Pharmacy Research Articles

The U.S. Indian Health Service: A Seedbed for Innovative Pharmacy Practice

The U.S. Indian Health Service: A Seedbed for Innovative Pharmacy Practice

Development and evaluation of a model to identify publications on the clinical impact of pharmacist interventions

BackgroundPharmacists are increasingly involved in patient care. Pharmacy practice research helps them identify the most clinically meaningful interventions. However, the lack of a widely accepted controlled vocabulary in this field hinders the discovery of this literature. ObjectiveTo compare the performance of a machine learning model with manual literature searches in identifying potentially relevant publications on the clinical impact of pharmacist interventions. To describe the dataset that was built. MethodsAn automated PubMed search was performed weekly starting in November 2021. Titles and abstracts were retrieved and independently evaluated by two reviewers to select potentially relevant publications on the clinical impact of pharmacists. A Cohen's kappa score was calculated. Data was collected during an 11-month period to train a machine learning model. It was evaluated prospectively during a 5-month period (predictions were collected without being shown to the reviewers). The performance of the model was compared with manual searches (positive predictive value [PPV] and sensitivity). ResultsA transformers-based model was selected. During the prospective evaluation period, 114/1631 (7 %) publications met selection criteria. If the model had been used, 1273/1631 (78 %) would not have needed review. Only 3/114 (3 %) would have been incorrectly excluded. The model showed a PPV of 0.310 and a sensitivity of 0.974. The best manual search showed a PPV of 0.046 and a sensitivity of 0.711. On December 12, 2023, the dataset contained 8607 publications, of which 544 (6 %) met the criteria. The kappa between reviewers was 0.786. The dataset and the model were used to develop a website and a newsletter to share publications (https://impactpharmacy.net). ConclusionA machine learning model was developed and performs better than manual PubMed searches to identify potentially relevant publications. It represents a considerable workload reduction. This tool can assist pharmacists and other stakeholders in finding evidence that support pharmacists' interventions.

Delivery of enhanced asthma care in pharmacies: Perceptions and experiences of Australian service providers

BackgroundEvidence-based asthma management services have been tested in Australian community pharmacies for over 2 decades and have been well received by patients but are not retained in practice. The positive clinical outcomes of these tested services suggest the potential for wider implementation, for which the providers’ perspective is critical. ObjectiveThis investigation evaluates the implementability of the Pharmacy Asthma Service (PAS) through the experiences and perceptions of the community pharmacists delivering the service. MethodsForty-eight pharmacists took part in a posttrial semi-structured qualitative telephone interview, representing 42 of 51 (82%) eligible PAS intervention arm pharmacies. Qualitative data were deductively analyzed in accordance with the Implementation Outcomes Framework. ResultsPharmacists recognized the positive impact of the service on patients’ health outcomes, the pharmacist’s practice, and in fostering stronger and more beneficial pharmacist-patient relationships. However, whilst acknowledging the importance of such a service, the pharmacists faced challenges in recruitment and patient follow-up. Pharmacists stated that further work is required to address pharmacist and patient time constraints, patient health beliefs and to increase the acceptance of pharmaceutical care provision in community pharmacy practice by patients and other health care professionals. ConclusionPharmacists can deliver enhanced clinical care for asthma patients with positive perceived professional and patient outcomes. However, it remains evident that time, remuneration, and recognition of the pharmacist’s role in chronic care management form barriers to the implementation of asthma services in community pharmacies. Broader policy and systemic changes are required to successfully balance medication supply and quality patient management roles at the same time as a required shift in research processes.

Empowering pharmacy technicians as vaccine champions: A pilot study in independent community pharmacies

