Research in Social & Administrative Pharmacy最新文献

Background

Some studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated.

Objectives

To describe Indonesian pharmacists’ clinical decision making when handling self-medication cases for a cough.

Methods

An open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants’ statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted.

Results

A total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants.

Conclusion

The ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists’ differential diagnostic skills for triage.

Background

Medication harm affects between 5 and 15% of hospitalised patients, with approximately half of the harm events considered preventable through timely intervention. The Adverse Inpatient Medication Event (AIME) risk prediction model was previously developed to guide a systematic approach to patient prioritisation for targeted clinician review, but frailty was not tested as a candidate predictor variable.

Aim

To evaluate the predictive performance of an updated AIME model, incorporating a measure of frailty, when applied to a new multisite cohort of hospitalised adult inpatients.

Methods

A retrospective cohort study was conducted at two tertiary Australian hospitals on patients discharged between 1st January and April 31, 2020. Data were extracted from electronic medical records (EMRs) and clinical coding databases. Medication harm was identified using ICD-10 Y-codes and confirmed by senior pharmacist review of medical records. The Hospital Frailty Risk Score (HFRS) was calculated for each patient. Logistic regression analysis was used to construct a modified AIME model. Candidate variables of the original AIME model, together with new variables including HFRS were tested. Performance of the final model was reported using area under the curve (AUC) and decision curve analysis (DCA).

Results

A total of 4089 patient admissions were included, with a mean age ± standard deviation (SD) of 64 years (±19 years), 2050 patients (50%) were males, and mean HFRS was 6.2 (±5.9). 184 patients (4.5%) experienced one or more medication harm events during hospitalisation. The new AIME-Frail risk model incorporated 5 of the original variables: length of stay (LOS), anti-psychotics, antiarrhythmics, immunosuppressants, and INR greater than 3, as well as 5 new variables: HFRS, anticoagulants, antibiotics, insulin, and opioid use. The AUC was 0.79 (95% CI: 0.76–0.83) which was superior to the original model (AUC = 0.70, 95% CI: 0.65–0.74) with a sensitivity of 69%, specificity of 81%, positive predictive value of 0.14 (95% CI: 0.10–0.17) and negative predictive value of 0.98 (95% CI: 0.97–0.99). The DCA identified the model as having potential clinical utility between the probability thresholds of 0.05–0.4.

Conclusion

The inclusion of a frailty measure improved the predictive performance of the AIME model. Screening inpatients using the AIME-Frail tool could identify more patients at high-risk of medication harm who warrant timely clinician review.

Background

Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona.

Methods

A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members.

Results

Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as ‘easiest’ among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their “being more open to selling syringes without a prescription to someone who might use them for illicit drug use,” and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost.

Conclusions

An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.

Objectives

Community pharmacies are convenient healthcare settings which provide a wide range of services in addition to medicine supply. Continence care is an area where there is an opportunity for the implementation of new innovations to improve clinical and service outcomes. The objective was to systematically evaluate evidence for the effectiveness, safety, acceptability and key determinants of interventions for the promotion and implementation of continence care in the community pharmacy setting.

Methods

The protocol was registered in the International Prospective Register of Systematic Reviews database (PROSPERO: CRD42022322558). The databases Medline, Embase, PsycINFO and CINAHL were searched and supplemented by grey literature searches, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. In total, 338 titles and abstracts were screened, 20 studies underwent full-text screening and four studies met the inclusion criteria and underwent quality assessment. The results are reported narratively due to the heterogeneity of study designs.

Results

There was some evidence for the effectiveness of interventions, resulting in increased provision of consumer self-help advice and materials, referrals to other care providers, and an increase in staff knowledge and confidence in continence care. Evidence was inconclusive for clinical outcomes due to small sample sizes and poor follow-up rates. Acceptability of interventions to both pharmacy staff and consumers was generally positive with some frustrations with reimbursement procedures and time constraints. Facilitators of a successful pharmacy-based continence service are likely to include staff training, high-quality self-care resources, increased public awareness, and the establishment of effective referral pathways and appropriate reimbursement (of service providers).

