Journal of Pharmaceutical Policy and Practice最新文献

Objectives: This study evaluated the level of community pharmacy professionals' (CPPs) actual practices and contrasted it with their self-reported perceived involvement in diabetes management.

Methods: A self-reported cross-sectional and simulated patient (SP)-based study were employed at community drug retail outlets (CDROs) in Northwest Ethiopia. SP-case scenarios were used to examine the actual practices of CPPs in diabetes management and were compared with self-reported perceived involvement. The data were managed and analysed using SPSS version 26.

Results: About 184 participants in the self-reported and 100 CPPs' actual practices using three SP visits were included. The overall actual practice (17.8%) was found to be significantly different compared with the perceived level of involvement (73.5%) (p-value <0.05). About 94.3% of CPPs dispensed requested medications to the SP without a prescription. Despite most participants being perceived to be involved, more than 76% of CPPs did not counsel the SP for lifestyle modifications, avoiding risky behaviours, adherence to treatment, routine blood glucose checkups, diabetic foot care techniques, or consultation with physicians for further management.

Conclusion: A significant discrepancy between actual practices and perceived CPPs' involvement in the management of diabetes was observed. The findings may suggest that exploring possible gaps may be crucial.

Objective: To estimate the economic impact of the developed antimicrobial stewardship program (ASP) versus the preliminary ASP use, in the adults' general medicine settings in Qatar.

Methods: Patient records were retrospectively reviewed during two periods: preliminary ASP was defined as the 12 months following ASP implementation (i.e. May 2015-April 2016), and developed ASP was defined as the last 12 months of a 5-year ASP implementation in Hamad Medical Corporation (HMC) (i.e. February 2019-January 2020). The economic impact was the overall cost savings in resource use, including operational costs, plus the cost avoidance associated with ASP.

Results: A total of 500 patients were included in the study. The operational costs decreased with the developed ASP. Whereas antimicrobial consumption and resource utilisation, and their associated costs, appear to have declined with the developed ASP, with a cost saving of QAR458 (US$125) per 100-patient beds, the avoided cost was negative, by QAR4,807 (US$1,317) per 100-patient beds, adding to a total QAR4,224 (US$1,160) increase in the 100-patient beds cost after ASP development.

Conclusions: Despite that the developed ASP attained a total cost saving QAR458 (US$125) per 100-patient beds, the avoided cost was QAR-4,807 (US$-1,317) per 100-patient beds, which exceeded the cost savings achieved.

Background: Atrial Fibrillation (AF) increases the risk of stroke by a factor of five, leading a significant cost burdens on healthcare system. Pharmacists, especially those based in a primary care environment are well placed to support patients in this therapeutic area.

Objectives: To assess primary care pharmacists' actual knowledge on the management of AF symptoms and anticoagulation. Furthermore, to investigate the resources used by pharmacists.

Methods: A cross-sectional study using survey was conducted, targeting UK-based registered pharmacists employed within primary care settings. Quantitative data were analysed utilising descriptive univariate and bivariate statistics.

Results: 349 pharmacists completed the adapted 19-questions of the pharmacists' knowledge. Out of a maximum of 19 points, the mean score was 14.34 ± 2.2 (75 ± 11.6%). The questionnaire revealed several significant gaps in pharmacists' knowledge. Most of the surveyed pharmacists (62.8%) reported that they used sources of information to support their consultations. Half reported that they used the National Institute for Health and Care Excellence (NICE) guidance (52.4%) and the British National Formulary (BNF) (50.7%).

Conclusions: Primary care pharmacists are knowledgeable about AF and its management; however, some gaps exist which may require addressing. Although pharmacists use a variety of information resources, it is the traditional resources that remain the most frequently used.

Background: Thromboembolism is reported to be up to 27% in COVID-19 patients due to SARS-CoV-2 infection. Dysregulated systemic inflammation and various patient traits play a vital role in thrombosis progression.

Purpose: To assess odds and associated factors for thrombosis development among Lebanese COVID-19 patients.

Methods: This was a case-control retrospective study conducted in January-May 2021. Patients infected with COVID-19 and developed thrombosis were classified as cases and patients who were thrombosis-free identified as control. A questionnaire assessed socio-demographics, clinical parameters, and WHO COVID-19 disease severity.

Results: Among 267 patients, 26 (9.7%) developed thrombosis and the majority of thrombosis 34.6% was myocardial infarction, and the least (3.8%) was for catheter-related thrombosis. Results showed that the risk of thrombosis development is higher in patients with previous thromboembolic event (OR = 9.160) and previous intake of anti-hypertensive medications at home (OR = 3.116). However, females (OR = 0.330; CI: 0.118-0.925), intake of anticoagulants during hospital admission (OR = 0.126; CI: 0.053-0.300) and non-severe COVID-19 were at lower thrombosis risk (OR = 0.273). Patients who developed thromboembolic events had longer hospital stay (OR = 0.077).

Conclusion: Patients with COVID-19 and thromboembolism were at higher risk of mortality as compared to patients with COVID-19 but without thromboembolism. The use of anticoagulants significantly reduced the risk for thromboembolism.

Background: Drug stores is an option that people can receive health care services for their common illnesses. This is the first study aims to estimate cost savings for 16 common illness symptoms to the Thailand's health system.

