Practice Of Pharmacists Research Articles

475 Co-designing an intervention to support safe medicines self-management for older people living with frailty and polypharmacy

Abstract Introduction Older people face numerous challenges and safety risks when managing multiple medicines. They are required to cope with complex and changing regimens and co-ordinate input from multiple healthcare professionals. If not well managed, medicines can cause harm, and older people are more susceptible to errors. Some older people can devise and implement strategies to manage their medicines, e.g. creating checklists, ensuring timely supplies, solving problems, and seeking help (1). However, no interventions address the multiple tasks polypharmacy patients must perform to safely manage their regimens. Aim To develop an intervention to support medicines self-management for older people living with frailty and polypharmacy using experience-based co-design (EBCD) (2). Methods Following video or audio-recorded qualitative interviews with 32 older people taking 5 or more medicines, a ‘trigger film’ of patients’ medicines management experiences was produced and used during EBCD to facilitate priority setting. Separate meetings were held (1) with 16 staff (2 GPs, 4 GP practice administrators, 4 GP practice pharmacists, 1 practice lead, 2 senior nurses, 2 pharmacy technicians, 1 community pharmacist) and (2) with 13 patients and 2 family members, followed by a joint meeting with 8 older people and 9 staff where a shared set of three priorities was agreed. Two subsequent co-design workshops with 6 patients, 2 family members and 7 staff developed three candidate interventions. Workshop 1 explored key themes from the trigger film to develop solutions. Workshop 2 reviewed solutions and further developed design ideas. Intervention components were merged and those addressing patient safety challenges were retained to form the prototype intervention. Ethical approval was obtained for the interviews included in the trigger film, but not required for EBCD. EBCD meetings and workshops were conducted as quality improvement: people involved were collaborators, personal information was not captured, discussions were not recorded or analysed. Results Co-design priorities were to support patients in: day-to-day practical medicines management; understanding the wider medicines management system; communication with healthcare teams. The three solutions were: a quick-start guide to managing multiple medicines including talking about medicines and managing new routines; tips and tricks to support day-to-day management, including planning and adherence tools; a tool supporting preparation for medication reviews and asking questions about medicines. After merging intervention components and identifying those addressing medicines-self-management patient safety challenges, five areas were retained for the prototype intervention: checking what you get; keeping on top of supplies; monitoring how you take your medicines; times when problems are more likely; and how do I know if I need help? Discussion/Conclusion Through EBCD patients and staff worked together to improve people’s experiences of managing medicines and to enhance safety. The prototype intervention addresses five areas where older people with complex medicines regimens require support. The intervention requires feasibility testing and subsequent robust evaluation. Strengths and limitations: • A variety of staff roles joined the co-design, offering multiple different perspectives on medicines management • EBCD meetings and workshops were run online to avoid Covid infections. This may have excluded older people with no access to internet.

481 An exploration of general practice pharmacists’ (GPPs) views on their role in general practice: a cross-sectional questionnaire study

Abstract Introduction The integration of pharmacists into general practice across the UK (also called general practice pharmacists; GPPs) has been tested through different pilot plans; the intention of this integration was to address issues of the primary care workforce and workload (1). Currently, there is a lack of research examining the views of GPPs on their role and their impact in general practice within the UK. Findings from published studies may not be generalisable to specific UK regions due to differences in the organisation and funding mechanisms of healthcare between these regions (2). Aim To explore GPPs’ views regarding their role within general practice in one region of the UK. Methods Using a cross-sectional study design, a paper-based self-administered questionnaire was mailed to all general practices in one UK region (n=319) in June and July 2022 and was completed by one GPP in every general practice. The questionnaire was developed following a review of published literature related to GPPs’ views of their role in general practice (1,2). A variety of open-ended and closed-ended questions were included in six sections: demographics, activities of GPPs, GPPs’ communication within primary care, GPPs’ attitudes towards collaboration, GPPs’ communication with patients and GPPs’ views on their impact in primary care. All returned questionnaires were coded, entered into Microsoft Excel 365, and then imported into the Statistical Package for the Social Sciences (SPSS) version 28 to conduct descriptive statistical analysis. Responses to five-point Likert scale statements were also analysed descriptively by calculating the percentage of agreement or disagreement to each statement. Results One hundred and fifty-five responses were received, equating to a response rate of 48.5%. The majority of respondents were female (72.3%; n=112) aged between 30-39 years. The services that were provided by GPPs were medication reconciliation (99.4%; n=154) and medication reviews (97.4%; n=151). The majority of GPPs indicated that the most common method of communication between them and GPs was face-to-face (89.0%, n=138). Just under 60% of respondents (58.7%; n=91) expressed positive attitudes towards collaboration (based on a validated scale) with GPs, and most of them agreed/strongly agreed (84.5%; n=131) that the roles of the GPP and GP in patient care were clear. When GPPs contacted patients, the most common method of communication was via the telephone (98.7%, n=153). Only a third of GPPs (32.9%; n=51) agreed that patients were aware of the role they provided. The majority of GPPs expressed positive views on the impact of the GPPs on primary care and strongly agreed that the GPP role had a positive impact on patient outcomes (80.6%; n=125), alleviated work pressure within primary care (89.7%; n=139) and helped to reduce prescribing errors (81.3%; n=126). Conclusion The findings from this study indicated that GPPs were largely positive about their contribution to primary care and their impact on patients. However, they recognised that patients were largely unaware of their role. The findings may provide useful data for practices and service commissioners but may not represent the views of GPPs in other parts of the UK.

