Remote Pharmacist Research Articles

Abstract MP10: A Remote Pharmacist Intervention for Monitoring and Treating Hypertension for Patients Living in Rural Areas

Background: Hypertension is a significant, but modifiable, cause of morbidity. Many people are unaware that they have hypertension, and of those with a diagnosis, many do not have controlled blood pressure (BP). Undertreatment may be especially problematic in medically unserved rural areas with reduced access to medical care. The goal of this study was to evaluate whether a remote pharmacist-based intervention improves BP management for patients in rural areas. Methods: We recruited English- and Spanish-speaking rural adults from University of Iowa Health Care with at least 2 previous clinically measured BP values > 145 mmHg systolic or > 95 mmHg diastolic, for a 12-month study. Patients submitted up to 14 home BP measurements via text messaging pre-randomization. They had one conversation with the research pharmacist, and then they were randomized to the intervention or control group. The control group received only usual care for the rest of the study period. The intervention group received calls as often as once a month from a remote pharmacist who reviewed their home BP, gave medication recommendations to patients’ providers through the electronic medical record, and provided lifestyle recommendations. Research BPs and antihypertensive medication use were measured at baseline, 6 months, and 12 months. At the end of the study, patients were asked about their experiences with the remote pharmacist and the study in general. Results: There were 211 patients in the control group, and 209 in the intervention group. Average age was 58 years. Four percent of participants were Black, and 23% were Hispanic. Average BMI was 33, and 29% had diabetes. The decrease in systolic BP in the intervention group was 9.5 mmHg lower than the control group at 6 months (p<0.001), and 4.8 mmHg lower than the control group at 12 months (p=0.019). There were no changes in the probability of being treated, but the intervention group had 75% more medication changes in the first 6 months compared to the control group (p<0.001). Many patients commented about the ease of participation and were interested in continuing communications with the pharmacists and reporting home BP readings after the study finished. Conclusions: Our bi-directional texting and remote pharmacist intervention successfully lowered BP levels. Future work will expand this study to other populations and examine this study’s cost effectiveness.

Evaluation of remote pharmacist intervention on type 2 diabetes hemoglobin A1c reduction in an accountable care organization

Background The value of clinical pharmacists for ambulatory internal medicine clinics is well recognized, including their role in hemoglobin A1c (HbA1c) reduction in patients with type 2 diabetes mellitus (T2DM). However, there is a lack of data evaluating the clinical impact of remote, referral-based pharmacy programs. Methods This multicenter, cohort, retrospective chart review study analyzed the impact of pharmacist interventions on blood glucose control in patients aged 18 years and older who were diagnosed with T2DM with an HbA1c of 8.5% or greater and referred to the clinical pharmacy team for medication evaluation. Primary care providers may have accepted or rejected pharmacist recommendations. The primary study outcome was the mean change in HbA1c from baseline to follow-up at 2 to 5 months. Secondary outcomes included appropriate use of American Diabetes Association–indicated secondary prevention and any occurrence of glycemia-related events (i.e., T2DM-related emergency room visits or hospitalizations). Results At the conclusion of the study, the mean change in HbA1c from baseline to follow-up at 2 to 5 months was −2.7% and −0.6% for the accepted and rejected intervention groups, respectively (t = −2.94, P = 0.0068). Conclusions The results of this study suggest that remote pharmacist intervention significantly improves blood glucose control in adults with T2DM.

Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia.

