A qualitative, theory-based exploration of facilitators and barriers for implementation of pharmacist prescribing in chronic kidney disease.

BACKGROUND: While there is an accumulation of evidence that pharmacist prescribing is safe and effective, there is a lack of research on processes of implementation into practice, particularly for patients with complex clinical conditions such as chronic kidney disease (CKD). AIM: The aim was to explore the facilitators and barriers to the implementation of pharmacist prescribing for patients with CKD in the United Kingdom (UK). METHOD: Semi-structured interviews were conducted with UK Renal Pharmacy Group members who were independent prescribers. The Consolidated Framework for Implementation Research (CFIR) underpinned the interview schedule. Interviews were recorded, transcribed, and independently coded by two researchers. A thematic approach was used for analysis, with data generation continuing until saturation of themes. Ethical approval was granted. RESULTS: Data saturation was achieved following 14 interviews. Most interviewees were female (n = 11), all had secondary care as their main practice setting, and were highly experienced prescribers with 8 having 11 or more years of prescribing practice. Interviewees were positive regarding the development of their prescribing practice. Facilitators and barriers emerged across all 5 of the CFIR domains. Key facilitators were aspects of inner setting (e.g., organisational support and communication) while key barriers were also related to inner setting, specifically the need for adequate structural and financial resources. CONCLUSION: This theory-based study has illuminated the facilitators and barriers for the implementation of pharmacist prescribing in CKD. There is a need to consider the resources required for implementation of prescribing practice at an early stage of planning and development.

[Verification of Pharmaceutical Education System Reform].

The pharmaceutical education system underwent major changes in 2006 by extending the period of completion to six years. The decision was made by a resolution in the Diet, but a supplementary resolution was submitted at that time. In this paper, we discussed whether on-site pharmaceutical education complies with the accompanying resolution. As a result, current pharmaceutical education generally complies with what is stated in the supplementary resolutions.

Examination of differences between actual and potential revenue generation in a pharmacist-run ambulatory clinic.

BACKGROUND: Pharmacists are not billable healthcare providers under Medicare Part B or most insurance plans. Because of this, pharmacist services are relegated to incident-to-provider billing, despite pharmacists routinely providing services high in complexity. This discrepancy may negatively skew perceptions of pharmacists' contributions to outpatient clinic care. OBJECTIVES: The objective of this study was to identify the potential revenue generation for pharmacist-delivered services at a single, rural South Dakota clinic if pharmacists were considered billable healthcare providers. METHODS: This retrospective, single center study utilized a chart review of first-quarter data from a single ambulatory clinic served by a 0.5 full time equivalent pharmacist serving Chronic Disease Management (CDM) and COVID-19 patients. For each appointment, the chart note was reviewed for elements that would satisfy requirements for Current Procedural Terminology (CPT®) billing codes. Medicare and Medicaid reimbursement was determined using official 2022 Physician Fee Schedules and private insurance reimbursement was set at a single rate of 60% of the fee schedule of the most common private payer. RESULTS: During the three-month study period, 118 patients (206 appointments) were seen by the pharmacist. The amount paid to the clinic was estimated at $2,174.91. The hypothetical amount paid to the clinic if pharmacists were considered billable healthcare providers is $10,415.31 for CDM clinic and $7,953.48 for COVID-19 clinic, totaling $18,368.79. Excluding uninsured patients, the hypothetical total is $17,102.03, with a total unrealized revenue of $16,193.88. CONCLUSION: If pharmacists were considered billable healthcare providers and their services were billed accordingly, the potential revenue generation is significantly higher than actually generated revenue. This estimated data can be used to better quantify and qualify appointment-related data for non-pharmacist clinic managers.

