Community pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake.
Aim
This study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers.
Design
The framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer-reviewed quantitative, qualitative and mixed-method studies published between 1990 and 2022.
Results
A total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy-based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office.
Conclusion
Several initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered.
{"title":"Pharmacist's role in influenza immunisation: a scoping review","authors":"Edna Ribeiro Parracha PharmD, António Teixeira Rodrigues PharmD, PhD, Sofia Oliveira-Martins PharmD, MPH, PhD, Sónia Romano PharmD, Diogo Almeida PharmD, Bruno Sepodes PharmD, MSc, PhD, MPH, Carla Torre PharmD, MSc, PhD","doi":"10.1002/jppr.1932","DOIUrl":"10.1002/jppr.1932","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Community pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer-reviewed quantitative, qualitative and mixed-method studies published between 1990 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy-based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"273-286"},"PeriodicalIF":1.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1932","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Wembridge BPharm (Hons), M Clin Pharm, FANZCAP, Saly Rashed BPharm (Hons), Grad Cert Pharm Practice, M Clin Pharm, FANZCAP, Nick Monypenny BNursing, Grad Cert of Information Systems, RN, Hamish Rodda MBBS, BMedSci, FACEM
Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged-care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre- and post-intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR-generated documents. Despite similar hospital activity, the transition to EMR-generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post-intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR-generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21-094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities and met local requirements for an audit or quality assurance activity.
{"title":"Implementation of hospital electronic medical record Patient Friendly Medication Lists and Interim Medication Administration Charts","authors":"Paul Wembridge BPharm (Hons), M Clin Pharm, FANZCAP, Saly Rashed BPharm (Hons), Grad Cert Pharm Practice, M Clin Pharm, FANZCAP, Nick Monypenny BNursing, Grad Cert of Information Systems, RN, Hamish Rodda MBBS, BMedSci, FACEM","doi":"10.1002/jppr.1927","DOIUrl":"10.1002/jppr.1927","url":null,"abstract":"<p>Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged-care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre- and post-intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR-generated documents. Despite similar hospital activity, the transition to EMR-generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post-intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR-generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21-094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's <i>Ethical considerations in quality assurance and evaluation activities</i> and met local requirements for an audit or quality assurance activity.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"412-416"},"PeriodicalIF":1.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141652644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandros Chronas BBioMed, MD, Karin Thursky MBBS, BSc, MD, FRACP, FAHMS, FAIDH, Simone Mo BBioMed, MD, Lisa Hall BTech(BiomedSci) (Hons), PhD, Rodney James BMedSci, BMed, MPHTM, FRCPA, Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD
Background
Oral amoxicillin-clavulanic acid, a broad-spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin-clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.
Aim
To describe the quality of IV amoxicillin-clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.
Method
A retrospective data analysis of IV amoxicillin-clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH-2022).
Results
The proportion of prescriptions for IV amoxicillin-clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).
Conclusion
Intravenous amoxicillin-clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin-clavulanic acid prescribing.
{"title":"Intravenous amoxicillin-clavulanic acid: prescribing practices in Australian hospitals","authors":"Alexandros Chronas BBioMed, MD, Karin Thursky MBBS, BSc, MD, FRACP, FAHMS, FAIDH, Simone Mo BBioMed, MD, Lisa Hall BTech(BiomedSci) (Hons), PhD, Rodney James BMedSci, BMed, MPHTM, FRCPA, Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD","doi":"10.1002/jppr.1930","DOIUrl":"10.1002/jppr.1930","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral amoxicillin-clavulanic acid, a broad-spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin-clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the quality of IV amoxicillin-clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective data analysis of IV amoxicillin-clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH-2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of prescriptions for IV amoxicillin-clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Intravenous amoxicillin-clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin-clavulanic acid prescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"384-392"},"PeriodicalIF":1.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.
Aim
We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.
Clinical details
Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.
Outcomes
The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.
Conclusion
This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.
