Preparing competent graduates for delivering pharmaceutical care: an experience from Northern Cyprus.

BACKGROUND: This paper describes the implementation and evaluation of a clinical pharmacy practice (CPP) course in Northern Cyprus. The course covered a range of subjects, including internal medicine, cardiovascular and respiratory diseases, and drug information services. METHODS: An 8-week structured CPP course was designed for fifth-year students. Students' competencies were assessed using an objective structural clinical examination (OSCE) before and after the intervention. The course addressed all CPP competence domains and learning outcomes, and it utilized a wide variety of learning activities. Student perceptions, experience and preceptor evaluations were assessed using surveys. RESULTS: Students reported that the learning objectives of the course were met. Substantial knowledge and skills in different areas of CPP were gained. A significant overall enhancement in the average grades on the OSCE was identified (23.09 ± 0.75 and 27.51 ± 0.71 out of 40). Students received the highest scores in drug information data retrieval and interpretation (4.4 ± 0.13), communication skills (4.2 ± 0.09) and public health promotion (3.92 ± 0.12). The lowest scores were recorded in clinical prescription management problems (2.5 ± 0.23) and pharmacotherapy application (2.54 ± 0.18). CONCLUSION: Students' scores significantly improved from the baseline in the core competence domains. Most students found the structure, process and outcomes of the course to be beneficial and satisfactory.

Interprofessional pharmacotherapy workshop: intervention to improve health professionals' and students' attitudes towards collaboration between physicians and pharmacists.

Collaboration between physicians and pharmacists is recognized as an important factor for reducing medication errors and improving patient outcomes. Therefore, two pharmacotherapy workshops were delivered in Croatia - one for pre-registration medical (n=42, 4th-6th year) and pharmacy (n=38, 4th-5th year) students, and the other one for physicians (n=18) and pharmacists (n=23). The purpose of this study was to determine whether participation in common pharmacotherapy workshop could improve attitudes among participants towards interprofessional collaboration between pharmacists and physicians. Attitudes were measured by validated questionnaire "Scale of Attitudes Towards Collaboration Between Pharmacists and Physicians" at the beginning and at the end of the workshops. Three complex clinical scenarios were presented during the workshops. Participants were given general information about cases (all participants) and 2 groups of specific information (only for medical students/physicians and only for pharmacy students/pharmacists). For the first scenario, medical and pharmacy students/professionals were not allowed to exchange their specific information. However, participants collaborated for the 2nd and 3rd scenarios in order to achieve the hypothesized therapeutic goals. Before the workshops, pharmacists and pharmacy students showed more positive attitudes than physicians and medical students. However, the workshop contributed in closing the gap by equating health care professionals' attitudes. Additionally, students' attitudes were more positive after the workshop with an increase of 10% for medical and 2.2% for pharmacy students. This study indicates that interprofessional pharmacotherapy workshops could significantly improve attitudes toward collaboration between physicians and pharmacists for both students and practicing professionals.

Pharmacist Competences and Impact of Pharmacist Intervention on Medication Adherence: an Observational Study.

BACKGROUND: The aim of this study is to determine the results of pharmacist interventions on patient's adherence to drugs in community settings. SUBJECTS AND METHODS: The study was designed using a standard EQ-SDQ questionnaire and a Culig questionnaire about the adherence to drug. General Level Framework (GLF) was used as a tool for competence assessment among community pharmacists. Participants were pharmacists that issued the medication on repeat prescription in the pharmacy. They interviewed the patient at the first visit to the pharmacy and the next time when the patient came to refill the prescription. The survey was conducted during a two-month period in the Atlantic Pharma pharmacy chain. A total of 152 patients were included at the first visit and 87 patients at the second visit. RESULTS: About two thirds of patients (65.5%) identified themselves as adherent during the first survey, and this number increased slightly during the second interview (by 3.5%), but not statistically significant (p=0.75). A total number of drugs prescribed during the first and second survey was 252 and 253 respectively. The percentage of the advices given to the patients increased during the second survey, but not statistically significant (p=0.62). CONCLUSION: It is definitely important to check that a patient understands current disease and what are doubts and difficulties in taking a therapy. The reasons for possible nonadherence are different: fears, worsening of the clinical state or other negative treatment outcomes. Enough time should always be left to clarify anything that is unclear and to listen. Application of GLF program for improving pharmacist competences resulted in slightly increased patient adherence to medication. For further development of competences, pharmacist intervention should include some other contents, i.e. tailoring the dosage scheme, counselling about drug-drug and drug-food interactions. The pharmacist counseling should be reimbursed by the Croatian Health Insurance Fund.

