Pharmacy Users Research Articles

Convenience and price drive online pharmacy usage by veterinary clients.

To evaluate factors that influence client selection of a veterinary pharmacy and assess client perception of the impact of online pharmacies on veterinary clinics. Survey data and satisfaction metrics were compared between online pharmacies, a teaching hospital pharmacy (UW Veterinary Care), and primary care veterinary clinics between March and April 2023. Online pharmacy users were asked about perceived impact of online pharmacies on veterinary clinics. Personal values were correlated with the likelihood of using a pharmacy. 158 surveys were analyzed; 32.9% of respondents used an online pharmacy. Of those, 20% used a veterinary-affiliated online pharmacy. Convenience was the value most liked by online pharmacy and primary care clinic users. Online users reported liking price most, whereas veterinary clinic pharmacy users (UW Veterinary Care and primary care clinics) reported liking communication and trust. Online users ranked price as more important, whereas veterinary clinic users ranked personalized experience (caring, explanations, veterinary recommended) as more important. Regardless of pharmacy type, satisfaction scores were high. Most online users perceived a negative impact of online pharmacies on veterinary clinics; this did not change reported usage. Online and veterinary clinic users prioritized different values. Online users prioritized price and veterinary clinic users prioritized personalized experience. Online usage was not influenced by perceived impact. For veterinary clinics attempting to increase revenue, appealing to these 2 distinct driving values is essential. Offering practice-directed online pharmacies with competitive and transparent pricing could procure online consumers, while maintaining a personalized experience remains important for consumers purchasing prescriptions in-house.

Exploring a role for community pharmacists in the identification of alcohol-related liver disease: a qualitative interview study with professionals, patients, and the public.

To explore the views and attitudes of professionals, patients and the public to a role for community pharmacists in the identification of alcohol-related liver disease (ArLD). Semi-structured interviews were conducted with a purposive sample of patients with ArLD, members of the public, pharmacy staff, and clinicians managing patients with ArLD across the Wessex region of south England. The interviews explored experiences of alcohol, ArLD and health advice in pharmacies and elicited views of what a pharmacist role in identifying ArLD could entail and factors influencing this. Transcripts were analysed using reflexive thematic analysis. Twenty-six participants were interviewed and three themes were generated: (i) acknowledging, seeking help and engaging with a hidden problem; (ii) professional roles, boundaries and attributes; (iii) communication, relationships, collaboration and support. Participants reported key challenges to identifying people at-risk of ArLD. Offering testing for ArLD was perceived to motivate engagement but there were concerns about pharmacists performing this. A role was mostly seen to be finding people at-risk and engaging them with further care such as referral to liver services. This was perceived to require developing interprofessional collaborations, remuneration and training for pharmacy staff, and community-based liver testing. Professionals, patient and public participants recognized a role for pharmacists in the identification of ArLD. This was envisaged to incorporate educating pharmacy users about ArLD risk, and identifying and directly engaging those at-risk with liver and support services through development of interprofessional collaborations. The findings of this study support and can inform future work to develop this role.

Does the type of pharmacy used influence medication adherence? A retrospective observational study in Aotearoa, New Zealand.

Community pharmacies in New Zealand have varying ownership and operational structures. Unlike independent pharmacies, corporate and hybrid pharmacies do not charge prescription copayments. This research aimed to determine whether people receiving free prescriptions from corporate and hybrid pharmacies (via copayment waiver) have greater medication adherence than the users of independent pharmacies. A nationwide, retrospective, observational study linked 1 year of dispensing data (1/05/2022 to 30/04/2023) from the Pharmaceutical Collection to patient enrollment data using a National Health Index number to identify demographics of different pharmacy-type users. People were assigned to a particular type of pharmacy if they collected at least 70% of their prescriptions from there; if they did not meet this threshold, they were defined as mixed users. People were classified as adherent if dispensing data showed they collected their supply of medication to cover at least 80% of the study period. The sample captured 218,080 people taking at least 1 diabetes medication, with a total of 360,079 unique medications being included in the analysis. The majority, 156,893, used independent pharmacies. The type of pharmacy used was shown to be a significant predictor of adherence. Corporate and hybrid pharmacy users were 0.90 (95% CI 0.88 to 0.93) and 0.93 (95% CI 0.90 to 0.96) times as likely be adherent than the users of independent pharmacies. Mail order pharmacy users were the most likely to be adherent, whereas mixed pharmacy users were the least likely to be adherent. Our findings suggest that prescription copayments provided by corporate and hybrid pharmacies are not the most significant barrier to medication adherence. Further research may identify more efficient ways of improving medication adherence than removing prescription copayments for all.

