Journal of Pharmaceutical Policy and Practice最新文献

Background: Medication reconciliation is a key responsibility of ward pharmacists, who work closely with doctors. However, little is known about doctors' practices in the administration of this service.

Methods: A cross-sectional survey was conducted with doctors from the medical wards of 14 Perak government hospitals. A validated self-administered questionnaire was used to assess doctors' demographics, experiences with pharmacist-led medication reconciliation services (13 items) and practices in administering medication reconciliation-related information (8 items). Responses were measured on a 5-point Likert scale.This study explored doctors' experiences with and utilisation of medication reconciliation services provided by pharmacists in medical wards. The independent t-test and Kruskal-Wallis test were performed to evaluate the associations between the doctor's sociodemographic backgrounds with their experiences and practices towards pharmacist-led medication reconciliation services.

Results: A total of 209 doctors responded, with more than half of them being female (60.8%) and medical officers (76.6%). Most respondents agreed that ward pharmacists play an integral role (97.6%), perform quality reconciliation (97.2%), and reduce medication errors (97.1%) during medication reconciliation. The majority frequently expected the pharmacists to provide medication history assessments (90.0%), relied on their medication history assessments during prescribing at admission (88.6%) and discharge (89.0%), and collaborated on reconciliation issues (91.8%). Higher practice scores were observed among medical officers (3.89 ± 0.63, p = 0.01) and those aged >30 years (3.9 ± 0.46, p = 0.04), and those working in wards with ≥30 beds (3.94 ± 0.48, p = 0.02).

Conclusion: Doctors demonstrated positive experiences and practices regarding pharmacist-led medication reconciliation services provided by ward pharmacists. These findings suggest that doctors acknowledge the role of pharmacists in medication reconciliation services.

Background: The perception of pharmacy policymaking among early-career pharmacists is crucial for developing and advancing the profession. This study aimed to construct and validate a new tool, the Pharmaceutical Policymaking Perception Scale (PPPS), and assess pharmacy students' and graduates' perceptions of pharmaceutical policymaking in Lebanon.

Methods: A standardized questionnaire was disseminated through electronic platforms. It included sociodemographic characteristics, education-related variables, and scales measuring leadership, general self-efficacy, strategic thinking, and public service motivation. The validity of the newly developed PPPS was confirmed, and concepts were linked through multivariate analyses.

Results: The PPPS tool exhibited excellent psychometric properties, with its items loading on two factors representing the positive and negative perceptions of pharmaceutical policymaking. The scale demonstrated excellent reliability as well as robust content, construct, structural, and concurrent validity. Only 4% of participants scored above 70, indicating relatively low perceptions of pharmaceutical policymaking in Lebanon. Higher PPPS scores were associated with higher self-efficacy and strategic thinking, while lower scores were linked to reduced public service motivation. No association was found between PPPS and leadership.

Conclusion: The novel PPPS scale offers valuable insights into pharmacists' views, enabling a more comprehensive assessment of policymaking perceptions. The potential disconnection between the studied concepts raises concerns. Further research is recommended to confirm these findings, and urgent action by educators and policymakers is essential to effectively engage with early-career pharmacists and enhance their motivation to serve the profession in challenging circumstances.

Background: Currently, no nationwide reports exist that describe the effects of drug shortages on the work of hospital pharmacists in Japan. Using a questionnaire survey, we evaluated here the impact of recent drug shortages on the work of hospital pharmacists in Japan.

Methods: We distributed a questionnaire to the directors of the pharmacy departments of 853 hospitals belonging to the Japan Municipal Hospital Association. The questionnaire consisted of questions on the situation regarding recent drug shortages at the responding hospitals and the time spent by hospital pharmacists dealing with drug shortages between February 13, 2024, and March 15, 2024.

Results: The proportion of hospitals that answered at least one survey question was 25.7% (219/853). Almost all respondents (98.1% [214/218]) answered that the recent drug shortages negatively affected other practices of the hospital pharmacy. The median time spent dealing with drug shortages in all responding hospitals was 19.5 h of 32 days (including 23 weekdays). The estimated annual labour cost of hospital pharmacists required to deal with the recent drug shortages in the 8,110 hospitals of Japan amounted to 7.1 billion JPY/year (approximately 50 million USD/year).

Conclusions: A survey of directors of hospital pharmacy revealed that recent drug shortages have been a burden on pharmacists at most hospitals, as they have spent a notable amount of time dealing with such drug shortages.

Background: Health Technology Assessment (HTA) supports optimal healthcare resource allocation by providing evidence-based input for decision-making. The manuscript aims to: (1) summarise the development process of methodological guidelines for Oman with involvement of key stakeholders to facilitate consistency, transparency and robustness in technology appraisal, and (2) present the features of the accepted HTA guidelines.

Methods: Guideline development included five steps: (1) learnings from international HTA guidelines; (2) multistakeholder workshop on key components of the Omani methodological guidelines; (3) survey to facilitate consensus on most critical elements; (4) drafting the guidelines based on collected observations; and (5) validation through feedback from policy-makers and HTA experts.

