There is increasing interest in the potential benefit of therapeutic drug monitoring (TDM) in oncology. However, uptake in Australian hospitals is limited.
This study sought to explore hospital pharmacists' experiences with TDM in oncology, seeking to determine if they could provide insights into barriers and facilitators to its implementation.
Hospital oncology/haematology pharmacists (n = 18) from all Australian states participated in semi-structured interviews. Interviews explored experiences of TDM, and perceived barriers and facilitators to TDM uptake in oncology. Interviews were analysed using an inductive approach to generate themes. Ethical approval was granted by the St. Vincent's Hospital Human Research Ethics Committee (Reference no: 2022/ETH00533) and the study conforms to the Australian National statement on ethical conduct in human research. Informed consent was obtained from all participants via distribution of project information sheets and the completion of written consent forms.
Most participants provided care in metropolitan tertiary adult hospitals. They reported that TDM was not used routinely to inform therapy for most oncology drugs, but acknowledged potential benefits, particularly when a concentration–effect relationship is established for efficacy or toxicity. Three themes captured the barriers and facilitators to implementation of TDM in oncology: (1) evidence and knowledge translation, (2) logistics and practicalities, and (3) the clinical team.
Pharmacists are keen to integrate TDM in oncology patients. Key factors perceived to influence TDM uptake are evidence, knowledge, and logistics (assay availability, funding, staff). Standardised guidance, complemented by clinical champions and pharmacokinetic expertise within the multidisciplinary team, is needed to provide confidence in changing dosing practices. Improved access to relevant drug assays will ensure result turnaround times support dosing decisions.
Pharmacists have been recognised for their important role in providing care to patients affected by tuberculosis (TB). Most research is conducted in high-burden countries. The role of clinical pharmacists (CPs) in Australia, where the incidence of TB is relatively low, is less clear.
To clarify the role of CPs in TB care in a metropolitan, multi-site healthcare network in Australia and identify strengths and areas for improvement in practice.
This retrospective electronic health record review used a convergent mixed-methods design to identify pharmacist involvement and intervention in 80 adult patients affected by active TB. Demographic and electronic health record data were analysed concurrently using descriptive statistics and thematic analysis. This project was exempt due to the local policy requirements that constitute research by the Monash Health Research Office (Research Support Services) (Reference no: QA/103394/MonH-RES-23-0000-802Q). The justification for this exemption was as follows: the study conforms with the Ethical considerations in quality assurance and evaluation activities, used retrospective patient data from existing health records which was deidentified for analysis and stored securely to protect patient privacy.
Five core activities specific to the role of CPs in TB care were identified: adherence monitoring/support, maintaining accurate records, TB medicines optimisation, education and counselling provision, and monitoring TB medicines safety. An identified strength and the most frequent involvement was adherence monitoring. The most frequent intervention was vitamin D dosing recommendations. Variability in clinical knowledge and provision of gold-standard care between pharmacists was evident, including the supply of TB-specific information and recommendations based on microbiology results.
This study outlines suggested core activities for CPs caring for patients affected by TB. To improve practice, the development of clinical education modules for TB and standardised patient counselling tools should be prioritised. The authors advocate for specialised TB pharmacists to collaboratively direct the standard of care and guide CPs in providing quality TB care across Australia.
Prescribing is a complex task and high-risk area in clinical practice. The safe prescribing of insulin is an essential skill for doctors. The introduction of the integrated electronic medical record (ieMR) system added a new layer of complexity in prescribing insulin.
To develop an insulin prescribing online resource for adult patients.
Mixed methodology was used for this study conducted between August 2020–July 2021. Phase 1 involved qualitative data collection via stakeholder interviews which informed phase 2, the creation of the online resource. The final phase, phase 3, involved piloting the usefulness of the online tool via a pre- and post-tool survey to determine any change in their knowledge and confidence. Ethical approval was granted by the Gold Coast Hospital and Health Service Human Research Ethics Committee (Reference no: LNR/2021/QGC/73635) and the study conforms with the Australian National statement on ethical conduct in human research. Informed consent was obtained from all participants via distribution of a project information sheet, completion of a written consent form for interview participants, and completion of the anonymous and voluntary pre- and post-tool surveys for survey respondents.
