Research in Social & Administrative Pharmacy最新文献

The term ‘clinician’ is not reserved for any healthcare professional group. However, there is a general acceptance that a clinician would have the knowledge, skills and behaviours to enable them to clinically assess and manage a patient autonomously. The expectation, in a modern collaborative healthcare system, is that this work would be completed as a part of a planned and integrated multi-disciplinary care delivery structure, where any given clinician delivers a devolved element of that patient's care. Forthcoming changes to regulation and professional development pathways in the UK will have a profound impact on pharmacist professional identity and practice. From 2026, all new UK pharmacist registrants will have full independent prescribing rights. A paradigm shift is expected to enable the development of a Pharmacist Clinician Model, incorporating pharmaceutical care needs with wider clinical assessment, diagnostic, and clinical management responsibilities. Consideration is given to this model and its implications. Changes to regulation, policy, education, and the governance required to deliver safe and effective pharmacist clinicians are outlined. A philosophical critique on the nature of being a clinician, and the differentiation of pharmacist clinician roles compared to other healthcare professions, is given. A further examination of the projected risks and expected benefits of this transformative practice model are then explored.

Background

Hypertension is the chronic disease that most affects the elderly population worldwide and is the main modifiable risk factor for cardiovascular diseases. In hypertensive elderly patients, health literacy emerges as a key component for achieving better clinical outcomes.

Objective

This study aims to describe the health literacy strategies used for elderly patients with arterial hypertension.

Methods

A review of the scientific literature was conducted in accordance with recommendations from the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Three databases were used to identify relevant studies which were then assessed for eligibility, extracted, and categorized.

Results

A total of 6442 articles were identified in the databases, out of which 1486 were duplicates and were removed. Based on titles and abstracts, 4887 articles were excluded, and 59 were eliminated through full-text analysis for not meeting the eligibility criteria. Ten studies were included in this scoping review. The identified strategies included face-to-face group educational sessions, face-to-face individual educational sessions, use of written educational materials, educational sessions through electronic devices and/or computers, individual counseling, physical exercise, and personal health diary. The most addressed topics were the nature of hypertension, nutrition, and physical exercise. The study environments highlighted the importance of involving a multidisciplinary team in health literacy strategies for elderly individuals whith hypertension.

Conclusions

Interventions with mixed measures were commonly used by the authors and encouraged disease self-management. Access to information and the promotion of critical thinking allowed patients to have better disease control. However, studies linking health literacy and elderly individuals with arterial hypertension are still scarce, indicating the need for further research.

Background

The Medical Subject Headings (MeSH) thesaurus is the controlled vocabulary used to index articles in MEDLINE. MeSH were mainly manually selected until June 2022 when an automated algorithm, the Medical Text Indexer (MTI) automated was fully implemented. A selection of automated indexed articles is then reviewed (curated) by human indexers to ensure the quality of the process.

Objective

To describe the association of MEDLINE indexing methods (i.e., manual, automated, and automated + curated) on the MeSH assignment in pharmacy practice journals compared with medical journals.

Methods

Original research articles published between 2016 and 2023 in two groups of journals (i.e., the Big-five general medicine and three pharmacy practice journals) were selected from PubMed using journal-specific search strategies. Metadata of the articles, including MeSH terms and indexing method, was extracted. A list of pharmacy-specific MeSH terms had been compiled from previously published studies, and their presence in pharmacy practice journal records was investigated. Using bivariate and multivariate analyses, as well as effect size measures, the number of MeSH per article was compared between journal groups, geographic origin of the journal, and indexing method.

Results

A total of 8479 original research articles was retrieved: 6254 from the medical journals and 2225 from pharmacy practice journals. The number of articles indexed by the various methods was disproportionate; 77.8 % of medical and 50.5 % of pharmacy manually indexed. Among those indexed using the automated system, 51.1 % medical and 10.9 % pharmacy practice articles were then curated to ensure the indexing quality. Number of MeSH per article varied among the three indexing methods for medical and pharmacy journals, with 15.5 vs. 13.0 in manually indexed, 9.4 vs. 7.4 in automated indexed, and 12.1 vs. 7.8 in automated and then curated, respectively. Multivariate analysis showed significant effect of indexing method and journal group in the number of MeSH attributed, but not the geographical origin of the journal.

Conclusions

Articles indexed using automated MTI have less MeSH than manually indexed articles. Articles published in pharmacy practice journals were indexed with fewer number of MeSH compared with general medical journal articles regardless of the indexing method used.