{"title":"Two instances of successful oral desensitisation following hypersensitivity reaction in a patient receiving osimertinib: a case report","authors":"Georgia D. Bennett BPharm, Krysti Rosmalen-Brinkley MBBS, Kristoffer Johnstone BPharm, Genevieve Messina BPharm","doi":"10.1002/jppr.1928","DOIUrl":"https://doi.org/10.1002/jppr.1928","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical details</h3>\u0000 \u0000 <p>Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcomes</h3>\u0000 \u0000 <p>The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"328-332"},"PeriodicalIF":1.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1928","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lemlem G. Gebremichael PhD, Alline Beleigoli PhD, Jonathon W. Foote RN, ICU Cert, ACE, Norma B. Bulamu PhD, Joyce S. Ramos PhD, Orathai Suebkinorn RN, MSN, Julie Redfern PhD, Robyn A. Clark PhD, the National Health and Medical Research Council (NHMRC) Country Heart Attack Prevention Project Team
<div> <section> <h3> Background</h3> <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p> </section> <section> <h3> Aim</h3> <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p> </section> <section> <h3> Method</h3> <p>A cross-sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face-to-face, telephone, or general practice-hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and <i>χ</i><sup>2</sup> test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015-2484) which included a waiver of consent per the <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p> </section> <section> <h3> Results</h3> <p>Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.</p> </section> <section> <h3> Conclusion</h3> <p>GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recomme
{"title":"Missed opportunity: a clinical data linkage study of guideline-directed medical therapy and clinical outcomes of patients discharged with acute coronary syndrome who attended cardiac rehabilitation programs","authors":"Lemlem G. Gebremichael PhD, Alline Beleigoli PhD, Jonathon W. Foote RN, ICU Cert, ACE, Norma B. Bulamu PhD, Joyce S. Ramos PhD, Orathai Suebkinorn RN, MSN, Julie Redfern PhD, Robyn A. Clark PhD, the National Health and Medical Research Council (NHMRC) Country Heart Attack Prevention Project Team","doi":"10.1002/jppr.1923","DOIUrl":"https://doi.org/10.1002/jppr.1923","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face-to-face, telephone, or general practice-hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and <i>χ</i><sup>2</sup> test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015-2484) which included a waiver of consent per the <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recomme","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"314-322"},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1923","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vincent Woodward BSc, MPharm, Meghrie Panjarjian BSc, MPharm, Devika Devi MPharm, Jane Hanrahan BSc (Hons), PhD, Michael Soriano BPharm, Matt Roper BMedSc (Hons), BPharm (Hons), Hala Musa BSc (Hons), MS, MPharm, Stephanie Davies BPharm, Peter Samios BPharm, GradDipClinPharm, Michael Teh BPharm, GradDipHospPharm, Peter Barclay BPharm, Clare Naughtin BPharm, Régis Vaillancourt BPharm, PharmD, Carl Nikolaidis BSc, Bryan Pelland BSc, Jonathan Penm BPharm (Hons), GradCertEdStud (Higher Ed), PhD
<div> <section> <h3> Background</h3> <p>Cytotoxic medicine contamination of preparation and administration areas of oncology healthcare facilities poses a risk to staff facing repeated low-level exposure over time. The use of closed-system transfer devices (CSTDs) during preparation and administration of cytotoxic products may reduce the levels of contamination. The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.</p> </section> <section> <h3> Aim</h3> <p>The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.</p> </section> <section> <h3> Method</h3> <p>A retrospective, cross-sectional study across four Australian hospitals was conducted. Cytotoxic medicine contamination was determined via surface wipe sampling on six specified surfaces. The samples were tested for cyclophosphamide, docetaxel, etoposide, ifosfamide, irinotecan, methotrexate, paclitaxel, pemetrexed, topotecan, and vinblastine. This project was exempt due to the local policy requirements that constitute research by the South Eastern Sydney Local Health District Human Research Ethics Committee (Reference no: ETH01899). The justification for this ethics exemption was as follows: this was a study involving sample testing only and did not include human participants or participation.