Mental Health Evaluation in Community Pharmacies-A Cross-Sectional Study.

Portugal has a high prevalence of anxiety and depression, and community pharmacists are well-placed to identify mental health problems and monitor their treatment. This study aimed to screen undiagnosed people for symptoms of anxiety and depression and to monitor these conditions in diagnosed patients. We conducted an observational, cross-sectional study of a sample of community pharmacy users. Anxiety and depression symptoms were assessed using the Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Altogether, 591 participants were enrolled between September 2020 and July 2021, 74.9% of whom were female. Of the 477 undiagnosed participants who completed the GAD-7, 87 (18.2%) had moderate or severe anxiety symptoms. Of the 485 participants who completed the PHQ-9, 59 (12.1%) had moderate or severe symptoms of depression. Of the 94 patients diagnosed with anxiety, 37 (39.4%) reported moderate to severe symptoms. Similarly, of the 97 patients with depression, almost half (49.5%) reported moderate to severe symptoms. Anxiety levels were lower among men and among those who reported not taking any medication (p < 0.001). Moderate or severe symptoms of depression were more common among women (p < 0.001), participants with lower education levels (p < 0.005), participants who live alone (p < 0.007), and those taking medication for insomnia (p < 0.001), pain (p < 0.001), anxiety (p < 0.001), and/or depression (p < 0.001). Screening for anxiety and depression revealed that a significant proportion of undiagnosed participants had clinically relevant symptoms of anxiety and depression. However, among participants diagnosed with anxiety and depression, between 40% and 50% were uncontrolled, respectively. These data highlight pharmacists' role in identifying customers at risk of anxiety and depression as well as the need for better monitoring of those already diagnosed.

Carbon Reduction Impact from Synchronising PrescriptionS (CRISPS): A pilot study

Abstract Introduction Synchronising the dates of patients’ repeat prescriptions can reduce monthly community pharmacy visits or home deliveries, which may improve patients’ adherence to medicines.[1] It should also reduce carbon dioxide (CO2) emissions associated with avoidable travel, but previous research does not appear to have determined the potential size of this reduction. This pilot study therefore attempted to do so using routinely collected data. Aim To estimate potential carbon savings from synchronising repeat medicines for a sample of patients from one community pharmacy. Methods All patients who had prescriptions dispensed four times per month or more from a single medium-sized (approximately 2,500 items dispensed per month) urban community pharmacy in England were identified from the pharmacy’s home delivery application. The threshold of four deliveries per month was selected to increase the likelihood of this frequency being due to asynchronised prescriptions. Data were collected (August 2023) for deliveries in June 2023 as there were no public holidays or events to affect prescription ordering. Data included patients’ postcode, delivery dates, and using the Patient Medication Record, the pharmacist collecting the data determined acute or one-off prescription items, that neither the patients nor the repeat medicines were new, and where deliveries were made to supply medicines owing. The pharmacy was selected because it efficiently managed stock to minimise items owing. The distance that would have been travelled was calculated as if the medicines had been collected from the pharmacy as a dedicated journey to and from the patient’s home address instead of being delivered. The saving in miles and CO2 emitted for different vehicle types was modelled by assuming that for each patient, all deliveries that were not for acute items or medicines owing could have been reduced to a single delivery if prescriptions had been synchronised. UK Government conversion factors were used to calculate CO2 emissions.[2] Results Data were collected for 59 patients, of whom 7 patients had 8 deliveries, 4 had 7 deliveries, 6 had 6 deliveries, 16 had 5 deliveries and 26 had 4 deliveries. The total number of deliveries to these patients was 269 but would have been 80 deliveries if the repeat prescriptions had been synchronised (70% reduction). The distance travelled would have been reduced from 842 miles to 241 miles (71% reduction). This would have resulted in a 71% reduction in CO2 emissions, although the reduction in volume in kilograms of CO2 emitted would have varied (by an estimated 137 Kg CO2 or 51%) depending on whether e.g., a small diesel car was used or a large petrol car (reduction of 133kg versus 270 kg CO2). An average diesel car was estimated to have reduced CO2 emissions by 163 kg. Conclusion The findings demonstrate that potential carbon savings from medicines synchronisation can be modelled from routinely collected data, but with limited accuracy, especially as patients receiving home deliveries may not be representative of all pharmacy users. Challenges remain in how to measure actual carbon savings of prescription synchronisation and overcoming barriers to widespread implementation of clinically appropriate synchronisation.

