Integrated Pharmacy Research and Practice最新文献

Background: In the realm of Evidence-Based Medicine, introduced by Gordon Guyatt in the early 1990s, the integration of machine learning technologies marks a significant advancement towards more objective, evidence-driven healthcare. Evidence-Based Medicine principles focus on using the best available scientific evidence for clinical decision-making, enhancing healthcare quality and consistency by integrating this evidence with clinician expertise and patient values. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) have become essential in evaluating the broader impacts of treatments, especially for chronic conditions like HIV, reflecting patient health and well-being comprehensively.

Purpose: The study aims to leverage Machine Learning (ML) technologies to predict health outcomes from PROMs/PREMs data, focusing on people living with HIV.

Patients and methods: Our research utilizes a ML Random Forest Regression to analyze PROMs/PREMs data collected from over 1200 people living with HIV through the NAVETA telemedicine system.

Results: The findings demonstrate the potential of ML algorithms to provide precise and consistent predictions of health outcomes, indicating high reliability and effectiveness in clinical settings. Notably, our ALGOPROMIA ML model achieved the highest predictive accuracy for questionnaires such as MOS30 VIH (Adj. R² = 0.984), ESTAR (Adj. R² = 0.963), and BERGER (Adj. R² = 0.936). Moderate performance was observed for the P3CEQ (Adj. R² = 0.753) and TSQM (Adj. R² = 0.698), reflecting variability in model accuracy across instruments. Additionally, the model demonstrated strong reliability in maintaining standardized prediction errors below 0.2 for most instruments, with probabilities of achieving this threshold being 96.43% for WHOQoL HIV Bref and 88.44% for ESTAR, while lower probabilities were observed for TSQM (44%) and WRFQ (51%).

Conclusion: The results from our machine learning algorithms are promising for predicting PROMs and PREMs in AIDS settings. This work highlights how integrating ML technologies can enhance clinical pharmaceutical decision-making and support personalized treatment strategies within a multidisciplinary integration framework. Furthermore, leveraging platforms like NAVETA for deploying these models presents a scalable approach to implementation, fostering patient-centered, value-based care.

Background: The World Health Organization (WHO) recommends HIV self-testing (HIVST) to complement the existing HIV testing services. Pursuant to this, Rwanda approved the over-the-counter sale of Oral Quick HIV self-tests in community pharmacies, facilitating home testing and addressing accessibility issues. However, the availability and affordability of HIVSTs in these settings remains unexplored. Hence, this study determined the availability and affordability of HIVST kits in Community Pharmacies across Rwanda.

Methods: This cross-sectional study was conducted among 220 licensed community pharmacists between February and May 2023. Tools standardized by WHO and Health Action International (HAI) were used to evaluate the affordability of HIVST kits. An ANOVA followed by a post-hoc test examined significant price differences across regions. Bivariate and multivariate logistic regression analyses were used to identify the factors associated with the availability of HIVST kits.

Results: The availability was 76%, with 53% being finger-stick tests. Pharmacies owned by pharmacists were almost twice as likely to have HIVST available (AOR=1.858; 95%: 1.280-2.629, p=0.007) than their counterparts. Pharmacies in Kigali were more likely to stock HIVST (AOR=3.549; 95%: 1.283-9.814, p=0.015) than in other regions. Pharmacies experiencing frequent requests for HIVST were more likely to have HIVST available (AOR=0.22; 95%: 0.07-0.66, p<0.001) than those with fewer requests. Both oral quick and finger-stick HIVST were priced beyond the affordability of low-income earners. Moreover, significant price differences for Oral Quick HIVST (F=11.349; p<0.001) were observed across regions, with Kigali's prices significantly differing from those in the southern (p<0.001) and western Provinces (p=0.004).

Conclusion: HIVSTs are not economically priced for the lowest-paid workers, with variations in availability and prices across the country. Policymakers should apply subsidies or price regulation strategies to make HIVST more affordable, ensuring equitable access to all regions and income levels.

