Research in Social & Administrative Pharmacy最新文献

Introduction: Clear patient instructions are essential in pharmaceutical care. However, literature reveals a consistent gap between the readability of medication messages and population skills. This study aimed to assess the comprehension of information in three Prescription Medication Leaflets, with and without supplementary US Pharmacopeia (USP) pictograms, among Spanish adolescents completing secondary education.

Methods: We conducted a multicenter randomized controlled trial. From March to June 2022, 590 students were randomly assigned to read Prescription Medication Leaflets for ibuprofen, amoxicillin/clavulanic acid, and omeprazole, with or without USP pictograms. Comprehension was evaluated via questionnaire, alongside the European Health Literacy Survey short form, and sociodemographic data were collected. Mann-Whitney U and chi-square tests were used for analysis.

Results: Participant comprehension was significantly below the European standard, which requires at least 80 % readability for Prescription Medication Leaflets, even with pictograms. Pictograms, however, significantly enhanced comprehension across all medication package inserts (p < 0.001 for all comparisons), especially among students with higher health literacy. High health literacy was a statistically significant factor in comprehension only within the experimental group (p = 0.005; p = 0.039; p = 0.004).

Conclusion: The discouraging results highlight the imperative for innovation in medication labeling design, employing patient-centered approaches. USP pictograms have been shown to significantly enhance the reading comprehension of medication package inserts among the Spanish population.

Introduction: Misuse of over-the-counter (OTC) medications by older adults (age 65+) can comprise Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Pharmacies in the United States are prevalent sources of OTCs and are an apt setting to address OTC misuse. Senior Safe™ is a pharmacy-system redesign for preventing older adult OTC misuse. The redesign uses signage to designate high-risk OTCs and safer products for older adult use, as well as prompting older adults to engage with pharmacy staff around medication safety issue.

Objectives: This study compared misuse in pharmacies with initial Senior Safe implementation (Immediate Effects group) to pharmacies with Senior Safe after 3 months (Sustained Effects group).

Methods: A non-equivalent group design, involving older adults recruited from matched and randomly-allocated pharmacy sites within a health system, compared the Immediate Effects (n = 83) and Sustained Effects (n = 65) groups. All participants were recruited outside the pharmacy and were given hypothetical symptom scenarios from which to choose (i.e., cough/cold/allergy, pain, or sleep). Participants were then asked to select an OTC to treat that symptom, and explain their OTC use at symptom onset and if symptoms persisted/worsened. Participants' reported OTC use was evaluated for each misuse type. Multivariate modeling estimated differences in misuse between the Immediate and Sustained Effects groups.

Results: No significant differences emerged between Immediate and Sustained Effect groups for any misuse type for which statistical modeling was conducted. Drug-Age misuse was statistically less likely for sleep products (OR = 0.170, p = .005) and for adults aged 85+ when compared to the 65-74 and 75-84 age categories (OR = 3.979, p = .053; OR = 6.900, p = .031, respectively).

Conclusions: These non-significant results suggest that the intervention effect was maintained at three months. Overall, then, misuse reductions occurring immediately after intervention implementation did not significantly increase after three months. System buy-in, including assessing costs to implement and maintain Senior Safe, is critical to promote broader adoption.

Background: In recent years, the life expectancy of HIV patients has increased due to the introduction and development of antiretroviral therapies. However, although it has become a chronic pathology, the patients present a higher metabolic, hepatic, and renal risk and a greater aging than the general population.

Objective: To identify the main factors associated with clinical alterations in patients with HIV.

Methods: Observational, descriptive, retrospective, retrospective study in HIV patients attended by a pharmaceutical manager during 2023. A descriptive analysis was performed with measures of central tendency and summary, and a bivariate and multivariate analysis by means of logistic regression considering the presence of clinical alterations as the dependent variable.

Results: A total of 11126 HIV-positive patients were evaluated, mainly men (90 %), with a mean age of 40 years (SD 12.8) and a range between 19 and 95 years. A total of 48.5 % presented clinical alterations at risk levels that should be intervened in a timely manner to ensure the patient's adequate health status. Factors such as age, antiretroviral regimen, adherence, and drug persistence (p < 0.001) were found to be associated with the development of clinical alterations in patients with HIV.