The semi-structured interviews with ten stakeholders identified four key issues with insulin prescribing: (1) uncertainty around correct terminology, (2) ambiguity of different prescribing pathways, (3) frequency of dose checks, and (4) action when a dose is missed. Based on these findings, an online resource that was user-friendly and complemented current resources was constructed. The pre- and post-tool surveys (n = 8) used in the pilot evaluation of the online tool demonstrated a statistically significant improvement for seven of 12 responses highlighting enhanced prescribers' confidence in accessing the existing resources as well as navigating and prescribing insulin through the ieMR system.
The practical online resource was easy to navigate and increased doctors' confidence to prescribe insulin through an electronic platform. Application of this tool has potential to reduce insulin prescribing errors, an important aspect of patient safety.
Geographical maldistribution of pharmacists to regional and rural areas in Australia is well documented in a similar fashion to other health professions. This narrative review aimed to identify the enablers and barriers to staff recruitment and retention and ascertain the extent of evidence in the literature from the perspective of prospective employers.
A comprehensive literature search was undertaken for peer reviewed, English language articles published from 2002–2022 using non-Medical Subject Headings (MeSH) terms including ‘rural’, ‘remote’, ‘pharmacy’, ‘pharmacist’, ‘employer’, ‘manager’, ‘workforce’ and ‘practice’, with pharmacy-specific filters applied using databases MEDLINE/EBSCOhost, PudMed, Scopus, ScienceDirect, and DOAJ (Directory of Open Access Journals). The themes identified were tabulated and analysed.
A large number of themes were identified, and much of the literature focused on the perspectives of employees. The most commonly identified themes in the 12 studies included ‘rural origin or background/initial training’, ‘professional relationship with other health professionals’, and ‘lifestyle/lifestyle enabled by cost of housing and living’. Some previously highly regarded predictors such as ‘rural origin’ were less common.
Recent studies suggest that positive experiences during rural clinical placements and initial employment after undergraduate study are likely to be statistically impactful. Only few themes were shared between employees and employers. The existing literature is heavily skewed towards the views of prospective employees, while relatively little regarding the views of employers. Further, original research from an employer's point of view, especially with regards to the challenges they face and any incentives they offer in attracting a pharmacist workforce to rural and regional areas, is needed.
Historically, health research conducted in Australia with Aboriginal and/or Torres Strait Islander Peoples has not been requested by communities. Health policies cite evidence for inclusive care including cultural perspectives.
To determine if the design and implementation of a pharmacist-led diabetes screening study was culturally appropriate for Aboriginal and/or Torres Strait Islander Peoples admitted to a metropolitan hospital, located in New South Wales (NSW), Australia.
Data were drawn from four components: (1) timeline and key steps to develop the study, (2) study alignment with the NSW Aboriginal health ethics guidelines: key principles, (3) elements and processes of bicultural care, and (4) the extent of community participation. Ethical approval was granted by the Human Research Ethics Committee of the Aboriginal Health and Medical Research Council of NSW (Reference no: #1709/20) and the St Vincent's Hospital Human Research Ethics Committee (Reference no: #2020/ETH01314) and the study conforms to the Australian National statement on ethical conduct in human research. In the original intervention study, informed consent was obtained from all participants via distribution of a project information sheet and completion of a written consent form.
The process to design and implement the larger study demonstrated cultural appropriateness across four analyses. Strengths included involvement from knowledge holders and Aboriginal clinician-researchers. Analyses illustrated respect for community priorities as central to the research process. This required sufficient time for respectful conversations, formation of strong partnerships, and reciprocity. Future studies should ensure time is set aside to build relationships with patients in concept building and design phases. Results cannot be generalised to another hospital. However, study findings could inform diabetes care efforts in other hospital settings.
Respectful, non-rushed two-way communication was crucial to the cultural appropriateness of the study. This study offers suggestions for pharmacists wishing to conduct research in this area. Future research is needed to incorporate Indigenous research methodologies into study designs and to apply the Australian Bicul
Before 2002, products for head lice were entered in the Australian Register of Therapeutic Goods (ARTG) as Registered or Listed Medicines, depending on the active ingredients. Since 2002, the Australian definition of a medical device has been consistent with that of the European Union, allowing many lice treatments and prevention products to be included in the ARTG as a Class 1 medical device (C1MD).
To analyse C1MD entries in the ARTG that incorporate the term ‘lice’ in their title, ingredient list, or indications.
