scholarly journals Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050196
Author(s):  
Sumaira Omer ◽  
Mengyuan Pan ◽  
Salamat Ali ◽  
Sundus Shukar ◽  
Yu Fang ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare System ◽  
Secondary Outcome ◽  
Local Health ◽  
Hospital Pharmacists ◽  
Drug Shortages ◽  
Khyber Pakhtunkhwa ◽  
Validated Questionnaire ◽  
The Impact ◽  
Policy Solutions

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.

scholarly journals Implementation, Evolution and Impact of ICU Telepharmacy Services Across a Health care System

2019 ◽  
Vol 54 (4) ◽  
pp. 232-240 ◽  
Author(s):  
Desiree E. Kosmisky ◽  
Sonia S. Everhart ◽  
Carrie L. Griffiths
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Healthcare System ◽  
Improve Patient Care ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Use Of Technology ◽  
American Society ◽  
The Impact

Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.

scholarly journals Genomic miscellany and allelic frequencies of Plasmodium falciparum msp-1, msp-2 and glurp in parasite isolates

2021 ◽  
Author(s):  
Muzafar Shah ◽  
Ibrar Ullah ◽  
Sahib Gul Afridi ◽  
Muhammad Israr ◽  
Asifullah Khan ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Plasmodium Falciparum ◽  
Local Health ◽  
Multiplicity Of Infection ◽  
High Genetic Diversity ◽  
Khyber Pakhtunkhwa ◽  
Chain Reactions ◽  
Allelic Family ◽  
Allelic Frequencies ◽  
The Impact

Plasmodium falciparum, the main causative agent of malaria is an important public health vector in Khyber Pakhtunkhwa, Pakistan. Identification of the genetic diversity of malaria parasites can inform the intensity of transmission and identify potential deficiencies in malaria control programs. The aim of this study was to investigate the genetic diversity, allele frequencies and multiplicity of infection (MOI) of P. falciparum in Khyber Pakhtunkhwa, Pakistan. Methods: A total of 85 isolates from patients presenting to the local health centers with P. falciparum species were collected from 2017 to 2019. Parasite DNA was extracted from a total of 200 micro litter whole blood per patient using the Qiagen DNA extraction kit according to manufactures instructions. The polymorphic region of msp-1, msp-2 and glurp loci were genotyped by using nested polymerase chain reactions followed by gel electrophoresis for fragment analysis. Results: Genetic diversity and allelic frequencies of msp-1, msp-2 and glurp were identified in 85 blood samples. A total of 62 msp alleles were detected in which 30 for msp-1 and 32 for msp-2. For msp-1 the successful amplification occurred in (75/85) 88.23% isolates for msp-1, 78.9% (67/85) for msp-2 and 70% (60/85) for glurp. For msp-1, the K1 allelic family was predominant at 66.66% (50/75), followed by RO33 and MAD20. The frequency of samples having only K1, MAD20 and RO33 were 21.34% (16/75), 8% (6/75) and 10.67% (8/75) respectively. In msp-2, the FC27 allelic family was the most abundant with 70.14% (47/67) compared to 3D7 with 67.16% (45/67). Nine glurp RII region genotypes were identified. The overall mean multiplicity of infection was 2.6 with1.8 and 1.4 for msp-1 and msp-2 respectively while for glurp RII genes (MOI=1.03). There was no significant association between multiplicity of infection and age group (Spearman rank coefficient = 0.050; P = 0.6). There was significant correlation between MOI and parasite density for msp-2 allelic family. Conclusion: Our study showed high genetic diversity and allelic frequency with multiple clones of msp-1, msp-2 and glurp in P. falciparum isolates from malaria patients in Khyber Pakhtunkhwa Pakistan. In the present study the genotype data provided the valuable information which is essential for monitoring the impact of malaria eradication efforts in this region.

Drug Shortages: An Approach to Managing the Latest Crisis

2003 ◽  
Vol 38 (8) ◽  
pp. 748-752
Author(s):  
Michelle A. Leady ◽  
Ann L. Adams ◽  
Janice L. Stumpf ◽  
Burgunda V. Sweet
Keyword(s):  
Patient Care ◽  
Medication Errors ◽  
Medical Costs ◽  
Drug Shortages ◽  
Contact Person ◽  
Primary Contact ◽  
Therapeutic Outcomes ◽  
Increased Risk ◽  
The Impact ◽  
Policy And Procedure

In recent years, many drug shortages have compromised patient care. Drug shortages can lead to altered therapeutic outcomes, increased risk of medication errors, and increased medical costs. This article presents one hospital's successful algorithm for managing medication shortages. Methods included drafting a shortage policy and procedure; identifying a primary contact person to assess the impact of the shortage; identifying appropriate clinicians to perform research; establishing references for identification of alternative agents; and promptly communicating with and disseminating shortage information to appropriate individuals.

scholarly journals 812. The Impact of Post-Operative Cephalexin on Surgical Site (SSI) Infections During a Cefazolin Shortage

