Role Of Pharmacist Research Articles

Pharmacists in global primary healthcare systems: A comprehensive model for community health empowerment

Pharmacists play an increasingly important role in global primary healthcare systems, evolving from traditional dispensers to active participants in patient-centered care. This paper advocates for the stronger integration of pharmacists into healthcare teams to improve patient outcomes, medication adherence, and overall healthcare delivery. Through a comprehensive review, we examine the evolving role of pharmacists, the key challenges to their full integration, and the substantial opportunities they present, particularly in managing chronic diseases, providing preventative care, and enhancing patient education. We propose a model for empowering pharmacists to contribute more effectively to community health, especially in underserved areas. The paper also highlights the potential global impact of pharmacists in reducing healthcare costs, improving disease management, and promoting public health initiatives. Lastly, recommendations for future policy reforms, education enhancements, and research directions are offered to support the continued expansion of pharmacists' roles in primary healthcare systems worldwide.

Medication Management in Adults With Intellectual and Developmental Disabilities: Psychiatric Pharmacists in Primary Care.

This study describes the role of psychiatric pharmacists (PPs) in medication management at a county-hospital-based primary care clinic serving adults with intellectual and developmental disabilities (IDD). During a 20-week period, PPs provided 308 interventions for 97 patients with IDD, 55% of whom had a concomitant psychiatric/behavioral disorder and 70% of whom were taking at least one psychotropic medication. PP services included medication reviews (48%), medication histories (13%), collaborative care (12%), pharmacotherapy interventions (11%), advisory services (9%), and patient/caregiver education (7%). Psychotropics were involved in 66% of interventions. Our results demonstrate that PPs may address psychotropic-related challenges in this practice setting by performing a variety of services. Additional studies are needed to fully evaluate the impact of this integrative model.

Role of the cardiology pharmacist in improving quality of care for patients with acute myocardial infarction based on ESC-ACCA quality indicators

Abstract Background The European Society of Cardiology-Acute Cardiovascular Care Association (ESC-ACCA) suggested the use of quality indicators (QIs) to improve quality of care for patients with acute myocardial infarction (AMI). Among these QIs are prescribing of angiotensin-converting enzyme inhibitor (ACEi) and beta blocker (BB) if left ventricular ejection fraction (LVEF) was ≤40%, and prescribing high intensity statin and dual antiplatelet therapy (DAPT) before discharging patients from the coronary care unit (CCU). Purpose To identify the role of cardiology clinical pharmacy specialist in improving quality of care for patients with AMI based on ESC-ACCA QIs. Methods A cross-sectional study was conducted at a single CCU in Iraq between January 2021 and August 2023. Patients with AMI with or without LVEF ≤40% were included in the study. Patients' profiles were reviewed to collect data about suggestions by the cardiology clinical pharmacy specialist to initiate high intensity statin, addition of a second antiplatelet therapy to keep patients on DAPT, or addition of ACEi and/or BB if LVEF ≤40%. Results Total number of patients included was 326 of whom 119 (37%) patients had LVEF ≤40%. Drug interventions by the cardiology clinical pharmacy specialist with the initiation of statin and addition of a second antiplatelet therapy to optimize DAPT for patients with AMI and initiation of ACEi and/or BB for patients with AMI and LVEF ≤40% are shown in table 1 and figure 1. Drug interventions were based on the updated ESC guidelines and agreed by the interventional cardiologists. Conclusions Role of the cardiology clinical pharmacy specialist was important in bridging gaps in the medical therapy and improving quality of care for patients with AMI and/or LVEF ≤40% by optimizing patients medications particularly for the initiation of ACEi. ACEi was initiated in about one-quarter of the patients with AMI and LVEF ≤40% based on the suggestion of the cardiology clinical pharmacy specialist and approved by the interventional cardiologists.

