Integrated Pharmacy Research and Practice最新文献

Background: The first online pharmacy (soma.com), started in the United States in 1999, a decade later, e-pharmacy industry has transformed owing to the rise of online shopping, electronic health solutions and direct-to-consumer healthcare. With over 35,000 online pharmacies worldwide, developing countries like Uganda are seeing the emergence of online pharmacy services yet there is limited data on their readiness to provide these services. We evaluated readiness to offer online pharmaceutical services in Kampala Metropolitan Area (KMA).

Methods: A cross-sectional study was conducted in 272 retail pharmacies selected by proportionate stratified random sampling from Kampala, Wakiso, Mukono, and Mpigi districts of KMA. Data to assess human resource and technological readiness was collected quantitatively using a questionnaire while assessment of legal and regulatory readiness was done qualitatively using key informants (regional managers of National Drug Authority). Descriptive statistics was conducted for quantitative data and thematic analysis was done for qualitative data.

Results: Majority, 222 (95%) of the pharmacies engaged in online pharmacy services offering; tele-pharmacy 189 (85%), home drug delivery 141 (64%), e-prescriptions 97 (44%), home delivery with follow-up 94 (42%), prescription reminder services 79 (36%), and online consultations 75 (34%). Only 23 (10.4%) of online pharmacies had good human resource readiness, 124 (55.9%) had good technological infrastructure readiness and only 20 (9%) had good readiness for both Technological infrastructure and Human resources. Findings also showed a lack of specific regulations and legal frameworks for online pharmacies, minimal enforcement on the quality and authenticity of products sold online, and minimal public awareness and education on online pharmacy services.

Conclusion: The majority of the pharmacies in KMA practiced some online pharmacy with over half of the pharmacies having the necessary infrastructure and the majority lacking the human resource requirements for online pharmacy services.

Along with the positive development in health services and facilities, hospital pharmacy practice in Nepal has also evolved. The minimum service standards (MSS) developed by the Ministry of Health and Population of Nepal act as a structured framework to assess hospitals' readiness and capacity to deliver quality health services and consist of three significant domains: governance and management standards, clinical service management standards, and support service standards. The clinical service management standards also consist of the hospital pharmacy service standards of practice checklist. This study presents a perspective review of MSS checklists and their implications for pharmacy services, where we discuss how the MSS checklist acts as a viable tool for strengthening the hospital pharmacy practice in Nepal's primary, secondary, and tertiary hospitals. Following the MSS checklist, hospital administration, hospital leaders, hospital management committee, and the hospital pharmacy and therapeutic committee can help to develop further action plans to mitigate issues, thus resulting in 100% compliance with the checklist and quality improvement. This paper can also serve as evidence or a start-up for conducting MSS-based research at the provincial and federal levels to inform hospital pharmacy-based practices among the policy-related institutions in the coming days.

Purpose: Pharmacists ensure prescription accuracy to safeguard patient safety. Clinical decision support systems (CDSS), integrated with computerized physician order entry (CPOE), help detect medication errors and enhance care quality. Traditional homegrown CDSS (HG systems) require manual updates, while commercial CDSS offer real-time, curated drug data but come with licensing costs. To evaluate the impact and benefits of integrating a commercial CDSS with a CPOE system on clinical decision-making and pharmaceutical care in a Taiwanese medical center.

Patients and methods: This retrospective study was conducted in a 1,354-bed teaching hospital in southern Taiwan in 2022. Alerts generated by a homegrown (HG) CDSS and a commercial CDSS, both integrated with CPOE, were compared. Fifty-six trained inpatient pharmacists reviewed prescription alerts. Effective alerts were defined as those initially missed by physicians but corrected after pharmacist intervention. Alerts were categorized by clinical issue type and severity. A model incorporating the probability of adverse drug events (ADEs), extended hospital stays, and daily costs was used to estimate cost savings. A benefit-cost ratio was calculated to assess the added value of the commercial CDSS.

Results: The commercial CDSS generated 357 effective alerts, and the HG system generated 251. Over 95% of pharmacist interventions were accepted by physicians. The commercial CDSS helped avoid inappropriate prescriptions, which resulted in estimated cost savings from USD 78,540 to USD 103,530 and reduced hospital stays by 470-620 days.

Conclusion: Using a commercial CDSS to assist pharmacists in prescription verification provides the most real-time information and efficiently identifies inappropriate prescriptions. This reduces medical costs and avoids prolonged hospitalization owing to ADEs.

Background: Pharmaceutical care is currently being implemented in Polish community pharmacies, but remains unsupported by state funding, limiting its widespread adoption. In Spain pharmacists there provide a wide range of pharmaceutical care services.

Objective: The aim of the work is to understand how other countries, such as Spain, have approached pharmaceutical care, which may offer potential strategies. Given this constant evolution and the challenges they face, a comprehensive review of current pharmaceutical care practices is necessary.

