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Published By Centro De Investigaciones Y Publicaciones Farmaceuticas (Cipf)

1885-642x, 1885-642x

2021 ◽  
Vol 19 (3) ◽  
pp. 2350
Author(s):  
Narayan Gaurang ◽  
Rajendran Priyadharsini ◽  
Kandan Balamurugesan ◽  
Mathiyalagen Prakash ◽  
Devanathan Reka

Background: Good prescribing practices form the essence of drug therapy for better patient care. The major aim of better prescribing is to improve rational prescribing. Deprescribing gained momentum in recent decades. Objective: This study aimed to explore the attitude and beliefs of deprescribing among patients and their caregivers forming dyads in a tertiary health care facility. Methods: Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescribing was assessed by using validated rPATD (revised Patient attitude towards deprescribing) questionnaire. Cohen's kappa coefficient was used to measure the agreement between the views of people and their caregivers forming dyads about medication cessation. Results: 312 patients and caregivers (156 forming dyads) participated in the study. Among 156 patients, 25.6% were hypertensives & 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belong to the elderly age group. 2.5% were taking >5 medications. 43.6% of patients and 62.2% of caregivers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the treating physician's advice, but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop taking medicines for a long time. Conclusions: In our study, more than 50% of people and their caregivers were willing to try medication cessation under their physician's recommendation. There was moderate agreement between patients and their caregivers in the trial of medication cessation. Thus, the results obtained from this study may help towards improving rationalized prescribing practices in the institutional setup.


2021 ◽  
Vol 19 (3) ◽  
pp. 2471
Author(s):  
Louise Deep ◽  
Carl R. Schneider ◽  
Rebekah Moles ◽  
Asad E. Patanwala ◽  
Linda L. Do ◽  
...  

Background: Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution. Objective: To evaluate the number and type of medication discrepancies identified by pharmacy students. Methods: Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies. Results: There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system. Conclusions: Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.


2021 ◽  
Vol 19 (3) ◽  
pp. 2377
Author(s):  
Denis Choquette ◽  
Jonathan Chan ◽  
Mohammad Bardi ◽  
Carolyn Whiskin ◽  
Gabriel Torani ◽  
...  

Background: Recent approvals for novel agents such as the small molecule Janus kinase inhibitors (JAKi), combined with the advent of biosimilars has widened the gamut of available therapeutic options in the treatment of rheumatoid arthritis (RA). This combined with the introduction of mandatory non- medical switches to biosimilars in some jurisdictions by both public and private payors has led to a significant increase in the volume of therapeutic changes for patients. Pharmacists are well positioned to ensure effective and safe transitions, however there is a significant unmet need for objective and subjective clinical guidance around therapy as well disease state monitoring in RA that facilitates best practices throughout the patient journey. Objective: In this paper we aim to create a consensus derived monitoring algorithm for pharmacists to facilitate best practices throughout therapeutic transitions from originator biologic to other originator biologics, biosimilars, and Janus kinase inhibitors in RA. Methods: The Nominal Group Technique (NGT) was used to understand if consensus could be found among the participants. Clinically relevant questions were developed to capture solutions to the identified unmet need. The faculty considered the questions as individuals, and privately generated answers/ideas. After discussion and consideration, the participants ranked the ideas and established a consensus. Results: Based on the outcome of the consensus discussions, an algorithm was created to help guide pharmacists through therapeutic transitions in RA. The tool covers important topics such as pre-transition considerations, avoiding the nocebo effect for biosimilars, specific considerations for each drug or class, monitoring efficacy, and when to refer. Conclusions: New classes of anti-rheumatic drugs including JAKi, along with the introduction of biosimilars are presenting more opportunity for therapeutic changes and monitoring in patients with RA. We hope our evidence-based consensus derived guidance tool will assist frontline pharmacists in supporting their patients to a successful therapeutic transition in RA.