</p> </section> <section> <h3> Results</h3> <p>Environmental contamination with cytotoxic medications was observed at all hospitals, regardless of the CSTD used. Of the 24 samples tested, the agent most frequently seen was ifosfamide with 29% (<i>n</i> = 7), followed by cyclophosphamide 13% (<i>n</i> = 3), and methotrexate 8% (<i>n</i> = 2). There was no statistically significant difference between hospitals that used CSTDs compared to hospitals that did not (25% vs 42%, p = 0.67). Contamination was more extensive in preparation areas than administration areas, and was observed on the biological safety cabinets (BSC) worktop, packaging bench, and floor in front of the BSCs.</p> </section> <section> <h3> Conclusion</h3> <p>All sites had contamination present for cytotoxic medicines. There was no statistically significant difference in the proportion of contaminated surfaces between sites that used CSTDs versus sites where CSTDs were not used. Only ifosfamide contami
在肿瘤医疗机构的制备和用药区域，细胞毒性药物污染会给长期反复接触低浓度药物的工作人员带来风险。在准备和使用细胞毒性产品时使用封闭系统转移装置（CSTD）可降低污染水平。这项研究的主要目的是确定使用封闭系统转移装置的医院与未使用封闭系统转移装置的医院在准备和给药区域的细胞毒性药物污染水平。该研究对澳大利亚四家医院进行了一项回顾性横断面研究，通过对六种特定表面进行表面擦拭取样来确定细胞毒性药物污染情况。样本中检测了环磷酰胺、多西他赛、依托泊苷、伊福法胺、伊立替康、甲氨蝶呤、紫杉醇、培美曲塞、托泊替康和长春新碱。根据悉尼东南部地方卫生区人类研究伦理委员会（South Eastern Sydney Local Health District Human Research Ethics Committee，编号：ETH01899）的当地研究政策要求，该项目获得了伦理豁免。获得伦理豁免的理由如下：这是一项仅涉及样本检测的研究，不包括人类参与者或参与。所有医院都发现了细胞毒性药物的环境污染，无论使用的是哪种 CSTD。在检测的 24 份样本中，最常见的药物是伊福酰胺，占 29%（7 人），其次是环磷酰胺，占 13%（3 人），甲氨蝶呤占 8%（2 人）。使用 CSTD 的医院与未使用 CSTD 的医院在统计学上没有明显差异（25% vs 42%，P = 0.67）。配制区的污染比用药区更严重，生物安全柜 (BSC) 工作台、包装台和生物安全柜前的地板上都有污染。在统计学上，使用化学安全柜和未使用化学安全柜的医疗点在受污染表面的比例上没有明显差异。只有在使用 CSTD 的药房区域发现了伊福酰胺污染。我们鼓励采用安全的工作方法并对员工进行培训，以进一步将接触风险降至最低。
{"title":"Surface contamination of cytotoxic medicine in preparation and patient care areas in Australian hospitals: a retrospective cross-sectional study","authors":"Vincent Woodward BSc, MPharm, Meghrie Panjarjian BSc, MPharm, Devika Devi MPharm, Jane Hanrahan BSc (Hons), PhD, Michael Soriano BPharm, Matt Roper BMedSc (Hons), BPharm (Hons), Hala Musa BSc (Hons), MS, MPharm, Stephanie Davies BPharm, Peter Samios BPharm, GradDipClinPharm, Michael Teh BPharm, GradDipHospPharm, Peter Barclay BPharm, Clare Naughtin BPharm, Régis Vaillancourt BPharm, PharmD, Carl Nikolaidis BSc, Bryan Pelland BSc, Jonathan Penm BPharm (Hons), GradCertEdStud (Higher Ed), PhD","doi":"10.1002/jppr.1925","DOIUrl":"10.1002/jppr.1925","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytotoxic medicine contamination of preparation and administration areas of oncology healthcare facilities poses a risk to staff facing repeated low-level exposure over time. The use of closed-system transfer devices (CSTDs) during preparation and administration of cytotoxic products may reduce the levels of contamination. The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective, cross-sectional study across four Australian hospitals was conducted. Cytotoxic medicine contamination was determined via surface wipe sampling on six specified surfaces. The samples were tested for cyclophosphamide, docetaxel, etoposide, ifosfamide, irinotecan, methotrexate, paclitaxel, pemetrexed, topotecan, and vinblastine. This project was exempt due to the local policy requirements that constitute research by the South Eastern Sydney Local Health District Human Research Ethics Committee (Reference no: ETH01899). The justification for this ethics exemption was as follows: this was a study involving sample testing only and did not include human participants or participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Environmental contamination with cytotoxic medications was observed at all hospitals, regardless of the CSTD used. Of the 24 samples tested, the agent most frequently seen was ifosfamide with 29% (<i>n</i> = 7), followed by cyclophosphamide 13% (<i>n</i> = 3), and methotrexate 8% (<i>n</i> = 2). There was no statistically significant difference between hospitals that used CSTDs compared to hospitals that did not (25% vs 42%, p = 0.67). Contamination was more extensive in preparation areas than administration areas, and was observed on the biological safety cabinets (BSC) worktop, packaging bench, and floor in front of the BSCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>All sites had contamination present for cytotoxic medicines. There was no statistically significant difference in the proportion of contaminated surfaces between sites that used CSTDs versus sites where CSTDs were not used. Only ifosfamide contami","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"306-313"},"PeriodicalIF":1.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141373029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander T. Gallo MPharm, PhD, Paul B. Fitzgerald MBBS, MPM, PhD, FRANZCP
Purpose of Review
On 1 July 2023, the Therapeutic Goods Administration approved 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for the treatment of post-traumatic stress disorder (PTSD). Accordingly, the purpose of this review is to provide an overview of MDMA and what pharmacists should know as this treatment emerges.