The influence of SARS-COV-2 pandemic in the pharmaceutical service in ALBANIA.

In the second year of the COVID-19 pandemic, the role of the pharmacists was confirmed as central at the territorial level. The purpose of this study was to assess knowledge, attitudes, and practices of pharmacists in Albania, critical changes in the Albanian pharmaceutical market during the COVID-19 pandemic and evaluate factors influencing the quality of the pharmaceutical service. A nationwide survey was conducted, using an online questionnaire targeting Albanian pharmacists during 2021. Most of the respondents were females (86.2%), belonged to the 30-39 age group (51.7%) and worked in community pharmacies (73%). Although most of the respondents did participate in training courses (62.8%), only about 38% of them had good knowledge about COVID-19 (score 5/8). Moreover, the level of knowledge increases the possibility to apply the rules. 65% of the pharmacists who were very afraid of getting infected with COVID -19, stated that they followed the WHO rules compared to 37 % of those who were not afraid. Regarding the medicines offered, 64% of the respondents claimed that there have been difficulties in ensuring the adequate medicines during the pandemic. Furthermore, although 61% of the pharmacists declared that the price of medicines during the pandemic has not changed, 58% of them thought that the revenues of all pharmaceutical sectors have risen. From this study it is concluded that although the pharmacists in Albania have demonstrated strength, professionality, and commitment to offer pharmaceutical service to the highest level, they faced numerous challenges during this difficult time. In the future, the pharmacist's role can be extended in the community to provide successful medical service and their collaboration within and between pharmacists and physicians is essential.

Using sociotechnical theory to understand medication safety work in primary care and prescribers’ use of clinical decision support: a qualitative study

ObjectivesThe concept of safety work draws attention to the intentional work of ensuring safety within care systems. Clinical decision support (CDS) has been designed to enhance medication safety in primary...

Psychotropic stewardship: Advancing patient care.

Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.

Impact of the Novel CoronaviruS (COVID-19) on Frontline PharmacIsts Roles and ServicEs: INSPIRE Worldwide Survey.

Pharmacy has been recognized as a vital healthcare profession during the COVID-19 pandemic. The primary objective of the INSPIRE Worldwide survey was to determine the impact of COVID-19 on pharmacy practice and pharmacists' roles around the world. A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Participants were recruited through social media, with assistance from national and international pharmacy organizations between March 2021-May 2022. The questionnaire was divided into (1) demographics, (2) pharmacists' roles, (3) communication strategies, and (4) practice challenges. The data were analyzed using SPSS 28, and descriptive statistics were used to report frequencies and percentages. A total of 505 pharmacists practicing in 25 countries participated. The most common role that pharmacists undertook was responding to drug information requests (90%), followed by allaying patients' fears and anxieties about COVID-19 (82.6%), and addressing misinformation about COVID-19 treatments and vaccinations (80.4%). The most common challenges were increased stress levels (84.7%), followed by medication shortages (73.8%), general supply shortages (71.8%), and inadequate staffing (69.2%). Pharmacists within this study were significantly impacted by the COVID-19 pandemic and took on new or adapted roles (e.g., providing COVID-specific information, managing patients' emotions, and educating on public health measures) to meet the needs of their communities. Despite, the significant challenges (e.g., increased stress, supply chain challenges, addressing misinformation, and staffing shortages) faced by pharmacists, they continued to put their patients' needs first and to provide pharmacy services.