Exposure of Pharmacists and Pharmacy Technicians to Violence in Community Pharmacies in Southeast Europe: Frequency and Ethical Considerations.

Pharmacists and pharmacy technicians working in community pharmacies are exposed to the risk of violence in their workplaces. Studies have shown that workplace violence is affecting their job satisfaction, productivity, and mental health. This study aims to identify the frequency of different types of violence, as well as the common perpetrators that community pharmacy staff in SEE (Southeast Europe) are dealing with. A cross-sectional study was conducted using an online questionnaire created for this purpose. Selected community pharmacies in Croatia, Serbia, Bosnia and Herzegovina, and Montenegro participated in this study. In total, 732 responses were collected from 24 pharmacy chains or independent pharmacies including all community pharmacy staff. More than 80% of pharmacists and pharmacy technicians reported having been exposed to verbal violence at the workplace, while more than 20% of them reported physical and sexual violence in the preceding 12 months. There were no statistically significant differences between pharmacists and pharmacy technicians, gender, age groups, or countries in relation to exposure to physical, verbal, and sexual violence. The most common perpetrators were identified as patients/clients. More than 90% of pharmacy staff reported they did not receive any kind of support from their employer nor any other help after experiencing a robbery. There is a need for a structured approach to addressing violence in pharmacies including organized support for pharmacy staff. Achieving quality patient care, despite dealing with violent individuals or situations daily, is one of the greatest ethical challenges for healthcare providers in community pharmacies to be empowered.

SMART Pharmacists Serving the New Needs of the Post-COVID Patients, Leaving No-One Behind.

This study aims to demonstrate the improvements in clinical symptoms in patients with post-COVID syndrome after a community pharmacy-based intervention in Serbia. The Pharmaceutical Chamber of Serbia ("Chamber") invited pharmacists to deliver post-COVID patient care counselling, supported by the SMART Pharmacist Program, offering education and guidance. Present symptoms, duration and patient self-reported severity of symptoms on a scale of 1-5 on the first visit were recorded. After the counselling and proposed self-medication treatment, the time of the follow-up visit and the severity of the recorded symptoms were also recorded. The prospective data collection lasted from December 2021 to September 2022. In total, 871 patients with post-COVID symptoms were included in the study, served by 53 pharmacists. The most frequently reported post-COVID symptoms coincided with the literature, mostly related to the respiratory system (51.2%), immunity status (32.2%), fatigue and exhaustion (30.7%), skin, hair and nails (27.4%) and cognitive functions (27.9%). A total of 26.5% of patients were referred to their family physician (general practitioner), and 69.5% returned to the pharmacist for a follow-up visit. On the first visit, the median severity of patients' symptoms was three, while on the second visit it dropped to one. The pharmacists' intervention led to a significant improvement in the post-COVID patients' condition.

The first nationwide implementation of pharmaceutical care practices through a continuing professional development approach for community pharmacists.

BACKGROUND: Noncommunicable diseases account for the majority of all deaths and impose a high socioeconomic burden, causing disability and premature deaths. Pharmacists can contribute to the prevention and management of these diseases through the provision of pharmaceutical care services. AIM: The aim of this study was to implement a nationwide practice developed by the Turkish Pharmacists' Association aiming to realize pharmaceutical care provision of standard quality to patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension at community pharmacies through a continuing professional development approach. SETTING: Community pharmacies in Turkey. DEVELOPMENT: A project with the involvement of all community pharmacists who were willing to participate was developed. After piloting, the 'project' turned into a 'practice' with a focus on asthma, chronic obstructive pulmonary disease, diabetes and hypertension management. IMPLEMENTATION: The training process occurred as a peer-training activity. Consultants and academic staff trained the trainer pharmacists during a 3-day course. Community pharmacists (n = 6161) received training regarding pharmaceutical care, asthma, chronic obstructive pulmonary disease, diabetes and hypertension from their peer trainers (n = 341) and began to practice pharmaceutical care and follow-up of patients' outcomes on a regular basis. EVALUATION: Among all community pharmacists in Turkey (n = 26,177), 24% attended training. Among these pharmacists, 21% started to implement practice. With community pharmacists' contribution to patient care, significant improvements in the majority of the outcome parameters regarding asthma, chronic obstructive pulmonary disease, diabetes and hypertension management were noted. CONCLUSION: This first nationwide practice showed us that community pharmacists can help improve the health outcomes of patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension through the provision of pharmaceutical care services.

