International Journal of Pharmacy Practice最新文献

Background: Interventions to reduce antibiotic use focus on general practitioners (GPs) and patient behaviour, not pharmacists, who may inadvertently drive antibiotic expectations by referrals to GPs. No data are available on pharmacist referrals for suspected antibiotic-requiring infections. We conducted a feasibility pilot to provide data for robust sample size calculation and identify areas for further exploration.

Method: Pharmacists and GPs were recruited independently using convenience sampling. They completed prospective data collection on 20 consecutive minor ailment encounters and consultations respectively. Pharmacists recorded patient gender, age, referral reason, and any comments. GPs recorded patient age, gender, reason for visit, and origin of patient referral including self-referral. All data were analysed descriptively. Generalized estimating equation multivariable logistic regression was used to investigate factors that may be associated with pharmacist referral rates.

Results: We recruited 19 pharmacists representing 466 minor ailments encounters, and 19 GPs representing 394 consultations. Pharmacists referred 17% (77/466) of all minor ailments encounters for suspected antibiotic-requiring infections. Comments suggested reasons included upper-respiratory tract, ear nose and throat, and urinary tract infections. Most of suspected antibiotic-requiring infections referrals were to a GP (81%; 62/77). No GP consultations for infection (n = 88) were documented as being referred by a pharmacist; the majority were self-referred (77%; 68/88).

Discussion: Our pilot indicated that exploration of pharmacist referral for antibiotics is feasible and warranted. Future studies should quantify referral rates, reasons for referral, and observed differences between pharmacist and GP results. Our results should be used for the basis of a robust sample size calculation.

Objectives: Identify factors associated with unmet healthcare needs in patients with multimorbidity and determine the support community pharmacists can offer to meet these needs.

Methods: People with multimorbidity were recruited from community pharmacies where research assistants approached all patients and asked them questions to determine their eligibility: having two or more chronic conditions, being at least 18 years old, and speaking either Arabic or English. Those who met the criteria were invited to participate in the study. Consenting participants completed a survey designed based on international guidelines, utilizing validated tools to measure healthcare needs, quality of life, treatment burden, and medication self-efficacy. Generalized linear models were used to identify predictors of unmet needs.

Key findings: Two hundred and twenty-four participants completed the survey (response rate = 81%). Participants indicated significant healthcare needs particularly in areas such as communication and relationships (M = 4.4 ± 0.9) and medication information (M = 3.8 ± 0.7). Higher education and medication self-efficacy were associated with lower needs for counselling (B = -0.966; P < .001 and B = -113; P < .001, respectively) and communication (B = -0.547; P < .008 and B = -0.088; P = .003, respectively).

Conclusions: This study demonstrated community pharmacists' potential to address multimorbidity. To optimize their role, primary healthcare delivery needs to be reorganized to empower pharmacists to support patients with complex healthcare needs.

Objectives: To explore clinical pharmacy practice among hospital pharmacists in the Lao People's Democratic Republic (Lao PDR).

Methods: A cross-sectional study was conducted in 158 hospitals of Lao PDR, surveying hospital pharmacists involved in patient care from January to March 2022. The number of pharmacists providing clinical pharmacy and their practice frequency were assessed. Differences across pharmacist characteristics, hospitals, and areas were examined.

Key findings: One hundred thirty-nine hospital pharmacists completed the questionnaire, a response rate of 87.9%. The number of hospital pharmacists per 100,000 population was highest in Xaisomboun and lowest in Savannakhet. The number of pharmacists per 1,000 km² was highest in Vientiane prefecture, and very low in many provinces. Only 12 (1.3%) pharmacists reported training in clinical pharmacy. The most prevalent activities were evaluating drug therapy (96.4%), upholding professionalism (96.4%), and committing professionalism (94.9%). The least prevalent were locating evidence (56.8%), applying knowledge (58.9%), and demonstrating continuing professional development (59.7%). Differences in practices were noted between age, qualification, and hospital types. Current major activities included rational drug use, antibiotic stewardship, and managing adverse drug reactions. Future expectations included diabetes, human immunodeficiency virus, and tuberculosis clinics.

Conclusions: Clinical pharmacy services like patient care and pharmacotherapy management are frequently provided, but there is a shortage of trained clinical pharmacists and variability in practices between hospitals and regions. Technical support, training programmes, and a clinical pharmacy framework are needed in Lao PDR.

