Journal of Pharmaceutical Policy and Practice最新文献

Introduction: Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.

Objectives: This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.

Methods: In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.

Results: Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p<0.001) and MI (16.4% vs. 4.6%; p<0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].

Conclusion: In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.

Background: Transition of care from hospital to community is a period that carries significant risk for medication errors, potentially leading to hospital readmission, and causing financial and emotional strain on patients and caregivers. Telehealth technologies offer promising solutions to reduce hospital readmission. Therefore, the goal of this systematic review was to examine the effect of interdisciplinary telehealth post-discharge services that include a medication-focused component on hospital readmissions.

Methods: Following the PRISMA guidelines, a search was conducted in five scientific databases using keywords related to hospital readmission, medication therapy, and telehealth interventions. The review focused on randomised controlled trials published between 2000 and 2023, written in English.

Results: Out of 1,144 papers screened, 23 were included in the review. These studies targeted telehealth service provision to people over 60 years old with chronic illnesses. Various post-discharge telehealth interventions, including medication-focused components, were examined. Most of the interventions were multifaceted, embedded medication-focused interventions with reminders for diet, exercise, symptom check-ups, and education. Among the 23 included papers, 10 studies demonstrated success in reducing readmissions. Seven of these studies targeted patients with heart failure (HF).

Conclusion: Overall, this review highlights the potential of telehealth medication-focused interventions in reducing hospital readmission rates in patients with HF.

Background: Brunei Darussalam's medicine control governance landscape is complex, driven by legislative directives and directed by the Brunei Darussalam Medicines Control Authority (BDMCA). While the medicine dispensing system in Brunei Darussalam, across both governmental and private sectors, is a critical component of the nation's healthcare, it remains under-researched, leaving gaps in understanding its distinctions, challenges, and opportunities. This study aimed to explore deep into the perspectives of pharmacists regarding the medicine dispensing systems in Brunei Darussalam, medicine accessibility, the classification and regulation of medicines, and the growing role of pharmacists.

Methods: Using a narrative qualitative approach, we conducted in-depth one-on-one interviews with six pharmacists, delving into their personal experiences with topics such as medicine classification and the broader systems for medication provision. The collected narratives were analysed through a rigorous thematic analysis, following the framework established by Braun & Clarke.

Results: Five themes emerged from the data: nuances of Brunei Darussalam's medicine dispensing landscape across both public and private sectors; accessibility and regulatory framework of medicines both in Brunei Darussalam and abroad; prospective implementations to enhance the current system; and the evolving role and expectations of pharmacists in the current healthcare environment. Notably, a significant contribution of this study was the illumination of the differential perspectives between pharmacists operating in governmental versus private contexts.

Conclusion: This study sheds light on the previously under-explored domain of Brunei Darussalam's medicine control governance and medicine dispensing system. By drawing from the first-hand experiences of practicing pharmacists, it offers actionable insights that could guide future policy developments, optimise medicine dispensation and regulation, and shape the evolving role of pharmacists in Brunei Darussalam.

Background: Medication-related problems (DRPs) are common among hemodialysis (HD) patients, and pharmacist-led medication reviews have been shown to address such issues. However, the impact of these interventions and the specific types of DRPs among this patient group remain unclear.

Objectives: This systematic review aimed to assess the impact of pharmacist-led medication reviews among HD patients, identify the most prevalent types of DRPs, and explore the factors associated with these problems.

Methods: A systematic search was conducted across databases such as Medline via PubMed, Science Direct, Google Scholar, and EBSCOHost, for studies published from January 2012 to July 2023. Studies included were those focusing on pharmacist interventions in HD patients. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of selected studies.

Results: After screening 343 articles, 10 studies (involving 1342 HD patients) were included. Nine studies were rated as high quality, and one as fair quality. The studies predominantly used prospective designs. A total of 4511 DRPs were identified, with suboptimal drug treatment, non-adherence to medications, and drug use without indication being the most common issues. Pharmacist interventions led to the resolution or reduction of DRPs, shorter hospital stays, improvement in laboratory outcomes, better quality of life (QoL), and enhanced patient understanding. However, interventions had minimal or no significant impact on reducing unplanned admissions, mortality rates, or improving medication adherence. The reduction in healthcare utilisation costs was inconsistent across studies.