Community pharmacies play a significant role in providing medicines, vaccines, consultations, and other important health services to the public. Community pharmacies continued to provide their services during the COVID-19 pandemic in most countries around

Community pharmacies play a significant role in providing medicines, vaccines, consultations, and other important health services to the public. Community pharmacies continued to provide their services during the COVID-19 pandemic in most countries around the world, and this was the case in Jordan. During the COVID-19 pandemic, the pharmacy staff needs to avoid the risk of exposure to the virus causing COVID-19 along with reducing the risk for customers. This paper summarizes the safety practices of most community pharmacies in Jordan during the COVID-19 pandemic, to protect staff and customers from the risk of exposure to COVID-19 infection. Data were collected in two folds. First, a survey was distributed online through social media targeting those pharmacists working in community pharmacies. Second, face-to-face interviews were conducted with the staff and owners of pharmacies in Jordan, asking about the procedures followed to enhance the safety practices of pharmacists. Analyzing responses revealed that since the start of the pandemic, about 94% of pharmacists were using personal protective equipment, 88% of pharmacies were frequently sterilizing the pharmacy and the main door handle, and 82% of pharmacies were providing medical masks, gloves, and alcohol at the entrance.

Critical Care Pharmacist Attitudes and Perceptions of Neuromuscular Blocker Infusions in ARDS.

Current critical care pharmacist (CCP) practices and perceptions related to neuromuscular infusion (NMBI) use for acute respiratory distress syndrome (ARDS) maybe different with the COVID-19 pandemic and the publication of 2020 NMBI practice guidelines. To evaluate CCP practices and perceptions regarding NMBI use for patients with moderate-severe ARDS. We developed, tested, and electronically administered a questionnaire (7 parent-, 42 sub-questions) to 409 American College of Clinical Pharmacy (ACCP) Critical Care Practice and Research Network members in 12 geographically diverse states. The questionnaire focused on adults with moderate-severe ARDS (PaO2:FiO2<150) whose causes of dyssynchrony were addressed. Two reminders were sent at 10-day intervals. Respondents [131/409 (32%)] primarily worked in a medical intensive care unit (ICU) 102 (78%). Compared to COVID-negative(-) ARDS patients, COVID positive(+) ARDS patients were twice as likely to receive a NMBI (34 ± 18 vs.16 ± 17%; P < 0.01). Respondents somewhat/strongly agreed a NMBI should be reserved until after trials of deep sedation (112, 86%) or proning (92, 81%) and that NMBI reduced barotrauma (88, 67%), dyssynchrony (87, 66%), and plateau pressure (79, 60%). Few respondents somewhat/strongly agreed that a NMBI should be initiated at ARDS onset (23, 18%) or that NMBI reduced 90-day mortality (12, 10%). Only 2/14 potential NMBI risks [paralysis awareness (101, 82%) and prolonged muscle weakness (84, 68%)] were frequently reported to be of high/very high concern. Multiple NMBI titration targets were assessed as very/extremely important including arterial pH (109, 88%), dyssynchrony (107, 86%), and PaO2: FiO2 ratio (82, 66%). Train-of-four (55, 44%) and BIS monitoring (36, 29%) were deemed less important. Preferred NMBI discontinuation criteria included absence of dysschrony (84, 69%) and use ≥48 hour (72, 59%). Current critical care pharmacists believe NMBI for ARDS patients are best reserved until after trials of deep sedation or proning; unique considerations exist in COVID+ patients. Our results should be considered when ICU NMBI protocols are being developed and bedside decisions regarding NMBI use in ARDS are being formulated.

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

BackgroundPharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams.MethodsA mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration.ResultsIn total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice.ConclusionInterprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

Human Papillomaviruses in Adolescents: Knowledge, Attitudes, and Practices of Pharmacists Regarding Virus and Vaccination in France