Introduction: Antimicrobial resistance (AMR) is largely driven by the inappropriate use of antibiotics. This has been attributed to the non-prescription sale of antibiotics in retail drug outlets. Despite the rising number of retail drug outlets in Malawi, the practice of drug dispensing in private pharmacies has not been evaluated. This study therefore assessed the prevalence of non-prescription sales of antibiotics in retail drug outlets in Lilongwe, Malawi.

Methods: A community-based simulated client cross-sectional study was conducted in Lilongwe, Malawi from December 2023 to February 2024 using mystery shopping. Data were analyzed using IBM SPSS software version 29 using both descriptive and Analytical statistics. We computed simple proportions and conducted a hypotheses test using Chi-Square to test for Significance.

Results: Antibiotic dispensing practices were surveyed in 51 retail drug outlets comprising 36 retail pharmacies and 15 drugstores. 35.3% (n=18) of the drug outlets had drug dispensing done by pharmacists, 13.7% (n=7) by pharmacy technicians, 21.5% (n=11) by pharmacy assistants and 25.5% (n=15) by drug dispensers who had no pharmacy-related training. The rate of non-prescription sales of antibiotics ranged between 53% for acute diarrhoea and 92% for upper respiratory tract infections. Amoxicillin was the most dispensed antibiotic across all case scenarios. Over 50% of dispensed antibiotics were done upon recommendation of the drug dispensers in the absence of a doctor's prescription. Furthermore, for all the dispensed antibiotics across all case scenarios, no advice was given for finishing a full course of the antibiotics.

Conclusion: This study found high rates of over-the-counter dispensing of antibiotics, which call for urgent and comprehensive regulatory measures to control antibiotic consumption in an urban part of Malawi that risks increased AMR. These could range from enacting stringent antibiotic dispensing policies to deploying digital systems to monitor prescription practices and community education on rational antibiotic use.

Background: The use of unlicensed medicines has been associated with safety concerns, availability and accessibility issues, and lack of integrated care across care settings.

Objective: To understand the interaction between the views and experiences of those who prescribe, those who supply and those who receive unlicensed "special" medicines, so that factors affecting the patient journey and successful treatment can be identified and used to inform areas for change.

Methods: A qualitative, phenomenological approach was adopted, with semi-structured interviews with prescribers, community pharmacy staff and patients. A combination of stratified, purposive, snowball and convenience sampling was used to identify participants. Interviews were analysed using reflexive thematic analysis and the findings were integrated using an adapted model of the Pillar Integration Process.

Results: Three pillars were constructed after synthesising results from interviews with patients (n=4), prescribers (n=5) and pharmacy staff (n=6): the awareness of licensing status; perceptions of patient care and acceptability of unlicensed medicine use; and challenges associated with the accessibility of unlicensed medicines. The varying levels of awareness when unlicensed medicines are prescribed and the varying perceptions of responsibility and acceptability of the use of unlicensed medicines help to explain the challenges faced by participants across the patient journey, Challenges identified included understanding what unlicensed medicines are, awareness of the licensing status when unlicensed medicines are prescribed, managing care across care settings to ensure the patient is effectively treated and ensuring continuity of care for patients in the community.

Conclusion: The results highlight a clear need for more integrated care and support for prescribers to reduce the chances of delays between care settings, and more patient-centred care to ensure that any delays when accessing medicines do not lead to treatment disruption for the patient. The new national guidelines informed by findings of this study can support policy-makers across the globe.

Introduction: Improper disposal of unused antibiotics poses a significant global challenge, drawing attention from various stakeholders. This discharge of antibiotics into the environment can occur through various means such as industrial production, consumption, and excretion by humans and animals, as well as improper disposal of unused or expired antibiotics. The aim of our study is to investigate the availability of proper disposal of antibiotics in community pharmacies and to explore obstacles and opportunities from pharmacist's point of view.