Sources of Information
EMBASE, MEDLINE, and CINAHL databases were searched to provide an overview narrative synthesis of the literature on MDMA, relevant to pharmacists.
Key Findings
Cytochrome P450 2D6 is involved in the metabolic pathway of MDMA, an enzyme inhibited by a number of drugs used in the pharmacological management of PTSD (e.g. selective serotonin reuptake inhibitors). Co-administration of these drugs with MDMA can lead to increases in plasma MDMA concentrations. Additionally, inhibition of the serotonin transporter can inhibit the uptake of MDMA into the presynaptic terminal, dampening the effects of MDMA and potentially, limiting the effectiveness of MDMA-assisted psychotherapy. Accordingly, these drugs are typically withdrawn prior to treatment with MDMA. While selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor drugs with MDMA are unlikely to cause serotonin toxicity, monoamine oxidase inhibitors can. Other drugs, such as caffeine, alcohol, over-the-counter medicines, and complimentary/alternative medicines, can also interact with MDMA.
Conclusion
With a detailed knowledge of the pharmacology of MDMA, pharmacists may play a role in MDMA-assisted psychotherapy by collecting a detailed medication history and assisting clinicians in the withdrawal of interacting medicines.
{"title":"3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy: what the pharmacist needs to know","authors":"Alexander T. Gallo MPharm, PhD, Paul B. Fitzgerald MBBS, MPM, PhD, FRANZCP","doi":"10.1002/jppr.1921","DOIUrl":"10.1002/jppr.1921","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose of Review</h3>\u0000 \u0000 <p>On 1 July 2023, the Therapeutic Goods Administration approved 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for the treatment of post-traumatic stress disorder (PTSD). Accordingly, the purpose of this review is to provide an overview of MDMA and what pharmacists should know as this treatment emerges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sources of Information</h3>\u0000 \u0000 <p>EMBASE, MEDLINE, and CINAHL databases were searched to provide an overview narrative synthesis of the literature on MDMA, relevant to pharmacists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>Cytochrome P450 2D6 is involved in the metabolic pathway of MDMA, an enzyme inhibited by a number of drugs used in the pharmacological management of PTSD (e.g. selective serotonin reuptake inhibitors). Co-administration of these drugs with MDMA can lead to increases in plasma MDMA concentrations. Additionally, inhibition of the serotonin transporter can inhibit the uptake of MDMA into the presynaptic terminal, dampening the effects of MDMA and potentially, limiting the effectiveness of MDMA-assisted psychotherapy. Accordingly, these drugs are typically withdrawn prior to treatment with MDMA. While selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor drugs with MDMA are unlikely to cause serotonin toxicity, monoamine oxidase inhibitors can. Other drugs, such as caffeine, alcohol, over-the-counter medicines, and complimentary/alternative medicines, can also interact with MDMA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With a detailed knowledge of the pharmacology of MDMA, pharmacists may play a role in MDMA-assisted psychotherapy by collecting a detailed medication history and assisting clinicians in the withdrawal of interacting medicines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 3","pages":"199-208"},"PeriodicalIF":1.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1921","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nameer van Oosterom BPharm (Hon), PhD, Michael Barras PhD, Neil Cottrell PhD
Background
Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality, with total hip arthroplasty (THA) and total knee arthroplasty (TKA) at the highest risk. Safe and appropriate thromboprophylaxis is essential. However, investigations into prescribing practices have been limited.
Aim
To describe current VTE prophylaxis regimens in Australian patients following an elective THA/TKA and compare these regimens to an international standard.
Method
A retrospective multisite case series of patients admitted for a THA/TKA in six tertiary hospitals in Queensland, Australia, was conducted over 12 months (1 October 2017–30 September 2018). Patient and medication data were collected following surgery and for 60 days after discharge to determine changes to the patients' thromboprophylaxis regimen. Results were summarised and compared to National Institute for Health and Care Excellence (NICE) guidelines. Ethical approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2018/QMD/46757) and the study conforms to the National Statement on Ethical Conduct in Human Research.