Results: The Omani HTA guidelines consist of six sections: target indication, medical assessment, economic evaluation, budget impact analysis, social and ethical considerations, and transparency. Health benefit evaluation should prioritise policy-relevant outcomes, including mortality, morbidity, and quality of life. Using clinical assessment reports published by reputable HTA agencies is advocated. When added value is demonstrated over a policy-relevant comparator, cost-utility analysis with QALYs calculation, a 3% discount rate, and cost-effectiveness thresholds is the preferred approach. Budget impact analysis should cover a four-year horizon. Full disclosure of conflicts of interest, expert contributions, and public availability of HTA dossiers are mandatory to enhance transparency.

Conclusion: Acceptance of Omani HTA methodological guidelines by the Ministry of Health represent an important milestone in improving the evidence base of policy decisions in Oman. The guidelines offer a standardised, transparent framework to judge the value and affordability of health technologies in alignment with international standards and local healthcare needs and priorities.

Background: Despite established guidelines recommending cardioprotective medications for patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), prescribing practices often fall short of recommendations. In this study we aimed to assess the prescribing trends of guidelines-recommended cardioprotective medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), and high-intensity statins, among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in Qatar's primary health care corporation (PHCC).

Methods: This retrospective cross-sectional study analysed electronic medical records data from 29 PHCC centres in Qatar for the period January-December 2021. Prescription rates of SGLT2i/GLP-1RA, ACEi/ARB, and high-intensity statin were assessed based on documented medication usage. Logistic regression was used to identify factors associated with guideline-directed prescribing. The study received ethics approval from the PHCC in Qatar, with de-identified data accessible only to the Principal Investigator.

Results: Among the 2,870 eligible subjects, only 10% (n = 292) were prescribed high-intensity statins, 12% (n = 357) received SGLT2i/GLP-1RA, and 56% (1,617)were prescribed ACEi/ARB. Male gender, higher HbA1c, and a diagnosis of dyslipidaemia were positively associated with increased likelihood of adherence to relevant clinical practice guidelines. However, these factors only explained only 16% of the observed variance.

Conclusion: The majority of patients with T2DM and ASCVD did not receive the completed guideline-recommended regimens of cardioprotective medications, suggesting a significant gap in clinical practice. Urgent implementation of multifaceted strategies is warranted to address barriers and clinical inertia, thereby optimising cardiovascular risk reduction and secondary prevention therapies.

Background: As the population ages, addressing potentially inappropriate medications (PIMs) for patients with heart failure (HF) is extremely important, and many medical professionals are working on this issue. However, it is unclear whether the various PIM countermeasures being implemented throughout Japan are leading to the suppression of PIMs for patients with HF. The characteristics of hospitalised patients with HF and prescription patterns of PIMs over the past decade were investigated.

Method: Data from the Japanese Cardiovascular Disease Registry Database and the Diagnostic Procedure Combination Database of 1,452,034 inpatients aged ≥18 years diagnosed with HF between April 2012 and March 2022 were analysed. The study was stratified into three periods: 2012-2015, 2016-2019, and 2020-2022.

Results: Typical PIMs, such as benzodiazepine, anxiolytics medications, α-glucosidase inhibitors, thiazolidine, sulfonylurea, non-dihydropyridine calcium antagonists, digoxin, non-steroidal anti-inflammatory drugs, anticholinergics, and β2 agonists showed decreased prescription trends over the years (P for all trends <0.01). Inpatient PIM prescriptions rarely continued at discharge.

Conclusion: These results suggest that typical PIMs for hospitalised patients with HF have declined during the past decade. Medical providers should contribute to optimising medications that minimise PIM administration to patients with HF. In the future, PIMs for patients with HF may need to be monitored as a safety indicator.

Background: The internet has become a critical resource for accessing health information worldwide. Online health information seeking (OHIS) is increasingly common among hospitalised patients, particularly those with chronic conditions. While prior studies have explored OHIS in individual countries, limited evidence exists comparing behaviours across different sociocultural and healthcare contexts. This study compared patterns of internet use for health information among hospitalised patients in Switzerland and Qatar.

Methods: A comparative cross-sectional study was conducted between January and June 2016 in two tertiary hospitals in Switzerland, and Qatar. Eligible patients (18-80 years) admitted to internal medicine, visceral surgery, or orthopaedics wards completed a 33-item structured questionnaire, available in French and Arabic, covering sociodemographic characteristics, internet access, health information-seeking behaviour, and use during hospitalisation. Both descriptive and inferential statistics were applied to identify predictors of OHIS.

Results: A total of 820 patients participated (617 Swiss, 203 Qatari). Swiss patients were older (mean age 57 ± 15) than Qataris (44 ± 16, p ≤ 0.001). Qatari patients were more likely to search for health information online compared with Swiss patients (85% vs 65%, p ≤ 0.001). They searched more frequently for information on diseases (74% vs 56%), treatments (59% vs 41%), healthcare professionals (40% vs 20%), and hospitals (41% vs 18%). Online health information had greater reported impact among Qataris, prompting them to ask further questions to doctors (75% vs 50%, p ≤ 0.001) and influencing decisions to consult physicians (33% vs 22%, p ≤ 0.05). Both cohorts expressed interest in reliable, tailored online resources, with Qataris showing stronger preference for interactive and video-based platforms.

