International Journal of Pharmacy Practice最新文献

Objectives: Pharmacist independent prescribers (PIPs) enhance patient care but there is variability in their integration in community pharmacy (CP). The objective was to collate and characterize literature on the integration of 'standard of care' model PIPs in CP for acute common clinical conditions (CCCs).

Methods: This review followed the Arksey and O'Malley framework. Eligibility criteria, search databases, and terms were defined. Information sources were searched from January 2006 to October 2023. Following screening, full text review, and data extraction a narrative synthesis approach was used to address the review objectives. All steps were independently checked by two of the review team. Barriers and facilitators for integration used the Consolidated Framework for Implementation Research as a theoretical lens.

Key findings: Ten papers remained for full text review from 1075 records. Most studies were from Canada and focused on pharmacist views, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antimicrobial prescribing. A wide range of barriers and facilitators influencing implementation were identified including; 'regulatory constraints' and 'fiscal challenges' at a macro socio-organizational level and several challenges within organizations; lack of clarity on the pharmacists' scopes of practice and linked consumer confusion, staffing levels, and workload with specific mention of paperwork and access to patient records.

Conclusions: Most evidence for CCC management by PIPs relates to antimicrobials, originates in Canada and identifies multiple challenges. Given this there is a need to consider this topic further to identify ways to address the challenges and facilitate integration of PIPs in CP.

Objectives: Pharmacy preceptors are pivotal in shaping pharmacy education by bridging theoretical knowledge with clinical practice. This review synthesizes the literature on pharmacy preceptor roles, responsibilities, and precepting models while exploring the unique challenges and opportunities in the UAE healthcare context. The evolving focus on clinical pharmacy within the United Arab Emirates highlights the necessity of tailored precepting strategies to meet local needs.

Methods: A comprehensive literature review was conducted using Scopus, PubMed, and Google Scholar. Search terms focused on pharmacy preceptor roles, responsibilities, precepting models, and challenges and strategies for overcoming them. Thematic analysis was employed to extract and categorize key insights, particularly those relevant to the United Arab Emirates.

Key findings: The review identifies the four core roles of preceptors: direct instruction, modelling, coaching, and facilitating, as defined by the American Society of Health-System Pharmacists. It highlights global and UAE-specific challenges, such as preceptor shortages, cultural barriers, and the need for structured mentorship programmes. Innovative precepting models, including Peer-Assisted Learning and the Layered Learning Practice Model, are discussed for their potential adaptability to the UAE's healthcare system.

Conclusions: Addressing the challenges faced by pharmacy preceptors in the United Arab Emirates requires a multi-faceted approach, including ongoing training, institutional support, and customized precepting strategies. By combining global best practices with local contextualization, the United Arab Emirates can enhance pharmacy education and align it with its healthcare priorities.

Background: Many terms have been used in the literature to describe medicines use behaviour without standardized definitions. It is unclear whether these terms are being applied interchangeably and variably across different measurement methods.

Aim: To review the definitions of medicines adherence, compliance, persistence, and concordance in the published literature on older adults and identify how they have been measured.

Methods: A systematic literature search with review of reference lists was conducted. Two investigators independently reviewed the identified articles. A content analysis was conducted using NVivo V.14 to identify the main elements for defining medicines adherence, compliance, persistence, and concordance. Descriptive statistics were used to summarize the studies by their type, country of study, and related participant characteristics.

Key findings: One hundred and fifteen identified papers were eligible for inclusion. Discrepancies were found in the definitions of each term. Commonalities were found between the definitions of medicines compliance, adherence, and persistence. Only one study was found on medicines concordance. Similar instruments such as the medication possession ratio (MPR) and proportion of days covered (PDC) were used to determine medicines adherence, compliance, and persistence. Some measurement instruments were applied differently across studies in which different cut-off values were used to classify outcomes.

Conclusions: There is a considerable overlap and inconsistency in the definitions of terms used to describe medicines use behaviour. The imperative to standardize the definitions appears as a critical step to strengthen consistent measurement approaches leading to accurate estimates of medicines use outcomes.

Objectives: This paper aimed to explore the knowledge, existing policies, and practices in community pharmacies and primary healthcare centers regarding the provision of medication needs of Deaf and Hard-of-Hearing (HOH) patients, including potential ways to improve such services.

Methods: Critical case sampling was employed in conducting in-depth interviews of 27 participants from selected cities in Metro Manila, Philippines. Recorded voice interviews were transcribed verbatim and underwent manual thematic analysis supported by MAXQDA.

Key findings: Four key themes pertaining to ways of communication, local sectors' initiatives to healthcare accessibility, private sectors' compliance with mandated laws, and plans for improving the pharmacy services for Deaf and HOH patients. There were no standardized policies in community pharmacies and primary healthcare centers tailored for these patients; nevertheless, they were compliant with government-mandated laws on healthcare accessibility and equality. Participants expressed interest in learning Filipino Sign Language to bridge the communication gaps to improve comprehension of these patients' special healthcare needs.

Conclusions: Unavailability of an inclusive standard operating procedure led pharmacy service providers to use conventional writing, digital messaging systems, and inappropriate raising of voices to communicate with the Deaf and HOH patients. Apart from the mandated laws, support from the local government and pharmacy sector through active discussions, information dissemination, seminars, or training, particularly on Filipino Sign Language, is relevant for efficient exchanges of health information between healthcare providers, Deaf, and HOH patients.

Objectives: To explore factors that either enable or hinder pharmacist independent prescribers (PIPs) when they expand the scope of their prescribing practice.