Results
The study included 1011 patients (43.1% THA, 56.9% TKA), and thromboprophylaxis was used in 98.1% of inpatients and in 94.3% of discharge patients for 5.2 (±5.2) and 29.2 (±15.9) days (±standard deviation) respectively. Low-molecular-weight heparins (LMWHs) were the primary drugs for inpatients (71.2%) and aspirin 150 mg for discharge (42.0%), most commonly for 6 weeks (31.8%). Aspirin was used for significantly longer duration than rivaroxaban and LMWH (p < 0.001). A two-staged prophylaxis regimen was implemented, most commonly any anticoagulant as an inpatient; followed by rivaroxaban on discharge (32.7%) or an anticoagulant as an inpatient with aspirin on discharge (26.4%). Overall, adherence to NICE guidelines was low; THA: 8.7%, TKA: 5.9%.
Conclusion
VTE prophylaxis regimens varied considerably, and consequently, adherence to international guidelines was low. There is a need for local, peer-led guidelines to ensure consistent, safe, and effective prophylaxis.
{"title":"Prevention of venous thromboembolism after total hip and knee arthroplasties in Australian hospitals: what are we using?","authors":"Nameer van Oosterom BPharm (Hon), PhD, Michael Barras PhD, Neil Cottrell PhD","doi":"10.1002/jppr.1919","DOIUrl":"10.1002/jppr.1919","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality, with total hip arthroplasty (THA) and total knee arthroplasty (TKA) at the highest risk. Safe and appropriate thromboprophylaxis is essential. However, investigations into prescribing practices have been limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe current VTE prophylaxis regimens in Australian patients following an elective THA/TKA and compare these regimens to an international standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective multisite case series of patients admitted for a THA/TKA in six tertiary hospitals in Queensland, Australia, was conducted over 12 months (1 October 2017–30 September 2018). Patient and medication data were collected following surgery and for 60 days after discharge to determine changes to the patients' thromboprophylaxis regimen. Results were summarised and compared to National Institute for Health and Care Excellence (NICE) guidelines. Ethical approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2018/QMD/46757) and the study conforms to the <i>National Statement on Ethical Conduct in Human Research</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 1011 patients (43.1% THA, 56.9% TKA), and thromboprophylaxis was used in 98.1% of inpatients and in 94.3% of discharge patients for 5.2 (±5.2) and 29.2 (±15.9) days (±standard deviation) respectively. Low-molecular-weight heparins (LMWHs) were the primary drugs for inpatients (71.2%) and aspirin 150 mg for discharge (42.0%), most commonly for 6 weeks (31.8%). Aspirin was used for significantly longer duration than rivaroxaban and LMWH (p < 0.001). A two-staged prophylaxis regimen was implemented, most commonly any anticoagulant as an inpatient; followed by rivaroxaban on discharge (32.7%) or an anticoagulant as an inpatient with aspirin on discharge (26.4%). Overall, adherence to NICE guidelines was low; THA: 8.7%, TKA: 5.9%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VTE prophylaxis regimens varied considerably, and consequently, adherence to international guidelines was low. There is a need for local, peer-led guidelines to ensure consistent, safe, and effective prophylaxis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"287-295"},"PeriodicalIF":1.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanja Mirkov BPharm, PGDipPH, Rhondda Jones BSc, BInfTech, PhD, Alexander Ison BPharm, Allan Wilesmith CertIVInfoTech, Jason Black BScPharm (Hons), ClinDipPharm
<div> <section> <h3> Background</h3> <p>Provision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication-related harm.</p> </section> <section> <h3> Aim</h3> <p>To report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia.</p> </section> <section> <h3> Method</h3> <p>A literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period-prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi-squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383-1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non-identifiable data about human beings.</p> </section> <section> <h3> Results</h3> <p>In total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non-Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%).</p> </section> <section> <h3> Conclusion</h3> <p>The study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the prop
