Enhancing Evidence-Based Pharmacy by Comparing the Quality of Web-Based Information Sources to the EVInews Database: Randomized Controlled Trial With German Community Pharmacists.

BACKGROUND: Self-medication counseling in community pharmacies plays a crucial role in health care. Counseling advice should therefore be evidence-based. Web-based information and databases are commonly used as electronic information sources. EVInews is a self-medication-related information tool consisting of a database and monthly published newsletters for pharmacists. Little is known about the quality of pharmacists' electronic information sources for evidence-based self-medication counseling. OBJECTIVE: Our aim was to investigate the quality of community pharmacists' web-based search results for self-medication-related content in comparison with the EVInews database, based on an adjusted quality score for pharmacists. METHODS: After receiving ethics approval, we performed a quantitative web-based survey with a search task as a prospective randomized, controlled, and unblinded trial. For the search task, participants were instructed to search for evidence-based information to verify 6 health-related statements from 2 typical self-medication indications. Pharmacists across Germany were invited via email to participate. After providing written informed consent, they were automatically, randomly assigned to use either web-based information sources of their choice without the EVInews database (web group) or exclusively the EVInews database (EVInews group). The quality of the information sources that were used for the search task was then assessed by 2 evaluators using a quality score ranging from 100% (180 points, all predefined criteria fulfilled) to 0% (0 points, none of the predefined criteria fulfilled). In case of assessment discrepancies, an expert panel consisting of 4 pharmacists was consulted. RESULTS: In total, 141 pharmacists were enrolled. In the Web group (n=71 pharmacists), the median quality score was 32.8% (59.0 out of 180.0 points; IQR 23.0-80.5). In the EVInews group (n=70 pharmacists), the median quality score was significantly higher (85.3%; 153.5 out of 180.0 points; P<.001) and the IQR was smaller (IQR 125.1-157.0). Fewer pharmacists completed the entire search task in the Web group (n=22) than in the EVInews group (n=46). The median time to complete the search task was not significantly different between the Web group (25.4 minutes) and the EVInews group (19.7 minutes; P=.12). The most frequently used web-based sources (74/254, 29.1%) comprised tertiary literature. CONCLUSIONS: The median quality score of the web group was poor, and there was a significant difference in quality scores in favor of the EVInews group. Pharmacists' web-based and self-medication-related information sources often did not meet standard quality requirements and showed considerable variation in quality. TRIAL REGISTRATION: German Clinical Trials Register DRKS00026104; https://drks.de/search/en/trial/DRKS00026104.

An analysis of pharmaceutical care for critical patients of an adult Intensive Care Unit

Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting "prescriber informed only" (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.

[Implementing Clinical Evidences into Community Pharmacies: Results of the COMPASS and COMPASS-BP Studies].

Evidence-based medicine (EBM) has led to the development of evidence-based guidelines. The quality of guidelines has been improved by measuring their quality with The Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE). However, evidenced by guidelines not implemented in clinical practice or society, the evidence-practice gap has become apparent. The dissemination and implementation research, which studies methods to solve this problem, has attracted the attention of both clinicians and clinical researchers in recent years. In hypertension and diabetes, it is possible to prevent complications by maintaining good blood pressure and blood glucose levels. However, it is difficult for patients to maintain good laboratory values over the long term, and there has been no solution to this problem. Recently, it has been reported that pharmacists in the U.S. and Canada can improve patient outcomes over the long term by using pharmacies to treat these diseases. This review describes the results of the COMPASS study (diabetes) and the COMPASS-BP study (hypertension), which are the first cluster randomized controlled trials conducted in pharmacies in Japan. In addition, it discusses the possibility of implementation in pharmacies in Japan.

[How Should Pharmacists Use the Evidence in the Community-based Integrated Care System?]

Regarding the Separation of Dispensing and Prescribing (SDP) in Japan, there are some negative opinions that the value of separating these services has not been commensurate with the cost. On the other hand, there is substantial data showing the current state of SDP and its merits, which has been collected and published in academic journals. In 2019, the Japan Pharmaceutical Association searched for articles on this subject in domestic academic journals published over the past five years, and found that there were more than 300 articles that evaluated efforts to contribute to therapeutic efficacy and safety at pharmacies. Among these, some addressed the roles required of pharmacies in a community-based integrated care system, such as efforts toward coordinated medicine management of patients who visit multiple medical institutions, follow-up with patients receiving drug therapy, utilization of patient test values at pharmacies, and home medical care. These research results can be utilized in healthcare policy making. However, even with this volume of existing research, it is hard to determine whether such research is sufficient to connect these findings to measures that would improve policy issues. Therefore, it is necessary to identify for researchers the types of evidence that would help guide and formulate effective new SDP policies.