Human papillomaviruses (HPVs) are responsible for one of the most common sexually transmitted diseases in the world, and their oncogenic role has been well demonstrated in genital, anal, and oropharyngeal areas. However, a certain distrust and a lack of knowledge about this vaccine are perceptible among French adolescents and their parents. Thus, health professionals and, more particularly, pharmacists appear to be key persons to promote HPV vaccination and restore confidence in the target population. The present study aims to assess the knowledge, attitudes, and practices regarding HPV vaccination among pharmacists, particularly in boys, following the 2019 recommendation to vaccinate them. The present study was designed as a cross-sectional, quantitative, and descriptive survey that was conducted from March to September 2021 among pharmacists in France. 215 complete questionnaires were collected. Gaps in knowledge were found, only 21.4% and 8.4% obtained a high level of knowledge related to, respectively, HPV and vaccination. Pharmacists were confident in the HPV vaccine (94.4%), found it safe and useful, and felt that the promotion of the vaccine was part of their role (94.0%). However, only a few have already advised it, which they justify due to a lack of opportunity and forgetfulness. Faced with this, training, computerized reminders, or supportive materials could be implemented to improve the advice and thus the vaccination coverage. Finally, 64.2% were in favor of a pharmacy-based vaccination program. In conclusion, pharmacists are interested in this vaccination and the role of promoter. However, they need the means to facilitate this mission: training, computer alerts, supportive materials such as flyers, and the implementation of vaccination in pharmacies.

Over-the-counter antibiotic dispensing: knowledge and practice of community pharmacists in the United Arab Emirates

Abstract Objectives This paper aimed to assess the knowledge and practice of community pharmacists in regard to dispensing over-the-counter (OTC) antibiotics with the aim of bringing their professional knowledge up to date and promoting best practices to optimize the use of antibiotics and slow the rise in resistance. Methods A cross-sectional descriptive study design was used to assess the knowledge and practice of community pharmacists towards OTC Antibiotic Dispensing. Participants were issued an invitation through verified and official WhatsApp and Facebook accounts of community pharmacists residing in the United Arab Emirates to fill in a validated-web-based questionnaire. The questionnaire was composed of four sections. It aimed to gather basic demographic data, and address knowledge and practice amongst pharmacists of dispensing OTC antibiotics. Data were analysed using SPSS version 26. Key findings A total number of 438 participating community pharmacists in the study completed the whole questionnaire. The average knowledge score was 68.6% with a 95% confidence interval (CI) of [66.9%, 70.2%]. The average practice score was 71.4% with a 95% confidence interval (CI) of [69.5%, 73.2%]. Conclusions It is recommended that several interventions are launched to promote improved prescribing behaviour, particularly ensuring that all pharmacies receive standardized guidelines on antibiotic use and inviting pharmacists to workshops and other training programmes dedicated to promoting rational drug use. Moreover, regulatory bodies must devise, enforce and monitor the implementation of policies governing how antibiotic prescriptions and patient consultations are managed by community pharmacists.

Prescribing practices of oncology pharmacists working in ambulatory cancer centers in Alberta.

To describe and quantify independent prescribing of oncology pharmacists working in adult, ambulatory cancer centers in Alberta, Canada. A retrospective chart review of oncology pharmacists prescribing in the electronic health record, ARIA® was conducted. Prescriptions from January 1, 2018 to June 30, 2018 were analyzed. Descriptive statistics were used to quantify prescription volume and class of medications prescribed. A cross-sectional analysis was then performed on a random sample to determine the type of prescription intervention and evaluate pharmacist documentation. Over 6 months, 3474 prescriptions were ordered by 33 clinically deployed pharmacists. The median number of medications prescribed was 7 per month (interquartile range: 1.50-27.00; Range: 0.17-79.5). When prescribing was standardized by pharmacist's time clinically deployed, the median was 21.67 (interquartile range: 5.00-79.67; range: 0.67-216.67) prescriptions per month per full-time equivalent. The most prescribed class of medication was antiemetic (24.1%). From a sample of 346 prescriptions, 172 (50%) were new medications initiated, 160 (46%) were the continuation of existing prescriptions and 14 (4%) were prescription dosage adjustments. Adherence to the specified documentation standards was 47%. Oncology pharmacists utilize their independent prescribing to initiate and continue supportive care medications for cancer patients. The prescribing volume varied greatly among pharmacists. Opportunities exist to further engage pharmacist prescribing.

Evaluation of the Care Pathway in the Context of the Dispensing of Emicizumab (Hemlibra) in Community Pharmacies in France: Protocol for a Cross-sectional Study Based on the Kirkpatrick Model.