Conclusions: Establishing a prioritization in the follow-up and management of HIV patients focused on patients older than 60 years, with treatment regimens that include protease inhibitors and non-nucleoside reverse transcriptase inhibitors, in antiretroviral therapy initiation, non-adherent and/or with drug persistence problems, could generate more effective interventions focused on reducing clinical risks.

Background: Medicine-related symptom assessment tools have been developed to assist healthcare professionals in detecting potential medicine-related symptoms. This systematic review aimed to identify and evaluate the measurement properties of medicine-related symptom assessment tools.

Method: A systematic search was conducted in Ovid Medline, Ovid Embase, Ovid PsychInfo, and SCOPUS databases up to March 16, 2024. The primary studies that described either the development or measurement properties of a tool for identifying medicine-related symptoms were included. Screening and data extraction was done independently by two reviewers using Covidence. The methodological risk of bias and assessment results of reported measurement properties were evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Result: Eleven studies met the inclusion criteria, reporting on nine unique tools. All included tools had sufficient content validity assessment results. The PHArmacotherapeutical Symptom Evaluation-20 (PHASE-20) had adequate to very good methodological quality internal consistency, construct validity, and reliability. The Patient-Reported Adverse Drug Event Questionnaire also showed adequate methodological quality with sufficient reliability, criterion validity, and construct validity but required over 30 min to complete. The PHASE-proxy exhibited adequate to very good methodological quality, with sufficient results in criterion validity, structural validity, internal consistency, and reliability. The Patient-Reported Outcome Measure Inquiry into Side-Effects showed sufficient content validity but lacked data on other measurement properties.

Conclusion: The majority of the identified tools were tested for one or more measurement properties. Among these tools, PHASE-20 is suitable for assessing medicine-related symptoms in elderly individuals who can participate independently, while PHASE-Proxy is for older adults with dementia or communication disabilities in nursing homes.

Purpose: Diversion or theft of controlled substances is a recognized problem affecting healthcare systems globally. The purpose of this study was to develop a framework for identifying and characterizing system factors leading to vulnerabilities for diversion within hospitals.

Methods: We applied a qualitative framework method, which involved 1) compiling a list of critical diversion vulnerabilities through observations and proactive risk analyses in the inpatient pharmacy, emergency department and intensive care unit of two Canadian hospitals; 2) coding the vulnerabilities into deductively and inductively derived themes and subthemes; and 3) building a conceptual framework.

Results: Our framework for diversion demonstrates how mitigating downstream diversion outcomes (e.g., harms to patients, healthcare workers, and institutions) requires the redesign of upstream system factors associated with pilfering and forgery processes. We identified 20 subthemes associated with the following five overarching themes of system factors contributing to diversion risk: task (e.g., variation in how work was done or lack of verification), person (e.g., use of insider knowledge or collaboration among staff), tools/technologies (e.g., limitations of electronic systems to identify discrepancies), organization (e.g., cultural/behavioural norms or hospital policies for controlled substance management), and internal environment (e.g., layout of the space).

Conclusion: The Diversion Framework is a conceptual model developed for use by practitioners, researchers, and policy makers to identify system factors and analyze medication-use processes that may be vulnerable to diversion. This in turn can inform safeguards to prevent harm to patients, healthcare workers and the institution.

Background: There has been a growing interest in granting prescribing rights to pharmacists as a strategy to improve healthcare access. Researchers continue to explore the impact and implementation of pharmacist prescribing. Given the recent international changes in this field, an overview of current territories allowing pharmacist independent prescribing would provide a comprehensive understanding for researchers and policymakers.

Aim: This scoping review aims to summarize the countries and specific jurisdictions where pharmacists can prescribe independently in community pharmacy, and map the conditions they can prescribe for, required training, and reimbursement policies.

Method: This scoping review was conducted in October 2024 and has been reported following the PRISMA-ScR guidelines. Searches were performed in Scopus, Web of Science, CINAHL, PubMed, and Cochrane databases, along with grey literature searches using Google.