The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes. A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically. The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research. Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed. The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes. The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Assessment of embedded versus remote pharmacist versus remote student pharmacist outreach on statin prescribing

BackgroundThe Statin Use in Persons with Diabetes (SUPD) measure is a Star measure by the Center for Medicare & Medicaid Services. The Duke Population Health Management Office has a team of pharmacists and pharmacy students who conduct targeted outreach to patients at risk of failing statin quality measures. Pharmacy services are embedded in select primary care clinics and other clinics are supported remotely. ObjectivesThe primary objective of this review is to compare the initiation rates of recommended statin prescriptions between embedded pharmacist versus remote pharmacist versus remote student pharmacist outreach groups, all of which have different levels of autonomy within pharmacy practice. The secondary objectives are to identify the barriers to the implementation of statin therapy and to assess the statin drugs and intensity of the statins prescribed. MethodsA single-center, retrospective chart review was performed for SUPD patients with Medicare insurance. SUPD patients included patients between 40 and 75 years of age, diagnosed with type 2 diabetes, and were not dispensed at least 1 statin medication of any intensity during the 6-month measurement period. The primary outcome was the initiation of recommended statin medications prescribed, or pended for the primary care provider to prescribe, for qualifying patients by embedded, remote, and remote student pharmacists. Secondary outcomes included the reasons for the nonimplementation of statin recommendations, reasons statin therapy was not prescribed to patients contributing to the SUPD measure gap, and statin drug and dose prescribed for appropriateness. ResultsA total of 189 patients were included in the evaluation. In this study, 34.9% of the patients filled the prescribed or pended statin prescription and 83.3% of patients filled the prescribed or pended statin prescription at the recommended intensity according to the American College of Cardiology/American Hospital Association guidelines, effectively closing the SUPD measure gap. The initiation rates of recommended statin prescriptions between the embedded pharmacist, remote pharmacist, and remote student pharmacist outreach were numerically different at 36.7%, 28.2%, and 36.7%, respectively, even though not statistically different (P = 0.61). ConclusionRemote student pharmacists’ performance was equal to that of the embedded pharmacists when comparing the initiation rates of statin medications prescribed or pending the primary care provider’s approval. The most common reason for nonimplementation of statin therapy is that the statin was refused by the patient. Atorvastatin and rosuvastatin were the two most commonly prescribed statins.

Application, Benefits, and Limitations of Telepharmacy for Patients with Diabetes in the Outpatient Setting.

After the COVID-19 pandemic, telepharmacy has become increasingly widely used as an alternative to pharmaceutical care by remote pharmacists. Patients with diabetes mellitus are one of the patients who get benefit the most from telepharmacy practices, which allow patients to consult without meeting face to face and minimize the risk of virus transmission. The authors conduct an assessment of the benefits and limitations of using telepharmacy that are used throughout the world and then hopes that they can become a reference in the development of telepharmacy in the future. A total of 23 relevant articles were used for analysis in this narrative review after searching for articles in three sources, including PubMed, Google Scholar and ClinicalTrials.gov, until October 2022. This narrative review shows that telepharmacy plays an important role in improving clinical outcomes, patient therapy adherence and reduce the number of patient visit and hospitalization, but telepharmacy also has limitations in its use related to security and privacy, as well as pharmacist intervention that has not been maximized. However, telepharmacy has great potential to facilitate diabetes mellitus patients in pharmaceutical services.

A Survey of Prescription Errors in Paediatric Outpatients in Multi-Primary Care Settings: The Implementation of an Electronic Pre-Prescription System.