This commentary explores how a change in the professional identity of pharmacists from medicines supplier to clinical decision-maker might take place. Three leverage points are identified that support this change. The first leverage point involves workplace culture. Pharmacists require workplaces that support them to assume direct responsibility for drug therapy decisions that may not have traditionally been part of pharmacy practice. The second leverage point involves terminology. Pharmacists need to be able to name and describe the process they use when making decisions about drug therapy. The third leverage point encompasses pharmacy education. Future pharmacists require a foundation that enables them to mobilize their knowledge and skills about drug therapy to act as clinical decision-makers with patients that require complex care. By acting on multiple leverage points, advocates for change in the pharmacy profession can assist pharmacists to establish themselves as decision-makers about drug therapy, shift their professional identity, and reformulate their view of the profession.

Background

Early identification and treatment of mental illnesses is imperative for optimal patient outcomes. Pharmacists may play an important role in mental healthcare through the provision of screening services for mental illnesses.

Objective

(s): To systematically review the impact of pharmacist-led mental illness screening on clinical or patient-reported outcomes and identify and report any follow-up or referral systems used in pharmacist-led screening interventions for mental illnesses.

Methods

A systematic review was conducted by searching MEDLINE, CINAHL, Embase and APA PsycInfo via EBSCOhost from inception to 9 March 2023 to identify studies involving pharmacist-led screening interventions for mental illnesses. Data was collected on the mental illness in question, setting and population characteristics, screening tools used, clinical or patient-reported outcomes, and follow-up and referral systems reported.

Results

Twenty six studies were identified that related to screening for mental illnesses, such as depressive disorders and substance use disorders. There were a variety of study designs, including uncontrolled studies (n = 23), pre-post studies (n = 2) and randomised controlled trials (n = 1). Screening was conducted in different settings, with most studies conducted in community pharmacies (n = 21/26, 87.8 %) and focusing on depression screening (n = 12/26, 46.1 %). A range of follow-up and referral methods to other healthcare professionals were reported, including verbal (n = 3/26, 11.5 %), both written and verbal (n = 3/26, 11.5 %), communications via electronic health record (n = 2/26, 7.7 %) and written (n = 1/26, 3.8 %).

Conclusions

Pharmacists provide screening for a variety of mental illnesses in different settings. Various referral methods and follow-up pathways may be utilised for post-screening patient care. However, current evidence is insufficient to establish improvements in early detection, treatment, or outcomes. Further large, well-designed studies are required to support the role of pharmacists in mental illness screening, provide evidence on the impact of pharmacist-led mental illness screening services and inform the most effective follow up and referral methods.

Background

The variety of methods for counting medications may lead to confusion when attempting to compare the extent of polypharmacy across different populations.

Objective

To compare the prevalence estimates of polypharmacy derived from medico-administrative databases, using different methods for counting medications.

Methods

Data were drawn from the Québec Integrated Chronic Disease Surveillance System. A random sample of 110,000 individuals aged >65 was selected, including only those who were alive and covered by the public drug plan during the one-year follow-up. We used six methods to count medications: #1-cumulative one-year count, #2-average of four quarters' cumulative counts, #3-count on a single day, #4-count of medications used in first and fourth quarters, #5-count weighted by duration of exposure, and #6-count of uninterrupted medication use. Polypharmacy was defined as ≥5 medications. Cohen's Kappa was calculated to assess the level of agreement between the methods.

Results

A total of 93,516 (85 %) individuals were included. The prevalence of polypharmacy varied across methods. The highest prevalence was observed with cumulative methods (#1:74.1 %; #2:61.4 %). Single day count (#3:47.6 %), first and fourth quarters count (#4:49.5 %), and weighted count (#5:46.6 %) yielded similar results. The uninterrupted use count yielded the lowest estimate (#6:35.4 %). The weighted method (#5) showed strong agreement with the first and fourth quarters count (#4). Cumulative methods identified higher proportions of younger, less multimorbid individuals compared to other methods.

Conclusion

Counting methods significantly affect polypharmacy prevalence estimates, necessitating their consideration when comparing and interpretating results.

Background

Prescribing cascades can lead to unnecessary medication use, healthcare costs, and patient harm. Pharmacists oversee prescriptions from multiple prescribers and are well positioned to identify such cascades, making pharmacists key stakeholders to address them.

Objectives

To evaluate community pharmacists’ awareness, identification, and management of prescribing cascades and to assess behavioural determinants that may be targeted in future strategies to minimise inappropriate prescribing cascades.

Methods

An online survey was developed using the Theoretical Domains Framework (TDF) and emailed to all registered community pharmacists in Ireland (n = 3775) in November 2021. Quantitative data were analysed using descriptive and inferential statistics. Free-text sections were given to capture reasons for non-resolution of identified prescribing cascades and suggestions to aid prescribing cascade identification and management; this text underwent content analysis.

