Exploratory research in clinical and social pharmacy最新文献

Background: Effective treatment of osteoporosis is hindered by poor adherence and lack of persistence with medical therapy. Interventions can be designed to elicit and address patients' concerns about side effects and promote self-management. Objective(s): The aim was to develop and evaluate the impact of a community pharmacy-based medication management intervention on patients' adherence to osteoporosis medicines using both objective and subjective measures of adherence. Secondary aims were to report the proportion of patients that had been referred to their General Practitioner (GP) for assistance with osteoporosis management, and to measure patients' experiences with the service. Methods: This study used a cohort design. Community pharmacy dispensing data were obtained as an objective measure of adherence. Self-reported beliefs about medicines (Beliefs about Medicines Questionnaire) and self-reported adherence (Medication Adherence Reporting Scale 5) were also collected. Data were collected and compared between baseline, 4 weeks after intervention, and endpoint (approximately a year after intervention). Analysis of correlations between measures was also conducted. GP referral percentage and perceived service quality scale (pSQS-SF6) was obtained. Results: Pharmacists and support staff from 26 Australian community pharmacies were recruited and trained to implement the service, and 107 patients were recruited. Of these, 71 were available for follow-up interviews by research team at 4 weeks, and 54 at the endpoint. No changes were found in pre-post analysis for the objective or self-reported measures of adherence. Patients' concerns about osteoporosis medicines were lower at 4 weeks and at the study endpoint compared to baseline. Uptake of pharmacists' referrals to patients' GPs was 48.1% by 4 weeks. Patient experience was rated highly (median pSQS-SF6 = 6.5/7). Conclusions: This study demonstrates the potential of community pharmacy interventions designed to optimize medication adherence by eliciting patients' thoughts and feelings about using osteoporosis medicines and addressing them using motivational interview techniques.

Background

Low levels of knowledge among health professionals about autism spectrum disorders (ASD) can impair the care provided to people with autism. In Brazil, there are still no validated instruments that assess the knowledge of pharmacy students and pharmacists regarding ASD.

Objective

This study aimed to carry out the cross-cultural adaptation of the Autism Stigma Knowledge Questionnaire (ASK-Q) into Brazilian Portuguese and to evaluate the evidence of content validity.

Methods

This study was conducted in two stages, as recommended in the literature. Stage 1 corresponded to cross-cultural adaptation carried out in six phases (translation of the ASK-Q, synthesis of the translations, evaluation by a committee of experts, evaluation by the target audience of pharmacy students and pharmacists, reverse translation, and evaluation by the author of the original instrument). Step 2 corresponds to the assessment of content validity evidence.

Results

The instrument presented semantic, idiomatic, conceptual, and cultural equivalences, and the author considered the adaptation adequate. Content validity had an adequate coefficient (0.89). The ASK-Q was cross-culturally adapted to the Brazilian context according to the main theoretical framework.

Conclusions

Future studies will be conducted to evaluate other evidence for the validity of the ASK-Q-Brasil. These studies will be fundamental in assessing knowledge about ASD.

Professionalism represents the ethical contract that binds professionals and society. Its technical aspects, such as the professional practice model, form the foundation for attitudinal and behavioral characteristics, including the fiduciary relationship between pharmacists and patients. Despite significant interest in the topic, contextualizing professionalism proves to be a challenging endeavor, relying on collaboration among formal leaders, academics, and practitioners in the field. Consequently, defining, understanding, teaching, and evaluating pharmaceutical professionalism contribute to shape societal perceptions and the understanding of pharmacists and students, who may occasionally struggle to grasp the underlying rationale behind professional practices. Moreover, contextualizing professionalism entails addressing various challenges, such as fostering support for professionalism and its adaptation, which encompasses pharmacists' performance across diverse clinical services, their interpersonal interactions with patients, families, communities, and fellow healthcare professionals, as well as personal job satisfaction amidst obstacles as job insecurity, ethical dilemmas, and compromised autonomy.

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction.

Objectives

This study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users.

Methods

A cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25–43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n = 22, control group (CG, n = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0–≤20%), fair (>20–≤40%), moderate (>40 – ≤60%), or optimal (>60–100%). The data are presented with descriptive statistics.