BackgroundPrescription errors impact the safety and efficacy of therapy and are considered to have a higher impact on paediatric populations. Nevertheless, information in paediatrics is still lacking, particularly in primary care settings. There exists a need to investigate the prevalence and characteristics of prescription errors in paediatric outpatients to prevent such errors during the prescription stage.MethodsA cross-sectional study to evaluate paediatric prescription errors in multi-primary care settings was conducted between August 2019 and July 2021. Prescriptions documented within the electronic pre-prescription system were automatically reviewed by the system and then, potentially inappropriate prescriptions would be reconciled by remote pharmacists via a regional pharmacy information exchange network. The demographics of paediatric patients, prescription details, and types/rates of errors were assessed and used to identify associated factors for prescription using logistic regression.ResultsA total of 39,754 outpatient paediatric prescriptions in 13 community health care centres were reviewed, among which 1,724 prescriptions (4.3%) were enrolled in the study as they met the inclusion criteria. Dose errors were the most prevalent (27%), with the predominance of underdosing (69%). They were followed by errors in selection without specified indications (24.5%), incompatibility (12.4%), and frequency errors (9.9%). Among critical errors were drug duplication (8.7%), contraindication (.9%), and drug interaction (.8%) that directly affect the drug's safety and efficacy. Notably, error rates were highest in medications for respiratory system drugs (50.5%), antibiotics (27.3%), and Chinese traditional medicine (12.3%). Results of logistic regression revealed that specific drug classification (antitussives, expectorants and mucolytic agents, anti-infective agents), patient age (<6 years), and prescriber specialty (paediatrics) related positively to errors.ConclusionOur study provides the prevalence and characteristics of prescription errors of paediatric outpatients in community settings based on an electronic pre-prescription system. Errors in dose calculations and medications commonly prescribed in primary care settings, such as respiratory system drugs, antibiotics, and Chinese traditional medicine, are certainly to be aware of. These results highlight an essential requirement to update the rules of prescriptions in the pre-prescription system to facilitate the delivery of excellent therapeutic outcomes.

Impact of oncology clinical pharmacist intervention on clinical trial enrollment in The U.S. Oncology Network’s MYLUNG Consortium.

1503 Background: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium (MYLUNG) clinical trial platform aims to advance the use of precision medicine in non-small cell lung cancer patients through a series of prospective and iterative clinic trials. “Protocol 2” is evaluating the patient and tissue journey of newly diagnosed lung cancer patients presenting for care. Timely patient accrual to oncology clinical trials is a known practice challenge. The US Oncology Network recently implemented a clinical pharmacist (ClinReview) to provide remote clinical services to support Protocol 2 enrollment. Methods: An oncology-trained clinical pharmacist remotely reviewed chemotherapy regimen orders and a weekly custom recruitment report within six community network practices (n = 149 physicians). The ClinReview pharmacist identified, screened, and assisted with recruitment of eligible patients for enrollment in the MYLUNG study. Relevant and concise patient data were provided to the on-site research team to facilitate ease of enrollment. Enrollments and intervention data were tracked to monitor the impact of the pharmacist intervention. The primary outcome of monthly enrollment was evaluated using a paired t-test. Results: Over a 6-month period, the ClinReview pharmacist screened 367 potentially eligible patients, 325 patients were recommended for enrollment, and 103 patients (32%) were consented and enrolled. Enrollment due to this ClinReview intervention increased monthly and ranged from 5 in first month to 33 enrollments in month 6. Average monthly enrollment was significantly greater after ClinReview intervention (3.4 patients/month vs. 6.8 patients/month; p = 0.008). Of the 154 patients recommended for enrollment that were not enrolled, 104 (68%) exceeded their eligibility window allowed by the trial, 15 (10%) were deceased or enrolled into hospice care, 10 (6%) declined trial participation, and 25 (16%) transferred care or were treated at outside facilities. Conclusions: We demonstrate that incorporation of an oncology clinical pharmacist in clinical research teams significantly enhanced clinical trial enrollment. The remote pharmacist easily adapted into clinic workflows in community practices. Validation across a broader spectrum of differentially resourced oncology practices will be conducted as the MYLUNG clinical trials platform is executed. [Table: see text]