Factors Facilitating and Hindering Development of a Medication Use Review Service in Eastern Europe and Iran-Cross-Sectional Exploratory Study.

Polypharmacy is a common issue in patients with chronic diseases. Eastern-European countries and Iran are exploring possibilities for implementing the Medication Use Review (MUR) as a measure for optimizing medication use and ensuring medication safety in polypharmacy patients. The aim of this study was to gain insights into the development of the community pharmacy sector and map facilitators and barriers of MUR in Eastern Europe and Iran. The representatives of the framework countries received a questionnaire on community pharmacy sector indicators, current and future developments of pharmacies, and factors encouraging and hindering MUR. To answer the questionnaire, all representatives performed document analysis, literature review, and qualitative interviews with key stakeholders. The socio-ecological model was used for inductive thematic analysis of the identified factors. Current community pharmacist competencies in framework countries were more related to traditional pharmacy services. Main facilitators of MUR were increase in polypharmacy and pharmaceutical waste, and access to patients' electronic list of medications by pharmacists. Main barriers included the service being unfamiliar, lack of funding and private consultation areas. Pharmacists in the framework countries are well-placed to provide MUR, however, the service needs more introduction and barriers mostly on organizational and public policy levels must be addressed.

Learn Today-Apply Tomorrow: The SMART Pharmacist Program.

The SMART Pharmacist Program was initiated by the Accreditation Council for Pharmacy Education (ACPE) and Pharma Expert in 2014. It was designed to introduce a new continuing education model for pharmacists for the Turkish Pharmacists' Association, and to support development of competencies for future practice. After successful implementation in Turkey, the Program spread to 16 additional countries. To assure quality, globally adopted and validated tools and best practices were used, respecting the national context. National competency frameworks and quality indicators for pharmaceutical care delivery were developed. Pharmacists' learning portfolios were introduced and patient care modules created. Under the sub-title "Learn Today-Apply Tomorrow," the changes in practice were introduced under the leadership of national host organizations. The Program showed an impact on the patient level in several countries, especially in areas of patient care in Asthma and Chronic Obstructive Pulmonary Disease (COPD), Hypertension and Dyslipidemia, Diabetes, and the patient care process in general (e.g., identifying drug-related problems, improving patient safety, collaborating with medical doctors). Changes are visible at the individual (pharmacists) and organizational levels. Barriers and facilitators to the change-management process during Program implementation are identified. In some countries, the Program is recognized as one of the most important initiatives in pharmacy education and practice, with visible support of national medicines agencies, academia, government, and WHO regional offices.

Improving community pharmacists' clinical knowledge to detect and resolve drug-related problems in Croatia: a before/after survey study investigating the efficacy of an educational intervention.

OBJECTIVES: The aim of this study was to increase the knowledge level of community pharmacists in Croatia to identify and resolve drug-related problems (DRPs). DESIGN: Before/after survey study. SETTING: University of Split School of Medicine. PARTICIPANTS: 115 community pharmacists from all over the Croatia. INTERVENTIONS: An interactive 3-day clinical pharmacy workshop with the goal of increasing the knowledge level of community pharmacists in Croatia to identify and resolve DRPs in routine practice. Teaching methods were based on interactive clinical case solving. OUTCOME MEASURE: Change of the community pharmacists' knowledge based on preworkshop and postworkshop evaluation. A survey-based clinical knowledge measurement tool was used in order to evaluate the efficacy of the workshop. The lowest possible total score was 0 and the highest was 80. A higher survey score indicates a higher level of clinical knowledge to identify and resolve DRPs. RESULTS: Participating pharmacists had significantly higher postworkshop mean survey score (49.1±8.0) than the preworkshop mean survey score (42.9±8.2), with the mean score difference of 6.2 (95% CI 4.3 to 8.1). Furthermore, it was found that community pharmacists significantly increased their survey scores, regardless of their age. CONCLUSIONS: Interactive and case-based clinical pharmacy workshop could be a valuable tool to increase the knowledge of community pharmacists about identification and management of DRPs in routine practice. However, further studies are necessary to evaluate the long-term knowledge maintenance and the improvement in patients' clinical outcomes.