Commercialized since 2019, emicizumab (Hemlibra) was available only in French hospital pharmacies for prophylaxis of hemophilia A with or without inhibitors. Since June 15, 2021, patients can choose between a hospital and community pharmacy. These changes in the care pathway have important organizational consequences for patients, their relatives, and health professionals. Two training programs are available for community pharmacists: the "HEMOPHAR" training program proposed by the national reference center for hemophilia and the Roche training program proposed by the laboratory that markets the product. The PASODOBLEDEMI study aims to evaluate the direct impact of the training programs provided to community pharmacists in the context of the dispensing of emicizumab, and to evaluate patients' satisfaction with their treatment whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy. We designed a cross-sectional study based on the 4-level Kirkpatrick evaluation model: the immediate reaction of community pharmacists following training (Reaction), the knowledge acquired during the training (Learning), the professional practice of community pharmacists during dispensing of the product (Behavior), and patients' satisfaction related to the treatment whether it is dispensed from a hospital or from a community pharmacy (Results). Considering that single outcome measures cannot adequately reflect the complexity of this new organization, the Kirkpatrick evaluation model provides 4 distinct outcomes: the immediate reaction after the HEMOPHAR training program, the level of knowledge acquired after the HEMOPHAR training program, the impact of training on professional practice, and patient satisfaction with access to emicizumab. We developed specialized questionnaires for each of the 4 levels of the Kirkpatrick evaluation model. All community pharmacists involved in dispensing emicizumab, whether they have followed the HEMOPHAR or the Roche training program or neither, were eligible for inclusion. All patients with severe hemophilia A were eligible, irrespective of inhibitor use, age, treatment with emicizumab, and whether they chose dispensation from a community pharmacy or retained dispensation from a hospital pharmacy. The new organization for dispensing emicizumab to patients with hemophilia A in French community pharmacies must be accompanied by optimal safety and quality conditions due to the risk of serious and urgent bleeding situations in the management of rare bleeding diseases. The elaboration of the PASODOBLEDEMI protocol has already a positive impact with the commitment of all health professionals, physicians, hospital and community pharmacists, and the patient community. The results will be disseminated among the French authorities and will enable, if necessary, proposing this access model to other rare diseases. ClinicalTrials.gov NCT05449197, https://clinicaltrials.gov/ct2/show/NCT05449197?term=NCT05449197; ClinicalTrials.gov NCT05450640, https://clinicaltrials.gov/ct2/show/NCT05450640?term=NCT05450640. DERR1-10.2196/43091.

Enhanced primary care after hospitalization: General practitioner, pharmacist and patient feedback from the REMAIN HOME trial.

Pharmacist and general practitioner (GP) collaborative models of care are continuing to evolve in the Australian primary care setting. The REMAIN HOME study investigated whether a pharmacist integrated into 14 different primary care teams in general practice (the "practice pharmacist model") reduces readmission to hospital for patients prescribed five or more long term medicines or high risk comorbidities. The aim of this paper is to describe the attitudes of GPs, patients, and practice pharmacists towards this model of pharmacist and GP collaboration. To explore the views and opinions about the model of care (pharmacist integration into general practice), participating GPs were invited to complete a survey that included the 13-item validated Attitudes Toward Collaboration Instrument for GPs (ATCI-GP) one month after the pharmacist had been integrated into the practice. Survey instruments were also created for patients and pharmacist participating in the intervention. These were deployed after the initial consultation and at the end of the intervention period respectively, to elicit each stakeholders' views and experiences of the service. Data were analysed using descriptive statistics. In total, 48GPs, 43/101 patients (43%) and 11/13 practice pharmacists (85%) completed the survey. The majority of GPs strongly agreed or agreed with all statements of the ATCI-GP, indicating support for the practice-integrated pharmacist model. Most patients agreed that there was a role for a pharmacist in their general practice (n=28, 76%), and that they would like to see the pharmacist again (n=34, 79%). Pharmacists indicated that they enjoyed the role (n=11, 91%) and found the position professionally satisfying (n=9, 82%). Most pharmacists agreed that co-location (inside the general practice itself, rather than in a co-located pharmacy) was beneficial (n=8, 73%) and all pharmacists (100%) acknowledged the benefits of having access to patient medical records. Free text comments from GPs were enthusiastic overall, although some concerns about the financial viability of the model in the current setting were raised. The primary limitation of the study is the anonymous nature of the survey, meaning clustering of responses across the 14 sites could not be determined. A practice pharmacist model of care in the Australian primary care setting appears to be accepted by GPs, patients and practice pharmacists and provides promising evidence that this model of care is likely to be well accepted if implemented more broadly in the Australian healthcare setting, provided that it can be appropriately remunerated.