A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Objective. To provide optimal asthma care, community pharmacists must have advanced, contemporary knowledge, and the skills to translate that knowledge into practice. The development and evaluation of an innovative multi-mode education program to enhance pharmacists' clinical knowledge and practical skills is described.Methods. The online education modules were collaboratively developed alongside asthma and pharmacy organizations. The education program was comprised of five evidence-based education modules delivered online and a skills review conducted either in-person with real-time feedback (urban pharmacists) or via video upload and scheduled video-conference feedback (regional and remote pharmacists). A mixed methods approach was used to evaluate the feedback obtained from pharmacists to assess the content, efficacy, and applicability of the education.Results. Ninety-seven pharmacists opted into the program and successfully completed all education requirements. A larger proportion of pharmacists did not pass trial protocol-based education modules on their first attempts compared to the number that passed the asthma and medication knowledge-based modules. Prior to skills review, the proportion of pharmacists demonstrating device technique competency was suboptimal. Pharmacists rated the education modules highly in both quantitative and qualitative evaluations and reported that the program adequately prepared them to better deliver care to asthma patients.Conclusion. We developed, implemented, and evaluated a novel multi-mode asthma education program for community pharmacists that supports knowledge and practical skill development in this crucial area of patient care. The education program was well received by pharmacists. This form of education could be used more broadly in international collaborative trials.

Evaluating hematology/oncology clinical pharmacist activities via self-reported work sampling.

Hematology/oncology clinical pharmacists' work activities have been described in previous literature, but time spent on pharmacist tasks has not been well characterized. Random work sampling (WS) is a form of activity assessment to determine the proportion of time spent in various types of work. Based on results from previous WS evaluations at University of Utah and its Huntsman Cancer Hospital, activities were changed to maximize time dedicated to clinical activities and pharmacists' benefit to providers and patients in both inpatient and ambulatory care settings. Therefore, updated random WS evaluations were completed during spring 2019 and fall 2020. Personal digital assistant (PDA) devices were used to record hematology/oncology clinical pharmacists' onsite or remote location and work activity data. Data were collected 8 times per hour on weekdays, with a goal of 275 observations per pharmacist. Results were then classified as clinical, professional, or technical activities. In 2019, 9,079 observations were recorded by 31 onsite pharmacists. In 2020, 28 pharmacists recorded 8,803 observations (5,524 during onsite work and 3,279 during remote work). The overall distribution of pharmacists' work activities remained stable between 2019 and 2020, with 89% of activities classified as clinical or professional. Pharmacists spent a smaller proportion of time on in-person communication in 2020, balanced by increases in chart review and text-based communication. Onsite pharmacists reported a larger proportion of clinical activities, while remote pharmacists reported a larger proportion of professional activities. Continued WS assessment of work activity patterns will allow identification of opportunities to streamline workflows, maximize pharmacist engagement in clinical activities, and development of remote work policy.

Impact of pharmacist outreach on glucagon prescribing

BackgroundHypoglycemia is a major limiting factor in the glycemic management of diabetes. As a method of treating hypoglycemia, the American Diabetes Association recommends glucagon to be prescribed for all individuals at increased risk of clinically impactful hypoglycemia. Glucagon Emergency Kits have been shown to reduce emergency department visits and overall health care costs. Despite these known benefits, glucagon continues to be underprescribed. Previous pharmacist-led interventions embedded in a single clinic have been shown to positively affect the rate of glucagon prescribing in patients with diabetes. ObjectiveThis study aimed to compare the rate of glucagon prescribing between quality improvement remote pharmacist outreach to multiple primary care and endocrinology specialty clinics and the control group in 1 month following a pharmacist-led provider outreach. MethodsThis was a single-center, 2-arm study with a simple randomization design. ResultsOn pharmacist outreach, 61 of 109 patients (56.0%) in the outreach group were prescribed a glucagon product within 1 month of their primary care provider (PCP) or endocrinology appointment compared with 1 of 113 (0.9%) of patients in the control group (P < 0.001). Glucagon prescribing occurred in 25 of 35 Black patients (71.4%) compared with 36 of 73 white patients (49.3%) in the outreach group. Glucagon prescribing was associated with race (P = 0.03; chi-square test). ConclusionsThe pharmacist-led provider outreach before a PCP or endocrinology appointment has a positive and statistically significant impact on glucagon prescribing rates. The pharmacist outreach had a higher impact on Black patients than white patients, possibly because of a lower rate of glucagon prescribing in Black patients before the outreach.

