Integrated Pharmacy Research and Practice最新文献

Background: Tracer drugs are the representative of essential medicines and satisfy the priority healthcare needs of the population. Managing tracer drugs through logistics management information systems is a strategy to enhance their smooth flow for continuous provision of quality health service. This study assessed the availability of tracer drugs and implementation of their logistic management information system in public health facilities of Dessie, North-East Ethiopia.

Methods: Cross-sectional study was conducted from September 15-30, 2017, in all public health facilities of Dessie. The data were collected by reviewing tracer drugs logistic formats and conducting physical inventory. Key informant interview was employed to all pharmacy heads and store managers. Data analysis was done using statistical package for social science version 20 and Microsoft Excel 2010.

Results: Twelve tracer drugs were managed by health facilities. The overall mean availability, mean duration, and average frequency of stock out of tracer drugs (last 6 months) were 74.7%, 48.8 days, and 1.43, respectively. In eight health facilities, logistic records were available, but all health facilities did not use stock cards. Also, 3 out of 9 used the health commodity management information system. On average, 77.8% of the tracer drugs had bin cards, of which, 86% were updated. The discrepancy between physical count and stock keeping records was ranged from 0% to 100%. The causes of stock out were inadequate supply, lack of recording forms, and their inconsistent use.

Conclusion and recommendations: The availability of tracer drugs was less than the recommended percent, and inadequate supply, poor availability and use of recording forms were the reasons for stock out. Thus, health facility managers and pharmacy heads should work in harmony to ensure uninterrupted supply and implement a logistic management information system.

Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.

Background: Disposal of pharmaceutical waste among patients is a global challenge, especially in developing countries like Ethiopia. Improper medication disposal can lead to health problems and environmental contamination. Therefore, the present study was aimed to assess disposal practices of unused medications among patients in public health centers of Dessie town, Northeast Ethiopia.

Methods: A descriptive cross-sectional survey was conducted among 263 patients in four public health centers of Dessie town, Ethiopia from March to June 2019. Face-to-face interviews using structured questionnaires were used to collect data from each study subject.

Results: The majority of the respondents, 224 (85.17%), had unused medications at their home during the study period. The most commonly reported disposal method in the present study was flushing down into a toilet, 66 (25.09%). None of the respondents practiced returning unused medications to the pharmacy. Moreover, 85 (32.31%) of the respondents reported never disposing of their medications and believed that it is acceptable to store medications at home for future use.

Conclusion: In the present study, there was a high practice of keeping medications at home and most of the disposal practices were not recommended methods. In addition, most of the respondents did not receive advice from pharmacists and other health-care professionals on how to dispose of unused medications. Hence, there is a need for proper education and guidance of patients about disposal practices of unused medications.

Objective: The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression.

Methods: A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies.

Results: This paper includes two main sections: 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples.

Conclusion: The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.

Purpose: Self-medication is drug use without advice from a medical professional. Proper self-medication can reduce health expenses and physician waiting time. However, prescription or over-the-counter drugs are considered unsafe when used irrationally. Presumably, university students can make informed decisions regarding their lives. However, there are limited studies documenting self-medication in Ugandan universities. This study sought to document the prevalence, patterns and factors associated with self-medication among students enrolled at Mbarara University of Science and Technology (MUST).

Patients and methods: A descriptive cross-sectional study was done on 385 medical and non-medical students. Data were collected by interviewer-led semi-structured questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS) version 20. The statistical significance was considered as p < 0.05 for both univariate and multivariate analyses.

Results: This study showed a 63.5% prevalence of self-medication. Self-medication reasons were classifying illnesses as minor (33%), time-saving (15%), having old prescriptions (11%) and high consultation fees (9%). Not self-medicating reasons included risk of using wrong drugs (19%), insufficient knowledge (17%), fear of side effects (15%), wrong drug use (15%) and misdiagnosis (14%). Respondents accessed drugs from pharmacies (56%), friends/family (17%) or private clinics (15%). Headache relievers, pain relievers and antibiotics were most commonly self-medicated. In adjusted analysis, being female, existing allergies, and being in advanced years of study were associated with increased odds of self-medication. No statistically significant difference existed between medical and non-medical students regarding self-medication. Self-medication likelihood increased with a lack of access to medical services.

