International Journal of Pharmacy Practice最新文献

Objectives: In Sweden, oral formulations of diclofenac became prescription-only in 2020, and over the counter (OTC) topical forms were placed behind the counter in 2023. This study investigated the effect of these policy changes on diclofenac dispensed or sold.

Methods: Aggregated data on diclofenac dispensed against prescription or sold OTC from January 2019 to February 2024 were analysed descriptively.

Key findings: The volume fell substantially after oral formulations became prescription-only. Placement of topical formulations behind the counter had a more modest effect.

Conclusions: Policy changes have had a significant effect on the volume of diclofenac dispensed or sold in Sweden, especially the prescription requirement.

Objectives: To evaluate the outcomes of chronic kidney disease (CKD) screening in community pharmacies through creatinine measurement and glomerular filtration rate (GFR) estimation in patients meeting specific risk criteria.

Methods: This was a multicenter observational study. People who entered participating pharmacies for any reason and met the inclusion criterion of not having a CKD diagnosis were invited to participate in the study. If they agreed, the pharmacist conducted a point-of-care blood creatinine test, and the GFR was calculated using the CKD-EPI formula. Those with a positive CKD indicator (<45 ml/min/1.73 m2) were referred to their general practitioner (GP) for evaluation. People with a GFR > 60 ml/min/1.73 m2 were not considered to have CKD. Those with a GFR between 45 and 60 ml/min/1.73 m2 were asked to return for reassessment 1 month later. Those with a GFR 45 < ml/min/1.73 m2 were then considered CKD-positive and referred to the GP. All the data were recorded by the pharmacist.

Key findings: One hundred and forty-one community pharmacies from 40 provinces of Spain enrolled 2116 patients. In the first analysis, 1428 (67.5%) were negative, 165 (7.8%) were positive, and 523 (24.7%) needed a second analysis. In the second analysis, 164 (7.8%) were negative, 243 (11.5%) were positive, and 116 (5.5%) did not reattend. In summary, by intention to treat, 1592 (75.2%) were negative and 408 (19.3%) tested positive and were referred to their GP.

Conclusions: The results of CKD detection in community pharmacies are in line with screening in other healthcare settings, confirming they could be a reliable resource in future population-screening strategies.

Objectives: The study aimed to analyse changes in the prescribing trends of anxiolytics in Croatia over the past 15 years, focusing on changes in prescribing patterns and the average cost per defined daily dose (DDD) and to evaluate how frequently patients covered by the Croatian Health Insurance Fund (CHIF) received private prescriptions for anxiolytics.

Methods: Data on total consumption of anxiolytics in Croatia were obtained from two sources: the IMS database and the CHIF database for the period from 2006 to 2022.

Key findings: The total usage of anxiolytic drugs increased from 61.13 DDD/1000 in 2006 to 82.78 DDD/1000 in 2022, an increase of 35.42%, while the financial expenditure in the same period decreased by 15.57%. Diazepam is the anxiolytic drug with the highest prescription rate, with an increase of 67.42%. The highest increase overall was in the total consumption of alprazolam, despite a decrease from 21.22% in 2011 to 16.53% in 2022 in private prescriptions, indicating a substantial increase in prescriptions covered by insurers.

Conclusions: Despite being either not recommended by clinical guidelines or of doubtful efficacy in many cases, prescribing of anxiolytics is common. There is a noticeable increase in anxiolytic drug use in Croatia during the investigated period, while the total financial expenditure has decreased due to price pressure on medications imposed by the national insurer. The high rate of private prescription of anxiolytics is observed. An enhanced national regulatory framework for prescribing anxiolytics in Croatia is needed.

Objectives: Safe and effective use of topical corticosteroids (TCS) relies heavily on appropriate pharmacist counselling in community pharmacies, to optimize treatment and improve outcomes for patients suffering from atopic dermatitis. This study aimed to investigate community pharmacists (CPs)' counselling practices on TCS and their attitudes towards the fingertip unit (FTU) method, patients' knowledge, and adverse drug reactions (ADRs).

Methods: A cross-sectional survey was conducted among CPs in Croatia. A questionnaire was developed, which explored CPs' counselling practices on TCS, their awareness and implementation of the FTU method, and their experience with ADRs. Data was analysed using descriptive statistics.

Key findings: A total of 351 participants engaged with the survey. Over half (57.5%, CI: 52.2%-62.8%) of CPs use a combination of verbal and written counselling, and the majority (>96.6%) explain the dose, method of administration, frequency, and duration of topical corticosteroid therapy to most of their patients. Most (75.2%) are familiar with the FTU method; however, less than half (43.9%) routinely explain it in their counselling. Approximately half of CPs (49%) believe that patients have insufficient information knowledge on the correct TCS application (dose, frequency, and duration of treatment).

Conclusions: CPs' counselling practices focus primarily on the method of administration, frequency, and duration of treatment. CPs have a good awareness of the FTU method, however, are less likely to explain it routinely in practice. Additional education around TCS and ADR training may be beneficial for CPs to enhance their counselling practices.

Objectives: To describe pharmacy academics' perceptions of scopes of practice, knowledge, and skills required for the education of pharmacists and pharmacy technicians in the management of minor ailments (MMAs) in Indonesia.