Factors contributing to the recruitment and retention of rural pharmacist workforce: a systematic review

BackgroundRecruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists’ retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages.MethodsA systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists.ResultsThe final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors.ConclusionsThe results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.

An emergency plan for management of COVID-19 patients in rural areas.

Aims of the studyTo describe the experience of six hospitals in the management of COVID‐19 patients in rural areas through an assessment of proportions, types and clinical outcomes of remote clinical interventions.MethodsThis was a prospective observational study conducted in six Egyptian hospitals over a period five months. An emergency response was implemented in each hospital in order to connect clinical pharmacists with COVID‐19 patients living in rural areas. Pharmacists used phone calls and social media applications, such as WhatsApp® to conduct two types of interventions; (a) Proactive interventions and (b) outcome‐based interventions. IBM SPSS V26 was used for data analysis.ResultsOf the 418 patients included, 351 (83.97%) recovered, 60 (14.35%) were hospitalised and 7 (1.67%) were deceased. Medication orders per patient, high‐alert medications per patient and prescribing errors per patient were 5.82, 1.45 and 0.74, respectively. Telepharmacy teams conducted 3318 phone calls, 2116 WhatsApp® chats and 1128 interventions, of which 812 (71.92%) were process‐based and 316 (27.98%) were outcome‐based. Among these interventions, four significant determinants of improvement in clinical outcomes were found: substitution of a prescribed drug (Adjusted odds ratio [AOR] = 4.03; 95% confidence interval [CI], 2.54‐5.87), adding a drug to the prescription (AOR = 3.15; 95% CI, 1.87‐4.76), advice the patient to stop smoking (AOR = 3.53; 95% CI, 1.98‐5.17) and cessation of drug therapy (AOR = 3.11; 95% CI, 1.25‐4.55). The most common medications involved in drug‐related interventions were Hydroxychloroquine, Azithromycin and Paracetamol.ConclusionOur findings demonstrate significant impact of the remote pharmacist interventions on both medicines use and clinical outcomes of COVID‐19 patients in rural areas. Pharmacists in developing countries should be supported to implement remote clinical services to provide patients in rural places with optimal care.

Rural pharmacists and stakeholders perspectives of expanded pharmacy practice: A descriptive study.

To explore pharmacist and stakeholder perspectives of pharmacists providing expanded services in rural community pharmacies. A descriptive qualitative study with an ethnographic lens of rural culture collected data via in-depth semi-structured interviews with stakeholder representatives and rural and remote pharmacists. Regional, rural and remote practice settings as defined by the Modified Monash Model MM3-MM7. Twelve rural or remote pharmacists and eight stakeholder representatives from various government and professional organisations participated in the study. Macro-, meso- and micro-level perspectives of pharmacists providing expanded pharmacy services in rural community pharmacies. At the macro-level, both pharmacists and stakeholders agreed that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. The meso-level revealed that pharmacist participants expected expanded practice to improve rural pharmacist recruitment and retention through improved professional satisfaction. The importance of effective collaboration and coordination with other health care providers in a community was described by pharmacists and stakeholders to ensure success of expanded services. All participants agreed that sustainability of these services relied on appropriate remuneration. At the micro-level, expanded pharmacy services are expected to save consumers' time and money as patients are redirected into appropriate health care settings. Enablers and barriers across policy, health professional, consumer and community levels need to be addressed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

Medication management for complex patients in primary care: application of a remote, asynchronous clinical pharmacist model

