Research in Social & Administrative Pharmacy最新文献

Background: Pharmacy technicians play a crucial role in the healthcare system to enable pharmacists to focus on clinical services. However, a lack of recognition for their role and contribution leads to high turnover rates.

Objective: To identify the reasons behind pharmacy technicians leaving, or intending to leave, pharmacy practice.

Methods: This study used a mixed methods approach, incorporating an online survey (n = 11,762; response n = 603, 5.2 % response rate) and semi-structured interviews (n = 19) with pharmacy technicians in England. The survey was designed based on instruments used previously to explore pharmacy professionals' career commitment, organisational commitment, job satisfaction, job stress and intention to leave. Open-ended survey texts (n = 24,410 words) were analysed using Leximancer, a text-mining software application. The interviews offered qualitative insights into the views and experiences of pharmacy technicians and the factors that contribute to their intention to leave practice.

Results: Career advancement opportunities for pharmacy technicians are limited, especially when compared to pharmacists in leadership positions. Organisational commitment has an impact on individual career commitment. We found significant associations between the sector pharmacy technicians work in and their intention to remain working with their current employer for two or more years, with those in general practice were most likely to remain working at their current place of employment for at least two years (N = 85,91 %) and those in community pharmacies were least likely (N = 87,71 %). Respondents were most likely to be satisfied with freedom to choose working methods (72 %) and least likely to be satisfied with the opportunity for promotion/career advancement (38 %).

Conclusion: The phenomenon of 'occupational regret', where negative emotions prompt employees to leave their chosen career, must be acknowledged and addressed to ensure retention. Ensuring clear role definitions, equitable remuneration, and career progression opportunities for pharmacy technicians is vital for their retention and, ultimately, the quality of patient care.

Background: Systematic reviews are critical for evidence-based healthcare decisions, but their validity depends on the quality of conduct and reporting. AMSTAR-2, a widely used tool for assessing the quality of systematic reviews, identifies seven critical domains influencing review validity, although its developers recommend flexibility in prioritizing these domains. To date, no studies have analyzed the impact of this change on systematic reviews with meta-analysis (SRMAs) evaluating clinical pharmacy services.

Objective: To evaluate the quality of SRMAs on clinical pharmacy services and the effect of modifying AMSTAR-2 domains criticality on quality assessment.

Methods: Systematic searches (updated January 1, 2023) were conducted in PubMed, Scopus, and Web of Science to identify SRMAs reporting the effects of clinical pharmacy services. Manual reference list searches of included studies were also performed. The methodological quality of SRMAs was assessed using the AMSTAR-2 tool. Changes in the overall classification of each SRMA were analyzed by hypothetically removing the critical designation for domains in the original tool.

Results: Out of 153 eligible SRMAs, 138 (90.2 %) were classified as critically low quality, 13 (8.5 %) as low quality, and 2 (1.3 %) as moderate quality. Despite slight improvement in methodological quality over time, this change was not directly linked to the creation of various reporting and conducting guidelines and registries. Our analysis showed that the hypothetical removal of the criticality of each AMSTAR-2 domain did not significantly impact the overall quality assessment. Furthermore, all critical domains in AMSTAR-2 are considered essential in the field of pharmacy practice.

Conclusion: Most SRMAs on clinical pharmacy services were classified as low or critically low quality and modifying the AMSTAR-2 domain criticality did not improve these assessments. Researchers, journal editors, and peer reviewers must work to enhance SRMAs quality, which are crucial for providing robust evidence for pharmaceutical services.

Background: The incorporation of Question Prompt Lists (QPLs) into pharmacy interactions has been tested as an innovative strategy aimed at enhancing patient engagement and addressing personal information needs. However, there is a gap in understanding regarding how QPLs induce or reduce patient activation and contribute to improved medical treatment. The specific aim of the study was therefore to qualitatively describe how pharmacy encounters in which QPL are introduced unfold, in order to identify and discuss relevant interactional mechanisms that induce or reduce patient activation.

Methods: The QPL, which includes questions about usage, interaction, side effects, and follow-up, was introduced to patients during pharmacy encounters. Employing a qualitative inductive approach based on principles from conversation analysis (CA), audio-recordings from 56 QPL encounters in community pharmacies were transcribed and thematically analysed.

Results: Most meetings began with a long initiation phase focused on determining which medications to take home. This was followed by an introduction to the QPL and a natural break where the pharmacist left to get the medicines, giving the patient an opportunity to contemplate their needs, as prompted by the QPL. While the QPL itself was not explicitly explained or discussed, the majority of patients asked questions and shared personal information. Even those who were disinterested felt compelled to justify their stance, demonstrating the influence of the norm of reciprocity. However, instances of unsolicited information provision by the pharmacist, were still identified.