Perfil das Discrepâncias Obtidas por meio da Conciliação Medicamentosa em Pacientes Oncológicos: Revisão Integrativa da Literatura / Profile of the Medication Reconciliation Discrepancies in Oncology Patients: Integrative Literature Review / Perfil de las Discrepancias Obtenidas por la Conciliación de Medicamentos en Pacientes Oncológicos: Revisión Integradora de la Literatura

Introdução: O cuidado ao paciente oncológico demanda ações de uma equipe multiprofissional em virtude da complexidade do seu tratamento. Um dos serviços oferecidos pelo farmacêutico, visando a contribuir para segurança do paciente, é a conciliação medicamentosa capaz de detectar discrepâncias nas prescrições e prevenir erros de medicação. Objetivo: Traçar o perfil das principais discrepâncias encontradas na literatura em pacientes oncológicos durante a prática da conciliação medicamentosa realizada por farmacêuticos. Adicionalmente, visa-se a uma abordagem descritiva sobre as intervenções farmacêuticas realizadas nos estudos. Método: Revisão integrativa da literatura. Foram utilizados os descritores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para as estratégias de busca. As bases de dados selecionadas foram: PubMed, Web of Science, Embase e Scopus. Resultados: Inicialmente, identificaram-se 141 artigos. Destes, foram selecionados 11 trabalhos para serem discutidos. A conciliação medicamentosa foi realizada em pacientes na admissão hospitalar (27,3%), alta hospitalar (18,2%), e acompanhamento ambulatorial (54,5%). A maior parte era de estudos observacionais (72,7%) seguidos dos estudos de intervenção (27,3%). A principal discrepância relatada foi a de omissão/necessidade de adição de um medicamento (81,5%). As intervenções farmacêuticas estavam descritas mais detalhadamente em 36,4% das publicações. Conclusão: O estudo demonstrou a necessidade de mais trabalhos que correlacionem a prática da conciliação medicamentosa com a detecção de discrepâncias e intervenções farmacêuticas em Oncologia. Os farmacêuticos, objetivando a segurança do paciente, devem estruturar essa prática na vivência clínica dos pacientes oncológicos

Introduction: Cancer patient care requires actions of a multi-professional team due to the complexity of the treatment. One of the pharmacist's services to contribute for the patient safety is the medication reconciliation, able to detect discrepancies in prescriptions and preventing medication errors. Objective: Draw a profile of the main discrepancies found in the literature in cancer patients during the practice of medication reconciliation performed by pharmacists. Additionally, a descriptive approach of the pharmaceutical interventions found in the studies was also attempted. Method: Integrative review of the literature with descriptors "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" utilized to search in the following databases: PubMed, Web of Science, Embase and Scopus. Results: Initially, 141 articles were found and eleven were selected for discussion. Medication reconciliation was performed in patients at admission (27.3%), discharge from hospital (18.2%), and outpatient follow-up (54.5%). Observational Studies were the majority (72.7%) followed by intervention studies (27.3%). The main discrepancy reported was Omission/Need to add a medicine (81.5%). Pharmaceutical interventions were described in more detail in 36.4% of the publications. Conclusion: This study demonstrates the need for more articles that correlates the practice of medication reconciliation with the detection of discrepancies and pharmaceutical interventions in Oncology. Pharmacists should structure the practice of medication reconciliation in the clinical experience with cancer patients to improve their safety

Introducción: La atención a los pacientes con cáncer exige las acciones de un equipo multidisciplinario debido a la complejidad de su tratamiento. Uno de los servicios ofrecidos por el farmacéutico para contribuir a la seguridad del paciente es la conciliación de medicamentos, capaz de detectar discrepancias en las recetas y prevenir errores de medicación. Objetivo: Obtener un perfil de las principales discrepancias encontradas en la literatura en pacientes con cáncer durante la práctica de conciliación de medicamentos realizada por farmacéuticos. Además, también está dirigido a un enfoque descriptivo sobre las intervenciones farmacéuticas llevadas a cabo en los estudios. Método: Estudio de revisión integradora. Se ha utilizado los descriptores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para las estrategias de búsqueda. Las bases de datos seleccionadas fueron: PubMed, Web of Science, Embase y Scopus. Resultados: Inicialmente, se encontraron 141 artículos. Se seleccionaron 11 documentos a ser discutidos. La conciliación de medicamentos se realizó en pacientes con ingreso hospitalario (27,3%), alta hospitalaria (18,2%) y seguimiento ambulatorio (54,5%). La mayoría fue de estudios observacionales (72,7%) seguidos de estudios de intervención (27,3%). La principal discrepancia reportada fue la Omisión/Necesidad de añadir un medicamento (81,5%). Las intervenciones farmacéuticas se describieron con más detalle en el 36,4% de las publicaciones. Conclusión: El estudio demostró la necesidad de más trabajos que correlacione la conciliación de la medicación con la detección de discrepancias e intervenciones farmacéuticas en Oncología. Los farmacéuticos que buscan la seguridad del paciente deben estructurar esta práctica clínica en la experiencia clínica de los pacientes con cáncer

