tended to have a superior understanding of a wide variety of services provided by CPs as compared to non-members. Statistically significant predictors of primary-care and health-support functionality included male gender, having a primary-care pharmacist, age ≥60 years, recognition of the term “Health Support Pharmacy” and CO membership.ConclusionCO members, a class of patients with a superior awareness of health promotion, demonstrated a good understanding of the variety of services provided by community pharmacies and tended to positively rate their pharmacy. Moving forward, efforts to raise awareness about the importance of health-promotional activities among community pharmacy users should further reinforce the primary-care and health-support functions of community pharmacies.