Conclusion: There is a high rate of self-medication amongst female students, those in advanced years of study and those with existing allergies. Medical services access significantly reduced the chances of self-medication. Vital medical services need to be extended to the university students to receive information on medicines, diagnosis, prescription and treatment. More studies should evaluate the impact of a high rate of self-medication among these students.

Objective: A cross-sectional study was carried out to evaluate the practice of unlicensed and off-label drug prescribing/dispensing in children and neonates by physicians and clinical pharmacists in the metropolitan city of Karachi.

Methods: The study was conducted for the duration of 5 months - November 2018 to March 2019 - in different clinics and tertiary care hospitals of Karachi, Pakistan. Respondents were interviewed by our researchers using 30 items questionnaire. Descriptive statistics were used to evaluate the answers of respondents to survey items. Pearson correlation and independent sample t-test were employed to recognize the association between the responses of participants and independent variables. P values less than 0.05 were considered statistically significant.

Results: A total of 421 questionnaires were completed by physicians and clinical pharmacists. The mean age of the study participants was 49.5 years. Around 98% of pharmacists and 93.5% of physicians were well conversant with the definition of unlicensed and off-label drugs. Around 68% of physicians and 77% of pharmacists reported that they were more concerned about the efficacy of such drugs as compared to that of licensed medicines in children. The most frequent off-label categories observed in the study were dose (65.21%) and indication (17.52%). A vast majority (>80%) thought that approving new drugs by regulatory authorities will drop the occurrence of medication errors due to incorrect dosing. The British National Formulary (BNF) for children was used as the best reliable source of information among respondents.

Conclusion: The present study highlighted the common practice of unlicensed and off-label drug prescribing in pediatrics; however, respondents showed their concern towards decreasing such practice and are likely to welcome initiatives intended to assure medication safety in children.

Objective: Community pharmacists are the last point of contact before patients are provided with an inhaled asthma device and are expected to adequately educate and train patients on its use. Evidence has shown that pharmacists lack the knowledge and skills required to appropriately counsel patients on these devices. The aim of this systematic review was to focus on evaluating the effects of educational interventions on community pharmacists knowledge of inhaler technique.

Methods: A literature search was conducted using the databases Pubmed and Embase with no applied time restrictions. The databases were searched from inception to December 2018. Articles were eligible for inclusion if they reported outcomes evaluating the improvement in pharmacists knowledge of inhaler technique after an educational intervention and provided details of the intervention. Pharmacists working in settings other than community pharmacies and inhaler devices used for conditions other than asthma were excluded.

Results: Five studies met the eligibility criteria. Workshops and one-on-one instruction were the main educational strategies used in these studies to augment the pharmacists knowledge of asthma inhaler devices. A checklist was utilized by all studies to evaluate the pharmacists improvement of inhaler technique after an educational intervention. All studies showed an improvement in inhaler technique of pharmacists post-intervention.

Conclusion: Studies identified in this systematic review have shown that an educational intervention produced positive outcomes related to the pharmacists knowledge on the steps involved in using asthma inhaler devices. However, the study findings focused on short-term retention of knowledge of inhaler technique and did not address the application of these results in clinical practice.

Background: Health facilities (HFs) need an extensive range of antiretroviral (ARV) drugs and related HIV/AIDS commodities for diagnosis, prevention, and treatment of HIV/AIDS. This study was aimed to assess supply chain management performance from the perspective of achieving 90-90-90 treatment strategy at HFs of Southern Nations, Nationalities and People's Regional State (SNNPRS), Ethiopia.