[Approach to Starting Clinical Pharmacy Practice Experience Based on the Model Core Curriculum for Pharmacy Education (2013 Version) in Hokkaido Prefecture].

The Model Core Curriculum for Pharmacy Education was revised in 2013 and has been applied to all pharmaceutical universities throughout Japan since 2015. Based on this revised core curriculum for pharmaceutical education, Pharmacy Practice Experiences began in February 2019. This Model Core Curriculum focuses on application of outcome-based education in order to achieve "professional competencies for pharmacists". The Model Core Curriculum for Pharmacy Practice Experiences addressed two main points: the eight common diseases that trainees should learn about, and collaboration between universities, pharmacies, and hospitals to conduct effective training for students. In Hokkaido, the Pharmacy Education Council Hokkaido District Coordination Agency, organized by the Hokkaido Pharmaceutical Association, the Hokkaido Society of Hospital Pharmacists, Hokkaido University, and Hokkaido University of Science, and Health Sciences University of Hokkaido has worked to improve practical pharmacy education since four-year pharmacy education programs. Additionally, the agency is central to coordinating and responding to various issues and working toward the implementation of practical pharmacy training. I contributed as chair of the working group to implement pharmacy practice experiences based on revisions of the core curriculum. In particular, we formulated evaluation standards based on sample evaluations presented at a liaison conference on the practical aspects of pharmacy. In addition, in order to convey the changes in pharmacy practice experiences based on this revised core curriculum for pharmacists, I contributed to the implementation of new pharmacy practices as an instructor at seminars in Hokkaido.

Stakeholders find that step therapy should be evidence-based, flexible, and transparent: assessing appropriateness using a consensus approach.

BACKGROUND: Step therapy, one approach to utilization management, is used by health plans to ensure safe and clinically appropriate care while managing cost. Several patient and provider groups have each developed principles to guide the appropriate use of step therapy; however, no comprehensive multistakeholder informed set of criteria exist. OBJECTIVE: To assess multistakeholder consensus on criteria for the development and implementation of step therapy for pharmaceutical therapies. Stakeholders were asked to (a) assess the appropriateness of step therapy as a utilization management tool; (b) rate specific criteria across 5 domains (development, implementation, communication, appeals, and evaluation) of step therapy; and (c) categorize these criteria as standards or best practices. METHODS: We conducted a multiphase project culminating in a roundtable of experts representing patient, provider, plan, pharmacy, policy, and ethical perspectives. We first reviewed guiding principles, position statements, and legislative activity to draft criteria regarding step therapy protocol development, implementation, communication, and evaluation. To assess consensus across a convenience sample of experts, we employed an iterative 4-step modified Delphi method. Panelists were asked to (a) rate the overall appropriateness of step therapy, (b) rate the appropriateness of specific criteria, and (c) identify each as a standard or best practice. Appropriateness was rated from 1-9 and categorized in terciles (1-3: not appropriate, 4-6: neither, 7-9: appropriate) to assess quantitative agreement, disagreement, and indeterminate agreement. RESULTS: After the second round of voting, roundtable panelists (n = 16) disagreed on the appropriateness of step therapy for utilization management (50% appropriate, 31.25% neither, and 18.75% inappropriate). Agreement was achieved on 21 criteria across 5 themes (clinical criteria as the foundation for protocol development, implementation of protocols, transparency and communication of processes, navigation of the appeals process, and evaluation of health and administrative impact). Fourteen and seven criteria were categorized as standards and best practices, respectively. CONCLUSIONS: The stakeholders in this panel differed in their assessments of the appropriateness of step therapy but agreed regarding how these protocols should be developed, implemented, communicated, and evaluated. Most criteria were rated as standards that can be used by stakeholders when developing, implementing, and assessing step therapy processes today. DISCLOSURES: This study was funded by the National Pharmaceutical Council. Karmarkar was a fellow at the National Pharmaceutical Council and Duke-Margolis Center for Health Policy at the time this study was conducted. Dubois and Graff are employees of the National Pharmaceutical Council. This work was previously presented as a virtual poster during the AMCP 2020 eLearning Days, April 21-24, 2020.