Conclusions

There is a paucity of evidence regarding the contribution of the community pharmacy sector to continence care. The development of a new pharmacy bladder and bowel service should involve patients, healthcare professionals and policy stakeholders to address the potential barriers and build upon the facilitators identified by this review.

Patient summary

We identified research that had explored how community pharmacy (chemist) personnel might support people with continence problems (e.g. bladder and bowel leakage). Only four studies were identified, however, they reported that training for pharmacy personnel and providing self-help advice about continence can be successful and was well-received by patients.

Background

Acute respiratory distress syndrome (ARDS) is a lung complication of COVID-19 that requires intensive care and ventilation. Beta-hydroxybutyrate (BHB) is a ketone body that can modulate metabolism and inflammation in immune cells and lung tissues. We hypothesized that oral BHB could alleviate COVID-19 related ARDS by reducing pro-inflammatory cytokines and increasing anti-inflammatory cytokines.

Methods

We randomized 75 patients with mild (as per Berlin criteria) ARDS symptoms to receive oral 25 g twice daily or placebo for five days. The primary outcome was the change in pro-inflammatory cytokines (Interleukin-1β, Interleukin-6, interleukin-18, tumour necrosis factor-alpha) and anti-inflammatory cytokine (interleukin-10) from baseline to day 5. The secondary outcomes were the change in BHB levels from baseline to day 5, the number of hospitalization days, and the occurrence of adverse events.

Results

Treatment with formulated BHB resulted in a significant decrease in pro-inflammatory cytokines; Interleukin-1β (p = 0.0204), Interleukin-6 (p = 0.0309), interleukin-18 (p = 0.0116), tumour necrosis factor-alpha (p = 0.0489) and increase in interleukin-10 (p = 0.0246) compared treatment with placebo. Importantly, higher BHB levels (p = 0.0001) were observed after supplementation; additionally, patients who underwent this approach were hospitalized for fewer days. No serious adverse events were reported.

Conclusion

Beta-hydroxybutyrate, an oral adjunct therapy, has shown promising results in ameliorating symptoms of ARDS. This includes reduced inflammation, oxidative stress, and decreased patient fatigue levels. Further study with a large sample size is warranted to assess the potential of BHB therapy's effectiveness in reducing the development of severe illness.

Clinical trial registration

(http://ctri.nic.in/CTRI/2021/03/031790)

Background

Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists’ roles in practice, which are particularly prevalent in primary care teams.

Objectives

This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams.

Methods

This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case.

Results

Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and “not a physician”. These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists’ professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist.

Conclusion

Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.

This bibliometric review analyzes the evolution of telepharmacy research, significantly amplified by the COVID-19 pandemic. By employing bibliometric analysis, the study aims to provide a comprehensive overview of the current state and emerging trends in telepharmacy. This approach helps in identifying key areas of growth, predominant themes, and potential gaps in the literature. Utilizing data from 330 papers (1981–2023) sourced from Scopus and analyzed with Bibliometrix™, this study applies both performance analysis and science mapping methods to examine the telepharmacy literature. The findings reveal a consistent growth in telepharmacy research, with an 8.07 % average annual growth rate. Performance analysis highlights key authors, influential works, and leading journals and countries in the field. Document co-citation analysis identifies four developmental phases of telepharmacy: emergence, take-off, expansion, and future trajectory by uncovering the intellectual structure of the field. Co-words analysis elucidates evolving conceptual structures and significant subfields over time. These findings serve to inform practitioners and researchers about the evolving landscape of telepharmacy, guiding future research and practice in this increasingly important field.

Background

Geriatric Oncology is a specialty where a multidisciplinary approach can address the unmet needs of older adults with cancer. Older adults are at increased risk of adverse drug events (ADE) due to age-related changes in pharmacokinetics and pharmacodynamics, increasing treatment complexity, and medication burden.

