Research in Social & Administrative Pharmacy最新文献

Background

Approximately half of people prescribed medications do not take them as prescribed. There is a significant unmet need regarding the barriers to medication adherence not being addressed in primary care. There is no agreement on which outcomes should be measured and reported in trials of medication adherence interventions.

Objective

To develop a core outcome set (COS) for trials of medication adherence interventions in primary care for adults prescribed medications for long-term health conditions.

Methods

A list of potentially relevant outcomes from the literature was developed. Using a two-round Delphi survey of stakeholder groups representing patients and their carers; primary care staff; and academic researchers with an interest in medication adherence; each outcome was scored in terms of importance for determining the effectiveness of medication adherence interventions in primary care. This was followed by two consensus workshops, where importance, as well as feasibility and acceptability of measurement, were considered in order to finalise the COS.

Results

One hundred and fifty people took part in Delphi Round 1 and 101 took part in Round 2. Eight people attended the workshops (four attendees per workshop). Seven outcomes were identified as most important, feasible and acceptable to collect in medication adherence trials: Health-related quality of life, number of doses taken, persistence with medicines, starting (initiating) a medicine, relevance of the medication adherence intervention for an individual, mortality, and adverse medicine events.

Conclusions

This COS represents the minimum outcomes that should be collected and reported in all medication adherence trials undertaken in primary care. When developing and finalizing the COS, feasibility and acceptability of collection of outcomes has been considered. In addition to the COS, medication adherence trials can choose to include outcomes to suit their specific context such as the health condition associated with their medication adherence intervention.

Credibility refers to the trustworthiness, genuineness, and plausibility of the research findings and has always been a contentious issue in qualitative research, particularly for those conducting studies on the hermeneutic phenomenology paradigm. The relationship between credibility and high qualitative research is noted by many qualitative scholars. Member checking, also known as participant or respondent validation, is a technique for exploring the credibility of results where data or results are returned to participants to check for accuracy and resonance with their experiences. Although member-checking has long been accepted as the gold standard in quantitative research, research shows that it is not the pinnacle for expressing rigor in Heideggerian hermeneutic phenomenology because it contradicts many of the underpinning philosophies. Within this article the author explores how member checking has been used in published research and presents a brief overview of the various discourses on member checking in qualitative research. The author discusses the importance of evaluating whether the method fits with the theoretical position of a study and the importance to consider how member checking was undertaken and for what purpose. It is essential that researchers are transparent about what they hope to achieve with the method and how their claims about credibility and validity fit with their epistemological stance.

Background

Findings on the effectiveness of medication reviews led by community pharmacists (CPs) are often inconclusive. It has been hypothesized that studies are not sufficiently standardized, and thus, it is difficult to draw conclusions.

Objective(s)

To examine differences in the way CP-led medication review studies are set up. This was accomplished by investigating (1) patient selection criteria, (2) components of the medication review interventions, (3) types of outcomes, and (4) measurement instruments used.

Methods

A systematic literature search of randomized controlled trials of CP-led medication reviews was carried out in PubMed and Cochrane Library. Information on patient selection, intervention components, and outcome measurements was extracted, and frequencies were analyzed. Where possible, outcomes were mapped to the Core Outcome Set (COS) for medication review studies. Finally, a network analysis was conducted to explore the influence of individual factors on outcome effects.

Results

In total, 30 articles (26 studies) were included. Most articles had a drug class-specific or disease-specific patient selection criterion (n = 19). Half of the articles included patients aged ≥60 years (n = 15), and in 40% (n = 12/30) patients taking 4 drugs or more. In 24 of 30 articles, a medication review was comprised with additional interventions, such as distribution of educational material and training or follow-up visits. About 40 different outcomes were extracted. Within specific outcomes, the measurement instruments varied, and COS was rarely represented.

Conclusion

The revealed differences in patient selection, intervention delivery, and outcome assessment highlight the need for more standardization in research on CP-led medication reviews. While intervention delivery should be more precisely described to capture potential differences between interventions, outcome assessment should be standardized in terms of outcome selection by application of the COS, and with regard to the selected core outcome measurement instruments to enable comparison of the results.

Background

Even though the effectiveness of community pharmacists in helping customers to reduce weight has been evident, few pharmacists provided weight management services (WMS). To drive community pharmacist WMS provision, factors affecting their intention and WMS provision were important to be investigated.

Objective

The present study aimed to explore relationships among pharmacist authority, perceived customer obstruction, WMS performance support, obstacles, and facilitators with intention to provide WMS and WMS rovision using structural equation modeling (WMS.

Method

Self-administered questionnaires were utilized to collect data from 302 Thai community pharmacists from December 2022 to March 2023. Structural equation modeling (SEM) was used to explore the influencing factors on pharmacist WMS intention and WMS provision.

