International Journal of Pharmacy Practice最新文献

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.

Objectives: Global healthcare shortages are projected to reach 14 million by 2030. This study aimed to investigate reasons why pharmacists and pharmacy technicians leave/return to pharmacy practice and/or the register, identify factors influencing their successful reintegration, and examine whether Centre for Pharmacy Postgraduate Education Return to Practice/Register learning programmes were associated with a successful return.

Methods: A cross-sectional online survey was distributed to individuals who participated in the programme(s) between 2010 and March 2023 (n = 701). Data were collected through closed, Likert-type and free-text questions. Descriptive statistics and inferential analysis (Fisher's exact, Spearman's rank, t-test) were conducted, with thematic analysis for qualitative comments.

Key findings: The valid response rate was 15% (n = 106). Most respondents were female (n = 67, 79.8%), aged 35 and older (n = 82, 97.6%), and pharmacists (n = 77, 85.6%). The primary reason for leaving was family responsibilities, the main motivation for returning was career reconnection. Overall, 70.8% (n = 75) successfully returned to practice and/or professional registration after completing the programme(s). Reintegration was more likely amongst those satisfied with the programme(s) [Return to Practice (RTP): P = .007; Return to the Register (RTTR): P = .015], who had been away for ˂10 years (n = 41, 78.8%, P = .034), and who completed the programme(s) before 2020, prior to the shift to online delivery (RTP: n = 41, 83.7%, P = .003; RTTR: n = 16, 88.90%, P = .011).

Conclusions: The Return to Practice/Register programme(s) were effective in reintegrating pharmacy professionals. Successful reintegration was associated with shorter absences, high programme(s) satisfaction, and in-person delivery. Whilst focussing on pharmacy professionals, there is relevance to other professions and potential support needs for practice return.

Objectives: Medications contribute 25% of NHS England's carbon emissions, with the pharmaceutical sector significantly impacting its carbon footprint (CF). Limited research exists on the environmental impact of different formulations of the same drug. This project evaluated morphine, a potent opioid for moderate to severe pain, focusing on immediate-release (IR) formulations: oral tablets, oral solutions, and injections. Oral morphine solution is commonly the first line for acute or breakthrough pain. This study evaluates the environmental, financial, and social advantages of transitioning from IR oral morphine solution to IR oro-dispersible morphine tablets within a single National Health Service (NHS) Trust.

Methods: A bottom-up CF analysis was conducted on packaging materials. Cost comparisons and surveys of patients and staff evaluated financial and social impacts. Formulations studied were oral morphine solution (Oramorph 10 mg/5 ml) and Oro-dispersible tablets (Actimorph 10 mg).

Key findings: In two sites of a single NHS Trust (inpatients and discharges), switching entirely to tablets could reduce annual carbon dioxide emissions by 7350 kg of carbon dioxide equivalents (53%). Tablets could also eliminate an estimated 275 000 plastic syringes disposed of annually and £16 000 in equipment costs from a 100% switch. A limited patient survey showed that 90% of patients supported the use of environmentally friendly tablets as an alternative to liquid solution.

Conclusions: In conclusion, transitioning from oral morphine solutions to tablets has several benefits, including improving environmental sustainability, reducing costs, and enhancing patient care. Collaborative decision-making between healthcare providers and addressing operational challenges are essential for realizing these benefits.