Screening for Chronic Kidney Disease in the Community Pharmacy. CRIERFAC Study: Description of the Methodology

Chronic kidney disease (CKD) is the existence of abnormalities in renal structure or function with an impact on health. This is usually considered when estimated glomerular filtration (eGF) falls under 60 mL/min/1.73m2. Its clinical course leads to renal replacement therapy (dialysis or transplant) when eGF falls under 15 mL/min/1.73m2. Screening in at risk populations has been proven to be cost-effective. The aim of this work is to perform CKD screening in the community pharmacy. In this publication we report and justify the methodology in detail. Pharmacists from the community pharmacies taking part selected patients who complied with inclusion and not exclusion criteria. Creatinine was measured by means of a finger prick and eGF calculated with the formula CKD-EPI. If this is lower than a set value, which depends on age, referral to the general practitioner takes place. A total of 141 out of 200 pharmacies took part in the study. In all 2116 patients were recruited and 116 patients were lost. The final sample size was 2000 patients. The protocol was successfully implemented by community pharmacists and was extremely well received by community pharmacy users. The age adjustment for eGF thresholds provides a novel additional filter. The aim is not to overburden primary care centres with potential referrals of false positives. Confirmation of the diagnosis is subject to voluntary communication by the patient to the pharmacist.

Patient Experiences of Community Pharmacy Medication Supply and Medicines Reconciliation at Hospital Discharge: A Pilot Qualitative Study.

(1) Background: As part of the Scottish Government's five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients' experiences with this new service. (2) Method: Adult patients (≥18 years age) who consented to participate in the Community Pharmacy Hospital Discharge and Medicines Reconciliation Service were invited for an interview within 21 days of discharge from hospital. Qualitative, one-to-one, semi-structured patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis. (3) Results: Twelve patients were interviewed, evenly split by sex and with a median age of 62 years (range 36 to 88 years). Our analysis generated main five themes: patient engagement, stakeholder communication, practical factors, human factors, and comparative experiences. Many of these were interdependent. (4) Conclusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of obtaining their medication from the community pharmacy), and a pre-existing and trusted relationship in their usual community pharmacy were the key factors that regulated the patient experience. Generally, patients were positive about the introduction of this new service. However, the lack of a previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact patient experiences.

Combining zip code-based population data and pharmacy administrative claims data to create measures of social determinants of health.