BackgroundIncreasing vaccine uptake in communities has been essential, even before coronavirus disease 2019. The use of "vaccine champions" or "VaxChamps" has shown promise. VaxChamps, who are often community members with specialized training but no special credentials, advocate for vaccination by sharing their experiences and knowledge. Pharmacy technicians’ scope of practice, coupled with their frequent interactions with pharmacy patients, make them ideal vaccine champions and a natural fit for the VaxChamp program. This study assessed the implementation and impact of the VaxChamp program in North Dakota community pharmacies. ObjectivesTo describe the development and implementation of the VaxChamp program in community pharmacies and evaluate its effect on vaccination rates and vaccine-related tasks within each pharmacy’s organizational context. MethodsThe VaxChamp program involved training one technician per participating pharmacy to spend 5 hours per week on vaccine-related tasks. Data collection included pre-post surveys, monthly reports, and semi-structured interviews with VaxChamps and pharmacists-in-charge from 6 pharmacies. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using inductive methods to identify key themes. ResultsThe 6 participating pharmacies varied in location and staffing. Most had prior vaccine administration experience. VaxChamps’ roles ranged from administrative tasks to direct vaccine administration, depending on the pharmacy’s staffing and workflow. Vaccination rates for pneumococcal and hepatitis B vaccines increased in several pharmacies, while shingles vaccination rates declined. The presence of advanced pharmacy practice experience students often influenced VaxChamps’ responsibilities, underscoring the need for clear role delineation. ConclusionIntegrating pharmacy technicians as VaxChamps in community pharmacies is a promising strategy to increase vaccination rates and enhance public health. Future research should explore ways to better integrate technicians into comprehensive immunization strategies and address the contextual factors that influence program implementation.

Act for the future of community pharmacy

Community pharmacies serve as a vital gateway to primary care and public health, offering face-to-face pharmacist expert care to assure safe and effective medication use. However, they are disappearing at an alarming rate, with 20%-30% of all community pharmacy locations projected to close within the next year. The objective of this commentary is to highlight the critical need for systemic reforms and collective action within our profession to address the unique challenges faced by community pharmacies, ensuring their sustainability and continued role in providing essential health care services for patients. Key issues and evidence are provided to help pharmacy professionals better articulate why pharmacy closures are happening now and how we can work toward a transformed future. Pharmacy closures stem from an unsustainable business model characterized by declining reimbursement for prescription medications, opaque and anticompetitive pricing practices of pharmacy benefit managers, and limited reimbursement for clinical services. Among these challenges, our profession has the opportunity to create a future for community pharmacy where every person has local access to pharmacist expert care and medications through sustainable, integrated community pharmacy practice. Our profession must embrace community pharmacy teams’ role in patient care, champion opportunities to integrate community pharmacists and their support staff as members of the health care team, and advocate for payment transparency and transformation. Creating this future will take all pharmacists and all pharmacy professionals.

Influence of pH on the Stability of Pharmaceutical Compounds in Japan

Purpose: The aim of the study was to assess the influence of pH on the stability of pharmaceutical compounds in Japan. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study showed that the ionization state of a drug molecule can change with pH, leading to different degradation pathways. Acidic or basic conditions can catalyze hydrolysis, oxidation, and other chemical reactions, causing the drug to lose potency or form harmful by-products. For instance, ester and amide bonds in pharmaceuticals are prone to hydrolysis at extreme pH levels, while oxidative degradation is more prevalent at neutral or slightly basic pH. The stability of certain antibiotics, vitamins, and biologics is particularly pH-sensitive, necessitating careful formulation to maintain optimal pH levels. Buffer systems are often employed to stabilize the pH within a range that minimizes degradation. Additionally, the pH of the solution can influence the solubility and bioavailability of the drug, impacting its therapeutic efficacy. Thus, understanding and controlling the pH environment is crucial in pharmaceutical formulation to ensure drug stability, efficacy, and safety throughout its shelf life. Implications to Theory, Practice and Policy: Buffer theory, Arrhenius theory of acid-base reactions and Bronsted Lowry theory may be used to anchor future studies on assessing the influence of pH on the stability of pharmaceutical compounds in Japan. Practically, it is imperative for pharmaceutical companies to implement rigorous pH control in the formulation and storage of drugs. On a policy level, regulatory agencies should establish stringent guidelines for the pH stability of pharmaceutical compounds.

Impact of working environment on the level of occupational burnout among community pharmacists - a pilot study.

The disorder known as burnout develops as a reaction to the damaging impacts of workplace stress. When occupational stress is poorly managed, it can result in burnout, which has a detrimental impact on workers' performance and emotional and physical well-being. Those who work in the helping profession are the most vulnerable. Pharmacy practitioners are among the most vulnerable groups in the healthcare industry.

Privacy in Community Pharmacies in Saudi Arabia: A Cross-Sectional Study.