Improving medication safety in a Latin American hospital: Examination of medication errors and the role of pharmacists.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Prospective medication order review by a clinical pharmacist is uncommon in many South and Central American countries. Voluntary error reporting and analysis are similarly uncommon. This paper describes the results of pharmacist prospective order review, medication error reporting, and quality improvement activities in a Latin American hospital. METHODS: On January 1, 2020, the hospital initiated prospective review of all medication orders in both the hospital and clinic setting by pharmacists. Health professionals were encouraged to report errors identified to the hospital's voluntary reporting program. Data collected included the medication name and dose, stage of the medication use process, error severity, and error cause. Error reports were periodically reviewed by pharmacy staff. RESULTS: In the 402,100 orders reviewed, errors were found in 605 inpatient orders and 405 clinic orders (0.25%). Most errors were identified before they reached the patient (69.9% of inpatient errors and 81.0% of clinic errors). The prescribing phase was associated with the highest proportion of errors (50.8% of inpatient errors and 41.7% of clinic errors). The most common reasons for prescribing errors were confusing orders and wrong doses. Analgesics (22.7%) and antibiotics (21.3%) were the medication classes most frequently identified. After aggregated review, pharmacists generated 19 clinical alerts leading to system changes and staff education. CONCLUSION: This study demonstrates the impact of prospective order review by pharmacists on patient safety. In addition to preventing errors from reaching the patient, voluntary error reporting and evaluation led to system changes intended to reduce the likelihood that similar errors would occur again.

Impact of oncology pharmacy services on the management of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences. METHODS: A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs. RESULTS: A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase. CONCLUSION: This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.

Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India.

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.

A Nomogram for Predicting the Effectiveness of Consultations on Multi-Drug Resistant Infections: An Exploration for Clinical Pharmacy Services.

Purpose: The increasing multi-drug resistance (MDR) is a serious threat to human health. The appropriate use of antibiotics can control the progression of MDR and clinical pharmacists play an important role in the rational use of antibiotics. There are many factors that influence the effectiveness of multi-drug resistant organisms (MDRO) infection consultations. The study aimed to establish a model to predict the outcome of consultation and explore ways to improve clinical pharmacy services. Patients and methods: Patients diagnosed with MDRO infection and consulted by clinical pharmacists were included. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for MDRO infection consultation effectiveness, and then a nomogram was constructed and validated. Results: 198 patients were finally included. The number of underlying diseases (OR=1.720, 95% CI: 1.260-2.348), whether surgery was performed prior to infection (OR=8.853, 95% CI: 2.668-29.373), ALB level (OR=0.885, 95% CI: 0.805~0.974), pharmacist title (OR=3.463, 95% CI: 1.277~9.396) and whether the recommendation was taken up (OR=0.117, 95% CI: 0.030~0.462) were identified as independent influences on the effectiveness of the consultation. The nomogram prediction model was successfully constructed and the AUC of the training set and the verification set were 0.849 (95% CI: 0.780-0.917) and 0.761 (95% CI: 0.616-0.907) respectively. The calibration curves exhibited good overlap between the data predicted by the model and the actual data. Conclusion: A nomogram model was developed to predict the risk of consultation failure and was shown to be good accuracy and good prediction efficiency, which can provide proactive interventions to improve outcomes for potentially treatment ineffective patients.

Impact of the COVID-19 Pandemic on Pharmacist Interventions: A Retrospective Study with Inpatients in a University Hospital.

Background: Despite growing interest in understanding the challenges faced by multidisciplinary health teams during the COVID-19 pandemic, there is a lack of studies specifically focusing on changes in pharmacist interventions and drug-related problems. Objectives: To analyze and compare the interventions performed by pharmacists during comprehensive medication management in the adult intensive care unit and general internal medicine ward of the University Hospital of the University of São Paulo, Brazil, for defined periods before the onset of the COVID-19 pandemic and during the pandemic itself. Methods: All pharmacist interventions performed in relation to inpatient prescriptions from March to December 2019 (before the pandemic) and from March to December 2021 (during the pandemic) were collected and tabulated. These interventions were then classified according to the Pharmaceutical Care Network Europe (PCNE) system, version 9.1, and categorized based on first-level codes of the Anatomical Therapeutic Chemical classification system. Results: The analysis revealed substantial changes in the patterns of pharmacist interventions and the therapeutic classes of drugs for COVID-19-positive and COVID-19-negative patients during the pandemic relative to patients in the pre-pandemic period. Among COVID-19-positive patients, interventions were predominantly related to enhancing patient safety (PCNE code P2), drug selection (C1), dose selection (C3), prescribing and dispensing processes (C5), the drug-use process (C6), and patient transfers between different levels of care (C8). The drug-related problems addressed by pharmacist interventions primarily involved COVID-19-positive patients in the pandemic period and were related to systemic hormonal preparations (excluding sex hormones and insulins), anti-infective agents for systemic use, nervous system and drugs for the blood and blood-forming organs. Conclusion: The results of this study highlight the adaptability and competence of pharmacists in responding to critical scenarios such as the COVID-19 pandemic. These scenarios are characterized by new work dynamics, the hiring of additional professionals, an increase in the number of beds, the rapid evolution of evidence-based information, and drug shortages that necessitate the use of alternative medications. Pharmacists play a crucial role in ensuring patient safety during these difficult times.