Results

Pharmacist authority (r = 0.35), WMS performance support (r = 0.24), and facilitators (r = 0.22) were significantly correlated with community pharmacist WMS provision. Pharmacist authority (r = 0.50), facilitators (r = 0.46), and WMS performance support (r = 0.42) were significantly correlated with community pharmacist intention to provide WMS e structural equation model (SEM), pharmacist authority (β = 0.34) and intention (β = 0.16) significantly influenced WMS provision (R² = 0.20). Authority (β = 0.49) and WMS performance support (β = 0.28) significantly influenced pharmacist intention to WMS (R² = 0.42). The model from empirical data indicated a good fit with the hypothetical model (p-value = 0.000, Comparatively Fit Index = 0.9, and Tucker-Lewis Index = 0.878).

Conclusion

Pharmacist authority had direct effects with both their intention to provide WMS and WMS provision. WMS performance support had a direct effect on intention to provide WMS and an indirect effect on WMS provision. Facilitators also had significant correlations with intention to provide WMS and WMS provision.

Objective

To identify trigger tools applied to detect adverse drug events (ADEs) in older people and describe their utility and performance.

Methods

A systematic review was conducted in the PubMed, Lilacs, and Scopus databases (January 2024). Studies that developed, applied, or validated trigger tools and evaluated their utility and/or performance for detecting ADEs in older people were considered. Direct proportion meta-analyses using the inverse-variance method were performed for prevalence of ADEs and positive predictive value (PPV).

Results

Twenty-four studies (25 publications) were included. Twelve trigger tools were identified, of which six were developed for detecting ADEs in older population, four developed for general population and modified for older people, and two developed for general population. No tools for detecting ADEs in older people receiving palliative care or hospitalized in intensive or surgical care units were found. The performance of triggers was presented through PPV (11.5–71%), negative predictive values (83.3%), and sensitivity (30–94.8%). The overall PPV was 33.3% (95%CI: 32.5–34.2%). Triggers with good performance were changes in plasma levels of digoxin, glucose, and potassium; changes in international normalized ratio; abrupt medication stop; hypotension; and constipation. The prevalence of ADEs ranged from 2.8 to 66%, with overall prevalence of ADEs of 20% (95%CI: 19.3–20.8%). Preventability ranged from 8.4 to 94.4%. Metabolic or electrolyte disturbances induced by diuretics, constipation induced by opioids, and falls and delirium induced by benzodiazepines were the most prevalent ADEs.

Conclusion

The trigger tools are flexible and easy to apply, and they can contribute to the detection of ADEs, their associated risk factors, the level of harm, and preventability in different health settings. However, there is no consensus on good or poor values of PPV, which indicate the performance of triggers. Furthermore, there is limited evidence regarding the evaluation of performance through negative predictive value, sensitivity, and specificity.

PROSPERO

CRD42022379893.

Background

The growing significance of E-Pharmacy services in healthcare necessitates investigating the factors influencing users' behavioral intentions on these platforms. Comprehending these variables is imperative to maximize service provision, elevate customer satisfaction, and ultimately elevate healthcare accessibility and results.

Objective(s)

The main goal of this study is to explore the factors that shape consumers' inclination to use E-Pharmacy services, focusing on the framework provided by the Technology Acceptance Model. Additionally, we aimed to investigate how technological literacy plays a moderating role in this context, specifically within the South African setting.

Methods

Using a sample of 480 South African clients, the Technology Acceptance Model (TAM) and partial least squares structural equation modeling (PLS-SEM) were used to investigate the factors influencing behavioral intention to use E-Pharmacy services.

Results

The findings underscore perceived usefulness, trust, performance expectancy, and social Influence as fundamental drivers influencing users' intentions to adopt E-Pharmacy systems. Additionally, the study shows that consumers' intention to use E-Pharmacy services is significantly and favorably affected by their desire to utilize such services. This suggests that individuals are more likely to act on positive intentions when they are interested in using E-Pharmacy platforms. Intriguingly, technological literacy has emerged as a moderating factor in the relationship between the intention to use and the actual behavior of utilizing E-Pharmacy platforms. This demonstrates the importance of consumers' technical knowledge and skills in bridging the intention-behavior gap and highlights the necessity of adapting treatments and instructional strategies to account for various levels of technological literacy.

Conclusion

This study provides valuable insights into the complex relationships between factors influencing the acceptance of E-Pharmacy services in South Africa. This knowledge can have practical implications for lawmakers, developers of E-Pharmacy platforms, and healthcare professionals who aim to enhance user acceptance and utilization.

Background

Research in Social and Administrative Pharmacy has been expanding in the last decade. The recently published Granada Statements offer key recommendations to improve the quality of research in this field.

Objectives

To identify the factors associated with the citations of articles in the field of social, administrative, clinical pharmacy and practice research.

Methods

This study was a retrospective, observational analysis of articles published in three leading journals. Per article Google Scholar citations was the dependent variable. Predictor variables were extracted from all articles published from 2013 to 2015. The dependent variable was dichotomized using sample's median Google Scholar citations. Logistic regression analysis was performed to identify independent predictors of citations ≥ median.