Privacy in healthcare is a fundamental right essential to maintain patient confidentiality and trust. Community pharmacies in Saudi Arabia (SA) play a critical role in the healthcare system by providing accessible services and serving as initial points of contact for medical advice. However, the open nature of these settings poses significant challenges in maintaining patient privacy. This cross-sectional study used electronic surveys distributed across various online platforms. The target sample included Saudi adults, with a sample size of 385 participants to achieve 80% statistical power at a 95% confidence interval. The survey comprised demographic questions and sections evaluating perceptions of privacy, the importance of privacy, and personal experiences regarding privacy in community pharmacies. Descriptive statistics and logistic regression models were used for the analysis. A total of 511 responses were obtained. The mean age was 33.5 years, with an almost equal distribution of males (49.71%) and females (50.29%). Most participants held a bachelor's degree or higher (78.67%). Privacy perceptions varied, with only 9.0% strongly agreeing that there was a private space for consultations, while 64.0% felt that the design of community pharmacies did not adequately consider patient privacy, and 86.9% reported that conversations could be overheard. Privacy concerns were notable, with almost one-half of the participants (47.6%) having concerns about privacy and 56.6% doubting the confidentiality of their health information. Moreover, 17.6% reported being asked for unnecessary personal information when buying medication, and 56.2% admitted to avoiding discussing a health problem with the pharmacist due to privacy concerns. Experiences of privacy breaches were reported by 15.7% of respondents. Logistic regression analysis revealed that the availability of private space in the pharmacy and patients feeling that the pharmacy respects their privacy were associated with a lower likelihood of avoiding discussions with pharmacists due to privacy concerns (OR = 0.758, CI = 0.599-0.0957 and OR = 0.715, CI = 0.542-0.945 respectively) Conversely, greater privacy concerns and previous privacy breaches significantly increased the likelihood of avoiding discussions with pharmacists in the community pharmacy (OR = 1.657, CI = 1.317-2.102 and OR = 4.127, CI = 1.886-9.821 respectively). This study highlights the significant concerns regarding privacy practices in community pharmacies in SA. Thus, there is a need for standards to improve privacy in community pharmacies, such as mandating the need for private consultation areas and enhanced staff training on handling privacy-related issues. Addressing the issue of privacy is crucial for maintaining patient trust, improving healthcare service quality, and ensuring effective patient-pharmacist interactions.

Because I see you: Pharmacist social determinants of health as predictor of structural awareness

BackgroundThe contribution of Social Determinants of Health (SDOH) to health disparities and patient outcomes is widely acknowledged. Much less has been done to characterize provider SDOH, and in particular, their effect on delivery of structurally competent care. Differing lived experiences create blind spots to the critical upstream factors contributing to health. ObjectivesThe primary objective of this study was to examine the association between Structural Awareness (SA) and SDOH when controlling for year of first licensure, primary setting of pharmacy practice, race, and gender. The secondary objective was to examine the difference in mean SA scores with 4 stand-alone predictor variables: reliance on public transportation, insurance coverage gaps, food insecurity, and housing insecurity. MethodsThis study is a cross-sectional web-based survey of 606 Minnesota pharmacists. SDOH risk and SA scores were assessed using modified versions of the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences and Cultural Competence Self-Assessment Questionnaire tools, respectively. The association of these scores was assessed using a multiple linear regression model, and the association with stand-alone variables was done using t-tests. ResultsSDOH risk was significantly associated with SA at the 95% confidence level with a P-value of 0.0016. Food and housing insecurity were also significantly associated with SA score while reliance on public transportation and insurance coverage gaps were not. ConclusionPharmacy and other healthcare professional training programs should create opportunities for exposure to the SDOH experienced by their patients through immersive learning and/or experiential education.

Advocate Health works toward shared vision of pharmacy practice.

Advocate Health works toward shared vision of pharmacy practice.

Pharmacy Compounding Regulation in the German Pharmaceutical Market. Part 2. Organisational Features (Review)