Contexte: Malgré un intérêt croissant pour la compréhension des défis auxquels les équipes de santé multidisciplinaires ont été confrontées pendant la pandémie de COVID-19, peu d'études portent sur les changements chez les interventions des pharmaciens et les problèmes liés aux médicaments en particulier. Objectifs: Analyser et comparer les interventions réalisées par les pharmaciens lors de la gestion globale des médicaments dans l'unité de soins intensifs pour adultes et le service de médecine interne générale de l'hôpital universitaire de l'Université de São Paulo, Brésil, pendant des périodes définies avant le début de la pandémie de COVID-19 et pendant la pandémie elle-même. Méthodologie: Toutes les interventions des pharmaciens réalisées en lien avec les prescriptions hospitalières de mars à décembre 2019 (avant la pandémie) et de mars à décembre 2021 (pendant la pandémie) ont été collectées et compilées. Ces interventions ont ensuite été classées selon le système du Pharmaceutical Care Network Europe (PCNE), version 9.1, et catégorisées sur la base des codes de premier niveau du système de classification anatomique, thérapeutique et chimique. Résultats: L'analyse a révélé des changements substantiels dans les types d'intervention des pharmaciens et dans les classes thérapeutiques de médicaments pour les patients positifs pour la COVID-19 et négatifs pour la COVID-19 pendant la pandémie par rapport aux patients d'avant la pandémie. Parmi les patients positifs pour la COVID-19, les interventions étaient principalement liées à l'amélioration de la sécurité des patients (code PCNE P2), au choix des médicaments (C1), à la sélection des doses (C3), au processus de prescription et de délivrance (C5), au processus d'utilisation des médicaments (C6), et aux transferts de patients entre différents niveaux de soins (C8). Les problèmes liés aux médicaments traités par les interventions des pharmaciens concernaient principalement les patients positifs pour la COVID-19 pendant la période de la pandémie et se rapportaient aux préparations hormonales systémiques (à l'exclusion des hormones sexuelles et des insulines), aux agents anti-infectieux à usage systémique, au système nerveux ainsi qu'au sang et aux organes hématopoïétiques. Conclusion: Les résultats de cette étude mettent en évidence l'adaptabilité et la compétence des pharmaciens pour répondre à des scénarios critiques tels que la pandémie de COVID-19. Ces scénarios se caractérisent par une nouvelle dynamique de travail, l'embauche de professionnels supplémentaires, une augmentation du nombre de lits, l'évolution rapide des informations fondées sur des données probantes et des pénuries de médicaments nécessitant le recours à des médicaments alternatifs. Les pharmaciens jouent un rôle crucial pour assurer la sécurité des patients pendant ces périodes difficiles.

Impact of pharmacist managed oral epidermal growth factor receptor inhibitors.