PURPOSE Drug therapy problems impact about one third of US adults, and these issues are likely to continue to worsen as the population of aging Americans increases. The objective of this study is to assess the feasibility of a remotely delivered Comprehensive Medication Management (CMM) for primary practice patients who are polypharmatic and at high risk for drug therapy problems. METHODS Using medical and prescription claims data, a list of Medicare Advantage beneficiaries at high risk for drug therapy problems were identified. Participants were enrolled in a 6-month CMM program from February – November 2020. In the program, their existing drug therapy was assessed by a pharmacist, Drug therapy problems were identified and resolved. A Collaborative Practice Agreement allowed the pharmacists to make prescription changes as needed. RESULTS Eighty-three percent (202) of contacted individuals agreed to participate in the study. All participants were on 5 medications or more, and 71% were on more than eight. A clinical pharmacist found that 86% of participants had a drug therapy problem according to classification criteria. Seventy-nine percent of all drug therapy problems identified were resolved upon completion of the study. CONCLUSION The findings of this study suggest that engagement of a remote clinical pharmacist can contribute to efficient resolution of most drug therapy problems identified in a primary care population. A service model using remote pharmacist services may be an effective means of improving team-based primary care medication management for this population.

Patient satisfaction with a pharmacist-led best possible medication discharge plan via tele-robot in a remote and rural community hospital.

Medication reconciliation (MedRec) reduces the risk of preventable medication-related adverse events (ADEs). A best possible medication discharge plan (BPMDP) is a revised list of medications a patient will take when discharged from hospital; a pharmacist review ensures accuracy. For many hospitals, on-site pharmacists are non-existent. Extension of a visual presence via a mobile robotic platform with real-time audiovisual communication by pharmacists to conduct MedRec remains unstudied. This study explored patient perceptions of a pharmacist-led BPMDP using a telepresence robot. Time requirements, unintentional discharge medication discrepancies (UMD), programme inefficiencies/barriers and facilitators involved in pharmacist review of the discharge medication list and patient interviews were also described. This prospective cohort study enrolled adult patients admitted to a 12-bed community hospital at high risk of an ADE. Remote pharmacists reviewed the discharge prescription list, identified/resolved UMDs, and interviewed/counselled patients using a telepresence robot. Thereafter, patients completed an anonymous satisfaction questionnaire. Prescriber discharge UMDs were classified, and barriers/inefficiencies and facilitators were documented. Nine patients completed an interview, with a 75% interview agreement rate. All patients were comfortable with the robot and 76% felt their care was better. With a median of 11 discharge medications/patient, the UMD rate was 78%; 71% had omitted medications, 43% involved a cardiovascular medication, 88% were due to a hospital system cause, and 43% were specifically due to an inaccurate best possible admission medication history. Median times for interview preparation, interview and UMD/drug therapy problem resolution were 45, 15 and 10 min, respectively. Using a telepresence robot to provide pharmacist-led BPMDPs is acceptable to patients and an innovative, effective solution to identify/resolve UMDs.

Remote pharmacy service in primary care: The implementation of a cloud-based pre-prescription review system

BackgroundTo reduce the occurrence of inappropriate prescription in primary care through the introduction of a cloud-based pre-prescription review system. ObjectiveWe aimed to describe the implementation of a cloud-based pre-prescription review system in the pharmacy practice of Chinese community health centers (CHCs), which currently have few qualified pharmacists. Practice descriptionThe cloud-based pre-prescription review system featured reviews by remote clinical pharmacists and targeted the prevention of inappropriate prescription in primary care. Practice innovationThis study describes the implementation of remote pharmacy at 22 CHCs in Futian District, Shenzhen, China. A pre-prescription system was developed and deployed in the cloud, which is linked to CHCs, and a consortium of qualified clinical pharmacists located in tertiary hospital. All prescriptions were mandatorily reviewed before printing and payment. First, prescriptions were reviewed using cloud-based rational drug use software. Then any detected potentially inappropriate prescriptions were reviewed by the remote pharmacist. The pharmacist consortium also modified review rules to improve efficiency and accuracy. Evaluation methodsThe frequency and proportions of potentially inappropriate prescriptions identified by the review software and the remote pharmacist consortium were analyzed descriptively. ResultsDuring the 6-month study period (July 1, 2019-December 31, 2019), 340,117 prescription entries from general practitioners in 22 community health care centers were reviewed. Of these, 6479 (3.0%) unique potential entries were suspended for pharmacist review, of which 3230 (49.9%) needed correction from prescribers in the CHCs. The most common corrections were related to improper administration routes or drug-drug interactions or had no justified indications. ConclusionInappropriate prescription is not uncommon in CHCs. The cloud-based prescription prereview model proposed in this study can serve as an important tool for the prevention of inappropriate prescription in primary care. The pre-prescription review system also provided opportunities for pharmacists to participate in the enhancement of patient care in primary care.