INTRODUCTION. The Russian Federation has decided to restore the system of compounding pharmacies as an element of the critical national healthcare infrastructure and pharmaceutical supply chain. To improve Russian regulatory practices, develop novel advanced approaches to pharmacy compounding and quality control, and implement these approaches, it is necessary to study relevant good compounding practices applied in healthcare systems of other countries.AIM. The study aimed to analyse the German experience in the organisation and regulation of pharmaceutical compounding to suggest recommendations for the development and implementation of Russian guidelines on good compounding and dispensing practices.DISCUSSION. This work continues a comprehensive study that delves into the current provisions of German legislation governing the system of good compounding practices. This article examines the differences between approaches to compounding by medical and pharmaceutical specialists. According to the findings, compounding by medical specialists is guided by the “free practice of medicine” principle and is subject to minimal regulatory oversight. All pharmacy organisations operate as compounding pharmacies, thereby enhancing the physical accessibility of compounded medicinal products to the population. The authors highlight the features of a process-based quality assurance system encompassing production process controls and quality control methods for compounded medicinal products. Additionally, the authors discuss the applicability of rapid test methods to compounding. In accordance with the German concept of good pharmacy practices, a compounding pharmacy may use the available validation, qualification, and verification tools in the pharmaceutical development of compounded medicinal products and may outsource its internal quality control function. Using the concept of risk ranking, compounding pharmacies may design their own sampling programmes. The article describes approaches to and requirements for organising the evaluation of compounding prescriptions. In Germany, compounding pharmacies may independently assign shelf lives to the compounded medicinal products they produce.CONCLUSIONS. Some German solutions are of considerable practical importance and are applicable to the development and implementation of Russian guidelines on good compounding and dispensing practices. In particular, pharmacy organisations may outsource the quality control of their compounded medicinal products. Additionally, pharmacies can conduct the full-scale pharmaceutical development of compounding technologies and quality control methods (including rapid test methods) using the validation, qualification, and verification tools available to drug manufacturers. Moreover, pharmacy organisations may independently assign shelf lives to the compounded medicinal products they produce. Finally, pharmacy organisations may design their individual sampling programmes.

Emerging trends in precision medicine and its impact in pharmacy practice

Emerging trends in precision medicine and its impact in pharmacy practice

The Role of Effective Communication in Reducing Medication Errors in Pharmacy Practice

The Role of Effective Communication in Reducing Medication Errors in Pharmacy Practice

Harmony of Healing: Exploring Ayurveda's Timeless Wisdom in Pharmacy Practices: A Review

Ayurveda, an ancient system of medicine originating from the Indian subcontinent, has gained significant attention and recognition worldwide. Ayurveda emphasizes a holistic approach to health and disease management, focusing on the balance between mind, body and spirit. Traditional Ayurvedic practices incorporate various therapeutic interventions, including herbal medicines, dietary modifications, yoga, meditation and lifestyle modifications. With growing interest in natural and alternative therapies, Ayurveda has become a subject of extensive scientific investigation and integration into modern pharmaceutical practices. This review is to provide an updated and comprehensive understanding of Ayurveda¢s role in pharmacy and its potential contributions to the field of healthcare.

Implementation strategies and outcomes in the delivery of HIV test services (HTS) in community pharmacies in Nigeria

BackgroundStudies have shown that training interventions fail when proper strategies are not in place for their implementation. The study described the implementation strategies used in the delivery of the HIV test services (HTS) and measured implementation outcomes in the delivery of the services.MethodsThe study was conducted between August and November 2019 among 50 selected community pharmacies in Oyo State, Nigeria using a mixed-method quantitative and qualitative data survey design. The implementation strategies and activities used in the delivery of HTS in the pharmacies and during outreaches were described while both observational and survey methods were used to collect data. Implementation outcomes were measured and analysed in terms of penetration, adoption, acceptability, feasibility, fidelity, and appropriateness of the intervention.ResultsPenetration among respondents was 90%. Acceptability of the HTS was high (77.3%) among clients 20–49 years of age with 919 clients participating in the HIV screening. While 919 HIV tests were conducted, only 19 (2.1%) were positive. Adherence to the protocol of delivery of HTS (fidelity) indicated that all the respondents conducted rapid HIV testing, pre-testing counselling (43, 95.6%), post-testing counselling (40, 88.9%), and provision of confidential test results (39, 86.7%). Respondents’ responsiveness indicated that 23 (51.1%%) of the respondents could use up to 80% and above of the test strips given within the period. Researchers’ observations showed respondents’ ability to perform the tests as intended with little challenges. Participants felt that rendering the services was an interesting experience, and fulfilling, and allowed them to improve on their professional deliverables and practice. It also showcased the relevance of pharmacists in rendering HTS, creating awareness of the menace of HIV/AIDS, and helping people to stop the spread.ConclusionThe study showed that HTS is acceptable, appropriate, feasible, and easy to adopt in community pharmacies and penetration was high. For sustainability, community pharmacists should be well remunerated, and need for an established policy to include this scope in community pharmacy practice.