Methods: Online surveys were designed for academic staff teaching pharmacy and pharmacy technician students from all 30 institutions in Central Java, Indonesia. Those teaching both courses received both questionnaires. Percentage of common responses (PCR) described the level of similarity of perceived scopes of practice. Descriptive analyses described respondents' demographics and characteristics.

Key findings: No clear consensus was evident regarding the scopes of MA practice from academics teaching each group of students. The majority of academics teaching pharmacy students perceived that MAs such as migraine and indigestion (with the PCR >80%) should be exclusively managed by pharmacists, showing a strong consensus on the role of pharmacists in managing these ailments. Only a 50%-60% consensus was achieved on the scopes of MAs managed by pharmacy technicians. Some academics perceived pharmacy technicians were not competent to manage any MA. Notably, 52.9% of academics teaching pharmacy students taught management of MAs as a separate course, compared to 26.7% who taught pharmacy technician students.

Conclusions: Discord in the scope of practice perceptions between academics teaching pharmacy and pharmacy technician students requires resolution, including the diverse nature of training involving MMAs. Clearly defined scopes of practice are required to achieve consistent education of MAs for pharmacy and pharmacy technician students.

Objectives: The respiratory prescribing strategy previously published by the Scottish Government did not include any environmental sustainability information and required updating to incorporate this. It was recognized that ~3% of the carbon footprint of NHS Scotland results from the use of pressurized metered dose inhalers due to the high global warming potential of inhaler propellants. The aims of the guide were to support clinicians and people with respiratory illness in the appropriate use of medicines, while applying the principles of value-based health care and realistic medicine, including environmental sustainability. Person-centred medication review, including optimising appropriate inhaler use, is promoted using the 7-step methodology described in the Scottish polypharmacy guidance.

Methods: Stakeholders, including people with lived experience, third sector patient organizations and multidisciplinary team representatives from across primary and secondary care were invited to update the respiratory guide. Open consultation was undertaken before publication. Tools and resources to assist in implementation of the recommendations were developed, including data and patient facing resources.

Key findings: The 'Quality Prescribing Strategy for Respiratory Conditions: a guide for improvement (2024-2027)' was published by the Scottish Government in April 2024. It highlights key recommendations for respiratory prescribing, to improve care of people living with respiratory conditions and to reduce environmental impact of respiratory care.

Conclusions: The guide supports the implementation of national UK-based guidance, including the Scottish Intercollegiate Guidelines Network and National Institute for Health and Care Excellence guidance, together with the indicators and tools to drive improvement in prescribing and patient care by assisting clinicians with practical guidance and prescribing resources. It also supports healthcare organizations and sustainability committees to prioritize actions.

Background: Maintenance inhalers are commonly used for long-term management of respiratory conditions. These multidose devices contain several weeks of medication, are expensive, and have significant global emissions impact. As these medications are not useful for managing acute symptoms, it was questioned whether keeping these inhalers in hospital wardstock locations may contribute to inhaler wastage.

Objective: To determine if removal of maintenance inhalers from wardstock would reduce the number of inhalers dispensed.

Methods: This was a prospective quality improvement study examining medication utilization data within the Fraser Health Authority. An inventory report was run to determine where maintenance inhalers were located to select hospital sites to target. Maintenance inhalers were removed from wardstock at chosen sites and utilization data from 6 months prior to removal were compared to 6 months post-removal. Outcomes reported were change in number of inhalers dispensed, change in number of inhalers dispensed per active-order-day, change in expenditure, and change in carbon emissions. Informal assessments on workload and access were made during the 6-month follow-up period.

Key findings: Within 6 months after maintenance inhalers were removed from wardstock at two hospitals, 119 fewer inhalers and 43 fewer dry powder inhaler capsules were dispensed, representing $4541 in savings and a reduction in carbon emissions equivalent to 6,770.5 km driven by a typical gasoline car-enough to drive across Canada from the Pacific to the Atlantic coast. No indications of delayed access or increased workload were reported.

Conclusions: Routine reassessments of wardstock supply of maintenance inhalers or medications that are not acutely needed may be useful in alignment with formulary budget and planetary health.

Background: The article reviews the factors that affect healthcare professionals' adherence to safe medication therapy guidelines, which are important for patient safety and quality of care. The purpose of this review was to further our knowledge on the factors and interventions that contribute to medication guideline adherence among healthcare professionals.

Methods: This review employed a systematic, mixed-methods approach. The authors searched five databases for mixed studies (qualitative, quantitative, and mixed methods) from 2011 to 2023 and appraised them using the Mixed Methods Assessment Tool (MMAT). They extracted and synthesized the data using narrative synthesis.

Results: We identified 20 studies that met the inclusion criteria. We found that the factors influencing medication guideline adherence vary by the roles and settings of healthcare professionals. We classified these factors into four categories: guideline level, personnel level, system level, and leadership level. Guideline-level factors refer to the clarity and consistency of the medication guidelines, policies, or protocols. Personnel-level factors involve the behavior, education, and practice of healthcare professionals. System-level factors relate to the institutional and systemic aspects that support and maintain medication guideline adherence. Leadership-level factors concern the planning and management of medication guideline implementation by healthcare managers. We also discussed the interventions that can improve guideline adherence, including (i) educational programs, (ii) pharmacist-based interventions, and (iii) computerized prescribing programs.

Conclusion: This review provides a typology of factors to help organizations enhance medication safety adherence. The findings highlight the important role of hospital pharmacists in building multifaceted and multidisciplinary programs to address guideline adherence issues.