BACKGROUND: Pharmacists are an integral part of medication management, with the positive impact of their clinical services in patient outcomes previously studied and reported in literature. The roles and responsibilities of pharmacists continue to expand, including optimizing patient medication and health outcomes related to complex oral anticancer drugs. OBJECTIVE: To evaluate the impact of a pharmacist-managed oral chemotherapy clinic in patients with non-small cell lung cancer (NSCLC) taking oral epidermal growth factor receptor inhibitor (EGFRi) regimens within an integrated healthcare delivery system. METHODS: This was an observational cohort study using data from Kaiser Permanente Northern and Southern California regions on adult patients who received oncology pharmacist-managed care compared to patients with usual care. Patients were newly initiated with EGFRi therapy to treat NSCLC between 2017 and 2019. The follow-up period was defined as the time from index date (first sold date of EGFRi) to December 2020 or end of membership or death, whichever occurred first. Primary outcome measures included adherence to EGFRi, frequency of imaging during drug exposure, and presence of imaging prior to treatment change. Outcomes were analyzed with Chi-square test for categorical variables, and Student's t-test or Wilcoxon rank-sum test for continuous variables. RESULTS: There were 613 patients in the pharmacist-managed group and 714 patients in the usual care group. Overall, the mean age was 68.2 ± 11.3 years, and 65.1% were female. In the pharmacist-managed group, there was a significantly higher mean proportion of days covered (PDC) during the first three months of therapy (0.86 ± 0.24 vs 0.82 ± 0.36, p = 0.01) and a higher percentage of patients who were adherent to EGFRi therapy (with PDC ≥0.80) during the drug exposure period (95.8% vs 92.4%, p = 0.01). The rate of computed tomography (CT) and magnetic resonance imaging (MRI) during drug exposure was higher in the pharmacist-managed group compared to the usual care group (31.8% vs 20.7%, p < 0.01) with a higher number of mean scans completed per patient (1.15 ± 2.42 vs 0.62 ± 1.63, p < 0.01) and per patient-year (2.60 ± 7.27 vs 1.58 ± 5.95, p < 0.01). Overall, 66.2% of patients had a treatment change, with a higher percentage of patients in the pharmacist-managed group who completed a CT or MRI scan prior to treatment change (36.3% vs 26.3%, p < 0.01). Additionally, the median time between the scan and treatment change was shorter for patients with pharmacist-managed care (1.8 vs 4 months, p = 0.04). CONCLUSION: Clinical pharmacy services contributed to improved adherence, higher rates of imaging, and shorter time between imaging and treatment changes in NSCLC patients who were taking EGFRi regimens.

The Medicines Optimisation Innovation Centre: a dedicated centre driving innovation in medicines optimisation-impact and sustainability.

BACKGROUND: Sub-optimal medicines use is a challenge globally, contributing to poorer health outcomes, inefficiencies and waste. The Medicines Optimisation Innovation Centre (MOIC) was established in Northern Ireland by the Department of Health (DH) in 2015 to support implementation of the Medicines Optimisation Quality Framework. AIM: To demonstrate how MOIC informs policy and provides support to commissioners to improve population health and wellbeing. SETTING: MOIC is a regional centre with multidisciplinary and multi-sector clinical expertise across Health and Social Care and patient representation. DEVELOPMENT: Core funded by DH, MOIC has a robust governance structure and oversight programme board. An annual business plan is agreed with DH. Rigorous processes have been developed for project adoption and working collaboratively with industry. IMPLEMENTATION: MOIC has established partnerships with academia, industry, healthcare and representative organisations across Europe, participating in research and development projects and testing integrated technology solutions. A hosting programme has been established and evaluation and dissemination strategies have been developed. EVALUATION: MOIC has established numerous agreements, partnered in three large EU projects and strengthened networks globally with extensive publications and conference presentations. Informing pathway redesign, sustainability and COVID response, MOIC has also assisted in the development of clinical pharmacy services and antimicrobial stewardship in Europe and Africa. Northern Ireland has been recognised as a 4-star European Active and Healthy Ageing Reference Site and the Integrated Medicines Management model as an example of best practice in Central and Eastern Europe. CONCLUSION: MOIC has demonstrated considerable success and sustainability and is applicable to health systems globally.

Survey of Potential Drug Interactions, Use of Non-Medical Health Products, and Immunization Status among Patients Receiving Targeted Therapies.