The ARTG was searched for entries using the term ‘lice’. Each entry's Public Summary was reviewed and C1MD entries were classified using Global Medical Device Nomenclature codes. Additional information about C1MD entries was sought by enquiry of sponsors, review of product websites, and examination of products at point of sale. Ethics approval was not required for this research as it involved publicly available information and did not involve human participants or human data.
For only 20 of 31 C1MD entries for lice treatment or prevention were a complete list of ingredients or an active ingredient found from multiple information sources. Five C1MD entries had novel ingredients not in any medicine on the ARTG, and others contained an ingredient seemingly for a purpose not permitted in Listed Medicines.
In Australia, C1MDs designated for head lice treatment or prevention can be lawfully supplied without disclosure of their ingredients to the regulatory authority. Some C1MDs contained ingredients not found in any medicine on the ARTG. Additionally, some uses and indications of ingredients did not align with those permitted for Listed Medicines.
Neck of femur (NOF) fractures are associated with significant morbidity and mortality. Fractured NOF clinical care pathways (CCPs) standardise care; however, the impact of Partnered Pharmacist Medication Charting (PPMC) in this context remains unexplored.
To evaluate pharmacist involvement through PPMC on the proportion of patients initiated on the electronic medical record (EMR) integrated Fractured NOF CCP, at hospital admission.
A retrospective, pre- and post-intervention study was conducted in the orthopaedic unit of a tertiary-referral health service. Patients ≥65 years with a primary minimal trauma NOF fracture were included. In the intervention, the Fractured NOF CCP could be initiated through PPMC, in addition to usual care. The primary outcome of the study was the proportion of patients initiated on the CCP and secondary outcomes included the proportion of PPMC initiated CCPs and the time to CCP initiation. Ethical approval was granted by the Alfred Hospital Research and Ethics Committee (Reference no: 779/20) and the study conforms to the Australian National statement on ethical conduct in human research.
A total of 127 patients pre-intervention (January–August 2020) and 149 patients post-intervention (January–August 2021) were included. Fractured NOF CCP initiation increased post-intervention (n = 20, 15.7% vs n = 83, 55.7%, p < 0.0001). Emergency department initiation of the CCP was similar (n = 20, 15.7% vs n = 23, 15.4%, p = 0.94); and median (interquartile range [IQR]) time to initiation increased (0.9 h, IQR 0.4–1.9 h vs 3.9 h, IQR 2.0–6.3 h, p = 0.001). Post-intervention, 60 additional patients were initiated on the CCP through ward care components; median time to initiation was 16.4 h, IQR 11.8–20.6 h, and 61 (73.5%) patients were initiated on the CCP via PPMC.
Pharmacist involvement through PPMC significantly increased the proportion of patients initiated on the Fractured NOF CCP at hospital admission. The delay in initiation post-intervention requires further exploration.
A number of commonly used psychotropic medicines increase the risk of postoperative delirium. In some cases, these medicines could be safely tapered or held prior to planned surgery, which may reduce the incidence of postoperative delirium. However, the frequency with which patients use these medicines prior to planned surgery is unknown.
To determine the prevalence of opioid analgesic, antidepressant, gabapentinoid, and benzodiazepine use prior to planned surgery, the prevalence of delirium screening before and after planned surgery, and the incidence of postoperative delirium in older patients using high-risk medicines.
We conducted a retrospective analysis of electronic medical records (EMRs) from four acute-care hospitals. Patients aged 65 years or older who underwent planned surgery over a 2-week period were included. Data relating to patient age, gender, type of surgical procedure, length of surgery, type of anaesthesia, medications on admission, and 4AT delirium tests were extracted from the EMRs. This project was exempt due to the local policy requirements that constitute research by the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (Reference no: CALHN19857). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's National statement on ethical conduct in human research, met local requirements for an audit activity, and presented no foreseeable risk of patient harm.
The study included 158 participants with a median age of 75 years, of whom 41% were taking a medicine associated with increased risk of postoperative delirium prior to their planned surgical admission; 21% were taking an antidepressant, 15% an opioid analgesic, 13% a benzodiazepine, and 6% a gabapentinoid at the time of admission. In addition, 80% of participants had a 4AT test prior to surgery, and 61% received at least one 4AT test after surgery.
Among the older patients undergoing planned surgery, 41% used a medicine associated with increased risk of postoperative delirium, and not all older patients received delirium screening prior to or after surgery.
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