Complementary and alternative medicine use during the COVID-19 pandemic: Community pharmacists' knowledge, attitudes, and practices.

The challenges in COVID-19 treatment have driven patients to seek Complementary and Alternative Medicine (CAM) for the prevention and/or treatment of the disease. Pharmacists are uniquely positioned to promote the effective and safe use of CAM. Assess the beliefs, practices, and knowledge of community pharmacists in Lebanon about existing evidence for the use of CAM for the prevention and/or treatment of COVID-19. A national cross-sectional survey was conducted among community pharmacists during the COVID-19 pandemic in Lebanon (n=310 respondents). Participants completed an online questionnaire addressing, in addition to the socio-demographic characteristics; the beliefs, practices, and knowledge of pharmacists regarding the existing evidence of CAM use for COVID-19 prevention and/or treatment. Pharmacists (70%) received frequent inquiries about CAM for COVID-19 prevention or treatment. Only 25.5% of the pharmacists reported having enough time to get information about CAM and COVID-19. Almost all participants believed that pharmacists have a major role in the fight against COVID-19 (98%) and that they have enough information to counsel patients in that regard (75%). For practices, the majority of pharmacists reported counseling their patients on proper use (98%) and possible adverse reactions (93%) of CAM, but only 51% reported toxic or undesirable effects. Regarding knowledge, although most pharmacists answered correctly the questions on the role of CAM in preventing COVID-19, few knew about its role in treating the infection. Pharmacists who trust the WHO website as a credible source had a higher knowledge score (β=0.52, 95%CI: 0.05-0.986). The positive beliefs and practices of pharmacists towards CAM during the pandemic were coupled with a few gaps, especially in their knowledge about existing evidence for CAM use. Concerted efforts ought to be dedicated to supporting pharmacists in playing a more prominent role during health crises such as the COVID-19 pandemic.

An Attempt to Build the Practice Model of Pharmacist in Home Care Medicine for Children

Although the need for homecare medicine for children is increasing in Japan, few studies have focused on the role of pharmacists in this area. The purpose of the present study was to clarify the practice process of pharmacists in pediatric homecare medicine and develop a practice model. Three pharmacists with experience in homecare medicine for children participated in semi-structured interviews. The data were analyzed using the modified-grounded theory approach (M-GTA). The analysis generated 8 categories and 21 concepts. The practice of pharmacists in homecare medicine for children is the pharmacotherapy management process, and it aims at "enabling the transition from hospital to home for children and continuity of their homelife with family" in collaboration with other professions. Above all, the two concepts of "optimization of prescription and device selection to enable the hospital-to-home transition" and "optimization of prescription and device selection for ensuring patient safety" form the core of clinical decision making in the pharmacotherapy management process. By integrating these two optimization concepts, the transfer of patients to home can be undertaken smoothly, leading to safer pharmacotherapy in the lives of patients and their families. Furthermore, pharmacists considered clinical decision making from two perspectives: "the child's growth-based approach" and "homelife-based approach." The foundation of these practice processes comprised "professional responsibilities" and "consideration of families' feelings."

Exploring Australian pharmacists' perceptions and practices towards reducing the risk of medicines-related harm in aged care residents.

Background: Older people living in residential aged care facilities frequently experience medicines-related harm. Evidence regarding the perception and practices towards reducing these harms may facilitate the development of customised educational programs for pharmacists providing services in RACFs. Objective: To explore Australian pharmacists' opinions and practices towards reducing the risk of medicines-related harm in aged care residents. Methods: An online survey was developed based on a literature review, expert opinion, and feedback from pharmacists providing services in RACFs. A web link for the survey was shared via professional pharmacy organisations and social media groups with Australian pharmacists providing services in RACFs. Results: A total of 209 pharmacists participated in the survey. Of these, 76% (n = 158) were residential medication management review embedded pharmacists, and 24% (n = 51) were supply pharmacists for RACFs. Most pharmacists believed that medicines-related harm is common in residents (n = 174, 83%), yet few agreed that pharmacists have enough time to participate in medicines-related harm reduction services (n = 60, 28%). There was a high level of agreement regarding the key risk factors (e.g., inappropriate medicines, anticholinergic drug use, and transitions of care) and potential strategies (e.g., embedded pharmacists in RACFs, educating aged care staff, and collaborative pharmacist-led medication reviews) for reducing medicines-related harm in residents. Conclusion: Pharmacists agreed that older residents often experience medicines-related harm, but they did not frequently participate in medicines-related harm reduction services. Initiatives to engage pharmacists in team-based harm reduction services and educate aged care staff regarding safe medication management may improve residents' safety and health outcomes.