Conclusion: Pharmacist-led medication reviews were effective in resolving DRPs and improving clinical outcomes in HD patients, such as quality of life and lab values. However, their impact on healthcare utilisation and mortality remains inconclusive. Further research with longer follow-up is needed to assess the long-term economic outcomes of these interventions.

Background: Short-acting beta-2 agonists (SABA) are bronchodilators that offer rapid relief for asthma patients experiencing acute symptoms. The availability of SABA inhalers without a prescription may exacerbate the overuse of SABA. This study aimed to explore the perceptions, practices, and experiences of asthma patients and community pharmacists toward using SABA inhalers in Malaysia.

Methods: A qualitative study was conducted among eleven asthma patients and twelve community pharmacists using semi-structured individual interviews. All interviews were audio-recorded and transcribed verbatim and then analyzed by thematic analysis. The findings were reported using the COREQ checklist.

Results: Thematic analysis yielded eight major themes, (1) perceptions and understanding of good asthma control; (2) perceptions and experience towards asthma follow-up review; (3) perceptions of SABA's reliance; (4) practices towards the proper use of inhalers; (5) over-the-counter availability of SABA inhalers; (6) provision of pharmacists in SABA use assessment; (7) patients-healthcare professionals communication; and (8) recommendations for policymakers.

Conclusion: Most asthma patients and community pharmacists agreed that good asthma control was associated with reduced SABA usage and minimum asthma symptoms. The majority of patients claimed that visiting physicians for asthma follow-up reviews was unnecessary. Moreover, community pharmacists have raised concerns regarding patients' reliance on SABA inhalers due to the immediate relief effects, however, the majority of interviewed patients claimed that they did not rely on SABA inhalers. Additionally, community pharmacists were generally concerned about the frequency, dosage, and techniques using SABA inhalers. These concerns need to be addressed to improve the safe use of SABA inhalers. Language barriers, health literacy, long waiting times, and public education were the most important believed determinants of the safe use of SABA inhalers.

Background: The aim of this work is to find the factors related to over-the-counter drug (OTC) consumption in Europe considering the differences in OTC market regulation.

Methods: A sample obtained from the European Health Interview Survey (EHIS) of 2019 is used to estimate a logistic regression. This sample includes 286,413 people from 26 countries. The outcome variable is derived from the question about the use of non-prescribed drugs. The independent variables include a set of predisposing, enabling, and need factors. Finally, countries with similar OTC retail market regulations are considered to control for heterogeneity in this regard.

Results: The main findings show that OTC market deregulation is not strictly related to the share of OTC consumption. Despite some heterogeneity based on the type of OTC retail market regulation, there is a set of common drivers for its use by people across countries, such as age, gender, education, suffering from chronic disease or pain and being on a waiting list for medical treatment. When considering individual country and cluster of countries controls, there are some relevant results such as the role played by accessibility to pharmacies and OTC retailers; the positive correlation between OTC drugs and prescribed drug consumption, and the positive correlation between unmet health care needs due to financial household constraints and OTC drugs use.

Conclusions: There is no clear relationship between OTC drug use and OTC retail market regulation. There are several predisposing, enabling, and need factors that promote the use of OTC drugs. The relevant policies relate to the inequal access to OTC drugs across countries that may result from different market regulations and different consumption drivers.

Background: The medicines retail sector (MRS) enables access to life-saving health commodities. Despite efforts to harness this market for public health goals, in low- and middle-income countries it is rarely incorporated into pandemic preparedness. This paper analyses the role of the MRS in the response to COVID-19 in Uganda, the extent to which it was incorporated into national planning and in the continuity of essential services.

Methods: We conducted a cross-sectional study using sequential mixed methods in two purposively sampled rural districts in central Uganda. Qualitative research comprised 27 focus group discussions with drug shop vendors (DSVs), pharmacists, clinic staff and community members across two districts (n = 250); key informant interviews at national (n = 6) and district (n = 11) levels. Qualitative findings were used to modify a facility-based survey conducted in MRS outlets (n = 625). A household survey focusing on household dynamics and treatment seeking during COVID-19 was conducted in both districts (n = 1680).