Creation and maintenance of a table for assessment of evolving evidence for COVID-19-related treatments.

PURPOSE: This report describes the development and maintenance of a table to present an assessment of evidence for treatments used in patients with coronavirus disease 2019 (COVID-19). SUMMARY: AHFS Drug Information (AHFS DI) (American Society of Health-System Pharmacists, Bethesda, MD) is ASHP's evidence-based drug compendium that contains drug monographs written for pharmacists and other healthcare professionals. The professional editorial and analytical staff of pharmacists critically evaluate published evidence to develop drug monographs for AHFS DI. In response to the global COVID-19 pandemic, these skills were applied to assess emerging evidence for COVID-19-related treatments, and the information was compiled into a new resource for pharmacists and other healthcare professionals to use at the point of care. A list of therapies was developed and prioritized based on review of scientific and public discussions on the use of these therapies in patients with COVID-19; certain therapies used for supportive care and therapies that might theoretically be harmful to patients with COVID-19 also were considered for inclusion. Potential treatments were identified, and the evidence for use in patients with COVID-19 was assessed and summarized in a table format. Information presented for each therapy included the rationale for use, summaries of clinical trials or experience, trial registry numbers, and dosage regimens. Comments on safety and efficacy, including limitations of available data, were presented along with recommendations from recognized authorities. The editorial team continued to add new therapies to the table and update existing entries as new evidence emerged. CONCLUSION: A comprehensive table that summarized available evidence for potential treatments for patients with COVID-19 was developed. The table format enabled the drug information editorial staff to provide ongoing updates as new information emerged during the pandemic.

Evidence-based self-medication: development and evaluation of a professional newsletter concept for community pharmacies.

Background Providing evidence-based care is recognized as a key competence for all healthcare professionals. In order to support community pharmacists in evidence-based self-medication counseling, the umbrella organization of German pharmacists initiated the development of a nationwide concept. The key element of the concept was a professional newsletter that should help pharmacists incorporate research findings into their daily counseling practice. Objective To develop, implement and evaluate the professional newsletter concept. Setting German community pharmacies. Method Clinical pharmacists from a German university compiled and synthesized clinical trial data in a professional newsletter that would supply community pharmacists with evidence-based information on common over-the-counter medicines as well as instructions for searching and appraising scientific literature. The electronic newsletter was offered to interested community pharmacists free of charge, once or twice a month, after they signed up for a subscription. About one year after the publication of the first newsletter issue, the subscribers were invited to take part in an anonymous cross-sectional online survey. In all, 21 newsletter issues were published through the end of the survey period. Main outcome measure Perceived value of the professional newsletter with 10 predefined objectives. Results A total of 1975 persons subscribed to the professional newsletter. Of those, 150 persons working in community pharmacies completed the survey. Most of them perceived the synthesized information as 'useful' (81-95%). They attributed positive changes in knowledge (89%), skills (87-91%), awareness (85%), and motivation (67-77%) to the newsletter. However, almost half of them (43%) found it difficult to incorporate reading the newsletter in their everyday working life. Free-text feedback suggested that further modifications should be considered to facilitate a better integration of the newsletter into everyday pharmacy practice. Conclusion A nationwide provided professional newsletter can play a vital part in supporting pharmacists in evidence-based self-medication counseling. However, the practicability of such a newsletter needs to be further improved and the newsletter should be accompanied by additional measures.

Factors impeding the supply of over-the-counter medications according to evidence-based practice: A mixed-methods study.

OBJECTIVE: Despite the positive attitudes pharmacists have toward evidence-based practices (EBPs), its application in community pharmacies in Saudi Arabia is lacking. Therefore, this study aimed to explore and assess EBPs by community pharmacists in Saudi Arabia when they dispense over-the-counter (OTC) medications for three minor ailments: diarrhea, cough, and the common cold. RESEARCH DESIGN AND METHODS: We used a mixed-methods approach consisting of two study parts. The first was a quantitative investigation that used mystery shoppers. Four researchers, posing as mystery shoppers, visited 214 randomly selected pharmacies in the Riyadh region of Saudi Arabia. They used 14 questions from a standardized checklist to examine EBPs by community pharmacists. The qualitative part of the study entailed three focus-group discussions with 13 pharmacists from different community practice settings and explored factors that affected the application of EBPs when supplying OTC medications from the pharmacists' point of view. RESULTS: The analysis indicated that 40% of pharmacists dispensed OTC medications according to EBPs. Logistic regression analysis showed that one question, "Describe your symptoms", predicted the correct supply of OTC medications (p = 0.021). The qualitative section of the study identified nine factors that affected EBP. Some of these factors facilitated EBP, such as established patient-pharmacist relationships, some acted as barriers such as conflicts between available evidence, while other factors could either facilitate or hinder EBPs, such as the health literacy of the patient. CONCLUSION: Given that dispensing OTC medication is a core function of pharmacists, this study uncovered low adherence to EBPs by community pharmacists in Saudi Arabia when dispensing OTC medication for three minor ailments: diarrhea, cough, and the common cold. Furthermore, this study identified a number of explanatory factors for this low adherence. Targeting these factors could help change the behavior of pharmacists and decrease undesirable outcomes.