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care: A nominal group technique approach.

The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology.

Attributes of pharmacy's educational activities according to good pharmacy practice standards from the perspective of patients with diabetes

According to the Good Pharmaceutical Practice (GPP) Standards of Quality of Pharmacy Services, pharmacists should participate in preventive measures to improve the health of the population and prevent disease. The problem of diabetes is becoming increasingly relevant due to its prevalence and a significant number of undiagnosed cases. Patients with diabetes are frequent visitors to pharmacies and have specific needs for treatment.&#x0D; The purpose of the study was to determine the attributes of pharmaceutical educational activities in pharmacies according to the standards of GPP from the perspective of patients with diabetes, as well as to compare the obtained results with similar ones in other countries.&#x0D; The objects of the study were information sources regarding the involvement of pharmacists in the strategy of preventing diabetes in other countries, using literature review and analytical methods. To study the perspective of patients with diabetes, a semi-structured in-depth interview of patients with diabetes who use insulin therapy was applied.&#x0D; Based on research using the semi-structured in-depth interview method, attributes of educational activities were identified in providing pharmaceutical care to patients with diabetes according to GPP standards: identifying individuals with risk factor of diabetes and people with undiagnosed diabetes; group training of diabetes patients in self-management control; and recommendations flu vaccination in the pre-epidemic period. The availability of diabetes risk factor detection and blood glucose testing in pharmacies contributes to early diagnosis and motivates patients to change their lifestyles. Training people with diabetes by qualified specialists are important for diabetes patients. The organasing of the «diabetes self management school» in pharmacies will increase the accessibility of training for diabetes patients and at the same time enhance the role of pharmacists in clinical practice and the social image of the pharmacy. To promote flu vaccination among patients with diabetes, pharmacists should be actively involved in providing information and promoting vaccination.&#x0D; The identified attributes of educational activities in providing pharmaceutical care according to GPP standards have already been implemented in many countries of the world and have demonstrated their high efficiency for the health care system.

The impact of pharmacist practice of medication therapy management in ambulatory care: an experience from a comprehensive Chinese hospital

BackgroudWith the reform of medical system in China, Beijing municipal hospitals explored a new pharmaceutical care model and set up medication therapy management services (MTMs) in ambulatory care since 2019. We were one of the first hospitals to set up this service in China. At the present, there were relatively few reports about the effect of MTMs in China. In this study, we summarized the implementation of MTMs in our hospital, explore the feasibility of pharmacist-led MTMs in ambulatory care and the impact of MTMs on patients’ medical costs.MethodsA retrospective study was conducted in a university-affiliated, tertiary comprehensive hospital in Beijing, China. The patients who received at least one MTMs and with complete medical records and pharmaceutical documents from May 2019 to February 2020 were included. Pharmacists provided pharmaceutical care for patients according to the MTMs standards issued by the American Pharmacists Association, identified the numbers and classification of the patients’ perceived medication-related demands, identified medication-related problems (MRPs), and developed the medication-related action plans (MAPs). All MRPs found by pharmacists, pharmaceutical interventions, and resolving recommendations were documented, and calculate the cost of treatment drugs that patients can reduce.ResultsA total of 112 patients received MTMs in ambulatory care, among them 81 cases with the completed record were included in this study. 67.9% of patients had five or more diseases, 83% of them co-took over 5 drugs. While performing MTMs, 128 patients’ perceived medication-related demands were recorded in all, monitoring and judgment of adverse drug reaction (ADR) (17.19%) was the most common demand. 181 MRPs were found, with an average of 2.55 MPRs per patient. Nonadherence (38%), excessive drug treatment (20%), and adverse drug events (17.12%) were the top three MRPs. Pharmaceutical care (29.77%), adjustment of drug treatment plan (29.10%) and referral to the clinical department (23.41%) were the top three MAPs. Whereby the MTMs provided by pharmacists, the cost-saving of each patient was about $ 43.2 monthly.ConclusionBy participating in the MTMs of outpatients, the pharmacists could identify more MRPs and develop personalized MAPs timely for patients, thereby promoting rational drug use and reducing medical expenses.