Objectives

To review the literature to determine the incidence of unplanned hospitalisation due to ADE for all medications, both systemic anticancer therapy (SACT) and non-SACT medications.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search included the following databases: PubMed, CINAHL, and Embase. A manual search of Scopus was then performed. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, Mixed Methods Appraisal Tool (MMAT) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.

Results

Overall, three studies were included. One observational study reported 19 % of unplanned hospital admissions due to ADE in patients aged ≥70 years with cancer. The first retrospective study reported 24 % of unplanned hospital admissions are due to ADE in patients aged ≥70 years with cancer, and the second retrospective study reported 26 % of patients with metastatic melanoma treated with immune checkpoint inhibitors had an unplanned hospital admission due to an ADE.

Conclusion

There is a paucity of studies assessing unplanned hospitalisation due to ADE in older adults with cancer. Future studies are needed and should account for the reporting of potential ADE relative to supportive care, ancillary medications, and indeed chronic medications used to treat long-standing comorbidities.

Background

Deprescribing is an effective strategy to manage polypharmacy and improve patient outcomes. The notion of a potential role for pharmacists in a multidisciplinary team approach to deprescribing has been identified in quantitative and qualitative literature. However, stakeholders' perceptions of this role, and factors that may impede or facilitate the pharmacist's involvement have not been elucidated. The application in ambulatory care also requires clarification. Understanding stakeholders' views is essential to optimise involvement of the pharmacist in deprescribing and improve practice.

Objectives

First, to synthesize the perspectives and experiences of stakeholders (primary care providers, pharmacists, patients, and carers) regarding the role and involvement of the pharmacist in deprescribing in ambulatory care settings. Second, to identify barriers and strategies to enhancing pharmacist involvement in deprescribing.

Methods

A systematic search was conducted across CINAHL, Embase, Medline, and Scopus from database inception to April 2023 for qualitative studies in English exploring the pharmacist's role in deprescribing. Data were extracted for iterative and inductive development of themes. A meta-synthesis facilitated the identification of overarching themes. Qualitative secondary analysis enabled identification of barriers and facilitators to the pharmacist's involvement in deprescribing.

Results

From 285 articles identified, 9 studies were included which explored the views of general practitioners, specialist physicians, pharmacists, nurse practitioners, patients, carers, and general practice and clinic staff as stakeholders in deprescribing in ambulatory care. The meta-synthesis identified 4 over-arching themes: (1) therapeutic impetus and the status quo mentality, (2) role and responsibility, (3) multidisciplinary care, and (4) conflicting interests in pharmacy practice. Strategies to enhance pharmacists' involvement in deprescribing emerged from the data, and the pharmacist's role was strongly encouraged by stakeholders despite logistical and perceptual barriers identified.

Conclusions

Incorporation of the strategies to enhance the pharmacist's involvement in deprescribing identified in this review is encouraged to optimise patient-centred care and improve practice.

Background

Newer diabetes medications have cardiorenal benefits beyond blood sugar lowering that make them a preferred treatment option in many patients. Despite this, studies have shown that prescribing of these medications remains suboptimal with medication costs being hypothesized as a reason for underutilization.

Objective

To understand clinicians’ decision-making processes for prescribing diabetes medications in older adults, focusing on higher cost medications.

Methods

Observations of patient encounters and semi-structured interviews were conducted with clinicians from primary care, endocrinology, and geriatrics to elucidate themes into diabetes medication prescribing. A qualitative descriptive approach was used to analyze the data from interviews using an inductive coding scheme with themes derived from the data.

Results

Twenty-one interviews were conducted. Five themes were identified: 1) out-of-pocket costs drive prescribing decisions 2) out-of-pocket costs can be variable due to changing insurance plans or changing coverage 3) clinicians have difficulty with determining patient-specific out-of-pocket costs 4) clinicians manage the tradeoffs existing between cost, efficacy, and safety and 5) clinicians can use cost-modifying strategies such as patient assistance.

Conclusion

Addressing the challenges that medication costs pose to prescribing evidence-based medications for type 2 diabetes is necessary to optimize diabetes care for older adults.