Development and use of an innovative Gap Finding Tool to create Pharmaceutical Care Model within a paediatric oncology setting

Introduction A paediatric cancer ward is a setting where pharmacists participate in direct patient care, acting as coordinators between the patient, caregivers and healthcare professionals. The aim of the study was to develop a Gap Finding Tool to support the setting up of a pharmaceutical care model at a Paediatric-Adolescent Cancer Ward. Methods The Standards of Practice for Clinical Pharmacy Services by the Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy (2013), the American College of Clinical Pharmacy (2014) and the European Association of Hospital Pharmacists (2014) were used to compile the Gap Finding Tool. The developed Tool was tested for content validity by a panel of experts and subsequently implemented over 2 months. Results The Gap Finding Tool comprised of nine sections with an average of eight statements each about pharmacy services that should be provided at ward level. For each statement, the rater indicates whether these contributions are provided. When the Tool was implemented at the Paediatric-Adolescent Cancer Ward, four major gaps were identified, namely, absence of a clinical pharmacist, lack of medicines information, vetting of chemotherapy prescriptions by pharmacist with limited access to patient data and lack of pharmacist-input on medicines availability. Processes requiring optimisation included discharge medication advice and documentation processes. Conclusion The developed Gap Finding Tool is an innovative tool which is versatile and can be used in ward or ambulatory clinical settings to identify gaps in pharmaceutical processes and services and compare national or regional practices to international standards.

Overcoming institutionalised barriers to digital health systems: An autoethnographic study of the judicialization of a digital health tool.

Background The deployment of digital health systems may be impeded by barriers that or are linked to underlying enduring institutions. Attempting to challenge the barriers without addressing the underpinning institution may be ineffective. This study reflects on ways actors may surmount institutionalised barriers to the uptake of digital tools in health systems. Methods Institutional theory concepts were applied to an autoethnographic case study of efforts to introduce a digital tool to provide citizens with medicines information. Results The tool’s uptake was impeded because of state regulators’ institutionalised interpretation of pharmaceutical advertising laws, which rendered the tool illegal. The regulators’ institutionalised interpretation of pharmaceutical advertising laws was successfully challenged through various actions by the author- a pharmacist, and by allies beyond the health sector. These actions included: framing the tool as legal and constitutional, litigation, and redefining these concepts: ‘advertising’, ‘health institution’, and the role of regulatory bodies vis a vis innovation. Conclusion After identifying a barrier as being institutionalised or linked to an institution, actors might challenge such barriers by engaging in institutional work; i.e. deliberate efforts to challenge the relevant institution (e.g. a law, norm or shared belief). Institutional work may require the actions of multiple actors within and beyond the health sector, including judicial actors. Such cross-sectoral alliances are efficacious because they provide institutional workers with a broader range of strategies, framings, concepts and forums with which to challenge institutionalised barriers. However, actors beyond the health system (e.g. the judiciary) must be inquisitive about the potential implications of the digital health interventions they champion.

Content analysis of the official documents on the turnover of counterfeit medicines in Ukraine in 2017–2020

The purpose of the work was to conduct a content analysis of the orders of the State Medicines Service on the prohibition of the circulation of counterfeit medicines and the information messages of law enforcement agencies in 2017–2020. The object of the study was the orders of the State Medicines Service on the prohibition of the circulation of counterfeit medicines, information messages of law enforcement agencies to identify the facts of clandestine production and counterfeiting, publications on the problems of it’s distribution. The study used the methods of content analysis, systematization and generalization. Тo prevent the circulation of counterfeit medicines in the countries of the world, various methods of countering counterfeiting are being introduced, however, only in Ukraine was the restriction of measures of state supervision (control) in the pharmaceutical sector introduced as an element of deregulation. In connection with this, it was investigated how such restrictions, which were introduced three times, has influenced the identification and distribution of counterfeit medicines. For the study, a methodology for content analysis of official documents on the circulation of counterfeit medicines in the country for 2017–2020 has been proposed. In most of the orders of the State Medicines Service, revealed signs of drug falsification were introduced, which related to the labeling of packages. The imposition of a moratorium on planned measures of state supervision had a negative impact on the work of quality control bodies of medicines to identify counterfeits. In 2010–2014 (before the introduction of the first moratorium) the State Medicines Service issued 326 orders prohibiting the circulation of counterfeit medicines, but after the introduction of the moratorium, the number of orders for 6 years decreased significantly – to 118. So, in 2020, the State Medicines Service issued only 4 orders to prohibit the circulation of counterfeit drugs (for comparisons in 2017 – 18), although law enforcement officers revealed 6 facts of clandestine production and counterfeit. According to the results of the study, it was established that it was necessary to unify and standardize the management documents of the State Medicines Service on the prohibition of the circulation of counterfeit medicines, and also indicated the feasibility of introducing «field screening» of the often counterfeited medicines, to establish the real part of counterfeit medicines. Information messages from law enforcement agencies should not be limited only to the facts of revealing clandestine proceedings, but also should contain the results of court decisions on these facts. It is advisable to intensify interaction with regulatory authorities in other countries for a more effective exchange of information on detected of counterfeit medicines.