Clinical knowledge of community pharmacists in Croatia for detecting drug-related problems.

Background Drug-related problems (DRPs) interfere with patient's health outcomes and have a negative impact on healthcare resources. Successful management of DRPs is an essential part of pharmaceutical care. Pharmacists should have adequate clinical knowledge in order to effectively implement pharmaceutical care and manage DRPs. Objective To determine the clinical knowledge of community pharmacists in Croatia to detect and resolve DRPs. Method A sample of 302 community pharmacists have anonymously and voluntarily completed the validated survey-based clinical knowledge measurement tool. For each completed survey, all statements were scored individually, and a total score was calculated. The lowest possible total score was 0 and the highest was 80. Higher survey score indicates a higher level of clinical knowledge to detect and resolve a DRP. Results All community pharmacists had a mean score of 45.5 ± 8.6, while pharmacists from a pharmacy chain with mandatory education had a higher mean score of 50.2 ± 6.5. Multivariate linear regression revealed that only additional education (ß = 0.272, p < 0.001) is associated with a higher mean score, while age and gender have no influence on the survey score. Conclusion Additional education of community pharmacists could increase their clinical knowledge to detect and resolve DRPs.

Introducing clinical pharmacy services to cardiovascular clinics at a university hospital in Northern Cyprus.

Background Clinical pharmacists are the primary source of scientifically valid information and advice on the safe, rational, and cost-effective use of medications. However, ward-based clinical pharmacy services are not well optimized in Northern Cyprus. Objective Ward based clinical pharmacy services were introduced and evaluated in cardiovascular clinics. Setting Cardiology and cardiovascular surgery departments in a tertiary university hospital. Methods A prospective interventional study introduced and documented clinical pharmacy services for 120 days. Drug-related problems were classified using the Pharmaceutical Care Network Europe PCNE DRP classification tool V6.2. Main outcome measure Interventions proposed and acceptance rate of recommendations. Results A total of 133 patients were reviewed, and, 81 patients had drug-related problems. Only 402 (93.1%) of the 432 suggested interventions were accepted and regarded as clinically relevant. Drug-related problems primarily involved antihypertensive, diuretic, and antithrombotic agents. Treatment effectiveness was the major type of drug-related problems (107; 49.3%) followed by adverse drug reactions (74; 34.1%). Drug dose and selection were the most frequent causes of drug-related problems. Add/change/stop medications were the most common types of intervention at the prescriber level. A total of 171 (78.8%) of the identified 217 drug-related problems were solved, 4 (1.8%) of the problems were partially solved, 32 (14.7%) problems were unsolved, and 10 (4.6%) problems had unknown outcomes. Conclusion Clinical pharmacy services may have optimized therapy effectiveness and prevent adverse effects. The pharmacist interventions were highly accepted by cardiologists; this may indicate the presence of a great opportunity and need to optimize and implement CPS in other hospitals in Northern Cyprus.

Health care professionals' and students' attitude toward collaboration between pharmacists and physicians in Croatia.

BACKGROUND: As traditional roles of pharmacists and physicians seem nowadays insufficient to ensure patient safety and therapy effectiveness, interprofessional collaboration has been suggested to improve health outcomes. OBJECTIVE: To assess and compare the attitudes of physicians and pharmacists, as well as medical and pharmacy students in Croatia, toward interprofessional collaboration in primary health care. METHODS: The study included 513 pharmacists and physicians, and 365 students of pharmacy and medicine from Croatia. The validated questionnaire, Scale of Attitudes Toward Physician­Pharmacist Collaboration, was translated in Croatian and completed, anonymously and voluntarily, by all participants. Results Pharmacists showed a more positive attitude toward collaboration than physicians (53.8 ± 4.8 vs. 50.7 ± 5.0). Pharmacy students expressed the most positive attitude (56.2 ± 4.9), while medical students showed the remarkably lowest attitude toward collaboration (44.6 ± 6.2). CONCLUSION: Pharmacists and physicians in Croatia expressed a relatively positive attitude toward their collaboration, comparable with their colleges in the USA. On the other hand, medical students expressed a 21 % less positive attitude than pharmacy students which could have an effect on interprofessional collaboration in the future when those students start working as health care professionals. Future studies, focusing on the promotion of this collaboration, on both under-graduated and post-graduated level, are warranted.