Social determinants of health (SDoH) are key factors that impact health outcomes. However, there are many barriers to collecting SDoH data (eg, cost of data collection, technological barriers, and lack of standardized measures). Population data may provide an accessible alternative to collecting SDoH data for patients. To explain how population data can be leveraged to create SDoH measures, assess the association of population SDoH measures with diabetic medication adherence, and discuss how understanding a patient's SDoH can inform care plans and patient engagement. A nationally representative commercial sample of patients who were aged 18 years and older and met Pharmacy Quality Alliance inclusion criteria for diabetes mellitus were analyzed (N = 37,789). US Census and North American Industry Classification System data were combined with pharmacy administrative claims data to create SDoH measures. Derived measures represent 2 SDoH domains: (1) economic stability (housing density, housing relocation, jobs per resident, and average salary) and (2) health care access and quality (urban/rural classification, distance traveled to prescriber and pharmacy, use of a primary care provider [PCP], and residents per PCP). The association of population SDoH measures with diabetic medication adherence (proportion of days covered) was assessed via logistic regression, which included covariates (eg, sex, age, comorbidities, and prescription plan attributes). As housing density (houses per resident) increased, so did the likelihood of adherence (odds ratio = 1.54, 95% CI = 1.21-1.97, P = 0.001). Relative to patients who did not move, patients who moved once had 0.87 (95% CI = 0.81-0.93, P < 0.001) the odds of being adherent, and patients who moved 2 or more times had 0.82 (95% CI = 0.71-0.95, P = 0.008) the odds of being adherent. Compared with areas with fewer jobs per resident, patients living within a zip code with 0.16 to 0.26 jobs per resident were 1.12 (95% CI = 1.04-1.20, P = 0.002) times more likely to be adherent. Patients who lived in an urban cluster were 1.11 (95% CI = 1.01-1.22, P = 0.037) times more likely to be adherent than patients living in a rural area. Patients who travel at least 25 miles to their prescriber had 0.82 (95% CI = 0.77-0.86, P < 0.001) the odds of being adherent. Community pharmacy users had 0.65 (95% CI = 0.59-0.71, P < 0.001) the odds of being adherent compared with mail order pharmacy users. Patients who had a PCP were 1.26 (95% CI = 1.18-1.34, P < 0.001) times more likely to be adherent to their medication. Leveraging publicly available population data to create SDoH measures is an accessible option to overcome barriers to SDoH data collection. Derived measures can be used to increase equity in care received by identifying patients who could benefit from assistance with medication adherence.

Impact of a Pharmacy Care Management Service on Medically Complex Medicare Advantage Members

Summary Medicare Advantage (MA) programs have grown rapidly, and a shift toward more medically complex beneficiaries has implications for health care utilization, costs, and quality in the MA program. Ensuring safe and effective medication use in this population has been identified as a priority, yet there is limited evidence to guide MA plans’ pharmacy care management (PCM) efforts. The goal of this study was to investigate the impact of an integrated PCM program for MA beneficiaries taking multiple chronic medications, including a subset with high predicted cost savings from improved medication adherence, assessed using the Value of Future Adherence (VFA) score. Using adjudicated administrative claims data from a regional Medicare Advantage and Part D (MAPD) plan, a retrospective matched cohort study was designed. A total of 724 members receiving PCM services were matched to 3,620 control members who received usual pharmacy care. From these two cohorts, 196 of 724 PCM participant members and 980 of 3,620 control group members were defined as having a high VFA score. PCM program enrollees underwent monthly medication reviews, reconciliation, and synchronization of refills, which were dispensed and delivered to the home in adherence packaging by a specially equipped pharmacy. Members were contacted monthly and received, as needed, education, referral to health care providers, consultation with prescribers on changes to medication regimens, and referral to social support or case management programs. Primary outcomes of interest were per enrollee per month (PEPM) costs, resource utilization, and medication adherence for three MAPD Star Ratings measures — Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (renin-angiotensin system antagonists [RASAs]), and Medication Adherence for Cholesterol (statins) — over 12 months for all members and for the subgroup with a high VFA score. The authors found that among all PCM program enrollees, there was a $50 (95% confidence interval [CI], $15 to $86; P = 0.005) PEPM increase in average pharmacy spending compared with control members and an offsetting $158 (95% CI, −$265 to −$51; P = 0.004) PEPM decrease in medical spending, resulting in PCM participants having $108 (95% CI, −$221 to $5; P = 0.062) lower PEPM total cost of care. Compared with the control group, PCM enrollees had 15% (P = 0.008) fewer inpatient stays and improvements in medication adherence of 7.3% among members taking oral antidiabetic agents, 9.4% among members taking statins, and 12.9% among members taking RASA antihypertensive agents (P < .001 for all three measures). These effects were driven by the patients in the subgroup with a high VFA score, for whom PEPM total cost of care was $406 (95% CI, −$645 to −$161; P < 0.001) lower than control members. These findings support the potential value of an integrated PCM program for MAPD beneficiaries on multiple medications, particularly when targeted to those members predicted to benefit most.