Methods: The study design was guided by Newman TV et al. Chosen review type was an umbrella review, which includes systematic reviews, narrative reviews, and meta-analyses concerning pharmacist-led interventions in the field of pharmaceutical care. Utilized PRISMA framework. Used the PubMed database, which includes MEDLINE-indexed articles. Search strategy initially identified 18,076 articles and abstracts. Articles were limited to English-language, free full-text systematic reviews or meta-analyses published between January 2019 and October 2024. The dataset was reduced to 3,016 articles. Ultimately, 13 articles were selected for final analysis.

Results: Given the identified lack of funding and training gaps, Poland must address workforce shortages, strengthen interdisciplinary trust, and ensure proper remuneration for pharmacists. Drawing on Spain's experience, investing in pharmacist-led education and preventive services may significantly enhance care outcomes in community settings.

Conclusion: This review highlights key pharmaceutical services currently implemented in community pharmacies and identifies critical barriers that hinder their widespread adoption in Poland. The main tasks of pharmaceutical care are to reduce morbidity and mortality related to medications. These services are most often not provided due to the lack of additional remuneration for the pharmacist for their provision, which would serve as reimbursement for the cost of delivering these services. The results of this review will serve as a basis for developing future in-depth studies focused on the implementation and delivery of pharmaceutical care.

Purpose: To evaluate the local anesthetic drugs commonly used after hip arthroplasty and knee arthroplasty, and to provide a reference for clinical drug use and drug selection in medical institutions.

Methods: Based on the "Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions (Second Edition)", the included drugs were evaluated from five dimensions of pharmaceutical properties, effectiveness, safety, economy, and other attributes using a 100-point scoring method.

Results: The quantitative scoring results were ranked from high to low as Dishili-Ropivacaine injection (75 points), Naropin-Ropivacaine injection (68.97 points), liposomal bupivacaine (65.06 points), bupivacaine injection (61.05 points), and levobupivacaine injection (60.35 points).

Conclusion: The Dishili-Ropivacaine injection of the collectible variety is a strongly recommended variety, which is recommended to be introduced or retained in the drug catalog of medical institutions, and the Naropin-Ropivacaine injection and liposomal bupivacaine can be adjusted according to the actual situation and clinical needs of medical institutions.

This systematic review aimed to evaluate the association between pharmacists' interventions and health outcomes of patients with type 2 Diabetes Mellitus (DM) in the Middle East. A comprehensive database search was conducted in July 2024 using the electronic databases of PubMed, MEDLINE, Embase, Cochrane Library, Web of Science and Scopus. The search strategy involved the following keywords: "Impact", "Effect", "Pharmacist", "Pharmacy services", "Pharmaceutical Care", "Intervention", "Type 2 diabetes mellitus", "diabetes", and "Middle East". Articles published in the English language between January 2010 and July 2024 related to the research question were included. The data extracted from the included papers were summarized using narrative data synthesis. Twelve articles were selected from 536 retrieved articles, with most studies conducted in hospitals (n = 10) and randomized clinical trials (n = 8). The quality of studies was evaluated using the Cochrane risk of bias tool for RCTs and the Newcastle-Ottawa Scale for non-randomized studies to ensure transparent evaluation of the study quality. Narrative synthesis was employed to address variations in study design, outcomes, and biases. Pharmacist interventions reported included patient education (n = 11), counseling (n = 5), drug therapy initiation (n = 5), and dosage adjustment (n = 5). Studies reported significant reductions in glycosylated (HbA1c) (range: 1.4-1.78%) and fasting blood glucose levels (FBG) (range: 2.3-53 mg/dL), decreased systolic and diastolic blood pressure (range: 4.65-14.9 mmHg), body mass index (BMI) (range: 1-2.44 kg/m2), cholesterol, triglycerides, and total cholesterol, and improved medication adherence, self-care activities, and knowledge of diabetes management. In this review, pharmacist interventions reported were associated with improved clinical and humanistic outcomes among type 2 DM patients in the Middle-East. Therefore, collaborative care models involving pharmacists and other healthcare practitioners in the management of type 2 DM should be considered by health policymakers in the region.

Purpose: Telepharmacy must be monitored within a quality management system in order to guarantee the efficiency, safety and quality of the activities it encompasses. The Spanish Society of Hospital Pharmacy has proposed the first scorecard of quality and activity indicators for Telepharmacy (TIS). The objective of this project is to validate this TIS for its implementation in hospital pharmacy services.

Material and methods: The project was developed in 4 phases: elaboration of the validation questionnaire/validation criteria; selection of hospitals where the study will be carried out; completion of the validation questionnaire by the selected hospitals; analysis of the results, a proposal of conclusions, and preparation of the final document. The validation criteria were performed using the RAND/UCLA methodology for each of the 5 TIS characteristics: holistic, practical, quantitative, usability, and continuous improvement. Characteristics were considered validated when the median was found to be within the score range 5-9 and at least 2/3 (66.66%) of the respondents scored in the range containing the median.

Results: Forty-four hospitals were included and the responses related to TIS characteristics were: holistic=8.2 and 98.5% of responses >5; practical=7.9 and 98.9% of responses >5; quantitative=7.9 and 98.6% of responses >5; usability=6.9 and 87.37% of responses >5; continuous improvement= 7.9 and 100% of responses >5.