Methods: This study used a mixed-methods approach that consisted of two study arms: quantitative and qualitative. The quantitative arm used a mystery-shopper method for assessing the disposal of antibiotics in community pharmacies. The qualitative study arm consisted of several in-depth semi-structured focus groups with a sample of pharmacists working in community pharmacies in Riyadh.

Results: The mystery shopper arm showed that 85% (n=88) refused to take the return of antibiotics. Interviews with pharmacists have indicated a lack of knowledge on safe disposal methods for antibiotics and medications. Additionally, pharmacists have cited several factors contributed to accumulation of the antibiotics such as nonadherence or policies mandating the sale of whole medication packs instead of the required amounts as a contributing factor to this issue. Furthermore, there is a lack of dedicated facilities for the population to safely dispose of their medications and/antibiotics.

Conclusion: By acknowledging the factors contributing to improper disposal practices, recognizing the importance of proper antibiotic disposal, and advocating for multi-faceted initiatives, we can work towards mitigating this critical issue. Through collaborative efforts involving education, policy interventions, and community engagement, we can foster a culture of responsible medication disposal, ultimately safeguarding public health and environmental well-being.

Background: Finnish authorities have published specific instructions for prescribing, handling, and dispensing unlicensed medicines and for the associated communication with patients. However, there is a clear research gap concerning the quality of medication counselling given by doctors and especially pharmacists to patients who are prescribed unlicensed medicines. The success of such counselling was studied with a survey for both pharmacy staff and patients.

Methods: The survey was conducted in 2022 with two electronic semi-structured questionnaires, one for patients (or caregivers of underaged patients) purchasing medicines with special or fixed-term special permits from community pharmacies in Finland and one for the pharmacy staff dispensing such medication.

Results: In all, 49% of the 389 pharmacists did not know if the prescribing doctor had given any counselling to the patient, and 52% of the pharmacists had not given any counselling to the patient themselves. Still, 51% of the pharmacists considered that the patient had received sufficient medication counselling. Almost every one of the 36 patients expressed that they had received medication counselling, 61% of them from the prescribing doctor and 53% from a pharmacist.

Conclusion: Medication counselling on unlicensed medicines should be improved to ensure their safe and effective use. This survey revealed that many patients did not receive any such medication counselling as required by the Finnish Medicines Decree.

Purpose: Providing medical, nursing, and welfare services in each community is becoming increasingly important as population ages in Japan, and the demand for aseptic preparation in community pharmacies is expected to increase. In this study, the disparity in the distribution of community pharmacies providing aseptic preparation services were examined to explore how the unequal distribution of the pharmacies can be improved in the future.

Methods: The regional inequality of community pharmacies providing aseptic preparation services was evaluated using Gini coefficients. The regional distribution was evaluated using a geographic information system application.

Results: Only 8.0% of all insurance community pharmacies in Japan provided aseptic preparation services. The Gini coefficient of pharmacies providing aseptic preparation services for the total population of each municipality was 0.410. The population coverage, within 16 km of pharmacies providing aseptic preparation services, was 96.5% of the total population. The residential grid coverage, within 16 km of the pharmacies, was 75.2% of the total network, approximately one quarter not covered. It is estimated that the coverage ratios will improve by some percentage by 2050, although the projected population in 2050 is expected to decrease by approximately 20%.

Conclusion: The current number and distribution of pharmacies providing aseptic preparation services are inadequate, and measures need to be taken to avoid future problems.

Background: The use of telepharmacy in delivering pharmaceutical care services has grown in the past few years; however, there are perceptions of its inappropriateness for providing medical device training among pharmacy students and practicing pharmacists.

Objective: The primary objective of this study was to determine if the telepharmacy approach for providing inhaler technique training service was non-inferior to the face-to-face approach regarding pharmacy students' performance in simulated patient encounters. Secondary objectives were to determine students' self-assessment of their ability to demonstrate and practice inhaler technique between the two modes of communication and their perceptions of telepharmacy.