Satisfacción percibida por los usuarios de servicios farmacéuticos en Yopal Casanare ante el COVID 19

User satisfaction has become an indispensable requirement and even more with the appearance of COVID 19, companies were forced to improve the quality of their services. In Colombia, and especially the department of Casanare, there is a high degree of dissatisfaction with health sector companies. For this reason, the research project aimed to know the degree of perceived satisfaction of users of pharmaceutical services in the city Yopal Casanare. Through online questionnaires scale of Likert, applied to 133 users of pharmacies and drugstores of the private sector of the city. Non-probability sampling was used to calculate the sample size for convenience. It is also evident that there is a relationship between the degree of perceived satisfaction vs order of arrival and priority in care. In short, to meet the needs of users of pharmaceutical services in a shorter time; it is one of the alternatives identified for improving the degree of satisfaction in drugstores in the city of Yopal.

Pharmacy users' perceptions, awareness and future expectations of community pharmacy in England: a focus group study.

To explore pharmacy users' perceptions of current and future provision of community pharmacy services in England. Qualitative, reconvened focus groups were conducted with community pharmacy users. An initial focus group explored preliminary views. Participants were then given an evidence brief describing community pharmacy before a reconvened focus group two weeks later. Transcripts were analysed using inductive thematic analysis. Eleven individuals participated across two reconvened focus groups. Participants valued community pharmacies and staff, but lacked awareness of their services and roles: '… I don't think the general public is aware of all of this … it gives you a very different perspective'. Urgent care and long-term conditions management were identified as suitable for future development, facilitated by training, closer collaboration with general practices, shared access to health records, and premises with more space and confidentiality: 'I still think of it as a retail space more than as a health service'. Concerns were expressed about working conditions in community pharmacy and unplanned closures: 'doesn't sound like a great place to work'. Participants anticipated greater use of technology but did not want this to replace face-to-face contact with pharmacy staff: 'I am not saying it's inaccurate, it is so remote and impersonal'. Pharmacy users would value a greater role for community pharmacy in addressing the challenges currently faced by the health service in England, provided that their concerns on a range of issues are addressed.

Triptans utilization in Italian population: A real-life study in community pharmacies.

The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ).

Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role. A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated. Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers. Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

What do pharmacy users think of free pharmacy services? Investigating pharmacy users' perceptions, attitudes and willingness to pay for free healthcare from pharmacies

BackgroundEvidence exists of pharmacists providing free or partially subsidised clinical services in order to meet patient healthcare needs. Little is known about how patients perceive the quality and importance of such unfunded services to their healthcare. ObjectivesTo explore pharmacy user perspectives about unfunded services such as their valuation, why they chose to access these services from the pharmacy as well as their willingness to pay should pharmacies need to start charging for the provision of such services owing to budgetary constraints. MethodsThis study was nested in a larger nationwide study where 51 pharmacies were recruited across fourteen locations across New Zealand . Semi-structured interviews were conducted with patients who had accessed unfunded services in community pharmacies. Patients were followed up to identify their percieved health outcomes resulting from accessing the unfunded service. ResultsA total of 253 patient interviews were conducted on-site across 51 pharmacies in New Zealand. Two main themes were identified pertaining to (1) patient-provider relationship and (2) Willingness to pay. A total of fifteen different considerations were found to influence pharmacy users' decisions to access health services from the pharmacy. It was found that 62.8% of patients were willing to pay for unfunded services and the majority paying NZD$10. ConclusionPatients positively rate these services and largely deem them important for their healthcare. Willingness to pay for services were also variable between patients and were dependant on the type of service accessed.

Pharmacy dispensing of abortion pills in Ghana: experiences of pharmacy workers and users

BackgroundSelf-managed medical abortions are generally safe; however, pharmacy provision of abortion pills is against the Ghanaian abortion law. Nevertheless, evidence shows increasing numbers of women use it. An understanding of...

Pharmacovigilance of vaccines against COVID-19 in community pharmacies. Results with the first dose

