Role of clinical pharmacist in the palliative care of adults and elderly patients with cancer: A scoping review

Objective: We conducted this scoping review to map and summarize scientific evidence on the role of clinical pharmacists in the palliative care of adults and elderly patients with cancer. Data Sources: A literature search was performed in MEDLINE, PubMed Central, Embase, Web of Science, Scopus, and BVS/BIREME for studies published until November 22nd, 2020. Studies that reported work experiences adopted by clinical pharmacists in the palliative care of adults and elderly patients with cancer were included. Two independent authors performed study selection and data extraction. Any disagreements were resolved by discussion with the third and fourth authors. The pharmacist interventions identified in the included studies were described based on key domains in the DEPICT v.2. Data Summary: A total of 586 records were identified, of which 14 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 5) and Canada (n = 5) and described the workplace of the pharmacist in clinic/ambulatory (n = 10). Clinical pharmacists performed several activities and provided services, highlighting medication review (n = 12), patient and caregivers education (n = 12), medication histories and-or medication reconciliation (n = 6). The pharmacist interventions were mostly conducted for patients/caregivers (n = 13), by one-on-one contact (n = 14), and by face-to-face (n = 13). Pharmacists were responsible mainly for change or suggestion for change in therapy (n = 12) and patient counselling (n = 12). Pharmacist interventions were well accepted by the clinical team. Overall, studies showed that pharmacists, within an interdisciplinary team, had significant impacts on measured outcomes. Conclusions: In recent years, there have been advances in the role of the pharmacist in palliative care of patients with cancer and there are great opportunities in this field. They play an important role in managing cancer pain and other symptoms, as well as resolving drug related problems. We encourage more research to be carried out to strengthen this field and to benefit patients with advanced cancer with higher quality of life.

Analysis of Pharmacist Interventions in Adult COVID-19 Patients Admitted to a Tertiary Care Hospital

Background: Pharmacists are integral members of the multidisciplinary healthcare team who, with their skills, knowledge, and training, are well positioned to prevent, identify, and manage medication-related issues. Many published articles related to COVID-19 management have highlighted the important role of the pharmacists in assuring the safe, effective, and cost-effective use of medications. During such challenging times of COVID-19 pandemic that resulted in a high demand on medical resources and healthcare providers, pharmacists are well positioned to contribute and add more efforts to the healthcare system to achieve best use of the available resources including medications and providing high quality pharmaceutical care to help the patients and support the healthcare providers. Methods: This is a retrospective chart review included all admitted adult patients with confirmed COVID-19 diagnosis from 1 March 2020 till 30 June 2020. The documented clinical pharmacist interventions were extracted from the EMR and reviewed by multiple clinical pharmacists to identify type, number, frequency, outcome, and physician’s acceptance rate of documented interventions. Results: A total of 484 pharmacist interventions included in the final analysis. Antimicrobial stewardship interventions were the most reported (149, 30.8%) and antibiotics were the most reported class of medication, constituting 31.1% of the total interventions. “Optimized therapy” was the most commonly reported outcome (58.8%). Overall, 50.8% (246) of the interventions were rated as having “moderate” clinical significance using the clinical significance scoring tool. The physicians’ acceptance rate was 94.7%. Conclusion: Pharmacist interventions are associated with improved communication and medication use in admitted adult patients with COVID-19. Clinical pharmacists can play a crucial role in optimizing medication use in patients with COVID-19 through prevention, identification, and resolving existing or potential drug-related problems.

Productivity, workload, and clinical pharmacists: Definitions matter

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

A qualitative study on the working experiences of clinical pharmacists in fighting against COVID-19

Background The spread of coronavirus disease 2019 (COVID-19) has overwhelmed healthcare systems across the world. Along with the medical team, clinical pharmacists played a significant role during the public health emergency of COVID-19. This study aimed to explore the working experience of clinical pharmacists and provide reference for first-line clinical pharmacists to prepare for fighting against COVID-19. Methods A qualitative study based on descriptive phenomenology was employed with face-to-face and audio-recorded interviews to study the working experience of 13 clinical pharmacists (including two clinical nutritional pharmacists). All interviews were transcribed verbatim, and the interview data were analyzed thematically using NVivo software. Results Four themes emerged from interview data, including roles of clinical pharmacists, working experiences of clinical pharmacists, psychological feelings of clinical pharmacists, and career expectations of clinical pharmacists. Conclusions The results contributed to a deeper understanding of the clinical pharmacists’ work experiences in COVID-19 and offered guidance to better prepare clinical pharmacists in participating in a public health crisis.