Pharmacists' "Full Scope of Practice": Knowledge, Attitudes and Practices of Rural and Remote Australian Pharmacists.

PurposePoor health outcomes for patients living in rural and remote areas of Australia are often attributed to the lack of a range of accessible health professionals delivering health services. Community pharmacists are already an integral part of these communities and as such are often the most frequently consulted health professionals. The aim of this study was to explore rural pharmacist knowledge and experiences of expanded pharmacy and to identify the barriers and enablers to remote pharmacists providing expanded pharmacy services (EPS), which can be described as services outside of usual medication management tasks.MethodsRural and remote pharmacists (Modified Monash Model (MMM) categories 2–7) participated in an online survey. Descriptive statistics and chi-squared tests were performed and data from open-ended questions were analyzed, categorized into themes and quantitized.ResultsTwo-thirds (n=13, 68%) of rural pharmacists surveyed (n=19) had knowledge of EPS in rural pharmacies and the majority (n=17, 89%) agreed that these services would benefit rural communities. Mental health service referral was considered very/extremely important by the majority (n=16, 84%) of respondents; however, no pharmacists were currently providing mental health screening services while (n=15, 79%) were willing to provide these services. While staff shortages, costs, time and training were indicated to be the main barriers to the provision of EPS, enablers included accessibility of rural pharmacies and a perceived need.ConclusionThis study indicated that pharmacists are already providing some EPS and see value in their implementation; however, what constitutes an expanded service was unclear to some participants. Mental health services were highlighted as most important demonstrating a recognized burden of mental illness in rural and remote locations. Findings from this pilot study will provide further understanding for future development of the pharmacist’s scope of practice and implementation of EPS.

Strategies to increase the pharmacist workforce in rural and remote Australia: a scoping review.

Despite reports suggesting an oversupply of pharmacists, there is currently an inadequate supply in rural and remote Australia. This can lead to a reduction in pharmaceutical services for an already vulnerable population. The objective of this study was to identify strategies for increasing the pharmacist workforce and factors associated with retention in rural and remote Australia Methods: Database searches of Ovid Medline (Medline and Embase), CINAHL and Scopus were conducted. Full text of relevant studies conducted in Australia, reported in English and published between 2000 and 2019 were retrieved. The record titles were independently screened by two investigators, after which abstracts of disputed articles were collected for further evaluation. Where agreement could not be reached, a third independent investigator screened the residual articles for inclusion or exclusion. Overall, 13 articles focusing on the pharmacy profession were retrieved. Strategies that have been employed to increase the rural and remote pharmacist workforce include the establishment of pharmacy schools in rural areas, inclusion of rural content in undergraduate pharmacy curriculum, enrolment of students from rural backgrounds, rural placement and employment of sessional pharmacists. Factors associated with retention were personal, workplace or community factors. There is limited research focusing on the recruitment and retention of pharmacists in rural and remote Australia. Given that pharmacies in rural and remote areas are very accessible and often function as one-stop health hubs, additional personal, workplace and community support should be provided for rural pharmacists and pharmacy students undergoing placements in rural and remote communities.

