Journal of Pharmacy Practice and Research最新文献

Aung AK, Downie M, Shannon L, Johnson DF. Advanced Pharmacy Australia general medicine standards: paving the way for multidisciplinary care and collaboration. J Pharm Pract Res 2025; 55: 167–169.

In the above article, the first author's name was spelled incorrectly. It should be corrected from ‘Ak Kar Aung’ to ‘Ar Kar Aung’.

The name has been amended in the online article.

Supervised pharmacist prescribing (SPP) in the hospital setting, also known as Partnered Pharmacist Medication Prescribing (PPMP), represents a collaborative model of non-medical prescribing which could enable additional gains in efficiency, safety, and increased health service capacity. Following successful implementation of Partnered Pharmacist Medication Charting (PPMC) within our 783-bed quaternary metropolitan hospital, located in Western Australia, Australia, approximately 1800 medical practitioners were invited to complete a five-question survey via email to ascertain whether implementing SPP would be supported and thought to add value. There were 262 responses received within a two-week period, with 77.8% of doctors indicating they felt SPP would be beneficial to their team/the hospital. The Pharmacy Board of Australia previously concluded pharmacist prescribing within a collaborative healthcare environment fell within the current scope of pharmacist practice and that there were no regulatory barriers under national law. Our proposed model of SPP aligns with the Australian Medical Association's position on non-medical prescribing and recommendations in the Western Australian Sustainable health review. This project was exempt due to the local policy requirements that constitute research by the South Metropolitan Health Service Human Research Ethics Committee and registered as a quality improvement project in WA Health Governance, Evidence, Knowledge, Outcomes (Reference no: GEKO48966). The justification for this exemption was as follows: the project presented minimal patient risk and conforms with the National Health and Medical Research Council's Ethical considerations in quality assistance and evaluation activities. Informed consent was obtained from all participants. Potential participants were given project information via email indicating their participation was voluntary and anonymous. Participants provided their consent by completing the survey.

General Medicine is the largest provider of acute inpatient care in Victoria, and possibly also in the wider Australia and Aotearoa New Zealand.¹ Clinicians in General Medicine, including pharmacists, are trained to care for patients who are often elderly and frail, with multiple comorbidities, undifferentiated problems, and complex physiological and psychosocial needs. General Medicine services also care for vulnerable and marginalised patient populations, such as First Nations peoples, people experiencing homelessness, migrant and refugee populations, and people who inject drugs. General Medicine is also frequently involved in the care of perioperative patients, especially for those whose surgical issues are managed non-operatively, and patients who are pregnant with medical issues.

Management of general medical patients poses unique challenges. The specialty requires both breadth and depth of knowledge, concerning every organ system and their intricate interactions, and yet, the available best practice evidence-based guidelines are often single organ focused and may not directly apply to general medical patients. This is because patients who have competing comorbidities and are often not included due to highly selective exclusion criteria in major clinical trials. Patient presentations in General Medicine can range widely from being undifferentiated and acutely unwell, to management of stable chronic diseases which impact their lifestyle. There are also added layers of patient complexity such as cognitive, functional, and psychosocial issues which impact on access to care, medicine compliance, and health literacy. Additionally, certain considerations must be given in the management paradigm of some patient groups, for instance, prioritising and optimising quality of life for patients with advanced age and comorbidities, minimising medication adverse effects and related harm and reducing polypharmacy through deprescribing, while ensuring adherence to essential and critical medications. The care delivered must be of high quality and high value, not only based on the best available evidence, but also be holistic and patient-centred to tailor individual needs, circumstances, psychosocial, and physiological vulnerabilities. All clinicians in General Medicine have the obligation to minimise and eliminate low-value care options, that will not make any difference to patient outcomes, and may in fact result in harm, with significant associated economic and environmental costs.

From the systems perspectives, anecdotally, the models of care in General Medicine have been rapidly changing over the last two decades to meet the increasing service demands and to alleviate bed access pressures. While designed to improve patient flow through the hospital systems, evolving models that institute transitions through different care teams at different phases of the patient's journey, such as acute medical units/streaming teams

Hospital-based clinical pharmacy services improve patient outcomes, reduce medication-related problems, and lower the cost of medication therapy. Measuring the provision of clinical pharmacy services and related outcomes is essential to ensuring quality. Historically, clinical pharmacy performance measurement relied on manual reporting of performance measures, which was time-consuming. This study validated the use of counts of clinical progress notes, stored in hospital electronic medical records (EMRs), as measures of clinical pharmacy service provision. EMR-generated progress notes completed by pharmacy staff for a random sample of 300 adults admitted to three Australian hospitals between May–November 2021 were manually audited. The audit identified the type of progress notes completed, as indicated by their title, and the type of clinical pharmacy services documented. To determine the validity of using counts of these progress notes to indicate the completion of clinical pharmacy services, sensitivity, specificity, and positive predictive value were calculated using the manual audit as a gold standard. A total of 861 progress notes were audited. Progress notes titled PMM (which is short for Pharmacy Medication Management) Medication History, PMM Medication Review, and PMM Discharge Medications demonstrated high specificity and positive predictive values (>98%) for clinical pharmacy services at admission, during the inpatient stay, and at discharge, respectively, with sensitivities of 98%, 90%, and 89%. Counts of EMR-generated clinical pharmacy progress notes accurately measured service provision and can be used as reliable performance measures. Hospitals using EMR-generated clinical progress notes may apply a similar approach to derive accurate and efficient clinical performance measures. Ethical approval was granted by the Central Adelaide Local Health Network Human Research Ethics Committee (Reference no: 16357) and the University of South Australia Human Research Ethics Committee (Reference no: 205782) and the study conforms with the Australian National statement on ethical conduct in human research.