Results: At the national level, attempts were made to involve the MRS in policy and technical advice but this was not sustained. At the district level, almost no effort was made to include the MRS in the response to COVID-19. In the community, residents described their reliance on the MRS to provide medicines, especially during lockdowns. Medicine sellers subject to stringent rules on their movement during lockdown, reported some disruptions in tracer medicine stocks and an increase in prices at their suppliers. They adapted, finding new ways to purchase medicines but overall sales of medicines fell.

Conclusions: The MRS is critical to the distribution of medicines in many countries. This remains the case or can be heightened during health crises. Pandemic preparedness must incorporate strategies to support medicine sellers to ensure ongoing access to commodities during public health emergencies.

Background: The emergency medicine (EM) pharmacist is an integrated part of the Emergency Department (ED) interdisciplinary team in many countries, including Malaysia. The presence of EM pharmacists in the ED has positively impacted patient outcomes. Data on EM pharmacists' interventions is scarce in the Asian region. In Malaysia, data on interventions done by EM pharmacists in the EDs was unavailable. This study aimed to assess the type of interventions done by EM pharmacists in the ED of tertiary public hospitals in Malaysia.

Methods: This cross-sectional, multicenter study involved EM pharmacists from 14 tertiary hospitals in Malaysia. All accepted interventions done by EM pharmacists in the ED for patients admitted to the Red (critical) and Yellow (semi-critical) zones from January to June 2022 were extracted from the Clinical Pharmacy Report Form. All data were analyzed descriptively.

Results: The EM pharmacists documented 1659 accepted interventions on 1584 patients during the study period. Inappropriate regimens (n = 1117, 67.3%) and incomplete prescriptions (n = 339, 20.4%) were the main categories of accepted interventions in ED. Inappropriate drug (n = 574, 34.6%), dose (n = 292, 17.6%), and frequency (n = 176, 10.6%) were the top three subcategory interventions documented under inappropriate regimens. Antimicrobials, antihypertensives, and proton pump inhibitors were the commonest drug intervened under the categories of inappropriate drug intervention. There were 272 (16.4%) accepted interventions on high-alert medications (HAMs). Insulin, enoxaparin, and noradrenaline were the most intervened HAMs.

Conclusion: Inappropriate treatment regimens were the most common intervention category done by EM pharmacists in Malaysia. The significant number of interventions done by EM pharmacists demonstrated the importance of EM pharmacists as integral members of the EM team. This data can help improve the quality of clinical pharmacy services in the ED and is important for the future expansion of clinical pharmacy services in all EDs across Malaysia, neighbouring countries, and other developing countries.

Vision 2030 represents Saudi Arabia's strategic socio-economic plan aimed at promoting economic diversification and enhancing living standards. Launched in April 2016, this vision describes an innovative healthcare plan to improve services and outcomes. The merits and drawbacks of public hospitals' 'Model of Care' are examined in this study. This assessment summarises Vision 2030s healthcare revolution. This study explores the innovative 'Model of Care' and its potential to change Saudi healthcare. Prior to Vision 2030, Saudi Arabia's healthcare system grappled with escalating costs and a heavy reliance on foreign labour, signalling a need for transformative change. Vision 2030s patient-centric framework emphasises individualised treatment, and the National Guidelines Center's role in standardising healthcare processes is examined in this review. In addition, we also explored the new initiative of Electronic Health Records and telemedicine services. Additionally, we addressed the challenges associated with it, such as the imperative to address the digital divide and ensure data security. Vision 2030 in Saudi Arabia brought about a significant transformation in the provision of healthcare. Despite the presence of challenges, such as inadequate infrastructure, insufficient personnel, and resistance to change, this vision offers a robust foundation for effectively tackling these concerns. The implementation of these improvements is expected to enhance the calibre and accessibility of healthcare services. This transitional change ensures healthcare is both innovative and inclusive, particularly in socioeconomically disadvantaged regions. This measure is expected to enhance the general welfare and economic success of the population in Saudi Arabia. The future of healthcare in the Kingdom hinges on the effective implementation of evidence-based therapy, collaborative cooperation, and equitable practices. The healthcare sector possesses significant potential for substantial positive transformation, notwithstanding its continuous nature.