Conclusion: This study demonstrates that QPLs can enhance patient activation in pharmacy encounters, even without detailed explanations, but their impact is not straightforward. The presence of the QPL encouraged patients to engage, share personal information, and ask questions. These findings suggest that QPLs can create opportunities for patient involvement, even in brief pharmacy interactions.

Background: Pharmacy practice faculty research profiles extend beyond the clinical and social domains, which are core elements of pharmacy practice. But as highlighted by journal editors in the Granada Statements, there is no consensus on these terms. Four domains (clinical, education, social & administrative, and basic & translational) of pharmacy practice faculty research are proposed.

Objectives: To develop a classifier for categorizing pharmacy practice faculty publications into four proposed domains, and to compare the model with zero-shot performances of state-of-the-art, general purpose large language models (gpLLMs).

Methods: One thousand abstracts from 2018 to 2021 documents published by pharmacy practice faculty were reviewed, labelled and used to screen and finetune several Bidirectional Encoders Representations from Transformers (BERT) models. The selected model was compared with zero-shot performances of 7 state-of-the-art gpLLMs including ChatGPT-4o, Gemini-1.5-Pro, Claude-3.5, LLAMA-3.1 and Mistral Large, using 80 randomly selected abstracts from 2023 publications labelled with ≥80% consensus by all authors. Classification metrics included F1, recall, precision and accuracy, and reproducibility was measured with Cohen's kappa. A use case was demonstrated by testing the null hypothesis that the research domain distribution of faculty publications was independent of the pandemic.

Result: The model - Pharmacy Practice Research Domain Classifier (PPRDC) produced a 5-fold stratified cross-validation metrics of 89.4 ± 1.7, 90.2 ± 2.2, 89.0 ± 1.7, and 95.5 ± 0.6, for F1, recall, precision and accuracy, respectively. PPRDC produced perfectly reproducible classifications (Cohen's kappa = 1.0) and outperformed zero-shot performances of all gpLLMs. F1 scores were 96.2 ± 1.6, 92.7 ± 1.2, 85.8 ± 3.2, and 83.1 ± 9.8 for education, clinical, social, and translational domains, respectively.

Conclusions: PPRDC (https://sadeosun-pprdc.streamlit.app) performed better than gpLLMs in this abstract classification task. Among several other impacts, PPRDC opens a new frontier in bibliometric studies; it will also advance the goals of the Grenada Statements by aiding authors and journal editors in journal selection and article prioritization decisions, respectively.

Background: Falls among older adults are considered a significant global health concern, often leading to severe injuries and increased healthcare costs. Fall-risk-increasing drugs (FRIDs), such as opioids and benzodiazepines, have been identified as contributing factors, yet the causal relationship remains unclear. This study examined the association between FRIDs, identified using the STOPP version 2 and STOPP Fall criteria, and falls among older outpatients.

Methods: This retrospective cohort study included 19,705 patients aged 65 and older who visited outpatient clinics at Thammasat University Hospital, Thailand, in 2021. Data were collected from electronic medical records, including demographics, public health insurance schemes, diagnoses, and prescribed medications. FRIDs were identified using section K of STOPP version 2 and STOPPFall criteria. The association between FRIDs and falls was analyzed using multiple logistic regression.

Results: The prevalence of FRIDs was 33 %, with Lorazepam being the most common. The overall incidence of falls was 1.48 %. An adjusted relative risks (ARR) of falls in the participants with FRIDs was 1.35 (95 % CI: 1.03-1.76) and 1.31 (95 % CI: 1.03-1.66) according to STOPP version 2 and STOPPFall criteria, respectively. Females, patients over 70, and those with polypharmacy or frequent outpatient visits also had increased fall risks.

Conclusion: FRIDs are associated with an increased risk of falls among older adults in outpatient settings. These findings highlight the need for careful prescribing and monitoring of FRIDs, particularly in older patients with other fall risk factors.

Background: Worldwide, hospitals are responsible for restoring health. However, poorly executed processes in these institutions can lead to risks and harm to patients, especially in identifying drug related problems. This fact justifies the proposal of tools to support the diagnosis, management and resolution of these problems.

Objective: To develop and content validate a clinical record that is oriented towards drug-related problems.

Method: A drug-oriented clinical record was first developed, after which it underwent content validation. The study was carried out between September and December 2017.7 The first version of the drug-related clinical record was prepared by two experienced researchers, using studies and problem-oriented medical tools described in the literature. Thereafter, content validation was performed using the nominal group technique. The expert panel consisted of a physician, two nurses, and three pharmacists with clinical experience in a hospital setting or pharmaceutical care. After that, the respective instrument was assessed according to the criteria objectivity, simplicity, clarity, relevance. These criteria are intended to ensure the rigor and reliability of instrument content.