Evaluation and redesign of an internal medicine pharmacy practice model at a tertiary care hospital.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Clinical pharmacists are embedded into the care for patients admitted to internal medicine floors at Cleveland Clinic. The existing practice model utilized by the internal medicine pharmacy team had an uneven distribution of clinical activities among the various pharmacist roles. A study was completed to evaluate a potential adjustment to the pharmacy practice model. The objective of this study was to assess the type and quantity of clinical activities performed by each pharmacist role. These data were then utilized to evaluate the need for redistribution of care activities among the pharmacist roles and to determine the need for additional pharmacist full-time equivalents. From January to February 2023, data pertaining to the amount and type of clinical activities completed by the 9 internal medicine pharmacist roles was either manually collected or extracted from the electronic medical record. The data were then utilized to calculate a responsibility score for each role. Descriptive statistics were also calculated to assess the results. Each pharmacist role cared for an average of 34.4 patients (minimum, 24.4; maximum, 57.7) during the study period. The average responsibility score for each pharmacist role was 309.8 (minimum, 237.5; maximum, 447.8). On the basis of the data collected during the 4-week study period, a new pharmacy practice model was developed that incorporated 2 additional full-time equivalents. This model balanced patient care responsibilities among the pharmacist roles and moved the practice model from a location-based to a team-based coverage model.

Assessment of Knowledge, Attitude and Practice of Community Pharmacists towards Adverse Drug Reactions Reporting in Pokhara

Introduction: The pharmacovigilance activities were initiated since 2004 AD which promote Adverse Drug Reactions (ADRs) reporting in hospital-based set-up in Nepal. But the system lacks robust activities related to ADRs and its reporting on community-based pharmacy. The role of pharmacist is very essential in preventing harmful effects of medicine. Objective: The main objective of the research is to assess the knowledge, attitude and practice of community pharmacists towards ADR reporting and to correlates the KAP scores with the demographic distribution of the respondents. Methods: A cross-sectional study was carried out by using a self-administered structured questionnaire. During the study period 132 pharmacists working at community pharmacies in Pokhara were selected and they were interviewed. Results: Out of 132 pharmacies visited, with an overall response rate of 65.33%, only 87 pharmacists agreed to response. There were 56 males and 31 females. The pharmacists with post-graduation degree had a high KAP score (21.00) followed by PharmD (19.5), graduate pharmacists (19.35), and then assistant pharmacists (13.8). Conclusion: Majority of the pharmacist had relatively better attitude but good knowledge towards ADRs and pharmacovigilance. In spite of that the knowledge and attitude could not reflected on the practice of ADR reporting. The majority of respondents emphasize the reporting of ADR from ground level is essential, so that the outcome-based treatment can enhance the patient’s safety.

Patients with Delusional Infestation are being given conflicting advice by pharmacy colleagues.

The role of pharmacists in psychodermatology includes counseling patients on psychotropic medications, ensuring adherence, and providing guidance that complements the advice of dermatology health care professionals. This pilot study is the first to highlight discrepancies in counselling effectiveness between clinicians and pharmacists. Patients were provided with suboptimal, conflicting or contradictory advice and training specialized pharmacists with prescribing privileges and providing specific information on psychotropic medications are essential.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 2: Complications, postrevascularization care, and quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed. Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for postrevascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist's perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists' impact on patient and institutional STEMI outcomes.

Clinical pharmacist interventions in nutrition-and drug-related problems in critically ill patients with renal dysfunction: a non-randomized controlled study