Discussion: TIS has been validated for use in hospital pharmacy services and its tools and supporting documents are very useful and comprehensive. Hospital informatics systems are needed to allow efficient extraction of the data necessary to obtain the TIS indices.

Background: The global increase in type 2 diabetes mellitus (DM2) and obesity presents a significant public health challenge, as these interconnected conditions contribute to severe complications, including cardiovascular disease, stroke, and certain cancers. The incretin system, particularly glucagon-like peptide-1 (GLP-1), has emerged as a promising therapeutic target due to its role in glycemic control and weight management.

Objective: This review explores the molecular pharmacology of GLP-1 and its receptor agonists, evaluating their therapeutic efficacy in managing DM2 and obesity.

Methods: A comprehensive literature review was conducted, analyzing recent advancements in GLP-1-based therapies, their mechanisms of action, and their clinical applications. The review also highlights the pharmacokinetic modifications developed to enhance the stability and efficacy of GLP-1 receptor agonists.

Results: GLP-1 receptor agonists have demonstrated significant benefits in improving glycemic control, reducing body weight, and addressing metabolic complications. Novel therapeutic approaches, including dual and triple incretin receptor agonists, are showing enhanced efficacy in both diabetes and obesity management. However, challenges remain in optimizing treatment outcomes, addressing patient variability, and improving long-term adherence.

Conclusion: GLP-1-based therapies have revolutionized the management of DM2 and obesity. Continued research is essential to refine these treatments, overcome existing limitations, and develop personalized approaches to maximize patient outcomes.

Background: "The World Health Organization aims for universal HIV control by 2030, requiring robust healthcare infrastructure and efficient supply chain management". In Uganda, a functional real-time ARV Stock Status (RASS) monitoring system and dashboard was developed to provide real-time intelligent data and reliable and accurate information on antiretroviral drugs and other HIV commodities. This integrates data from different information systems for timely decision-making and supports evidence-based ARV commodities supply chain management solutions. This study aimed to identify the factors influencing the quality and reporting rate for Real-Time ARV Stock Status (RASS) weekly reporting in public health facilities in the West Acholi sub-region of Uganda.

Methods: A mixed-methods cross-sectional study was conducted in six public health facilities of the West Acholi sub-region. Quantitative data involved a review of 312 reports for the reporting rate. The available 180 RASS reports were reviewed for data quality; supplemental qualitative data was gathered through key informant interviews with 11 healthcare workers and stakeholders. Quantitative data was then cleaned using EPI data, and all the variables were coded and analyzed using SPSS version 21. The tables were then computed using the analyzed data from the software, and the pie charts were constructed using the Excel 2019 version. Thematic analysis was done for the key informant qualitative interviews.

Results: Analysis of RASS reports revealed a mixed level of quality, with only 40 reports (22%) categorized as good quality. The overall reporting rate was slightly more than half, with only 180 reports (57.7%) of the expected reports. Key factors influencing data quality were infrastructural limitations, such as unreliable internet, lack of proper equipment, and staff transfers. Lack of training on RASS and limited leadership support were documented to influence the data quality and RASS reporting rate.

Conclusion: The quality of RASS reports could have been better than the national set targets. The reporting rate was slightly above average but far below the national set targets. Several factors affecting both the reporting rate and quality of reports were cited. These include staff attitude, knowledge gap, Staff transfers, poor internet connectivity, and lack of internet data bundles.

Purpose: Artificial Intelligence (AI), especially ChatGPT, is rapidly assimilating into healthcare, providing significant advantages in pharmacy practice, such as improved clinical decision-making, patient counselling, and drug information management. The adoption of AI tools is heavily contingent upon pharmacy practitioners' knowledge, attitudes, and practices (KAP). This study sought to evaluate the knowledge and practices of pharmacists in Saudi Arabia concerning the utilization of ChatGPT in their daily activities.

Patients and methods: A cross-sectional study was performed from May 2023 to July 2024 including pharmacists in Riyadh, Saudi Arabia. An online pre-validated KAP questionnaire was disseminated, collecting data on demographics, knowledge, attitudes, and practices about ChatGPT. Descriptive statistics and regression analyses were conducted using SPSS.

Results: Of 1022 respondents, 78.7% were familiar with AI in pharmacy, while 90.1% correctly identified ChatGPT as an advanced AI chatbot. Positive attitudes towards ChatGPT were reported by 64.1% of pharmacists, although only 24.3% used AI tools regularly. Significant predictors of positive attitudes and practices included academic/research roles (β=0.7, p=0.005) and 6-10 years of experience (β=0.9, p=0.05). Ethical concerns were raised by 64% of respondents, and 92% reported a lack of formal training.

Conclusion: While the majority of pharmacists held positive attitudes toward ChatGPT, practical implementation remains limited due to ethical concerns and inadequate training. Addressing these barriers is essential for successful AI integration in pharmacy, supporting Saudi Arabia's Vision 2030 initiative.