Results: Experts' suggestions included modification of the order of some items, insertion of new items, modification of item-writing procedures, expansion of specific fields, and better specification of data that is to be filled in as an item. The final version of the instrument was titled "DAM Clinical Record" (Diagnostics - Adverse Clinical Findings - Medicines) and comprised 45 items categorized into six sections: Patient Identification, Anamnesis, Clinical Diagnosis, Adverse Clinical Findings, Medicines and Pharmaceutical Evaluation.

Conclusion: A clinical record oriented towards drug-related problems, named DAM, was developed to guide healthcare professionals in identifying and solving drug-related problems. All relevant information generated in the hospital setting was consecutively stored as drug problem-oriented clinical records after undergoing thorough content validation.

Introduction: The determinants of antimicrobial prescribing often involve social influence, which can be harnessed through behaviour change techniques (BCTs). While previous studies have used BCTs to address antimicrobial resistance, there is a lack of evidence regarding their application to address climate change-related issues in antibiotic prescribing. This study aimed to develop a behaviour change intervention (BCI) using information about greenhouse gas emissions to reduce liquid antibiotic prescribing.

Methods: A convenience sample of participants from a primary care practice in North East England participated in semi-structured interviews. The intervention design was guided by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Data were analysed thematically, mapped to the TDF, and used to refine the BCI.

Findings: Participants identified motivating factors related to high rates of liquid prescribing, climate change, and solid oral dosage form (pill) aversion. The broader context of practice, such as initiatives reduce cost and improve sustainability, provided opportunities for intervention. Participants demonstrated the capability to change prescribing behaviours and expressed willingness to share resources within their teams.

Conclusion: This study underscores the potential of BCIs using greenhouse gas emissions data to reduce liquid antibiotic prescribing. Further research should focus on implementing and evaluating these interventions in practice settings.

Background: Point-of-care testing (POCT) is a valuable diagnostic approach for identifying pathogens such as Group A Streptococcus (GAS) and influenza. Early detection through POCT allows for timely initiation of appropriate treatments improving public health outcomes and minimizing antibiotic misuse. Community pharmacists are well positioned to offer POCT and treatment, but they face significant system level barriers to widespread implementation and reach.

Methods: This narrative review employs Ecological Systems Theory to examine the role of community pharmacists in the implementation of POCT and subsequent treatment for respiratory infections and synthesize findings from a range of studies at different levels of the system. Medline was used to identify articles with MESH headings of rapid diagnostic tests and community pharmacists. Articles were reviewed and used to inform the synthesis. Additional articles were identified using free-text search to fill gaps in the domains.

Results: The review indicates that community pharmacists are well-positioned to provide POCT for respiratory infections, addressing barriers such as appointment availability, scheduling difficulties, and distance to primary care facilities. The accessibility of neighborhood pharmacies can significantly reduce health disparities by offering timely testing and treatment options. Studies demonstrate that early intervention facilitated by POCT in pharmacies leads to better health outcomes and more efficient use of antibiotics and antivirals.

Conclusions: Community pharmacists play a crucial role in expanding access to POCT and treatment for respiratory infections, particularly in underserved areas. Their involvement can lead to improved public health outcomes by ensuring early and appropriate treatment. Future research should focus on overcoming barriers to POCT implementation in pharmacies and further quantifying the impact on health disparities and treatment efficacy. The integration of POCT services in community pharmacies represents a significant advancement in public health strategy, enhancing the overall healthcare delivery system.

Background: Patients with hypertension and other comorbidities have difficulties adhering to their medications which have negative impacts on clinical outcomes. Although some studies have identified strategies to improve medication adherence, a thorough analysis of these interventions will provide synthesized evidence for clinical decision-making and improved health outcomes for patients with hypertension comorbidities.

Aim: To conduct a scoping review on interventions that have been utilised to improve medication adherence in patients with hypertension and other co-morbid conditions.

Methods: A systematic literature search was conducted in the following databases: CINAHL, COCHRANE TRIALS, MEDLINE, and SCOPUS. One (1) search engine, GOOGLE SCHOLAR was included. This was done between September 2023 to February 2024. The PRISMA-SCR guidelines were followed for this review. A total of 456 unique studies were identified after duplicates were removed. Following screening and eligibility assessments, 26 papers were selected for review with a focus on the study aim and purpose, study population, interventions used and adherence measures.

Results: Most of the interventions were delivered by pharmacists, with 25 studies utilising the multimodal intervention approach. A total of 22 studies (80 % of the total) found that the interventions significantly improved medication adherence. Results from 16 studies showed a significant improvement in blood pressure. Improvements in medication adherence were a common outcome of interventions that focused on patient education.

Conclusion: Interventions such as patient education, simplified treatment regimens, and multidisciplinary care can improve medication adherence and clinical outcomes in patients with hypertension and comorbidities, but further research is needed to understand long-term effects.