Digital Health Interventions by Clinical Pharmacists: A Systematic Review

Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. The purpose of this study was to systematically review CP-led digital interventions to improve patients’ health-related clinical outcomes. PubMed and the Cochrane Database were searched to select studies that had conducted a randomized controlled trial to evaluate clinical outcomes in adults following a CP-led digital intervention for the period from January 2005 to August 2021. A total of 19 studies were included in our analysis. In these 19 studies, the most commonly used digital intervention by CPs was telephone use (n = 15), followed by a web-based tool (n = 2) and a mobile app (n = 2). These interventions were provided to serve a wide range of purposes in patients’ outcomes: change in lab values (e.g., blood pressure, HbA1c) (n = 23), reduction in health service use (n = 8), enhancing adherence (n = 6), improvement in drug-related outcomes (n = 6), increase in survival (n = 3), and reduction in health-related risk (e.g., CVD risk) (n = 2). Although the impacts of telephone-based interventions on patients’ outcomes were decidedly mixed, web-based interventions and mobile apps exerted generally positive influences. To date, little research has investigated the cost-effectiveness of digital interventions. Future studies are warranted.

Pharmaceutical Care Network Europe (PCNE) Drug-Related Problems Classification Version 9.1: First Implementation in Sudan

Background: Clinical pharmacy services are an emerging specialty in Sudan. Many tools exist to document drug-related problems (DRP), such as the Pharmaceutical Care Network Europe (PCNE) classification. However, none has been attempted and published in Sudan. Objectives: The study aimed to identify the DRP and its characteristics in real hospital setting using non-modified version of PCNE. Method: Prospective study of clinical pharmacists' interventions during the routine care work of reviewing patients over a period from December 2020 to February 2021 at the wards of National Cancer Institute, University of Gezira, Sudan. Main outcome measure Using non-modified PCNE version 9.1 to identify the number, types, causes of the DRP, clinical pharmacists' interventions, acceptance, and outcomes. Results: Five minutes (range, 3-15 minutes) was the median time spent for evaluation and intervention by the clinical pharmacists, a total of 51 DRP were discovered among 40 patients with an average of 1.3 DRP per patient, an adverse drug event (possibly) occurring (29.4%) was the main problem, no or incomplete drug treatment (27.5%) was the main causes, above one-third of the clinical pharmacists' interventions were proposed to the prescriber, these interventions were accepted in 96% and fully implemented among 72.5% of the cases. At the end of the process, the majority of DRP (72.5%) were totally solved. Conclusion: Non-modified PCNE version 9.1 provides a suitable tool for the DRP process for Sudanese clinical pharmacists during routine work in the oncology setting. It hence can be considered as an optimal tool for further quality and policymaking.

Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

Background Clinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients’ quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital. Methods A before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4–12 mg/L), phenytoin (10–20 mg/L), or valproic acid (50–100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test. Results A total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists’ intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018). Conclusion Epilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient’s response and determine the most effective treatment with the fewest adverse drug reactions. Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04967326

Clinical pharmacy in Israel versus the US, can we "compare apples to apples"?—commentary

Clinical pharmacy is an umbrella of pharmaceutical services that is practiced by clinical pharmacists. Clinical pharmacists improve the quality of drug therapy, minimize the risk for drug related problems, reduce the risk of morbidity and mortality associated with polypharmacy and decrease the overall healthcare expenditure. Consequently, clinical pharmacy is focused on both the needs of the individual patient, as well as of the healthcare system. Clinical pharmacy is now well-established and practiced worldwide and in the last two decades has been implemented successfully in Israel. This commentary maintains that the comparison of clinical pharmacy practice in Israel and in the United States, published by AJ Rose et al., has several limitations that need to be considered when devising a road map that will fit the Israeli health care system and its environment. Emphasis should be placed on the implementation of automation and robotics, promulgating regulations to allow for integration of pharmacy technicians, and allocating funds for such services.