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S499-S500
Author(s):  
Sara Brown ◽  
R Brigg Turner ◽  
Dominic Chan
Keyword(s):  
Patient Care ◽  
Primary Outcome ◽  
Antimicrobial Prophylaxis ◽  
Community Based ◽  
Drug Shortages ◽  
National Drug ◽  
Observational Cohort ◽  
Impact Patient Care ◽  
Alternative Medications ◽  
The Impact

Abstract Background Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin. Methods This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups. Results There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07). Conclusion National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable. Disclosures All Authors: No reported disclosures

A Report of the Iowa Drug Distribution System

1968 ◽  
Vol 2 (11) ◽  
pp. 305-309
Keyword(s):  
Patient Care ◽  
Distribution System ◽  
Drug Distribution ◽  
Hospital Pharmacists ◽  
Study Approach ◽  
Unit Dose ◽  
The Impact

A Study of Patient Care Involving a Unit Dose System is a factual, well-arranged and thorough study of the impact of the unit dose system on pharmacy and nursing. In its 250 pages, Mr. Tester and his associates have outlined their study approach, the procedures carried out and the results obtained, supplying thereby an excellent guide to other hospital pharmacists contemplating such a system or variation of it. The report was published in 1967 as Study of Patient Care Involving a Unit Dose System and is available from the College of Pharmacy.

scholarly journals Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324356
Author(s):  
Nabeel Khan ◽  
Nadim Mahmud ◽  
Chinmay Trivedi ◽  
Walter Reinisch ◽  
James D Lewis
Keyword(s):  
Healthcare System ◽  
Veterans Affairs ◽  
Secondary Outcome ◽  
Disease Course ◽  
Increased Risk ◽  
National Cohort ◽  
Inflammatory Bowel ◽  
The Impact ◽  
Related Mortality

ObjectiveOur aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD.DesignThis was a retrospective national cohort study of patients with IBD in the Veterans Affairs Healthcare System. We categorised IBD medication use immediately prior to the COVID-19 pandemic and used survival analysis methods to study associations with SARS-CoV-2 infection, as well as a combined secondary outcome of COVID-19 hospitalisation or COVID-19-related mortality.ResultsThe analytical cohort of 30 911 patients was primarily male (90.9%), white (78.6%) and with ulcerative colitis (58.8%). Over a median follow-up of 10.7 months, 649 patients (2.1%) were diagnosed with SARS-CoV-2 infection and 149 (0.5%) met the combined secondary outcome. In adjusted models, vedolizumab (VDZ) use was significantly associated with infection relative to mesalazine alone (HR 1.70, 95% CI 1.16 to 2.48, p=0.006). Patients on no IBD medications had increased risk of the combined secondary outcome relative to mesalazine alone (sub-HR 1.64, 95% CI 1.12 to 2.42, p=0.01), however, no other IBD medication categories were significantly associated with this outcome, relative to mesalazine alone (each p>0.05). Corticosteroid use was independently associated with both SARS-CoV-2 infection (HR 1.60, 95% CI 1.23 to 2.09, p=0.001) and the combined secondary outcome (sub-HR 1.90, 95% CI 1.14 to 3.17, p=0.01).ConclusionVDZ and corticosteroid were associated with an increased risk of SARS-CoV-2 infection. Except for corticosteroids no medications including mesalazine were associated with an increased risk of severe COVID-19.

scholarly journals Impact of a pilot NHS-funded sore throat test and treat service in community pharmacies on provision and quality of patient care

2020 ◽  
Vol 9 (1) ◽  
pp. e000833 ◽  
Author(s):  
Efi Mantzourani ◽  
Andrew Evans ◽  
Rebecca Cannings-John ◽  
Haroon Ahmed ◽  
Kerenza Hood ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Care ◽  
Sore Throat ◽  
Community Pharmacies ◽  
Antibiotic Prescribing ◽  
Local Health ◽  
Test And Treat ◽  
Quality Of Patient Care ◽  
The Impact

ObjectiveA National Health Service (NHS)-funded sore throat test and treat (STTT) service was introduced in selected pharmacies in two local health boards in Wales, as an extension to the national pharmacy common ailment scheme. The aim of this study was to evaluate the impact of STTT on provision and quality of patient care, namely antibiotic use, patient safety and general practitioner (GP) consultation rates.MethodsSecondary analyses of STTT consultation data to describe service outcomes, and routine data to explore changes in antibiotic prescribing and the prevalence of complications. Data were also collected from one GP practice to explore the feasibility of measuring changes in sore throat consultation rates in general practice.ResultsLess than 20% of 1725 consultations resulted in antibiotic supply. The availability of STTT was associated with greater reductions in prescriptions for phenoxymethylpenicillin than in areas where STTT was not available (−3.8% and −3.4%, difference 0.4%). When pharmacy supplies were included, the reductions in the supply of the antibiotic were similar. No increase in the monthly number of incidents of quinsy was detected, and patients were appropriately referred to other healthcare professionals during pharmacy consultations. GP consultation rates since introduction of STTT were found to be lower than the equivalent monthly average since 2014.ConclusionsData from the first 5 months of the STTT service suggest that it may have a role in safely rebalancing uncomplicated sore throat management from general practice to community pharmacies while continuing to promote antibiotic stewardship.