Conclusion: This study highlights significant cross-country differences in OHIS behaviour among hospitalised patients, shaped by sociodemographic, cultural, and healthcare system contexts. Findings underscore the need for culturally relevant, trustworthy, and patient-centred digital health resources to enhance patient empowerment, improve clinician-patient communication, and reduce risks of misinformation.

Background: The U.S.-Thai Consortium for Pharmacy Education is a long-standing collaboration between the U.S. and Thailand that primarily focuses on faculty development. The success of this partnership has contributed to the improvement of pharmacy education and the advancement of pharmacy practice in Thailand. It may also serve as a model for collaborative efforts in pharmacy education and practice across Association of Southeast Asian Nations (ASEAN) countries. This study was designed to explore the views and perceptions on goals, directions, and trends for the new U.S.- ASEAN Consortium for Pharmacy Education.

Methods: A qualitative study was used. A focus group with semi-structured questions was conducted with 12 representative faculty members from nine ASEAN countries and the U.S. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation.

Results: Four key themes emerged: perceptions, challenges, expectations, and directions. Participants perceived the U.S.-ASEAN Consortium as a strategic networking platform for expanding international collaborations. Challenges were identified at both the institutional and national levels, with curriculum differences, financial constraints, and administrative issues affecting institutions, while cultural and language differences pose further obstacles. At the national level, top-down administrative structures were identified as restrictions. The main expressed benefit of joining the Consortium was enhancement of student experiences, including student exchange programmes. Gaining insights into organisational administration was also perceived as one of the benefits. Participants recognised that a successful collaboration required identifying common interests, setting goals, and proposing strategies, including developing a master plan, harmonising programmes, and establishing a uniform competency framework. Regular meetings and resource-sharing were identified as also essential to maintaining the engagement of Consortium members.

Conclusion: The U.S.-ASEAN Consortium was perceived as a platform to increase opportunities to collaboratively connect with other pharmacy schools internationally. The establishment of common interests and strategies was recommended to keep the collaboration moving forward.

Background: The pharmaceutical sector in Pakistan has grown over a period; however, there are certain barriers within the framework that regulate the growth and export of pharmaceuticals in the country. The purpose of this study was to highlight the current challenges for the pharmaceuticals' export from Pakistan, especially to countries with stringent regulatory authorities (SRAs), from a regulatory perspective, and to identify the facilitators that may help resolve these challenges.

Methods: In this qualitative study, data were collected from the participants from the regional offices of Drug Regulatory Authority of Pakistan (DRAP), located in Lahore, Islamabad, and Quetta. Regulatory participants with a minimum experience of 6 years and the designation of an assistant director or above were recruited through purposive sampling. Semi-structured interviews were used to collect information from regulatory experts. Inductive thematic content analysis was employed to conclude the data.Data analysis generated 5 themes and 20 categories/codes. Poor export performance and pharmaceutical growth was attributed to barriers such as: inadequate industrial research and development, non-compliance with the current standards of good manufacturing practices (cGMP), absence of regulatory requirements for high-tech equipment, insufficient academia-industry collaboration, shortage of locally manufactured active pharmaceutical ingredients and lack of support from the government. Accreditation with international organisations such as the World Health Organisation and the Pharmaceutical Inspection Co-operation Scheme was considered deficient. DRAP, in coordination with the Trade Development Authority, could enhance pharmaceutical exports. Addressing the above challenges could boost the export and expand international market share of Pakistani Pharmaceuticals in countries with SRAs.

Conclusion: The cGMP compliance, regulatory assistance, and appropriate research and development, including bioequivalence studies, could contribute to export enhancement to SRA countries. Further, the exports from Pakistan to countries with SRAs could be enhanced with DRAP's coordination with the trade development authority of Pakistan.

Introduction: Inappropriate polypharmacy is prevalent among patients with chronic kidney disease (CKD), and can be mitigated by deprescribing. We aim to evaluate the clinical and economic impact of a multidisciplinary deprescribing programme in Qatar's healthcare system.

Methods: This randomised controlled trial will be conducted at ambulatory dialysis centres, with an internal pilot to assess the feasibility of recruitment, intervention implementation, and safety measures. Patients will be randomised to usual care or an intervention group where a clinical pharmacist, in collaboration with a multidisciplinary healthcare team, will deliver a structured deprescribing intervention, including periodic monitoring over six months. Outcomes will be measured at baseline, three, and six months. The primary outcome is the proportion of patients with at least one potentially inappropriate medication (PIM). Secondary outcomes include pill burden, treatment burden, hospitalisations, emergency department visits, quality of life, and adherence. A cost-benefit analysis will also be performed. A total of 250 patients provides 90% power to detect a 50% reduction in PIM prevalence (α = 0.05). The statistical analysis will be based on the intention-to-treat principle, using mixed-effects models to account for repeated measures.

Discussion: Findings will provide novel evidence on deprescribing in CKD, informing future clinical and policy interventions.

Trial registration: ClinicalTrial.gov. NCT06324045. Registered on 15 March 2024.