A Call to Action: Impact of Pharmacy Education on Rural Practice

Rural populations are steadily growing, yet residents in these areas face significant disparities in health care access compared with their urban counterparts. This commentary examines the role of pharmacy education in addressing the challenges of rural pharmacy practice. With a focus on strategies outlined by the World Health Organization, the authors explore interventions such as admitting students from rural backgrounds, establishing health professional schools outside major cities, and providing clinical rotations in rural areas. Drawing on examples from Australia, Canada, the United States, and New Zealand, the authors highlight various approaches taken to bridge the rural pharmacy education gap. These include adapting admission criteria for pharmacy schools, integrating rural content into curricula, and offering rural-focused rotations and certificate programs. In addition, the authors discuss the importance of addressing student perceptions of rural practice, which often include concerns about social isolation, limited collaboration opportunities, and lifestyle factors. Looking ahead, the authors suggest future directions for pharmacy education, emphasizing the need to prioritize rural health issues in curricula, increase opportunities for rural placements, and engage pharmacists from rural backgrounds in teaching roles. By implementing these recommendations, pharmacy educators can better prepare students for rural practice, ultimately improving access to health care and reducing disparities in underserved communities.

Practice outcomes for the first decade of Rural Pharmacy Education (RPHARM) Program graduates

BackgroundThe maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates.MethodsDescriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis.ResultsApproximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural–Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois.ConclusionsApproximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates’ practice locations.

Testing of parenteral drug products for visible particles: comparison of the Ph. Eur. method with an alternative method using polarised light

ObjectivesParenteral drug products should be essentially free from visible particulate contamination. To ensure this, every batch produced must be subject to a 100% visual inspection. Monograph 2.9.20 of the European...

Assessing Cultural Intelligence in PharmD Education Through Art

ObjectiveThis study, conducted in collaboration with the University of North Carolina (UNC)–Chapel Hill’s Ackland Art Museum, assessed student experiences in a facilitated visual art experience designed to foster cultural intelligence among 143 first-year Doctor of Pharmacy students at the UNC Eshelman School of Pharmacy. MethodsA post-event survey was used to collect data on student perceptions of this experience and its implications. Quantitative items were analyzed using descriptive statistics. Qualitative items were deductively coded using the 4 domains of the Cultural Intelligence Framework: cultural awareness, cultural knowledge, cultural practice, and cultural desire. A convergent parallel mixed-methods approach was used to gain a deeper understanding of the data. ResultsOf the 143 students who completed the survey (response rate = 99%), nearly all agreed (n = 60, 42%) or strongly agreed (n = 70, 49%) that the art experience was valuable. Students indicated that it increased their confidence in having open dialogue concerning equity, inclusivity, and race, expanded their perspectives about the implications of inequities, and provided knowledge they can apply in their careers as health science professionals. Findings revealed students’ acknowledgment of their own backgrounds, enhanced understanding of bias and historical contexts, recognition of relevance to pharmacy practice, and expressed a desire for further cultural understanding. ConclusionThis research underscores the potential of visual art and museum partnerships in fostering positive perceptions and beliefs about cultural intelligence among aspiring pharmacists.

Practice Faculty Also Need Sabbatical Leaves

The academic sabbatical in higher education has been used as a tool for personal and professional growth. Although sabbaticals for tenured faculty have been widely accepted and utilized, their use for nontenure, contract, and practice-based faculty are not well-understood. To explore the reason behind this, the authors undertook focus sessions among practice faculty who had taken a sabbatical leave or were considering a sabbatical leave. Two themes emerged from the conversations with participants: (theme 1) practice faculty assume they are not eligible for sabbatical leaves and (theme 2) practice faculty assume sabbaticals must result in/lead to significant grant funding. Based on these results, sabbatical leaves appear to be under offered to and misunderstood by practice pharmacy faculty. In a time where pharmacy programs are struggling to recruit and retain practice faculty required to prepare the next generation of pharmacists, sabbaticals for practice faculty may be an effective strategy to support practice faculty and incorporate innovation into educational experiences. We hope that this project stimulates a broader conversation within pharmacy academia about the importance of investment in our critically important practice faculty.