Detection, reporting and monitoring of suspected Adverse Drug Reactions (ADR) in users of community pharmacies and their impact on health and daily life. Design: prospective observational. Subjects: people vaccinated against COVID-19, of legal age, who signed informed consent. Variables: number and percentage of participants who had at least one ADR. Number, type and frequency of possible reactivity. Impact on your daily life. The study was approved by CEIm-G (Exp. 2021-007). 10 pharmacies from Pontevedra and 2 from Ourense collaborated. 781 cases, 488 (62.5%) women. Age 56.8 (SD=17.9) years. 389 (49.8%) in risk group.495 (63.4%) vaccinated, 321 women (65.8%) and 174 (59.4%) men, reported at least one ADR: 236 (53.0%) Comirnaty®, 157 (82.6%) Vaxzevria®, 69 (66.3%) Spikevax® and 33 (80.5) Janssen®.1,367 ADR were recorded. The most prevalent: pain at the injection point 375 (48.0%), tiredness/fatigue 170 (21.8%), chills 118 (15.1%), headache 117 (15.0%), muscle pain 112 (14.3%) and fever 98 (12.5%).Of the 495 respondents with ADR, 77 (15.6%) needed professional help: from the family doctor 30 (39.0%), 9 (11.7%) in the emergency department, 1 (1.3%) in the hospital and 37 (48.1%) in the pharmacy. 118 (15.1%) were unable to carry out their daily activity.ADR were reported from 264 (53.3%) vaccinated. The number of vaccinated people who reported having suffered RA was high. Pain at the injection site the most prevalent. Half were treated at the pharmacy. Although they were generally mild, they markedly affected his daily life.

A Pharmacy Liaison–Patient Navigation Intervention to Reduce Inpatient and Emergency Department Utilization Among Primary Care Patients in a Medicaid Accountable Care Organization

Patients with unmet health-related social needs are at high risk for preventable health care utilization. Prior interventions to identify health-related social needs and provide navigation services with community resources have not taken place in pharmacy settings. To evaluate an enhancement of pharmacy care to reduce hospital admissions and emergency department (ED) visits among primary care patients in a Medicaid accountable care organization (ACO). This nonrandomized controlled trial was conducted from May 1, 2019, through March 4, 2021, with 1 year of follow-up. Study allocation was determined by odd or even medical record number. The study was performed at a general internal medicine practice at a large safety-net hospital in Boston, Massachusetts. Patients who qualified for the hospital's pharmacy care program (aged 18-64 years and within the third to tenth percentile for health care utilization and cost among Medicaid ACO membership) who attended a visit with a primary care clinician were eligible. Of 770 eligible patients, 577 were approached, 127 declined, and 86 could not be contacted. Patients in the control group received usual pharmacy care focused on medication adherence. Patients in the intervention group received enhanced pharmacy care with an additional focus on identification of and intervention for health-related social needs. The intervention took place for 1 year. The primary outcome was inpatient hospital admissions and ED visits (composite outcome) in the 12 months after enrollment during the intervention period. Among 364 allocated patients (mean [SD] age, 50.1 [10.1] years; 216 women [59.3%]), 35 were Hispanic of any race (9.6%) and 214 were non-Hispanic Black (58.8%). All participants were included in the intention-to-treat analysis. In analyses controlling for baseline hospital admissions and ED visits the year prior to enrollment, the enhanced pharmacy care group was not associated with the odds of having any hospital admission or ED visit (adjusted odds ratio, 0.62 [95% CI, 0.23-1.62]; P = .32) among all patients and was not associated with the visit rates among those with any visit (adjusted rate ratio, 0.93 [95% CI, 0.71-1.22]; P = .62) relative to the usual pharmacy care group in the year following enrollment. The findings of this nonrandomized controlled trial suggest that inpatient and ED utilization among Medicaid ACO members at a safety-net hospital was not significantly different between groups at 1-year follow-up. ClinicalTrials.gov Identifier: NCT03919084.

Bedside check of medication appropriateness (BED-CMA) as a risk-based tool for bedside clinical pharmacy services: A proof-of-concept study at the trauma surgery ward