scholarly journals 3317 Translating simulation-based team leadership training into patient-centered outcomes

2019 ◽  
Vol 3 (s1) ◽  
pp. 57-58
Author(s):  
Rosemarie Fernandez ◽  
Elizabeth D. Rosenman ◽  
Anne K. Chipman ◽  
Sarah Brolliar ◽  
Marie C. Vrablik ◽  
...  
Keyword(s):  
Patient Care ◽  
Trauma Patient ◽  
Leadership Training ◽  
Leadership Effectiveness ◽  
Team Leadership ◽  
Secondary Outcome ◽  
Team Leaders ◽  
Simulation Based ◽  
Complex Skills ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of simulation-based team leadership training on team leadership effectiveness and patient care during actual trauma resuscitations. This translational work addresses an important gap in simulation research and medical education research. METHODS/STUDY POPULATION: Eligible trauma team leaders were randomized to the intervention (4-hour simulation-based leadership training) or control (standard training) condition. Subject-led actual trauma patient resuscitations were video recorded and coded for leadership behaviors (primary outcome) and patient care (secondary outcome) using novel leadership and trauma patient care metrics. Patient outcomes for trauma resuscitations were obtained through the Harborview Medical Center Trauma Registry and analyzed descriptively. A one-way ANCOVA analysis was conducted to test the effectiveness of our training intervention versus a control group for each outcome (leadership effectiveness and patient care) while accounting for pre-training performance, injury severity score, postgraduate training year, and days since training occurred. Association between leadership effectiveness and patient care was evaluated using random coefficient modeling. RESULTS/ANTICIPATED RESULTS: Sixty team leaders, 30 in each condition, completed the study. There was a significant difference in post-training leadership effectiveness [F(1,54)=30.19, p<.001, η2=.36] between the experimental and control conditions. There was no direct impact of training on patient care [F(1,54)=1.0, p=0.33, η2=.02]; however, leadership effectiveness mediated an indirect effect of training on patient care. Across all trauma resuscitations team leader effectiveness correlated with patient care (p<0.05) as predicted by team leadership conceptual models. DISCUSSION/SIGNIFICANCE OF IMPACT: This work represents a critical step in advancing translational simulation-based research (TSR). While there are several examples of high quality translational research programs, they primarily focus on procedural tasks and do not evaluate highly complex skills such as leadership. Complex skills present significant measurement challenges because individuals and processes are interrelated, with multiple components and emergent nature of tasks and related behaviors. We provide evidence that simulation-based training of a complex skill (team leadership behavior) transfers to a complex clinical setting (emergency department) with highly variable clinical tasks (trauma resuscitations). Our novel team leadership training significantly improved overall leadership performance and partially mediated the positive effect between leadership and patient care. This represents the first rigorous, randomized, controlled trial of a leadership or teamwork-focused training that systematically evaluates the impact on process (leadership) and performance (patient care).

scholarly journals Clinical impact of the etoposide injection shortage

2019 ◽  
Vol 26 (1) ◽  
pp. 187-192
Author(s):  
Hualy Li ◽  
Sarah K Cimino
Keyword(s):  
Adverse Events ◽  
Patient Care ◽  
Disease Progression ◽  
Medication Errors ◽  
The United States ◽  
Clinical Impact ◽  
Drug Shortage ◽  
Treatment Delays ◽  
Drug Shortages ◽  
The Impact

Purpose Drug shortages have become a constant challenge in patient care over the past two decades. In 2018, there was a shortage of etoposide injection in the United States. The purpose of this study was to analyze the impact of the etoposide injection shortage. Methods This single-center, retrospective chart review included patients prescribed an etoposide-containing chemotherapy regimen between January 2018 and August 2018. The primary objective was to determine the percentage of patients who required a change in treatment due to the etoposide injection drug shortage. For the secondary objectives, the following was compared between patients who received etoposide injection versus alternative etoposide formulations (etopophos injection or oral etoposide): adverse events, medication errors, treatment delays, disease progression, and drug costs. Results Twenty-two patients were included in this study. Overall, seven (32%) patients required a change in treatment due to the etoposide injection shortage. Of the seven patients, six required the use of an alternative etoposide formulation and one patient had etoposide omitted in at least one treatment cycle. There were no significant differences in adverse events, medication errors, treatment delays, or disease progression when comparing patients who received etoposide injection versus alternative etoposide formulations. The average drug cost per cycle was significantly higher in the patients who required a change in treatment. Conclusions To our knowledge, this is the first study to characterize the clinical impact of the etoposide injection shortage. Results from this study highlight the direct impact that drug shortages have on patient care.

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