Results

The community pharmacists reported counselling patients on NSAID precautions (80–86%) and dosages (51–69%). Gastrointestinal bleeding risk was assessed by 61–89% of the pharmacists, and time constraints (39–42%) and patient impatience (47–75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%–21%; IG: poor to moderate, 14%–45%), NSAID risk factors assessed (CG: poor to poor, 10%–9%; IG: poor to fair, 11%–27%) and counselling offered (CG: poor to poor, 6%–7%; IG: poor to fair, 6%–22%).

Conclusions

Short online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations.

Background

Minimizing medication waste through the redispensing of oral anticancer drugs (OADs) that were unused by patients provides economic and environmental benefits, but this is not yet universally implemented in clinical care.

Objective(S)

To identify barriers and facilitators to the implementation of redispensing unused OADs in clinical care.

Methods

A multicentre intervention study following a hybrid effectiveness-implementation type I design was conducted, consisting of semi-structured interviews with key stakeholders involved in the redispensing program: pharmacy employees, prescribing clinicians in oncology and haematology, patients who participated in redispensing and patients who declined trial participation. Questions encompassed experiences and suggestions for future implementation. The Consolidated Framework for Implementation Research (CFIR) guided data collection and categorisation of identified barriers and facilitators through thematic analysis.

Results

In total, 35 interviews were conducted, identifying 15 themes encompassing barriers and facilitators, reflecting all CFIR domains. Facilitators encompassed: 1) convenient process requiring an acceptable time-investment; 2) support from project leaders and implementation champions; 3) being well-motivated by personal values and societal impact; 4) feeling ensured of medication quality upon redispensing; 5) endorsement by healthcare providers for patient participation; 6) clear and personal patient communication; 7) good visibility of intervention successes; and 8) implementation well supported through a collaborative network. Barriers encompassed: 1) unclear target population; 2) redispensing legally prohibited; 3) absence of financial compensation for pharmacies; 4) complexity arising from two parallel work processes; 5) widespread communication on adjustments within local teams challenging; 6) patient's low receptiveness due to burden of oncology treatment; and 7) lack of familiarization among pharmacy technicians.

Conclusions

Facilitators for implementation of redispensing unused drugs mainly related to people's values, motivation, and societal demand, whereas barriers mainly encompassed practical issues, including knowledge, time, financial resources, and legal conditions. Strategies emphasizing the benefits of redispensing and further streamlining process compatibility could support implementation.

Background

Medication review and reconciliation is essential for optimizing drug therapy and minimizing medication errors. Large language models (LLMs) have been recently shown to possess a lot of potential applications in healthcare field due to their abilities of deductive, abductive, and logical reasoning. The present study assessed the abilities of LLMs in medication review and medication reconciliation processes.

Methods

Four LLMs were prompted with appropriate queries related to dosing regimen errors, drug-drug interactions, therapeutic drug monitoring, and genomics-based decision-making process. The veracity of the LLM outputs were verified from validated sources using pre-validated criteria (accuracy, relevancy, risk management, hallucination mitigation, and citations and guidelines). The impacts of the erroneous responses on the patients' safety were categorized either as major or minor.

Results

In the assessment of four LLMs regarding dosing regimen errors, drug-drug interactions, and suggestions for dosing regimen adjustments based on therapeutic drug monitoring and genomics-based individualization of drug therapy, responses were generally consistent across prompts with no clear pattern in response quality among the LLMs. For identification of dosage regimen errors, ChatGPT performed well overall, except for the query related to simvastatin. In terms of potential drug-drug interactions, all LLMs recognized interactions with warfarin but missed the interaction between metoprolol and verapamil. Regarding dosage modifications based on therapeutic drug monitoring, Claude-Instant provided appropriate suggestions for two scenarios and nearly appropriate suggestions for the other two. Similarly, for genomics-based decision-making, Claude-Instant offered satisfactory responses for four scenarios, followed by Gemini for three. Notably, Gemini stood out by providing references to guidelines or citations even without prompting, demonstrating a commitment to accuracy and reliability in its responses. Minor impacts were noted in identifying appropriate dosing regimens and therapeutic drug monitoring, while major impacts were found in identifying drug interactions and making pharmacogenomic-based therapeutic decisions.

Conclusion

Advanced LLMs hold significant promise in revolutionizing the medication review and reconciliation process in healthcare. Diverse impacts on patient safety were observed. Integrating and validating LLMs within electronic health records and prescription systems is essential to harness their full potential and enhance patient safety and care quality.

