Journal of Pharmacy Practice and Research最新文献

Chronic kidney disease (CKD) is a major health concern with a growing disease burden and inequalities in access to treatments. Glomerular filtration rate (GFR) is accepted as the best overall measure of kidney function and is considered the most important measure for medications cleared by the kidneys. In clinical practice, equations that estimate GFR using validated prediction equations are routinely used. This practice update was developed by a Working Group comprising clinical pharmacists representing the Society of Hospital Pharmacists of Australia (SHPA) Specialty Practice streams of Nephrology, Oncology and haematology, Critical care and Infectious diseases. It is intended to provide practical recommendations for clinical pharmacists who use equations to estimate GFR for medication dosing decisions. The limitations of the various equations in use — such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Cockcroft–Gault equation and Modification of Diet in Renal Disease — are summarised and compared to direct measures of kidney function using exogenous markers. The CKD-EPI equation is recommended to be used routinely as a primary measure of kidney function. Dose adjustments should also consider medication-specific, patient-related, and disease-related characteristics. Kidney function and the response to therapy should be continuously assessed by monitoring the signs, symptoms and disease outcomes, the emergence of adverse reactions or medication-induced disorders and use therapeutic drug monitoring (if available) to adjust doses accordingly.

Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost-beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).

Thyroid disorders are common in older people and cause significant morbidity. There may be fewer symptoms at presentation and increased susceptibility to adverse events, making diagnosis and management more challenging. The approach to management of thyroid disorders in older people differs from that for younger individuals. Factors that need to be considered include frailty, concurrent illness, polypharmacy, drug–drug interactions, and target organ sensitivity to treatment. This review discusses the clinical presentation, pathophysiology, and management of thyroid disorders and the effects of medications on thyroid function in older people.

Activity-based funding is a method of funding hospitals according to the type and volume of services provided and adjusted to their patient population. Currently, pharmacy practice is mainly evaluated with costs and volumes, which are insufficient to properly measure the contribution of pharmacists. Facing the province of Quebec statewide implementation of activity-based funding, expert committees were set up to develop a set of indicators using a predefined framework to assess pharmacy performance throughout all hospital activities and patient care. Through consultations, partners and stakeholders showed strong support for the initiative, putting more emphasis on the assessment of appropriateness as well as quality and safety. Among the different roles of pharmacists, respondents favoured the assessment of the pharmaceutical care and education of trainees and colleagues. Of the 150 candidate indicators initially identified, 24 were selected, of which 13 were prioritised for experimentation.