Integrated Pharmacy and PrEP Navigation Services to Support PrEP Uptake: A Quality Improvement Project.

Preexposure prophylaxis (PrEP) is highly effective in preventing HIV among both men and women, with the reduction in risk directly linked to medication adherence. Navigation services and other adherence interventions have demonstrated efficacy in medication uptake; however, their use may not be fully integrated into clinic operations or their roles clearly defined. This quality improvement (QI) project developed an evidenced-based PrEP Navigation (PN) tool to identify patient-reported barriers to uptake and to support process improvement at a large community health center in Washington, DC. Outcomes related to patient-reported barriers, patient demographics, and time to medication pickup from the pharmacy were measured before and after implementation. A total of 198 patients were included in this analysis. Mean days from initial prescription to medication pickup was reduced by 1.42 days (p = .030) following PN tool implementation. The evidenced-based PN tool is modifiable to the needs of the individual clinic and the patients they care for to support wide-scale PrEP uptake and continuous system process improvements.

Opciones terapéuticas disponibles para infección por covid-19 / Therapeutic options available for covid-19 infection

Resumen de evidencia disponible de tratamiento COVID-19. La información contenida en esta tabla de evidencia está cambiando rápidamente debido a las investigaciones en curso, por lo tanto, está sujeta a actualización a medida se publiquen los resultados de las mismas

Summary of available evidence of COVID-19 treatment. The information contained in this evidence table is changing rapidly due to ongoing investigations, therefore, it is subject to update as the results of these investigations are published.

Eligibility and Preventive Potential for New Evidence-Based Cardiovascular Drugs in Secondary Prevention.

Importance: Recently, 12 randomized clinical trials (RCTs) have demonstrated the efficacy of novel therapies for mainly secondary prevention of atherosclerotic cardiovascular disease. However, given the potential overlapping eligibility of the RCTs, along with the cost of the new therapies, there are uncertainty and questions about implementing these RCT findings in real-world clinical practice. Objective: To determine the eligibility and preventive potential for these new preventive therapies in a contemporary population. Design, Setting, and Participants: This population-based contemporary cohort study included 6292 patients with known ischemic heart disease (IHD) and 2277 with a previous myocardial infarction (MI) enrolled between November 2003 and February 2015. Analyses were performed in the Copenhagen General Population Study with a mean (SD) of 7.7 (3.5) years of follow-up. The data were analyzed between January and October 2019. Main Outcomes and Measures: We determined the drug eligibility and evidence-based potential for preventing major cardiovascular events of the 12 cardiovascular drugs tested in the following recent RCTs: IMPROVE-IT, PEGASUS, EMPA-REG, LEADER, SUSTAIN-6, FOURIER, CANVAS, REVEAL, CANTOS, COMPASS, ODYSSEY-OUTCOMES, and REDUCE-IT. The analyses were performed in patients with known IHD or with a previous MI at baseline. Results: Of 6292 participants, 3861 (61%) were men and the mean (interquartile range) age was 69 (62-76) years. In patients with IHD or MI at baseline, eligibility for 1 or more new medications was 80% (n = 5036) and 99% (n = 2273), respectively, by meeting RCT enrollment criteria. Dividing the new therapies into 4 drug classes (lipid-modifying, antithrombotic, anti-inflammatory, and antidiabetic drugs), 2594 and 1834 patients with IHD or MI (41% and 81%, respectively) were eligible for 2 or more drug classes simultaneously. The 5-year estimated percentage of major cardiovascular events that could be prevented for each new therapy was 1% to 20% in patients with IHD or MI at baseline. Conclusions and Relevance: Most patients with known IHD or previous MI are eligible for additional new secondary prevention therapies. This raises questions for the cardiovascular community and health care authorities about access to these potentially expensive therapies, including strategies for prioritizing their use.