Method: This study gathered retrospective secondary data from several studies and surveyed the median cost of medicines. Cost savings of care provided by pharmacists at drug stores in comparison to out-patient department (OPD) services at hospitals were quantified using cost of illness approach.

Results: The average number of hospital visits for treatment for 16 common illness symptoms was 2,356 visits per month. The estimation of the cost savings per visit from three perspectives, including government, patient, and societal, at tertiary care hospitals were 12.7-19.4, 12.7-25.6, and 18.9-25.6 USD, and at secondary care hospitals were 6.0-12.7, 6.0-18.9, and 12.2-18.9 USD. Every $1 reimbursed at drug stores will save additional costs in Thailand's health system, ranging from $0.04 to $0.24 and $0.02 to $0.16 at tertiary care hospitals and secondary hospitals, respectively.

Conclusion: Pharmacy services for 16 common illness symptoms can clearly save costs.

Background: Transition of care (TOC) is associated with an increased risk of medication-related problems. Despite recent advancements in pharmacy practice and research in the Middle East and North Africa (MENA), the characteristics and impact of regional pharmacy-supported TOC interventions remain unclear.This systematic review and meta-analysis aimed to describe pharmacist-supported TOC interventions in the MENA region and evaluate their effectiveness.

Methods: PubMed, CINAHL, EMBASE, Web of Science, World Health Organization's International Clinical Trials Registry Platform (ICTRP) were searched from their inception to March 9, 2023, for experimental studies published in English, comparing pharmacist-supported TOC interventions with usual care for adults (age ≥18 years) discharged from the hospital. The risk of bias was evaluated using Cochrane's risk-of-bias tool for randomised trials (ROB2) and the risk of bias in non-randomised studies of interventions (ROBINS-I) tool for randomised and non-randomised studies respectively. Narrative syntheses and meta-analysis methods were employed depending on the outcomes evaluated.

Results: Twelve studies (n = 2377 subjects), 10 randomised controlled trials and 2 quasi-experimental studies, were included. Most studies had high or serious risk of bias. The included studies were quite heterogeneous in terms of nature and the delivery of intervention, and assessment of outcome measures. Compared to the usual care group, pharmacist-led TOC interventions contributed to a significant reduction in preventable drug-related (N = 2) and cardiac-related healthcare utilisation (N = 1), a significant reduction in preventable adverse drug events (ADEs) (Odds ratio (OR) 0.34, 95% CI: 0.13-0.94) and an improvement in medication adherence. However, all-cause hospitalisation and medication discrepancies were not significantly reduced.

Conclusion: Pharmacy-supported TOC interventions may improve patient outcomes in the MENA region. However, considering the limited quality of evidence and the variability in intervention delivery, future well-designed clinical trials are needed.

Background: In Uganda, there is limited adoption of pharmaceutical care in hospitals due to pharmacist shortages and limited collaboration among healthcare professionals. Intern pharmacists are deployed annually to assist in patient care to address pharmacist shortages.

Objectives: Evaluate intern pharmacist's extent of involvement in pharmaceutical care activities, assess facilitators and barriers, and explore healthcare professionals' perceptions, attitudes, and opinions on implementation of pharmaceutical care.

Methods: A mixed-method concurrent study was carried out for four months. We conducted an online survey among 107 intern pharmacists from 26 hospitals, including National Referral, Regional Referral, Private Not-For-Profit, and General hospitals; predictors of extent of involvement were identified using linear regression models, using STATA 14. 24 key informants (nurses, prescribers, pharmacists) from five hospitals were interviewed; themes were developed using a deductive thematic analysis approach.

Results: Intern pharmacists had a median (Interquartile range[IQR]) age of 25 years (25-27) and 74.7% were male. About half (54.1%) of key informants were female and had a median (IQR) of 10 years (4.0-15.5) of professional experience. Interns focused on patient counseling, lacked documentation, and showed positive attitudes, and knowledge. Key informants supported implementation, but prescribers expressed dissatisfaction with interns' performance.

Conclusion: Enhancing pharmacy internship and training through developing policies and guidelines on pharmaceutical care practice, improving working conditions, and mentorship can address gaps impeding pharmaceutical care implementation by intern pharmacists.

Background: Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD.

Methods: A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team.

Results: Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD.

Conclusion: A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.

The success of universal coverage depends on ensuring that patients have access to medicine. Encouraging local production of medicines in developing countries can provide better access to medicines. In addition to determining the quality of pharmaceutical goods, Active Pharmaceutical Ingredients (APIs) also determine their cost. According to market forecasts, the active pharmaceutical ingredients market is expected to increase from USD 193.15 billion in 2023 to USD 285.29 billion by 2028. Pakistan largely depends on India and China for its Active Pharmaceutical Ingredient requirements. It was feared that a shortage of medicines would result from Pakistan's government suspending all trade with India on August 9, 2019. To improve health security in Pakistan, the Government of Pakistan has introduced an API promotion Policy in 2022. Financial and non-financial incentives have helped many countries develop their API industries like China, India, and Bangladesh. The current domestic API market of Pakistan is around 150 million $. After the introduction of the policy, the existing units are increasing their capacity while eight new API units are in the process of establishment. Through local production of APIs and intermediates, Pakistan can improve its health security by learning from the experiences of neighbouring countries, especially China.