Results: A total of 88 studies and reports were identified. The countries where pharmacist can prescribe independently include the United Kingdom, the United States, Canada, Australia, Poland, Switzerland, and Denmark. Pharmacists authorized as independent prescribers generally require post-registration training and are authorized to initiate, adapt, renew, or substitute prescriptions. For the payment and reimbursement, this service is publicly funded only in Canada, Denmark, France, and the United Kingdom.

Conclusion: Pharmacist prescribing practices vary significantly worldwide, with differences in terminology, legislation, and training requirements. This scoping review provides the necessary information to visualize and conceptualize the current scope of pharmacist independent prescribers, offering a foundation for advancing this practice in new jurisdictions. Further research should address current models in under-studied regions, explore the scope for pharmacists to prescribe for undiagnosed conditions, and analyze payment structures in non-funded jurisdictions.

Background: Artificial intelligence (AI), a branch of computer science, has been of growing research interest since its introduction to healthcare disciplines in the 1970s. Research has demonstrated that the application of such technologies has allowed for greater task accuracy and efficiency in medical disciplines such as diagnostics, treatment protocols and clinical decision-making. Application in pharmacy practice is reportedly narrower in scope; with greater emphasis placed on stock management and day-to-day function optimisation than enhancing patient outcomes. Despite this, new studies are underway to explore how AI technologies may be utilised in areas such as pharmacist interventions, medication adherence, and personalised medicine. Objective/s: The aim of this study was to identify current use of AI in measuring performance outcomes in pharmacy practice.

Methods: A scoping review was conducted in accordance with PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive literature search was conducted in MEDLINE, Embase, IPA (International Pharmaceutical Abstracts), and Web of Science databases for articles published between January 1, 2018 to September 11, 2023, relevant to the aim. The final search strategy included the following terms: ("artificial intelligence") AND ("pharmacy" OR "pharmacist" OR "pharmaceutical service" OR "pharmacy service"). Reference lists of identified review articles were also screened.

Results: The literature search identified 560 studies, of which seven met the inclusion criteria. These studies described the use of AI in pharmacy practice. All seven studies utilised models derived from machine learning AI techniques. AI identification of prescriptions requiring pharmacist intervention was the most frequent (n = 4), followed by screening services (n = 2), and patient-facing mobile applications (n = 1). These results indicated a workflow- and productivity-focused application of AI within current pharmacy practice, with minimal intention for direct patient health outcome improvement. Despite this, the review also revealed AI's potential in data collation and analytics to aid in pharmacist contribution towards the healthcare team and improvement of health outcomes.

Conclusions: This scoping review has identified, from the literature available, three main areas of focus, (1) identification and classification of atypical or inappropriate medication orders, (2) improving efficiency of mass screening services, and (3) improving adherence and quality use of medicines. It also identified gaps in AI's current utility within the profession and its potential for day-to-day practice, as our understanding of general AI techniques continues to advance.

Background: The prevalence of colorectal cancer (CRC) is on the rise among the younger population, with an anticipated increase in new cases for individuals aged 20-49 years by 2030. The accessibility of community pharmacists and their strong community connections present unique opportunities to enhance patient engagement in a population-based CRC screening program.

Objectives: This study seeks to assess the effectiveness of a community pharmacist-led point-of-care CRC screening program utilizing fecal immunochemical test (FIT) kits to identify CRC prevalence in high-risk individuals.

Methods and materials: Over the course of a 10-month prospective intervention conducted in UAE community pharmacies, we evaluated the impact of a pharmacist-led point-of-care colorectal cancer screening program. Six pharmacies were selected based on their services and capabilities. Eligible participants were those identified during medication reviews as exhibiting colorectal cancer risk factors. Pharmacists provided communication materials, distributed FIT kits, and implemented reminders. Participants collected samples for hemoglobin analysis, which served as an indicator of colorectal bleeding. Collected data encompassed demographics, lifestyle, and health-related characteristics. Pharmacists performed medication reviews and offered recommendations.