BackgroundCritically ill intensive care unit (ICU) patients often face life-threatening drug-related problems (DRPs) and malnutrition. Clinical pharmacists (CPs) play a crucial role in mitigating these issues and improving outcomes.AimThis study was designed to detect, prevent, reduce or resolve nutrition-related problems (NRPs) and DRPs in intensive care patients with renal dysfunction through clinical pharmacy services.MethodThis 9-month, prospective, non-randomized, controlled study was conducted in the ICU. During the intervention period (IP), CP recommendations addressing NRPs and DRPs were provided to the healthcare team. NRPs were evaluated using an expert-developed enteral nutrition consensus protocol, while DRPs were classified according to the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems Version 9.1.ResultsThe study included 60 patients with a median age of 73 years (IQR: 60.5–80). A total of 504 DRPs (8.4 per patient) were identified across all patients. DRPs were decreased by 50% during the IP compared to the observation period (OP) (p < 0.001). The most common causes of DRPs were ‘too low a drug dose’ (22.2%), ‘drug–drug interactions’ (17%), and ‘too high a drug dose’ (16.4%). Of the recommendations made to the prescribing physician, 140 (97.9%) were accepted. In the IP, targeted calorie and protein supplementation was fully achieved in more patients (p < 0.05). The most common recommendations included ‘changes in the rate of nutrition’ (66.7%), ‘vitamin supplementation’ (16.7%), and ‘changes in enteral nutrition products’ (7.7%).ConclusionThis study highlights the high incidence of DRPs and malnutrition risk in ICU patients with renal dysfunction, emphasizing the vital role of clinical pharmacists. Their collaboration with healthcare professionals significantly reduced both DRPs and NRPs.

A Realistic Case Confirming the Significance of Clinical Pharmacist Role Inside Community Pharmacists

The Article Abstract is not available

Adverse drug reactions in older people following hospitalisation: a qualitative exploration of general practitioners' perspectives.

Older people have greater comorbidity and medication burden. Adverse drug reactions occur in up to 30% of older people within one month of hospital discharge. General practitioners are key stakeholders in transitions of care from hospital to the community. The study aimed to explore general practitioner perspectives of adverse drug reactions in older people after hospitalisation, investigating the medication-related issues encountered and possible approaches to reduce the risk. An invitation to participate in the study was sent to general practitioners in Southern Tasmania, Australia. A semi-structured interview occurred in person at their practice or online. The questions covered experiences with managing medication in older people after hospital discharge, challenges and risks involving adverse drug reactions and suggestions to prevent adverse drug reactions. The interviews were transcribed and analysed through thematic analysis. Twelve general practitioners were interviewed, revealing four themes describing challenges, including (i) complex patients and acceptance of risk, (ii) patient confusion and decline in hospital, (iii) time taken to manage older patients and (iv) communication challenges. Three themes describing recommendations were identified, including (i) clear communication on discharge, (ii) patient involvement and (iii) roles for pharmacists. Prevention of adverse drug reactions after hospital discharge may require clear and timely communication to general practitioners, patients and families to be educated and empowered to help manage their own health and risk, and pharmacists to support both patients and general practitioners in managing the risks.

The juggling act of pharmacists in Sweden: a qualitative study on balancing healthcare professionalism and retail employment

BackgroundCommunity pharmacies in Sweden merge a state-funded professional community service with a retail business. While previous research has recognized its challenges, less attention has been paid to the potential conflict of interest it could result in regarding the work of pharmacists. This study aims to increase understanding of how pharmacists in Sweden combine their healthcare ambitions and obligations with those concerning being employees in a retail business.MethodsSemi-structured interviews were conducted with 28 pharmacists employed by pharmacy chains in Sweden. The data were thematically analysed.ResultsIn the analysis, three themes were formulated: Different interests, The conflict between professional work & business work, and Strategies to manage the conflicts. The analysis of the data reveals that pharmacists in Sweden experience a conflict of interest. They grapple with balancing being healthcare professionals with a focus on patient care and being valued retail employees that also focus on financial results. This conflict manifests in various situations, such as time management, communication focus, preferred behaviours, and different tasks. The different strategies applied by individual pharmacists to manage the work are results of job crafting. Pharmacists employ strategies such as compromise, mandate stretching, avoidance, and acceptance to manage the conflict. However, these strategies lead to compromises in their work.ConclusionThis study aimed to understand how pharmacists combine their healthcare ambitions and obligations with those of being employees in a retail business. The study demonstrated that Swedish community pharmacists need to perform a juggling act to be both professional healthcare workers and viewed as valuable retail employees. In situations when the conflict of interest occurs, the pharmacists use different strategies when determining how to prioritize between the professional work and the business work. The conflict of interest in the pharmacists’ work need to be taken into consideration when discussing pharmacists practices, the profession, or role it’s in the healthcare system.