A mixed methods study on medicines information needs and challenges in New Zealand general practice

Background Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. Methods A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. Results Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners’ medicines information needs were identified from the qualitative data: a ‘common core’ related to medicine dose, side effects and interactions and a ‘perplexing periphery’. Challenges in the perplexing periphery were the variation in information needs, complexity, ‘known unknowns’ and ‘unknown unknowns’. Key factors affecting general practitioners’ strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. Conclusions General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.

SOSIALISASI TENTANG SEHAT DENGAN OBAT TRADISIONAL DAN SUPLEMEN KESEHATAN DI MASA NEW NORMAL COVID-19

Untuk menghadapi pandemi Covid-19 selama New Normal dimana masyarakat dapat kembali melakukan aktifitas bekerja atau aktifitas lain di publik, maka diperlukan suatu upaya pengendalian dan pencegahan yang dapat dilakukan dengan meningkatkan daya tahan tubuh melalui kebiasaan hidup sehat antara lain menjaga kebersihan, asupan nutrisi yang baik, ditambah dengan penggunaan suplemen kesehatan dan ramuan herbal/obat tradisional. Informasi mengenai bahan obat tradisional dan suplemen kesehatan diperlukan, Maka dilakukan pengabdian masyarakat dengan metoda pemberian informasi atau penyuluhan untuk mengetahui OT (Obat Tradisional) dan suplemen kesehatan yang tepat untuk menghadapi pandemi di era New Normal. Sasarannya ibu-ibu tersebut karena ibu-ibu tersebut langsung berdampak pada situasi pandemi yang harus beraktifitas di daerah publik di era New Normal. Tujuan dari pengabdian masyarakat ini untuk meningkatkan pengetahuan mengenai bahan obat tradisional dan suplemen kesehatan dengan tepat dan bijak. Hasil posttest terhadap materi yang telah diberikan informasi dengan penyuluhan kepada peserta, diperoleh rata-rata nilai pengetahuannya adalah 98,57, hal ini terlihat mengalami peningkatan pengetahuan dibandingkan dengan pretest rata-rata 72,9. Dari hasil pengabdian kepada masyarakat tentang sehat dengan bahan alam di masa pandemic Covid-19 kepada ibu-ibu pegawai diperoleh terjadinya peningkatan pengetahuan terhadap materi tersebut, dan diharapkan peserta dapat mengaplikasikan dengan memanfaatkan Natural produk untuk meningkatkan daya tahan tubuh. Kata kunci: Covid-19, Obat Tradisional, Suplemen Kesehatan ABSTRACT To deal with the Covid-19 pandemic during the New Normal where people can return to work activities or other activities in public, it is necessary to control and prevent efforts that can be done by increasing endurance through healthy living habits, including maintaining cleanliness, good nutritional intake. , coupled with the use of health supplements and herbal ingredients / traditional medicines. Information about traditional medicinal ingredients and health supplements is needed. Therefore, community service is carried out by providing information or counseling methods to find out the right Traditional Medicine and health supplements to deal with the pandemic in the New Normal era. The target of these mothers is because these mothers have a direct impact on the pandemic situation which must be active in public areas in the New Normal era. The purpose of this community service is to increase knowledge about traditional medicinal ingredients and health supplements appropriately and wisely. The results of the posttest on the material that had been provided with information by counseling the participants, obtained an average value of knowledge of 98.57, this shows an increase in knowledge compared to the pretest average of 72.9. From the results of community service about being healthy with natural ingredients during the Covid-19 pandemic to employee mothers, an increase in knowledge of these materials is obtained, and it is hoped that participants can apply them by utilizing natural products to increase endurance. Keywords: Covid-19, Traditional Medicine, Health Supplements