Results

Of the 220 respondents, 51% were aware of the term ‘prescribing cascade’ before the survey, whilst 69% had identified a potentially inappropriate prescribing cascade in practice. Over one third were either slightly confident (26.4%) or not confident at all (10%) in their ability to identify potentially inappropriate prescribing cascades in patients' prescriptions before the survey, whilst 55.2% were concerned that patients were receiving prescribing cascades they had not identified. Most respondents wanted further information/training to help prescribing cascade identification (88.3%) and management (86.1%). Four predominant TDF domains identified were common to both i) influencing non-resolution of identified prescribing cascades and ii) in the suggestions to help identify and manage prescribing cascades: ‘Environmental Context and Resources’, ‘Social/Professional Role and Identity’, ‘Social Influences’ and ‘Memory, Attention and Decision Processes’.

Conclusions

There is a clear need to provide additional resources to help community pharmacists identify and manage prescribing cascades. These findings will support the development of theory-informed behaviour change strategies to aid the minimisation of inappropriate prescribing cascades and decrease the risk of medication-related harm for patients.

Background

Patient prioritization is a effective strategy to identify high risk patients for targeted Clinical Pharmacy Service (CPS) in hospital pharmacy. However, there is a paucity of patient prioritization tool to use in clinical practice.

Objectives

Describe the development, content validation and standardization of an adult patient prioritization tool for hospital CPS named, PrioFarClinH.

Methods

The tool was developed using a stepwise design multi: Scoping Review to identify prioritization criteria/sub-criteria; Delphi technique to obtain consensus under the identified criteria/sub-criteria; Survey with pharmacists evaluating applicability of the criteria/sub-criteria obtained from Delphi; Definition of criteria/sub-criteria to be included in PrioFarClinH attribution of scores. Content validation was performed by a panel of experts evaluating relevance, feasibility, clarity and adequacy of the score. Content Validity Index (CVI) was calculated. Standardization occurred through a retrospective observational study carried out at 24 and 72 h and median of the patient's hospital stay. An intragroup norm was performed, determining percentile ranks of the instrument's total scores. Patients with a P90 score were classified with a high level of prioritization for CPS.

Results

PrioFarClinH is divided into three sections, with prioritization criteria for health issues; therapeutic classes; laboratory parameters. It comprises 51 criteria with specific scores with simple total calculation. None of the criteria presented CVI <0.78, maintaining the items from the initial version of PrioFarClinH. The scores were adjusted per suggestions from the panel of judges. Data were collected from 393 patients. The P90 percentile in the three hospitalization stages (24 h, 72 h, and median) was found, respectively, in the following scores: 18.0, 20.0, and 22.6.

Conclusions

PrioFarClinH is a comprehensive tool to target and to prioritize adults patients most likely to benefit from CPS. Evidence for adequate content validity was provided. However, further validation of this tool is necessary to establish tool performance.

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.

Background

Due to multitude of gaps in Pakistan's healthcare system, community pharmacies serve as the” first port of call” for various illnesses. However, the present scarcity of pharmacists in these settings poses significant challenges to healthcare delivery in the country. This scarcity is primarily due to difficulties in retaining pharmacists for community practice. The aim of this study was to explore the factors that influence the retention of community pharmacists by using COM-B model.

Methods

A qualitative methodology employing the COM-|B model was utilized to design this study. In-depth interviews were conducted with pharmacists experienced in community pharmacy practice, at time and place convenient to them. Data were transcribed, translated and analyzed by deductive thematic analysis in accordance with the constructs of COM-B model.

Results

A diverse range of factors were identified that negatively influenced the retention of community pharmacists including working conditions and proprietor's demeanor, deficiency in training and intern experience, lack of career planning, low social acceptance, less salary and job satisfaction, less regulatory control and aptitude of renting out category. Conversely, the study also identified the factors that motivate community pharmacists to stay in their roles despite the challenges including strong educational background, abundant job opportunities, flexible schedules, direct patient engagement and positive impact on sales.

Conclusion

There was an observed discrepancy between the challenges faced by community pharmacists and the motivators that encourage them to continue their job. Due to a disparity and abundance of challenges rather than motivators, retention rates for community pharmacists are low. This imbalance shed light on areas where improvements are needed to enhance pharmacist retention. Various areas for change were highlighted including strict implementation of regulations, integration of practical experience of community pharmacy practice and internships into academic programs, career guidance, and raising patient awareness about the roles of community pharmacists.