Methods: A randomized crossover non-inferiority trial was conducted among undergraduate pharmacy students. Outcomes were measured by comparing Objective Structured Clinical Examination (OSCE) scores of participants' performance between two modes of communication while providing inhaler technique training service. Moreover, the participants also completed self-assessment and perception questionnaires.

Results: The telepharmacy approach was non-inferior to the face-to-face approach for demonstrating and practicing the correct inhaler technique based on OSCE scores and a predefined non-inferiority margin of -10%. The results also revealed no significant differences in student self-confidence between the two modes of communication. Moreover, participants had a largely positive perception of telepharmacy and its use in providing inhaler technique training service.

Conclusion: Considering our findings, telepharmacy is a viable alternative to traditional face-to-face consultations for providing inhaler technique training service. However, to address perceived difficulties and differences between virtual and face-to-face consultations, the pharmacy curriculum should include more telepharmacy-related didactic content with experiential learning and simulations.

Purpose: Patient satisfaction with pharmacy services, particularly in outpatient and discharge pharmacy settings, has become a vital metric for assessing medical quality. However, there's limited research on patient satisfaction in discharge pharmacy services in the Kingdom of Saudi Arabia (KSA). This study aims to systematically investigate and delineate the various patient-related and non-patient-related factors that significantly impact patient satisfaction in the realm of discharge pharmacy services.

Patients and methods: This cross-sectional study was conducted over three months at King Abdulaziz Medical City in Jeddah (KAMC-J). The sample size was determined using a single population proportion formula, which resulted in a required sample size of 384 patients. A validated questionnaire with a five-point Likert scale evaluated satisfaction from "Strongly Dissatisfied" (1 point) to "Very Satisfied" (5 points) has been used. Data collectors underwent training and obtained written consent from participants, with questionnaire completion taking 5-10 minutes face to face.

Results: The study encompassed 437 participants, primarily male (59%) with a college education (45.3%), residing mostly in Jeddah (67.3%). Notably, 84.4% were not healthcare providers, and most visited the pharmacy every six months (44.6%). The patient satisfaction survey revealed high scores for counseling understanding, pharmacist courtesy, and the way the pharmacist answered questions (4.94±0.31, 4.94±0.27, 4.94±0.32; respectively), but lower for understanding possible side effects (4.30±1.30) and pharmacy location (4.57±0.99). In logistic regression, visits lasting 10-15 minutes, and less than 10 minutes were significantly (p<0.05) associated with increased odds of patient satisfaction (OR=6.39, OR=9.45; respectively) Moreover, the medium length hospital stay was associated with decreased odds of patient satisfaction (OR=0.31, p=0.026).

Conclusion: In conclusion, the study determined a significant proportion of patients are satisfied with discharge pharmacy services at KAMC-J, with the length of consultation and hospital stay being pivotal to their satisfaction. Addressing these factors, alongside optimizing pharmacist-patient communication and pharmacy service efficiency, can substantially elevate the quality of pharmaceutical care and patient experience.

The field of healthcare is experiencing a significant transformation driven by technological advancements, scientific breakthroughs, and a focus on personalized patient care. At the forefront of this evolution is artificial intelligence-driven pharmacy practice (IDPP), which integrates data science and technology to enhance pharmacists' capabilities. This prospective article introduces the concept of "pharmacointelligence", a paradigm shift that synergizes artificial intelligence (AI), data integration, clinical decision support systems (CDSS), and pharmacy informatics to optimize medication-related processes. Through a comprehensive literature review and analysis, this research highlights the potential of pharmacointelligence to revolutionize pharmacy practice by addressing the complexity of pharmaceutical data, changing healthcare demands, and technological advancements. This article identifies the critical need for integrating these technologies to enhance medication management, improve patient outcomes, and streamline pharmacy operations. It also underscores the importance of regulatory and ethical considerations in implementing pharmacointelligence, ensuring patient privacy, data security, and equitable healthcare delivery.