Background

Artificial intelligence (AI) has the capability to analyze vast amounts of data and has been applied in various healthcare sectors. However, its effectiveness in aiding pharmacotherapy decision-making remains uncertain due to the intricate, patient-specific, and dynamic nature of this field.

Objective

This study sought to investigate the potential of AI in guiding pharmacotherapy decisions using clinical data such as diagnoses, laboratory results, and vital signs obtained from routine patient care.

Methods

Data of a previous study on medication therapy optimization was updated and adapted for the purpose of this study. Analysis was conducted using R software along with the tidymodels extension packages. The dataset was split into 74% for training and 26% for testing. Decision trees were selected as the primary model due to their simplicity, transparency, and interpretability. To prevent overfitting, bootstrapping techniques were employed, and hyperparameters were fine-tuned. Performance metrics such as areas under the curve and accuracies were computed.

Results

The study cohort comprised 101 elderly patients with multiple diagnoses and complex medication regimens. The AI model demonstrated prediction accuracies ranging from 38% to 100% for various cardiovascular drug classes. Laboratory data and vital signs could not be interpreted, as the effect and dependence were unclear for the model. The study revealed that the issue of AI lag time in responding to sudden changes could be addressed by manually adjusting decision trees, a task not feasible with neural networks.

Conclusion

In conclusion, the AI model exhibited promise in recommending appropriate medications for individual patients. While the study identified several obstacles during model development, most were successfully resolved. Future AI studies need to include the drug effect, not only the drug, if laboratory data is part of the decision. This could assist with interpreting their potential relationship. Human oversight and intervention remain essential for an AI-driven pharmacotherapy decision support system to ensure safe and effective patient care.

Background

Australia has a notable gap in guidance for pharmacists, caregivers and disability service providers in: (i) supporting people with disabilities (PWD) within the medication management cycle, (ii) understanding their obligations for providing high quality care, and (iii) preventing medication-related harm.

Objective

The objective of this study was to identify medication management issues for PWD from the perspective of disability caregivers and pharmacists when supporting PWD with their medication.

Methods

A qualitative study design using semi-structured interviews of pharmacists and disability caregivers was undertaken across six different states or territories in Australia.

Results

Interviews were conducted with registered pharmacist participants (n=10), and disability workers (n=10). Seven themes emerged for both pharmacists and caregivers, with most sub-themes and codes concordant between the two cohorts. Clinical issues, particularly related to polypharmacy and psychotropic use; confidence in providing medicines and medication information accurately to PWD; practical and behavioural issues caregivers experienced when administering medication; challenges in providing individualised and person-centred care to PWD; inadequate communication and transfer of information between healthcare professionals, caregivers, and PWD; insufficient disability awareness training for pharmacists and medication training for caregivers; and challenges working with provider organisations within the current practice environment were described.

Conclusions

This study highlighted seven areas where issues were perceived to arise in medication management for PWD. By understanding the issues perceived by those directly providing care, it may be possible to improve medication management. Further research is needed to understand the perceived role of pharmacists in supporting medication management for PWD and their caregivers, and how enabling pharmacists scope might reduce medication-related risks and support QUM in this sector.

Background

Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role.

Objective

The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota.

Methods

This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers.

Results

Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators.

Conclusions

Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Objective: This study aims to evaluate the effectiveness of the Quality Risk Management (QRM) system in hospital pharmacy intravenous admixture services (PIVAS). Methods: Failure Modes and Effects Analysis (FMEA) and risk matrix methods were used to systematically assess the critical risk points in PIVAS. By collecting and comparing relevant data from 2019 to 2023, key performance indicators (KPIs) before and after the implementation of the QRM system were quantitatively evaluated. Results: The results showed that the safety and efficiency of pharmacy services significantly improved after the implementation of the QRM system. The medication error rate significantly decreased from 3.2% to 1.1%, the average medication preparation time reduced from 15.5 min to 8.2 min, and staff satisfaction increased from 6.0 to 8.5 points. Other indicators, such as cross-contamination rates and handling errors, also showed significant improvement (all outcomes p < 0.001). Discussion: Systematic risk management effectively enhanced the operational performance of PIVAS, reduced medication errors, and improved the quality of healthcare services. This study highlights the key role of QRM in enhancing medication safety and productivity, providing empirical support for the implementation of similar systems in other healthcare institutions.