{"title":"Design and development of the clinical pharmacy key performance indicators dashboard for equity of service provision at regional and rural hospitals in North Queensland, Australia","authors":"Sanja Mirkov BPharm, PGDipPH, Rhondda Jones BSc, BInfTech, PhD, Alexander Ison BPharm, Allan Wilesmith CertIVInfoTech, Jason Black BScPharm (Hons), ClinDipPharm","doi":"10.1002/jppr.1920","DOIUrl":"10.1002/jppr.1920","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Provision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication-related harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period-prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi-squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383-1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non-identifiable data about human beings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non-Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the prop","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"296-305"},"PeriodicalIF":1.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nazanin Falconer PhD, FANZCAP (Research), Ian Scott MBBS, FRACP, MHA, MEd, Michael Barras PhD, FANZCAP (Lead&Mgmt, Research)
<p>Imagine hospitals where clinicians can quickly and accurately identify patients at risk of medication harm and why. This is what artificial intelligence (AI) promises, and it’s closer than we think.</p><p>While the past decade brought electronic health records (EHRs) and decision support systems, AI-enabled machine learning (ML) prediction models and large language models have emerged, with the potential to greatly assist clinical decision-making and improve patient outcomes. For example, AI can predict optimal doses of pharmacokinetically complex medications<span><sup>1</sup></span> and identify adverse drug reactions among coded discharge data. These new tools can support busy pharmacists by automating tedious tasks and discerning clinical scenarios warranting pharmacist intervention.</p><p>This editorial highlights considerations relating to AI/ML technologies applied to medicine management in Australian hospitals, drawing insights from local experience in designing and evaluating a ML dosing algorithm for unfractionated heparin (UFH).</p><p>Risk prediction algorithms are common, such as the CHADS-VASc and HAS-BLED scores, developed using conventional statistical (regression) methods. But with the availability of ‘big data’ from EHRs within multiple hospitals, clinician researchers, data scientists, and informaticians can now collaborate to develop more accurate real-time predictive algorithms using AI/ML. Some examples include predicting an individual’s likelihood of a medication-related hospital readmission, suffering a bleed with anticoagulant therapy, or rapid deterioration due to undertreated illness. Detecting and treating these conditions can optimise patient outcomes.</p><p>The ultimate question is whether AI tools enable clinicians to work smarter and more efficiently, save healthcare costs, and render patient care more effective and safe. Machines don’t tire and are not influenced by emotions, and they can learn and process vast amounts of information faster and more accurately than humans. But human oversight and judgement remains crucial in ensuring the appropriate design and use of algorithms and monitoring their performance. Machines exist to augment, not usurp, clinician decision-making, empowering pharmacists to focus more on empathic patient interactions, education, and counselling and fostering interprofessional healthcare delivery; integral care components for which no machine can substitute.</p><p>The future of hospital pharmacy is undeniably intertwined with the evolution of AI, and we should embrace and lead the agenda in using them as supportive tools to enhance our clinical practice.</p><p>The authors declare that they have no conflicts of interest.</p><p>Conceptualisation: NF, IS, MB. Investigation: NF. Writing — original draft: NF, IS, MB. Writing — review and editing: NF, IS, MB.</p><p>Ethical approval was not required for this editorial as it did not contain any human data or participants.</p><p>Not commissioned,
想象一下，在医院里，临床医生可以快速、准确地识别有用药风险的病人，并找出原因。过去十年间，电子健康记录（EHR）和决策支持系统应运而生，而人工智能支持的机器学习（ML）预测模型和大型语言模型也已出现，有望极大地协助临床决策并改善患者预后。例如，人工智能可以预测药代动力学复杂药物的最佳剂量1 ，并在编码的出院数据中识别药物不良反应。这篇社论强调了将人工智能/ML 技术应用于澳大利亚医院药物管理的相关注意事项，并从当地设计和评估非小量肝素（UFH）ML 剂量算法的经验中汲取了深刻的见解。但是，随着来自多家医院电子病历的 "大数据 "的可用性，临床研究人员、数据科学家和信息学家现在可以合作使用人工智能/ML 开发更准确的实时预测算法。其中一些例子包括预测个人因药物相关原因再次入院的可能性、抗凝治疗导致出血的可能性，或因疾病治疗不及时而导致病情迅速恶化的可能性。最终的问题是，人工智能工具是否能让临床医生更智能、更高效地工作，节省医疗成本，使患者护理更有效、更安全。机器不会疲倦，也不会受情绪影响，它们可以比人类更快、更准确地学习和处理大量信息。但是，人类的监督和判断对于确保算法的适当设计和使用以及监控其性能仍然至关重要。不可否认，医院药学的未来与人工智能的发展息息相关，我们应该接受并引领将其作为辅助工具的议程，以提高我们的临床实践水平：NF, IS, MB.调查：调查：NF。写作--原稿：NF, IS, MB.写作--审阅和编辑：NF、IS、MB：本社论不包含任何人类数据或参与者，因此无需获得伦理批准。本社论未接受委托，未经外部同行评审。本社论未从公共、商业或非营利部门的任何资助机构获得特定资助。
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