2021 ◽  
Vol 19 (3) ◽  
pp. 2440
Author(s):  
Kate Preston ◽  
Natalie M. Weir ◽  
Tanja Mueller ◽  
Rosemary Newham ◽  
Marion Bennie

Background: To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016. Objective: To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility. Methods: Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role. Results: Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available). Conclusions: The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources.


2021 ◽  
Vol 19 (3) ◽  
pp. 2364
Author(s):  
Zeinab Bitar ◽  
Chadia Haddad ◽  
Sahar Obeid ◽  
Souheil Hallit

Background: The patient's evaluation of treatment and its associated outcomes define the treatment satisfaction. The quality of treatment satisfaction and healthcare service has been affected by depression, anxiety and fear of the current coronavirus disease 2019 (COVID-19) pandemic. Objective: Therefore, this study aimed to assess factors associated with treatment satisfaction among Lebanese inpatients with schizophrenia, namely depression, anxiety and fear of COVID-19. Methods: A cross-sectional study was conducted between September and November 2020, enrolled 118 patients with chronic schizophrenia consecutively admitted to Psychiatric Hospital of the Cross, Lebanon. The Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale (FACIT-TS-PS) was used to assess treatment satisfaction, the Lebanese Anxiety Scale -10 (LAS-10) was used to assess anxiety, Montgomery-Asberg Depression Rating Scale (MADRS) to assess depression and the Fear of COVID-19 Scale to assess the level of fear of the COVID-19 pandemic. Results: The mean scores of the scales were as follows: treatment satisfaction (65.20; SD 16.11; median=71), LAS-10 (13.65; SD 6.02), MADRS (9.09; SD 6.69) and fear of COVID-19 (18.59; SD 6.78). Higher depression (r= -0.46, p<0.001) was significantly associated with lower treatment satisfaction. Female gender (beta=7.51, p=0.029) was significantly associated with higher treatment satisfaction score. Fear of COVID-19 did not show any significant association with the treatment satisfaction score. Conclusions: Results of this study found that depression and gender were associated with treatment satisfaction among inpatients with schizophrenia. No association has been found between fear of COVID-19 and treatment satisfaction among those patients. More research is warranted to evaluate treatment satisfaction and associated factors among chronic inpatients with schizophrenia, specifically during the COVID-19 pandemic, in order to improve treatment satisfaction and subjective well-being of patients.


2021 ◽  
Vol 19 (3) ◽  
pp. 2401
Author(s):  
Johanna Aponte-González ◽  
Paul Brown ◽  
Javier Eslava-Schmalbach

Background: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. Objective: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. Methods: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. Results: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. Conclusions: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.


2021 ◽  
Vol 19 (3) ◽  
pp. 2545
Author(s):  
Sarira El-den ◽  
Jack C. Collins ◽  
Timothy F. Chen ◽  
Claire L. O’Reilly

Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.


2021 ◽  
Vol 19 (3) ◽  
pp. 2413
Author(s):  
Ruben Viegas ◽  
Cristina A. Godinho ◽  
Sónia Romano

Background: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active. Objective: This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice. Methods: A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies. Results: In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3). Conclusions: Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.


2021 ◽  
Vol 19 (3) ◽  
pp. 2397
Author(s):  
M. Rozaini Rosli ◽  
Chin F. Neoh ◽  
David B. Wu ◽  
Nazariah W. Hassan ◽  
Mahani Mahmud ◽  
...  

Background: Successful diabetes treatment requires commitment and understanding of disease management by the patients. Objective: This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage. Methods: A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. Results: No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted. Conclusions: HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted. 


2021 ◽  
Vol 19 (3) ◽  
pp. 2469
Author(s):  
Kian K. Kong ◽  
Siew C. Ong ◽  
Guat S. Ooi ◽  
Mohamed A. Hassali

Background: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities. Objective: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique. Methods: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule. Results: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005). Conclusions: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.


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