28 Medication Compliance Aids and Acute Hospitals

Introduction An estimated 64 million Medication Compliance Aids (MCAs) are dispensed by pharmacies in England each year as a method of reasonable adjustment to improve medication adherence (NICE 2009) and support medicines administration by carers (RPS 2013). Complexities exist when implementing medication changes for patients using MCAs, particularly at hospital discharge or outpatient appointments, where practices seem to vary. This National Survey is the first to determine the current policy and service provision of MCAs by acute hospitals in England. Methods An electronic survey was emailed to Chief Pharmacists via the Regional Medicines Information Services in Spring 2019. Initial non-responders were contacted by email and telephone. Results 51% (73/144) of acute hospital trusts in England responded. 77% (56/73) dispensed medication in MCAs at discharge. Of these, 62.5% would initiate MCAs and 61% supplied a different length of MCA vs non-MCA prescription (see table). 41 hospitals had designated staff completing MCAs. The median time to complete an MCA was 59.5 minutes (range 10–200). The median time from prescription receipt in pharmacy to MCA arrival on ward was 144.5 minutes (range 60–1,440). Of the 17 hospitals not providing MCAs, the majority would, upon discharge, contact the community pharmacy that provided the MCA pre-admission to update any medication changes and request the provision of a new supply of medicines. Conclusion Despite the ubiquitous nature of the MCA, there is no standard approach to the supply of these devices from acute hospitals across England. When hospitals do provide MCAs their preparation is time consuming, often requiring additional staff. A national approach to MCAs might help patients and carers, and reduce medication-related problems and costs.

Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: a multimethod qualitative study

Background Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals, to provide patients with post-discharge medicines-related support. However, findings suggest that many PMHS are provided sub-optimally due to a lack of resources. This study sought to examine pharmacy professionals’ perceptions of the future of PMHS. Methods Participants comprised pharmacy professionals from NHS Trusts in England that provided a PMHS. Invitations to participate in a qualitative survey and then an interview were sent to pharmacy services at all NHS Trusts that provided a PMHS. This resulted in 100 survey participants and 34 interview participants. Data were analysed using Braun and Clarke’s inductive reflexive thematic analysis. Results Two themes were generated: Enhancing value for service users and Improving efficiency. Enhancing value for service users identifies pharmacy professionals’ suggestions for improving the value of PMHS for service users. These include providing access methods extending beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist to offer medicines-related support. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings. Conclusions PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally/nationally). However, such change is dependent upon the sharing of patients’ information between hospitals and the centralised hub/s or pharmacies. To enhance the value of PMHS for service users, providers should consider establishing other methods of access, such as email and video consultation. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

Ten recommendations to improve pharmacy practice in low and middle-income countries (LMICs)

Medicines are important health interventions and their appropriate use could improve health outcomes. Throughout the globe, pharmacists play a very important role to improve the use of medicines. Though high-income countries are debating on futuristic approaches, independent prescribing of pharmacists, clinical skills, and to expand pharmacy services; a large majority of low and middle-income countries still lag behind to strengthen pharmacy practice. This paper presents a key set of recommendations that can improve pharmacy practice in low and middle-income countries (LMICs). The ten recommendations include (1) Mandatory presence of graduate-level pharmacists at community pharmacies (2) Clear demarcation of the roles and responsibilities of different categories of pharmacists (3) Effective categorization and implementation of medicines into (a) prescription medicines (b) pharmacists only medicines (c) over the counter medicines (4) Enforcement of laws and regulations for the sale of medicines (5) Prohibiting doctors from dispensing medicines (the dispensing separation between pharmacists and doctors). (6) Involving pharmacies and pharmacists in Universal Health Coverage Schemes to improve the affordability of medicines (7) Strengthening national medicines regulatory authorities to improve the quality, safety, and effectiveness of medicines (8) Training of pharmacists in clinical skills, vaccination, and minor ailment schemes (9) Promoting independent medicines information for consumers and healthcare professionals by developing national medicines information strategy (10) Mandatory Continuing Professional Development (CPD) programs for the Pharmacists.