Research in Social & Administrative Pharmacy最新文献

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.

This paper calls for further study of transformational leadership and its further use in educating PharmD students as well as inclusion of continuing education programming and mentoring the behaviours of current pharmacists. It does not present an argument for reduction in use or diminishment of other leadership theories, many of which have at least some overlap with transformational leadership. Rather, emphasis on transformation leadership might be one of many solutions to challenges plaguing the profession currently, with some sense of negativity and challenging workplace conditions among many pharmacists; support personnel and drug shortages; and a need for more collegial citizenship behaviors and stronger organizational culture. Transformative leadership behaviors and communication, versus others particularly more transactional in nature, envisage a future for the entire profession as well as for the individuals who comprise them, articulate the value of the contributions made by the employee, and help imbue a sense of professional identity. These are things sorely needed in the modern workplace and are either explicitly stated or tacitly implied in educational standards and professional competencies. A recent study on transformational leadership as measured by the Multifactorial Leadership Questionnaire (MLQ) found more parsimonious structures toward the definition of transformational leadership and the outcomes resulting from its use, which actually makes it easier to discern and thus even more applicable to incorporate into models of pharmacy education and practice. The time to further study and employ transformational leadership is now.

Background: Various programs aimed at fostering the resilience of students have been implemented into healthcare undergraduate and postgraduate educational courses and degree programs. Which of these increase their participants' resilience under which circumstances, for whom and why remains uncertain.

Methods: A realist review of articles reporting program outcomes as measures of resilience through the use of via validated psychometric surveys was conducted to investigate which contexts favour the development of resilience of healthcare and health sciences students and which mechanisms have to be activated to achieve this outcome.

Results: Thirteen Context-Mechanism-Outcome Configurations were synthesised from data presented in 43 articles. These were combined with theories explaining the theoretical and psychological frameworks underpinning programs to develop a program theory of how and why resilience fostering programs work. Contexts which favour the development of resilience were the use of validated psychological frameworks as program foundation, e.g. Cognitive Behavioural Therapy, mindfulness-based training. Expert facilitation, longitudinal integration into curricula, flexible and multi-modal design and delivery, and opportunities for students to apply and practice resilience-building strategies also created favourable contexts. Meeting students' or practitioners' needs activated mechanisms of trust, engagement and recognition of a program's value and real-world benefits. An increase in resilience was achieved by students developing reflective skills, metacognitive awareness and positive habits of mind.

Conclusion: The program theory established via a realist review provides guidance on how the individual resilience of healthcare students can be fostered throughout their undergraduate, postgraduate degrees and early practice, potentially supporting them to flourish and remain long-term in their chosen professional roles.

Background: Telephone and video consultations have been used as telepharmacy modalities for a number of years, particularly during the COVID-19 pandemic where in-person services were limited. However, a widespread global literature review has yet to be completed on studies since June 2016 regarding the effectiveness of telephone and video consultations as telepharmacy models.

Objectives: The aim of this review was to summarise the synchronous telepharmacy models of care for adult outpatients since June 2016. The secondary aim was to report on the effect of these models on clinical, service, and user-perspectives and non-clinical outcomes compared to the standard model of care, as well as facilitators and barriers of the telepharmacy models.

Methods: A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and Embase in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient; data extraction and narrative analysis were then performed and NHMRC level of evidence determined.

Results: From 2129 unique articles reviewed, 103 were eligible for inclusion. Synchronous telepharmacy services in an outpatient setting were delivered by telephone consultations and video consultations, with the majority being delivered by the telephone modality (87 %) and the remainder by video (13 %). Services primarily involved a pharmacist providing a single consultation with a patient. The purpose of this was either to provide counselling, obtain a best possible medication history, or to provide ongoing support as part of a clinical program, such as diabetes and blood pressure monitoring. Patients reported the quality of care received through telepharmacy consultations provided the same level of care or was superior to in-person services. Key facilitators for the success of telepharmacy services were access to training, technical assistance, digital literacy and availability of technology.

Conclusions: Telephone and video telepharmacy services are being delivered across a range of outpatient clinical areas. More evidence is needed for video consultation services and how this modality may potentially provide further benefit for certain clinical tasks such as counselling and use of medication delivery devices. Overall, telepharmacy services enhance patient accessibility to healthcare and offer a convenient method of delivering high quality services.

Background: The Multifactor Leadership Questionnaire (MLQ) is a validated instrument used to explore participants' perceptions of leadership and the Outcomes of leadership, participants' evaluation of and satisfaction with leadership and willingness to put in extra effort. The factor structure of MLQ varies across studies. The aim was to explore the psychometric properties of the MLQ for early-career pharmacists rating their preceptor's leadership.