A Shared Focus: Comparing the Australian, Canadian, United Kingdom and United States Pharmacy Learning Outcome Frameworks and the Global Competency Framework.

This paper presents an analysis of the end of degree expectations, expressed as learning outcomes, for pharmacy graduates from Australia, Canada, United Kingdom and United States. The authors compare the end of degree expectations, through mapping these requirements to the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF). The anticipated end of degree expectations are similar but also reveal some individual characteristics. Irrespective of degree title, achievement of learning outcomes specified in any one of the four jurisdictions should enable students to become pharmacists who are patient-orientated medicines experts. The mapping provides impetus for cross-border institutional networking to generate a dependable set of assessment tools across national borders developing a common metric for outcome assessment irrespective of different program delivery.

Pharmacists' medicines-related interventions for people with intellectual disabilities: a narrative review.

BACKGROUND: People with intellectual disabilities (ID) have complex pharmaceutical care needs due to a high prevalence of multimorbidity, a notable degree of polypharmacy and a high risk of adverse drug reactions. Despite this, people with ID often experience significant health disparities compared to the general population. In most developed countries, increasing emphasis on deinstitutionalisation and community integration also means greater utilisation of primary health care services where general practitioners, pharmacists and carers may lack appropriate information about the pharmaceutical needs of this population. Aim of the review To explore what type of pharmaceutical care interventions were being undertaken for people with ID and how pharmacists' contributed to the care of people with ID as part of multidisciplinary teams. METHOD: Systematic searches of the following electronic databases were carried out; CINAHL, Pubmed, Medline, Embase, Cochrane library, Science Direct and International Pharmaceutical Abstracts. Results were limited to the period 1994-2014 using search terms 'learning disabilities', 'intellectual disabilities', 'mental retardation', 'developmental disabilities', 'learning difficulties' and 'pharmacist intervention', 'pharmaceutical care', 'primary care', 'pharmacy' "pharmacists" "pharmacy technicians". Agreement on studies to be included was arrived at by consensus and by using a pre-determined set of inclusion criteria. Due to the heterogeneous nature of the study aims, methods and presentation of study outcomes found, a narrative review was considered appropriate. RESULTS: In total, after removal of duplicates, 70 abstracts were identified and screened from the initial search. After screening and consensus agreement, eight articles which met the inclusion criteria were included in the review and were analysed under the following three themes; pharmacist interventions, pharmacists collaboration in provision of care, qualitative studies relating to patient, carers, and pharmacist views on care of people with ID. CONCLUSIONS: The limited evidence available in the literature suggests that pharmacists can make positive interventions in relation to the quality of the medication use process, in collaboration with other healthcare professionals, carers and patients with ID. However, further research will be required to increase the evidence base with regard to the benefits of providing pharmaceutical care to patients with intellectual disability and to inform future policy and planning.

Individualized education and competency development of Croatian community pharmacists using the general level framework.

OBJECTIVES: To measure Croatian community pharmacists' progress in competency development using the General Level Framework (GLF) as an educational tool in a longitudinal study. METHODS: Patient care competencies of 100 community pharmacists were evaluated twice, in 2009 and in 2010 in a prospective cohort study. During this 12-month period, tailored educational programs based on the GLF were organized and conducted, new services and standard operating procedures were implemented, and documentation of contributions to patient care in the pharmacist's portfolio became mandatory. RESULTS: Pharmacists' development of all GLF patient care competencies was significant with the greatest improvements seen in the following competencies: patient consultation, monitoring drug therapy, medicine information and patient education, and evaluation of outcomes. CONCLUSIONS: This study, which retested the effectiveness of an evidence-based competency framework, confirmed that GLF is a valid educational tool for pharmacist development.

Evaluation of Croatian community pharmacists' patient care competencies using the general level framework.

OBJECTIVES: To assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF). METHODS: The competencies of 100 community pharmacists working in 38 community pharmacies were evaluated using an adapted version of the GLF. RESULTS: Pharmacists demonstrated the best performance in the competency areas drug specific issues and provision of drug products; the poorest performance was in the competency areas evaluation of outcomes and monitoring drug therapy. Pharmacists' behavior varied the most in the following areas: ensuring that the prescription is legal, prioritization of medication management problems, and identification of drug-drug interactions. CONCLUSIONS: Competencies were identified that need to be developed to improve pharmacist interventions in community settings. This study provides the first data on pharmacists' performance in Croatia and serves as a starting point for future studies and actions.