Objectives: This study aimed to investigate public storage and disposal practices of unused medicine and their perception of the role of Jordanian authorities' responsibility for disposing of unused medicines.

Methods: This cross-sectional study was conducted over 3 weeks (February to March 2022). Data were collected online using a convenient sampling technique from 681 Jordanian population who agreed to participate.

Key findings: Around 73% (n = 495) of the participants reported storing unused medicines in the medicine cabinets at home, with 15.7% (n = 107) storing unused medicine in the kitchen and 15.3% (n = 104) in the bedroom. Findings showed that 28.0% (n = 191) disposed of unused medicines in the household rubbish, 22.6% (n = 154) shared them with anyone who needed them, or 19.8% (n = 135) with family and friends. Only a few participants return their unused medicine to the pharmacies 10% (n = 68), hospitals 6.3% (n = 43), and healthcare clinics 5.9% (n = 40).

Conclusion: The findings indicate that Jordanian participants have become more aware of proper practices for storing and disposing of unused medicines compared to the previous Jordan studies. However, factors influencing their behaviour regarding disposal practices of unused medicines are yet to be further studied. A Jordanian disposal scheme for unused medicines should be developed to help people return them to pharmacies, hospitals, and healthcare clinics.

Objective: This study explored community pharmacists' experiences and perceptions of information transfer from Queensland health hospitals for patients during transitions of care and the current utilization of electronic medical records for accessing patient information.

Methods: Qualitative methodology was used involving in-depth semi-structured interviews with community pharmacists to explore their experiences and perceptions with information transfer during patients' transitions of care. Purposive sampling was used to ensure the participation of community pharmacists who had experience with the medication management of patients discharged from Queensland health hospitals. Interviews were recorded and transcribed verbatim and thematically analysed. Reporting was undertaken in accordance with the consolidated criteria for reporting qualitative studies (COREQ) guidelines.

Key findings: Thirteen community pharmacists were interviewed between September 2023 and January 2024, one-on-one interviews were a mean of 23 minutes (SD +/- 3.22). Community pharmacists believed their role to include medication management, counselling, and ensuring patients follow-up with their general practitioners. Barriers included a lack of information transfer from the hospital, medication errors on discharge medication records and prescriptions, time constraints in the community pharmacy setting, and a lack of patient health literacy. The main modes of information transfer were phone calls, with emails containing discharge medication lists and prescriptions. Electronic medical records were not utilized by the community pharmacists; however, pharmacists were in support of their future use for patient medical information during transitions of care.

Conclusions: Future studies should address the challenges to patient and health practitioner uptake of electronic medical records, the possibility of training and support to mitigate the barriers of integrating platforms into existing software, how to ensure a consistent upload of patient data, and to address concerns with patient privacy and confidentiality.

Objectives: In response to high levels of demand for primary medical services in England, characterized by longer appointment waiting times and delayed referrals, the Government developed its National Health Service (NHS) Primary Care Recovery Plan. A key component of the plan is Pharmacy First (PF), which involves participating community pharmacies supplying prescription-only medicine after consultation with a pharmacist for seven common conditions: earache, uncomplicated urinary tract infections in women, sore throat, sinusitis, impetigo, shingles, and infected insect bites. The study aims to evaluate the implementation of the PF service and its impact on the volume of prescribing, case mix of General Practitioner consultations, accident and emergency department and other hospital use, equity of access, and cost for different groups of patients in different contexts, as well as its acceptability and fidelity.

Methods: A 36-month, mixed methods evaluation with five elements, namely evidence synthesis, semi-structured interviews, focus groups, quantitative analysis of impacts before and after implementation (e.g. using interrupted time series analysis) using routine data, and an economic evaluation. Findings will be synthesized and interpreted using the Consolidated Framework for Implementation Research supplemented by Proctor's Implementation Outcomes Framework.

Conclusions: The evaluation should have service level, policy, professional, and research impact both in England and beyond. This includes generating evidence to show: whether PF contributes to improving primary healthcare access, assessing the quality of antimicrobial use, identifying the scope for refinements to PF, and, overall, informing better implementation of PF. The findings will also provide robust evidence to enable policymakers to determine how to enhance the role of community pharmacy in England in the future. Furthermore, the evaluation will develop a data dashboard, and the methods and codes used to interrogate it (though not the patient data), will be made publicly available that could support other similar evaluations in England and internationally.