Methods: The MLQ was administered to provisionally registered pharmacists during the final half of their 1 year of supervised practice. Confirmatory and Exploratory Factor Analysis (CFA & EFA) and Structural Equation Modeling (SEM) were used to analyse the data.

Results: Responses were obtained from 430 participants (25 % of all Australian pre-registration pharmacists at the time). CFA demonstrated that the original 9-factor model and a range of previously published models were poor fit for the data. EFA revealed that a good fit was a model with 4 factors named: Passive laissez-faire, Strategic visionary, Personalized, and Active management by exception. Passive laissez-faire and Active management by exception were consistent with previously published models. The Strategic visionary and Personalized factors were interpreted as 2 forms of transformational leadership that includes the provision of rewards depending on performance. A SEM of MLQ sub-scales predicting Outcomes of leadership explained 90.3 % of variance. Personalized leadership was highly predictive (β = 0.743, P < 0.001) while the three other factors had negligible effects.

Conclusion: The psychometric analyses demonstrated overlap of the original 9-factors. A more parsimonious 4-factor model fit the data well.

Background: Older adults often manage multiple chronic diseases which necessitates the use of multiple medicines. Nevertheless, they also face an elevated risk of harm when medicines are used inappropriately. Studies indicate that socioeconomic disadvantage, beliefs, and health literacy may correlate with non-adherence and inappropriate medicine use. However, older adults are underrepresented in the current body of literature.

Objective: To investigate the influence of beliefs and health literacy on medication-related outcomes in older adults.

Methods: Participants ≥65 years living in the community were invited to complete a survey. Participants were asked to report demographics, medicines and complete three questionnaires: Self-Efficacy for Appropriate Medication use Scale (SEAMS), Beliefs about Medicines Questionnaire (BMQ) and Health Literacy Questionnaire (HLQ). Descriptive statistics, regressions and correlations were calculated.

Results: A total of 154 participants were included in the analysis (35.7 % male, age range 65-110 y). Mean SEAMS score was 33.2 out of 39 (standard deviation (SD) = 8.0), reflecting high self-efficacy for adherence. Mean HLQ scores were high across the four scales measured in the survey (scales 1, 5, 6, and 9). Sixty-two participants (44.0 %) were using five or more medicines (polypharmacy) and 18 (15.4 %) reported use of a potentially inappropriate medicine. Regarding beliefs, mean BMQ-specific scores were as follows: necessity score 17.5 (SD = 5.1) and concern score 12.0 (SD = 4.0), indicating strong beliefs in the necessity of medicines and few concerns. Results of the regression analysis indicated that where the BMQ-Necessity scores were employed as the independent variable, there was statistical significance with polypharmacy (p < 0.001). Additionally, moderate positive correlations were identified between (1) necessity beliefs and both polypharmacy (r = 0.401, p < 0.001) and adherence (r = 0.477, p < 0.001), and (2) adherence and HLQ scale 5 (r = 0.343, p < 0.001), scale 6 (r = 0.326, p < 0.001) and scale 9 (r = 0.320, p < 0.001).

Conclusion: Older adults who perceive their medicines as necessary are more inclined to report use of multiple medicines, leading to polypharmacy. Additionally, older adults with stronger beliefs in the necessity of medicines and higher levels of health literacy demonstrate greater self-efficacy for adherence. Health professionals should consider evaluating necessity beliefs in older adults to manage potential non-adherence, reduce the risk of polypharmacy, and thereby mitigate the risk of suboptimal medicine use.

Objective: To investigate the association between patient-reported experiences with new medication discharge counselling and readmission to hospital or emergency department (ED) visits within 30 days of discharge.

Methods: A retrospective cross-sectional study of patient-reported experiences from 8715 patients who reported being prescribed a new medication at discharge from a public hospital. Completeness of medication counselling was assessed based on (i) explanation of medication purpose, (ii) explanation of medication side effects, (iii) patient involvement in decision to use medication, (iv) provision of contradictory information. Multilevel models were used to estimate self-reported 30-day readmission or ED visit related to care received using adjusted odds ratios (AORs).

Results: Patients who were explained medication purpose were half as likely to report a readmission (AOR 0.54, 95%CI 0.31-0.93) or ED visit (AOR 0.65, 95%CI 0.48-0.87) within 30 days of discharge. Conversely, those who reported receiving contradictory information were more likely to report a readmission (AOR 1.62, 95%CI 1.16-2.26) and ED visit (AOR 1.82, 95%CI 1.41-2.34).

Conclusion: Patients who reported receiving comprehensive counselling on new medications were less likely to report being readmitted or visiting an ED within 30 days of discharge.

Background: Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic.

Objective: We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications.

Methods: A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines.

Results: Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians.

Conclusions: This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.