Methods: Following ethical approval, PIPs who had expanded their scope of practice since qualifying, who worked within one Health Board in North Wales, self-declared minimum 2 years' experience and prescribed once a month or more were recruited via gatekeepers to a semi-structured interview study. Thematic analysis was utilized after de-identification of verbatim transcripts.

Key findings: Both intrinsic and extrinsic themes were identified. Confidence and attitude were intrinsic themes that acted as facilitators. Extrinsic themes included support, governance, service, and workplace. Support was a key facilitator encompassing mentors, time, funding, management, peers, structured programs, space for reflective practice and accessible colleague advice. Lack of each of these support factors was perceived as a barrier. Governance frameworks were deemed enabling by some and restrictive by other participants. Service factors (for example new roles, or skill mix change within teams) and workplace factors (including multidisciplinary working and role models) both enabled scope expansion. Not working in a multidisciplinary team setting was seen as a barrier.

Conclusions: Previous studies on implementation in independent prescribing (IP) identified similar themes, suggesting scope expansion for PIPs is enabled by the same factors that support development of IP in general. Further research with different contexts or methodology is required to validate these results and inform future guidance on this topic.

Objectives: This ethnographic study explores hospital pharmacist prescribing practices in an inpatient multidisciplinary team (MDT) setting. This study aimed to identify the underlying mechanisms, including competencies, facilitators, and inhibitors, related to pharmacist prescribing practices in hospital settings.

Methods: Non-participant observations were conducted over six half-day sessions with three experienced prescribing pharmacists. Data were analysed using framework and thematic analysis. The RPS Competency Framework guided framework analysis, while thematic analysis identified overarching themes related to emotional intelligence and hierarchical dynamics.

Key findings: Key competencies frequently observed included interpreting patient records and collaborating with MDT members. Facilitators of effective prescribing included strong interdisciplinary collaboration and access to comprehensive patient information. Barriers such as fragmented IT systems, high workloads, and hierarchical constraints affected the pharmacists' ability to efficiently manage and document patient care. Emotional intelligence was identified as a critical skill for managing professional identity within hierarchical structures and handling the emotional toll of systemic inefficiencies.

Conclusions: Pharmacist prescribers significantly enhance patient care through collaboration and proactive engagement in MDTs. However, systemic barriers, particularly IT-related inefficiencies and hierarchical dynamics, limit their full potential. Training in emotional intelligence and improved interdisciplinary support may enhance the effectiveness of prescribing pharmacists. Addressing systemic issues, especially IT infrastructure, could optimize prescribing efficiency and reduce cognitive load.

Objectives: Liquid formulations are the most widely used pharmaceutical forms among children but may not be the most appropriate. 'Pill School' methodologies exist to teach children how to swallow tablets but are not yet integrated into primary care. The aim of this study was to explore the perspectives of key stakeholders on running 'Pill Schools'.

Methods: We used tailored surveys to gather perspectives from four key stakeholder groups: children and young people (CYP); parents and carers; school staff; and healthcare professionals (HCPs) working in general practice.

Key findings: In total, 140 people participated, including 11 CYP, 22 parents, 16 school-based staff (50%, n = 8 were head teachers), 91 primary care-based HCPs most of whom were GPs (60.4%, n = 55), pharmacists (16.5%, n = 15), and nurses (10%, n = 9). Most stakeholders consulted were supportive of the concept of 'Pill School'. Common enablers mentioned by HCPs were time and funding. The main barriers mentioned were time, capacity and workload with others citing parental concerns in addition.

Conclusions: The consultation explored stakeholders' perspectives of teaching children to swallow tablets in community settings. Most stakeholders were supportive of the concept of 'Pill School'. HCPs favoured starting with children aged 4 and above whilst parents and school staff favoured starting with children from 8 years and above. There was a clear interest in taking this forward to equip children with this life skill early on, avoiding them becoming adults who have difficulty swallowing tablets.

Objectives: Clinical pharmacists are integral members of multidisciplinary teams in intensive care units (ICUs); however, their presence remains uncommon in French ICUs. This study aimed to describe clinical pharmacy activities implemented in a university hospital's adult medical ICU and assess the ICU team's perception of this implementation, its impact on practice and the pharmacist's role in ICU.

Methods: This single-centre study covered a 6-month residency rotation. A pharmacy resident participated in daily rounds and reviewed prescriptions. Pharmacist interventions (PIs) were categorized using adapted codification. A cross-sectional survey conducted over 2 days evaluated the ICU team's views on clinical pharmacist practice interactions and future service requirements.

Key findings: The pharmacy resident provided direct patient care (e.g. pharmacotherapy and drug-related problems; 86.4%, n = 393/455); and indirect services (e.g. computerized prescribing templates implementation, research support, and pharmacotherapy education for ICU staff; 13.6%, n = 62/455). Most PIs were optimizations (74.7%, n = 340/455) compared with medication error rectifications (25.3%, n = 115/455), with a high acceptance rate for prescription-related PIs (89.3%; n = 351/393). Of all PIs, 44.4% (n = 202/455) were solicited by the ICU team. Survey results showed 100% (n = 30) of the medical team and 71% (n = 15/21) of nurses believed the pharmacy resident's presence improved the ICU's training programme. Key pharmacist services included participation in rounds, managing adverse drug events, and updating pharmacotherapy protocols.

Conclusions: This study illustrates a pharmacy resident's diverse services in ICU through medication error rectification, prescription optimization and indirect patient care. The ICU team valued this contribution, emphasizing the need for further integration of pharmacy services in French ICUs.