Methods: Facilities based cross sectional study design in 30 HFs (9 hospitals and 21 health centers) and five pharmaceuticals fund and supply agencies (PFSAs) was conducted. The HFs were selected randomly. Semi-structured questionnaires and observation checklists with logistic indicators assessment tools (LIATs) were used to collect data for HIV/AIDS related services from November 2016 to May 2017. In addition, we used in-depth face to face interview and thematic approach. Quantitative data were entered into Epi-Data version 3.1 and transported to SPSS version 20 to analyze the result. Qualitative data were analyzed using thematic approach.

Results: Only 9 (30%) HFs had received their orders from PFSA on time from date of report. Average lead time for ARV drugs was 46.4 days in hospitals and 59.2 days in health centers (HCs). Sixteen (60.7%) HFs reported their completed report and requisition format (RRF). From this, 53.3% HFs order was refilled correctly in quantity from that they need. Inventory accuracy rate was 77%. Major HFs, 20 (66.7%) faced at least one-time emergency order for ARV drugs, HIV test kits and viral load (VL) supplies. Whereas, 9 (30%) hospitals and 5 (16.67%) HCs were out of stock two and three times respectively. Sixteen (53.3%) commodities stocked out at least once in six months. Nevirapine (NVP) 10 mg/5 mL in 240 mL was the most stocked out (13 times) for an average 22 days. Uni gold was stocked out (16 times) with average of 34.5 days. Wastage rate was 2.5%. Twenty-five (83.3%) facilities had good storage conditions (>80% to the standard).

Conclusion: Unsatisfactory data records, stock-outs, interrupted reports, inaccurate inventory and wastage rates were indicators for defective supply chain management of HIV/AIDS commodities. Respective organizations should improve their responsible activities to secure commodities availability.

Background: Elderly people are most commonly associated with cardiac disease. Cardiovascular diseases are interlinked with co-morbidities which require multiple drug therapy in addition to cardiovascular drugs. This results to polypharmacy which carries a high risk of potential drug-drug interactions. Elderly patients are at a particular risk of drug related problems because of increased level of polypharmacy and the physiological changes which accompany aging. This study was aimed to assess polypharmacy and potential drug-drug interactions (DDIs) among elderly people with cardiovascular diseases at Yekatit 12 hospital.

Methodology: A retrospective cross-sectional study using patients chart review was conducted on all elderly people with cardiovascular diseases at Yekatit 12 hospital in the period between March 2018 and March 2019. The types, seriousness and level of potential DDIs were checked using Medscape online drug interaction checker.

Results: The mean number of drugs per prescription was 4.25 ± 1.754 and the prevalence of polypharmacy (concurrent use of 5 and more drugs) was 42.7%. Polypharmacy and potential DDIs were significantly associated with polymorbidity (P = 0.000), being hospitalized (P = 0.047) and congestive heart failure (P = 0.016). A total of 850-potential DDIs were identified, the mean number of potential DDIs was 3.37 per prescription. The potential DDIs were mainly significant (73.29%) in nature and pharmacodynamics (73.06%) in mechanism. The prevalence of total and serious potential DDIs were 84.3% and 17.3%, respectively. Most commonly interacting drug combination was aspirin + enalapril (30.2%).

Conclusion: A higher incidence of polypharmacy and increased risk of potential DDIs in elderly people with cardiovascular disease are major therapeutic issues at Yekatit 12 hospital.

Pharmacogenomics (i.e., the application of genetic information in predicting an individual's response to drug therapy) plays an increasingly important role in drug development and decision-making regarding precision medicine. This has been shown to reduce the risk of adverse events and improve patient health-care outcomes through targeted therapies and dosing. As the field of pharmacogenomics rapidly evolves, the role of pharmacists in the education, implementation, and research applications of pharmacogenomics is becoming increasingly recognized. This paper aims to provide an overview and current perspectives of pharmacogenomics in contemporary clinical pharmacy practice and to discuss the future directions on advancing pharmacogenomics education, application, and research in pharmacy practice.