Exploration of drug therapy related problems in a general medicine ward of a tertiary care hospital of Eastern Nepal

BackgroundInpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy. ObjectiveThis study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal. MethodsA three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs. ResultsA total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05. ConclusionDTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes.

CKD Care: Evaluating the Role of Clinical Pharmacists

CKD Care: Evaluating the Role of Clinical Pharmacists

Pharmacists as educators: Enhancing patient understanding and access to specialty medications through community workshops

Pharmacists are increasingly recognized as vital educators within the healthcare system, particularly in improving patient understanding and access to specialty medications. This review explores the expanding role of pharmacists as educators, emphasizing their unique expertise in providing accurate, accessible information and their impact on patient outcomes. The paper highlights community workshops as an effective tool for delivering education, focusing on the structure, content, and accessibility of these workshops to diverse patient populations. Furthermore, it examines patients' barriers to accessing specialty medications and how pharmacists can help overcome these challenges through education, support, and coordination with other healthcare providers. The review also discusses future directions for enhancing the educator role of pharmacists, the need for supportive policies, and the potential long-term benefits of pharmacist-led education on public health and healthcare costs. Recommendations for implementing and expanding community-based education initiatives are provided, emphasizing integrating these efforts into broader healthcare strategies. Keywords: Pharmacist-led education; Specialty medications; Community workshops; Healthcare access; Patient outcomes; Public health

PENGARUH KONSELING APOTEKER TERHADAP KEPATUHAN TERAPI PASIEN DIABETES MELITUS DI BEBERAPA PUSKESMAS DAN RUMAH SAKIT

Diabetes mellitus is a global health issue that requires a comprehensive management approach. Pharmacist interventions have proven effective in enhancing patient adherence to medication and improving clinical outcomes. This study aims to systematically review pharmacist interventions for diabetes mellitus patients and their impact on medication adherence and glycemic control. The research method used was a narrative literature review, analyzing 188 articles from PubMed and 200 articles from Google Scholar, with 20 studies meeting the inclusion criteria, including 12 studies conducted in community health centers (puskesmas) and 8 studies in hospitals. The findings indicate that pharmacist counseling interventions significantly improve medication adherence and lower HbA1c levels. In community health centers, adherence increased from 9.2% to 61%, and HbA1c decreased from 8.5% to 7.2%. In hospitals, the average HbA1c reduction was between 1.5% and 2%. The multifaceted counseling approach was more effective compared to telephone counseling, which showed an HbA1c reduction of 0.3%. These findings highlight the critical role of pharmacists in managing type 2 diabetes mellitus.

Normalising the Implementation of Pharmacogenomic (PGx) Testing in Adult Mental Health Settings: A Theory-Based Systematic Review.

Pharmacogenomic (PGx) testing can help personalise psychiatric prescribing and improve on the currently adopted trial-and-error prescribing approach. However, widespread implementation is yet to occur. Understanding factors influencing implementation is pertinent to the psychiatric PGx field. Normalisation Process Theory (NPT) seeks to understand the work involved during intervention implementation and is used by this review (PROSPERO: CRD42023399926) to explore factors influencing PGx implementation in psychiatry. Four databases were systematically searched for relevant records and assessed for eligibility following PRISMA guidance. The QuADS tool was applied during quality assessment of included records. Using an abductive approach to codebook thematic analysis, barrier and facilitator themes were developed using NPT as a theoretical framework. Twenty-nine records were included in the data synthesis. Key barrier themes included a PGx knowledge gap, a lack of consensus in policy and guidance, and uncertainty towards the use of PGx. Facilitator themes included an interest in PGx use as a new and improved approach to prescribing, a desire for a multidisciplinary approach to PGx implementation, and the importance of fostering a climate for PGx implementation. Using NPT, this novel review systematically summarises the literature in the psychiatric PGx implementation field. The findings highlight a need to develop national policies on using PGx, and an education and training workforce plan for mental health professionals. By understanding factors influencing implementation, the findings help to address the psychiatric PGx implementation gap. This helps move clinical practice closer towards a personalised psychotropic prescribing approach and associated improvements in patient outcomes. Future policy and research should focus on the appraisal of PGx implementation in psychiatry and the role of pharmacists in PGx service design, implementation, and delivery.