Results: A total of four hundred and one recruited int the study. The mean age of study cohort at baseline was 66.6 ± 11.3 years. In our study with 401 participants, 36.4 % had undiagnosed colorectal cancer (CRC). Univariate logistic regression identified older age, a history of Type 2 diabetes mellitus (DM), and inflammatory bowel disease (IBD) as significant factors associated with increased CRC prevalence, while aspirin users exhibited a lower likelihood of CRC. In the multivariate regression model, the history of Type 2 DM and IBD remained significant predictors for heightened CRC risk.

Conclusion: This study strengthens the plausibility of cause-and-effect relationships between colorectal cancer and demographic variables using epidemiological evidence. The significant relationships found between prevalence of CRC and age, type 2 diabetes, IBD and aspirin use support the effectiveness of using FIT kits in community pharmacist-led point-of-care CRC screening program to identify high-risk individuals. The finding highlights the significance of improving efforts on colorectal cancer prevention and control.

Background: The rising prevalence of chronic conditions and polypharmacy in the elderly increases the risk of anticholinergic burden, the cumulative effect of multiple anticholinergic drugs. However, no standard exists for assessing anticholinergic burden in these patients, resulting in various anticholinergic scales with differing methodologies and outcomes.

Objectives: To identify existing anticholinergic scales that are applicable to elderly chronic patients and to compare their main characteristics, included drugs and anticholinergic potential scores. In addition, we aim to analyse the previous validation of these scales.

Methods: We conducted a systematic review (MEDLINE, EMBASE and Web of Science; PROSPERO ID CRD42024505226; October 2023) for studies on anticholinergic scales applicable to elderly patients with chronic conditions. We also examined the validation of these tools in predicting anticholinergic-related adverse outcomes. Inclusion criteria targeted studies on anticholinergic scales for patients aged ≥65 with chronic conditions, excluding those hospitalized or with specific diseases. Quality assessments utilized JBI tools and SQUIRE 2.0 standards.

Results: From 1399 references, 18 anticholinergic scales development studies were included. Different scales varied in creation methodology, with some based on literature, review of previous scales or experimental data. The included studies are heterogeneous in terms of design and results of their quality analysis. For the second objective, 29 validation studies were considered, with mixed associations found between anticholinergic scales and health outcomes.

Conclusions: Current anticholinergic scales and validation studies are diverse and show mixed and controversial results, with evidence often coming from retrospective or low-quality studies; indicating the necessity for future research to focus on developing a clinically applicable tool for accurately assessing anticholinergic burden in the elderly with chronic conditions.

Background: The European cross-border electronic prescription (CBeP) was first introduced in Estonia and Finland. The CBeP service is gradually being implemented across Europe, prompting a need for practical studies to assess its benefits and potential shortcomings.

Objective: This study aimed to investigate Estonian and Finnish pharmacists' experiences with patient identification, personal data protection and safe use of medications with CBeP, as well as main advantages and areas of development of CBeP.

Methods: An online survey was conducted among Estonian and Finnish pharmacists in Spring 2021. The survey was distributed to 664 community pharmacies (289 Estonian and 375 Finnish pharmacies) where CBePs had been dispensed in 2020. The data were analysed using frequencies and a chi-square test. Answers to open-ended questions were categorized using content analysis and quantifying.

Results: In total, 84 responses from Estonia and 154 responses from Finland were included in the study. Majority of the respondents had never or had rarely encountered problems with identifying the patient with CBeP. Nearly all respondents rated the CBeP system to be safe from the standpoint of personal data protection. Approximately 70 % of the respondents in both countries agreed that it is difficult to counsel the patient with CBeP due to language barrier. More than half of the respondents reported that it is not easy to monitor drug interactions with CBeP. The most often mentioned benefit of CBeP was an improved medication availability and the main problem the CBeP dispensing software rigidity.

Conclusions: Estonian and Finnish pharmacists recognize the positive impact of CBeP on medication availability. Variations in providing patient counselling due to language barriers highlight the need for improved communication tools. Addressing concerns about drug interaction monitoring and technical rigidity is essential for seamless cross-border adoption of CBeP in Europe.