Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020).

BACKGROUND: Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. AIM: To conduct a systematic review of literature on economic evaluation of pharmacy services. METHOD: Literature (2016-2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost-benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost-benefit analysis (CBA). RESULTS: Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). CONCLUSION: The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services.

Pharmacy students' preparation to provide pharmaceutical care for patients with non-communicable diseases in six ASEAN countries: A qualitative study.

INTRODUCTION: Pharmacy education programs prepare graduates to promote health for patients with noncommunicable disease (NCDs), but there is limited information concerning Association of South East Asia Nations (ASEAN) countries. The study aim was to synthesize academic staff's, alumni's, and alumni supervisors' perspectives on preparation for students to provide pharmaceutical care in NCDs. METHODS: A qualitative research design was used. In-depth interviews with structured questions following the Context, Input, Process, and Product/Outcomes model framework were conducted with four academic staff, three alumni, and three alumni supervisors from six study sites in six countries. Interview questions were constructed in Thai and translated to English by using forward and backward translation. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation. RESULTS: Sixty participants were included. The context showed three main themes related to Burden of NCDs, Pharmacist Roles in NCDs, and Goals. The input showed three main themes of Teaching Methods, Development Plans for Academic Staff, and Budgets and Infrastructure. The process showed one main theme of Struggles in Teaching Methods. The outcomes/outputs showed three main themes of Individual, Organizational, and Professional Levels. Schools need curricula that focus on NCDs, pharmacist competency and skills, and academic preparation of students for practice. Gaps limiting achievement of goals included lack of well-trained academic staff, limited learning facilities, self-learning opportunities, acceptance from other health professionals, and career ladders. CONCLUSIONS: The preparation of pharmacy students varied in six ASEAN countries. Pharmacy education programs must address existing gaps that limit achievement of goals related to NCDs.

A systematic review of measures of medication adherence in consumers with unipolar depression.

OBJECTIVE: To identify and evaluate the range of adherence measures used to assess different phases of medication adherence (initiation, implementation, and discontinuation) to antidepressants, including the psychometric properties of the measures. METHODS: This systematic review followed the PRISMA statement. Medline, Embase, International Pharmaceutical Abstracts, CINAHL and PsychINFO were searched (1994-2015) for articles which reviewed or reported the psychometric properties of adherence measures in adults with unipolar depression without co-morbidity. Included articles were reviewed for the reliability and validity of their adherence measures. RESULTS: 26 studies met the inclusion criteria. Most assessed medication adherence at implementation and/or discontinuation phases. Self-report measures were the most frequently used, followed by electronic lid devices and pharmacy records. Standardized self-report measures such as Morisky, Green, and Levine Self-Reported Medication Taking Scale (MGLS) and Antidepressant Adherence Scale (AAS) demonstrated acceptable reliability and validity, while medication claims data showed good reliability as a long-term measure. CONCLUSIONS: Although the psychometric properties of various measures have been evaluated across the three phases of adherence, a standout measure with strong reliability and validity was not apparent. No single measure demonstrated reliability and validity throughout the adherence process. A range of different subjective and objective adherence measures is recommended to assess medication adherence across the different phases.

Consumer-related factors influencing antidepressant adherence in unipolar depression: a qualitative study.

PURPOSE: To explore factors which facilitate and negatively impact adherence, at initiation, implementation and discontinuation phases of adherence to antidepressant medicines. PATIENTS AND METHODS: Semi-structured, face-to-face interviews were conducted with patients suffering from unipolar depression. The digitally audio-recorded and transcribed verbatim were used. Transcripts were thematically content analyzed and data managed using N-Vivo software. RESULTS: Twenty-three interviews were conducted. The predominant factors facilitating initiation of therapy included self-motivation and severity of depression. Factors aiding persistence with therapy included belief in, and effectiveness of, antidepressants. Stigma and fear of adverse events inhibited initiation of therapy, whilst adverse events and ineffectiveness of antidepressants contributed to discontinuation. Patients with strong perceptions of the necessity and few concerns about antidepressants were more likely to adhere to treatment at all phases of adherence. CONCLUSION: Different factors influence medication adherence at the different phases of adherence. These factors were based on individual perceptions about depression and its treatment, and actual experiences of antidepressant treatment. This information should be considered by health care professionals in delivering targeted and tailored interventions to foster adherence. Strategies to address medication non-adherence in unipolar depression patients should consider the phase of adherence and individual perceptions about depression and its treatment, along with previous experiences with treatment for depression.

Development of clinical pharmacy services in Australia, Austria, Belgium, Bosnia-Herzegovina, Canada, Germany, Japan, Kosovo, Switzerland, the Netherlands, Thailand, USA and correlation with educational standards, level of research, and implemen.

OBJECTIVE: This study aimed to compare determinants of professional development between different countries to identify barriers and facilitators of development towards clinical pharmacy services and stimulate discussion of under-used potential and opportunities. MATERIALS: The study was conceived as a survey. The questionnaire was administered to a group of experts. METHODS: The survey was conducted as a cross-sectional study with descriptive and correlation analysis. A questionnaire was developed and adjusted to the study focus, covering aspects on general regulations for community pharmacies, professional education, implementation of clinical pharmacy services, and research in patient care. Results were compared for analyses. RESULTS: A total of twelve countries were included in this survey. Pharmacy studies took between 4 and 6 years plus residency in most countries. Curricula remained drug-oriented only in Austria, Bosnia-Herzegovina, and Germany; these three countries had the least pharmacotherapy content in their curricula. Canada, the USA, and Australia have established clinical pharmacy services in almost all fields of practice. Most other countries have implemented at least some clinical services, with the exception of Bosnia-Herzegovina, Germany, and Kosovo. The correlation coefficient between education, research, and implementation was 0.91. CONCLUSION: The results of the survey show that clinical pharmacy services are established to very different extents among the participating countries. The strong correlation suggests that achieving a successful transition in professional practice needs to address several aspects of education and research to reach progress. The collected data might help to identify potential areas of improvement to foster implementation of clinical pharmacy services.
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