Evaluating the impact of pharmacy-led telemedicine services on access to oncology care in rural areas

This review paper explores the impact of pharmacy-led telemedicine services on enhancing access to oncology care in rural areas. With the increasing prevalence of cancer and the challenges associated with delivering specialized oncology services in remote locations, telemedicine has emerged as a vital tool for bridging the healthcare gap. The paper highlights the significant role of pharmacists in managing complex medication regimens, improving patient adherence, and providing essential support through telemedicine platforms. Key findings indicate that telemedicine improves patient access to care and enhances patient and provider satisfaction, leading to better treatment outcomes. The review also discusses the implications for healthcare policy and practice, emphasizing the need for investment in telemedicine infrastructure and pharmacists' integration into this care model. Future research directions are proposed to evaluate the long-term effectiveness of these services and explore advanced telemedicine technologies. The potential of telemedicine to transform rural healthcare access and outcomes is vast, offering a promising solution to address the disparities in oncology care. Keywords: Telemedicine, Oncology Care, Rural Healthcare, Pharmacy-Led Services, Patient Access, Healthcare Disparities.

Pharmacist and veterinarian collaboration in Klang Valley, Malaysia: A veterinarians' perception

BackgroundThe collaboration between pharmacists and veterinarians plays a crucial role in ensuring optimal animal healthcare. Understanding the willingness of veterinarians to collaborate with pharmacists and analyzing the prescribing trends by veterinarians are essential factors in improving the quality of veterinary care. By analyzing these aspects, valuable insights can be gained to enhance interprofessional collaboration and optimize medication management in veterinary practice. ObjectivesTo examine the willingness of veterinarians towards interprofessional collaboration with community pharmacist. MethodsA cross-sectional study was conducted among 40 veterinary clinics in Klang Valley, Malaysia. Data was collected via online using Google Forms from registered veterinarians working in private veterinary clinics in Klang Valley, Malaysia. Descriptive statistics and statistical analysis were performed using SPSS version 27. ResultsThe overall willingness of veterinarians to collaborate with community pharmacists was measured with a median score of 51 out of 75. The results indicated that 55 % of veterinarians demonstrated high willingness to collaborate. Specifically, 52.5 % of veterinarians had a positive attitude towards collaboration, 55 % recognized the roles of pharmacists positively, and 57.5 % identified barriers to collaboration. These findings highlight a generally positive inclination towards interprofessional collaboration among veterinarians. ConclusionMore veterinarians demonstrated a positive willingness to collaborate with pharmacists for optimal patient care. However, several constraints were identified, including a lack of face-to-face communication, concerns about pharmacists' knowledge or skills in veterinary medicine, and financial interests. Addressing these issues could further enhance collaboration between veterinarians and pharmacist.

Social Determinants of Health in Pharmacy Practice

This narrative review explores the role of pharmacy practice in addressing social determinants of health and its potential to mitigate major public health issues in Iraq. It focuses on the key concepts of social determinants of health, their impact on public health, and their implications for the community. The paper defines social determinants of health, examines the connection between these determinants and pharmacy practice, and highlights the role of pharmacists in addressing these determinants. Social determinants of health, such as agriculture and food production, employment, education, and housing, can significantly influence the health status of individuals and communities. By understanding these factors, healthcare practitioners can shift their focus toward prevention rather than solely relying on medication, particularly for those in low-income situations. This approach can reduce the overall need for medications. The review proposes a framework for integrating pharmacy practice into public health strategies, emphasizing how social determinants of health shape this integration. Additionally, it suggests that pharmacists can contribute to improving public health by fostering preventive care within the community.