BackgroundBedside clinical pharmacy prevents drug-related problems, but is not feasible in many countries due to limited resources. Hence, clinical rules using structural information in the electronic health record can help identifying potentially inappropriate prescriptions (PIPs). We aimed to develop and implement a risk-based clinical pharmacy service and evaluate its impact on prescribing at the trauma surgery ward. MethodsThe proportion of residual PIPs per day, i.e. the number of PIPs that persisted up to 24 h after pharmacist intervention divided by the number of PIPs at T0, was evaluated before and after implementation of the intervention in an interrupted time series analysis. The pre-intervention cohort received usual pharmacy services, i.e. a 0.3 FTE clinical pharmacist trainee. Fifteen clinical rules, targeting antimicrobial, anticoagulant and analgesic therapy were implemented in the post-intervention period. The pre-intervention period was compared to two post-intervention scenarios: A) clinical rule alerts reviewed by a 0.3 FTE clinical pharmacist trainee; and B) clinical rule alerts reviewed daily for approximately 1 h by a clinical pharmacist trainee. ResultsPre-intervention, a median proportion of 67% (range 0%−100%) residual PIPs per day was observed. Scenario A showed an immediate relative reduction of 14% (p = 0.72) and scenario B a significant immediate relative reduction of 85% (p = 0.0015) in residual PIPs per day. In scenario A, recommendations were provided for 19% of clinical rule alerts, of which 67% was accepted by the surgeon within 24 h. In scenario B, recommendations were given for 56% of alerts, of which 84% was accepted. ConclusionsUsing clinical rules is an effective approach to organize bedside clinical pharmacy services and improves prescribing at the trauma surgery ward. Advanced training and daily follow-up of the clinical rules are two requirements to be considered.

Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study.

Chronic kidney disease (CKD) is a major health problem. Early detection is the key to reducing morbidity and mortality, but it is difficult because it occurs without symptoms. Diagnosis of CKD is also important to avoid nephrotoxic drugs and to adjust the doses of other medications that may be affected. Pharmacies, due to their proximity to the population, frequency of patient visits, and knowledge of medication use are an ideal location for point-of-care diagnosis or CKD. To detect and refer to the primary care physician patients with low estimated glomerular filtration rate (eGFR) who use nephrotoxic drugs or who may require a dose adjustment. Pharmacy users over 60 years of age who agreed to participate were given a creatinine/eGFR test with a point-of-care meter. The eGFR was calculated and if it was less than 60 ml/min/1.73 m2, their medications were evaluated to identify nephrotoxic drugs or drugs that potentially required adjustment. If either were found, they were referred to their doctor for further management. 198 patients were recruited in 4 pharmacies, of which 87 (43.9%) had an eGFR less than 60 ml/min/1.73 m2. They were taking a total of 635 medications. Of these 635 medications, 50 (7.9%) were affected by kidney function. Dose adjustment was recommended in 31 and discontinuation in 19. The primary care doctor accepted the recommendations for 14 medications: dose adjustment for 6 and withdrawal in 8. This represents 2.3% of medications taken by patients with an eGFR less than 60 ml/min/1.73 m2. The 50 medications identified were taken by 29 patients (33.3% of the 87 with a low eGFR) and a change in treatment was generated in 9 patients, representing 4.6% of the total number of patients in the sample, and 10% of the patients with a low eGFR. Point-of-care testing for kidney function in a pharmacy setting is feasible and identifies a significant number of patients with eGFR under 60 ml/min/1.73 m2. It also allows for appropriate medication management recommendations in this patient group.

Comparing different robots available in the European market for the preparation of injectable chemotherapy and recommendations to users.

Recent advances in technology have made it possible to develop robots for preparing injectable anticancer drugs. This study aims to compare characteristics between robots available in the European market in 2022 and to help future pharmacy users in their choices. Three sources of data were used: (1) a review of published articles in the MEDLINE database from November 2017 to end of June 2021 on chemotherapy-compounding robots used in hospital; (2) all manufacturers' documentation, and (3) demonstrations of robot operations in real hospital conditions and discussions with users and manufacturers. Robot characteristics included number of robots installed, general technical characteristics, type of injectable chemotherapy produced and compatible materials, productivity data, preparation control methods, residual manual tasks, chemical and microbiological risk management, cleaning method, software, and implementation time. Seven robots commercialized were studied. Several technical characteristics have to be taken into account in selecting the robot whose match the specific needs of a particular hospital, and which often require rethinking the current production workflow as well as the organization of the pharmacy unit. In addition to increasing productivity, the robots improve the quality of production thanks to better traceability, reproducibility, and precision of sampling. They also improve user protection against chemical risk, musculoskeletal disorders, and needle wounds. Nevertheless, when robotization is being planned, there are still numerous residual manual tasks to keep in mind. Robotization of the production of injectable anticancer drugs is booming within anticancer chemotherapy preparation pharmacy units. Feedback from this experience needs to be further shared with the pharmacy community regarding this significant investment.