Role of telepharmacy in pharmacist counselling to coronavirus disease 2019 patients and medication dispensing errors

Introduction Remote pharmacist interventions have achieved much more attention during the coronavirus disease 2019 (COVID-19) outbreak, since they reduce the risk of transmission and can potentially increase the access of vulnerable populations, such as patients with COVID-19, to pharmaceutical care. This study aimed to examine differences in rates and types of pharmacist interventions related to COVID-19 and medication dispensing errors (MDEs) across community pharmacies with and without telepharmacy services. Methods This was a prospective, disguised, observational study conducted over four months (from March 2020 to July 2020) in 52 community pharmacies (26 with and 26 without telepharmacy) across all seven states of the United Arab Emirates using proportionate random sampling. A standardised data-collection form was developed to include information about patient status, pharmacist interventions and MDEs. Results The test (telepharmacy) group pharmacies provided pharmaceutical care to 19,974 patients, of whom 6371 (31.90%) and 1213 (6.07%) were probable and confirmed cases of COVID-19, respectively. The control group pharmacies provided care to 9151 patients, of whom 1074 (11.74%) and 33 (0.36%) were probable and confirmed cases of COVID-19, respectively. Rates of MDEs and their subcategories, prescription-related errors and pharmacist counselling errors across pharmacies with telepharmacy versus those without remote services were 15.81% versus 19.43% (p < 0.05), 5.38% versus 10.08% (p < 0.05) and 10.42% versus 9.35% (p > 0.05), respectively. Discussion This is one of the first studies to provide high-quality evidence of the impact of telepharmacy on COVID-19 patients’ access to pharmaceutical care and on medication dispensing safety.

Optimization of Lipid-Lowering Therapy for High Cardiovascular Risk Patients Through Electronic Medical Record Reporting and Pharmacist Evaluation.

Identification of high cardiovascular risk patients on suboptimal lipid-lowering therapy (LLT) may be possible through electronic medical record (EMR) reporting, presenting an opportunity for pharmacist involvement in optimizing drug regimens. To (a) identify high cardiovascular risk patients with opportunities for LLT optimization through EMR reporting and (b) evaluate effectiveness of pharmacist review and treatment algorithm on recommending treatment modifications compared with algorithm application alone. We generated an EMR report to identify adult patients aged 21-75 years with clinical atherosclerotic cardiovascular disease and low-density lipoprotein cholesterol (LDL-C) level ≥ 70 mg/dL during a 6-month period and collected pertinent data elements. We selected a subgroup of patients for remote pharmacist review and determined recommendations based on our predefined LLT optimization algorithm and pharmacist clinical judgment. One pharmacist was responsible for making all recommendations and communicated potential treatment modification to primary care providers via email and/or EMR messaging. We tracked provider acceptable/rejection rate to all recommendations made. We also compared recommendations based on using the algorithm alone to combining pharmacist chart review and algorithm and examined reasons for any discrepancies. 941 patients met inclusion criteria, with 399 patients (42.4%) not currently on any LLT. At baseline, 249 patients (25.3%) were on a high-intensity statin, and 19 (1.9%) were on a proprotein convertase subtilisin/kexin type 9 inhibitor. A subgroup of 34 patients were reviewed, of which 30 (88.2%) were on suboptimal therapy despite not achieving LDL-C goals. The pharmacist recommended to intensify statin therapy for 16 patients (47.1%), initiate nonstatin therapy for 9 patients (26.5%), and initiate statin therapy in 5 patients (14.7%). Pharmacist recommendation acceptance rate was 53.3%, with no response received in 26.6% of cases. The algorithm evaluation alone yielded the same recommendation as the combined pharmacist review with algorithm in 30 (88.2%) of the cases and differed in 4 cases. The underutilization of LLT among high cardiovascular risk patients remains a growing issue despite effective treatment options with cardiovascular benefits. Pharmacists may be able to identify these patients by using reportable EMR data elements and applying a treatment optimization algorithm to make therapy recommendations and improve outcomes. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no relevant declarations of interest to disclose. This study was presented as a poster presentation at the APhA Annual Meeting, March 2019, Seattle, WA, and as a platform presentation at the Eastern States Conference, May 2019, Hershey, PA.