Results

The median number of citations per article was 17 (range 0–341), with a mean of 24.2 (SD 27.6). The number of references included in the articles (OR 1.03, CI 1.02–1.04), the year of publication (OR 0.31 CI 0.21–0.46 for articles published 2015), article social media mentions (OR = 1.01, CI 1.01–1.03 and OR 1.10 CI 1.04–1.18 for Facebook and X, respectively), the topic area of research namely pharmacy services (OR 1.65, CI 1.06–2.57) and medication adherence (OR 2.22 CI 1.13–4.33) were independently associated with article having citations ≥ median.

Conclusions

The number of references, the year of publication, social media mentions and the topic area of research, namely pharmacy services and medication adherence, were associated with citations above median in the leading journals of social and administrative pharmacy research. Authors may consider providing a thorough literature review in their articles, while researchers, editors, and publishers are advised to use social media to promote newly published work. This article complements the Granada Statements and may contribute to fostering wider dissemination of the discipline's outputs.

Background

Particularities in psychiatry care can increase the risk of medication errors (MEs).

Objective

To analyze the MEs that occurred in a psychiatric hospital and to quantify relationships between the use of certain types of medication and the type of MEs.

Methods

We conducted a retrospective register based cross-sectional study in a French psychiatric hospital (2014–2021). All MEs were analyzed using ALARM method to identify type, stage of occurring and interception (defenses), consequences, drug involved and root causes. The prevalence-odds ratio (POR) was calculated to estimate relationships between five selected medication situations (long-acting injectable antipsychotics (LAIA), oral liquid dosage forms in a multiple-unit-container (OLDS-MC), psychotropic drugs (PD), controlled medicines (CM) or high-alert drugs) and the type of MEs occurred.

Results

Among the 609 MEs reported, wrong dose (32.2%), wrong drug (30.3%), omission (14.2%) and wrong patient (12.9%) were frequently observed. The ME occurrence stage were prescribing (55.3%) and administration (30.2%). Medication order review intercepted 77.9% of MEs. CM or LAIA increased the risk of medication omission (POR: 3.9, 95%CI: 1.8–8.4 and 2.5, 95%CI; 1.2–5.1, respectively) while the use of high-alert medications decreased it (0.2, 95%CI: 0.1–0.8). OLDS-MC and PD were more likely to be administered to the wrong patient (6.1, 95%CI: 3.3–11.4 and 16.1, 95%CI: 7.2–35.8). LAIA were associated with an increased risk of wrong dose (3.4, 95%CI: 1.8–6.3). Actual errors risk was lower with high-alert drugs (0.5, 95%CI: 0.3–09), but higher with CM (3.5, 95%CI: 1.5–8.0), OLDS-MC (2.1, 95%CI: 1.2–3.8) and PD (2.5, 95%CI: 1.8–3.5). Patients exposed to high-alert drugs were likely to have a serious error (3.5, 95%CI: 1.2–10.4).

Conclusions

This study sheds an innovative approach to analyze MEs by demonstrating that certain medication situations were more likely to lead to certain types of error. This enables the most appropriate prevention barriers to be put in place to intercept ME.

Background

Federal authorization of the use of Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived point-of-care tests for SARS-CoV-2 by pharmacists during the pandemic resulted in a dramatic rise in the number of community pharmacies that became CLIA-waived test sites. Now as we exit the pandemic, the wide-ranging expansion of the scope of practice facilitated currently by the PREP Act is set to expire in fall 2024. As a result, American pharmacists’ ability to offer CLIA-waived testing services will revert to a patchwork of state laws.

Objective

This study aims to examine both the number of pharmacies in the United States with CLIA Certificates of Waiver before and after the SARS-CoV-2 pandemic and the state-by-state differences in the percentage of pharmacies with CLIA Certificates of Waiver.

Methods

Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website on May 3rd, 2015, August 4th, 2019, November 26th, 2020, October 6th, 2021, November 23rd, 2022, and December 4th, 2023. The website allows for the exportation of demographic data on all CLIA-waived facilities by state.

Results

The total number of pharmacies with a CLIA-waiver grew from 10,626 (17.9%) locations in 2015 to 12,157 (21.4%) locations in 2019, to 15,671 (27.6%) locations in 2020, and to 29,011 (51.6%) locations in 2023. States demonstrated considerable variability in the percentage of pharmacies possessing a CLIA certificate of waiver in 2023, with a range of 10.7%–87.9%.

Conclusions

Use of CLIA-waived tests in pharmacies has grown by 140% since 2019. The time period from 2019 to 2021 witnessed a 92.5% increase in pharmacies that possessed a certificate of waiver which was largely driven by the pandemic. Interestingly, from 2021 to 2023 the was continued growth in the market of 31.6%. This suggests that pharmacies continue to see opportunity in offering CLIA-waived testing services beyond those that had been extended as a result of the pandemic.