In recent years, several changes have occurred in the management of chronic immunological conditions with the emerging use of targeted therapies. This two-phase cross-sectional study was conducted through structured in-person interviews in 2018-2019 and 2022. Additional data sources included ambulatory medical records and the itemized reimbursement reporting interface of the National Health Insurance Fund. Drug interactions were analyzed using the UpToDate Lexicomp, Medscape drug interaction checker, and Drugs.com databases. The chi-square test was used, and odds ratios (ORs) were calculated. In total, 185 patients participated. In 53% of patients (n = 53), a serious drug-drug interaction (DDI) was identified (mean number: 1.07 ± 1.43, 0-7), whereas this value was 38% (n = 38) for potential drug-supplement interactions (mean number: 0.58 ± 0.85, 0-3) and 47% (n = 47) for potential targeted drug interactions (0.72 ± 0.97, 0-5) in 2018. In 2022, 78% of patients (n = 66) were identified as having a serious DDI (mean number: 2.27 ± 2.69, 0-19), 66% (n = 56) had a potential drug-supplement interaction (mean number: 2.33 ± 2.69, 0-13), and 79% (n = 67) had a potential targeted drug interactions (1.35 ± 1.04, 0-5). Older age (>60 years; OR: 2.062), female sex (OR: 3.387), and polypharmacy (OR: 5.276) were identified as the main risk factors. Screening methods and drug interaction databases do not keep pace with the emergence of new therapeutics.

Clinical pharmacy and telemedicine: an opportunity to improve epilepsy management.

Clinical pharmacy, as defined by the European Society of Clinical Pharmacy, is a comprehensive professional practice encompassing all pharmacist profiles regardless of the setting. It focuses on promoting optimal drug utilization for patient-centric clinical outcomes. Telemedicine leverages information and communication technologies for remote healthcare delivery, bridging geographical gaps. The integration of clinical pharmacy and telemedicine is crucial in modern healthcare paradigms, especially for patients with chronic illnesses. In 2021, marketing authorization was granted for cenobamate as adjunctive treatment for focal-onset seizures with or without secondary generalization in adults with epilepsy who have not been adequately controlled despite a history of treatment with at least two antiepileptic medicinal products. This review emphasizes the synergistic role of clinical pharmacists and neurologists in utilizing telemedicine for patient counselling, drug information dissemination, adverse drug reaction surveillance, and personalized medication management within the context of epilepsy care. This integration could enhance patient safety, therapeutic outcomes and address socio-economic challenges faced by chronic patients.

Considerations when treating influenza infections with oseltamivir.

INTRODUCTION: Since the coronavirus disease 2019-mandated social distancing policy has been lifted worldwide, the circulation of influenza is expected to resume. Currently, oseltamivir is approved as the first-line agent for influenza prevention and treatment. AREAS COVERED: This paper reviews the updated evidence in the pharmacology, resistance mechanisms, clinical pharmacy management, and real-world data on oseltamivir for influenza. EXPERT OPINION: Oseltamivir is an oral prodrug of oseltamivir carboxylate, an influenza A and B neuraminidase inhibitor. Recently, the therapeutic efficacy of oseltamivir has been demonstrated in several trials. Oseltamivir is generally well-tolerated but may lead to neuropsychiatric events and bleeding. Oseltamivir-resistant influenza virus has been associated with the H275Y mutation in the influenza A(H1N1)pdm09 virus, while most strains are still sensitive to oseltamivir. Dose adjustment for oseltamivir should be based on creatinine clearance and body weight in pediatric patients with renal failure. According to real-world data from Nanfang Hospital, the annual number of patients prescribed oseltamivir declined from 35,711 in 2019 to 8,971 in 2020, with marked increases in 2022 (20,213) and 2023 (18,071). Among the 206 inpatients, children aged < 6 years who were treated with oseltamivir had the shortest duration to defervescence.

The relationship between psychological burden and providing assistance with taking medication among caregivers of patients with dementia: a cross-sectional study.

OBJECTIVES: Previous studies have examined the psychological burden of caregivers of patients with dementia. However, although many caregivers struggle to assist patients with dementia with medication management, the relationship between assisting such patients with taking their medicines and the caregiver psychological burden is understudied. Therefore, this study identified the association between caregivers' psychological burden and assisting patients with dementia with taking medication. METHODS: A cross-sectional survey was conducted among caregivers of patients with dementia in Japan. The survey questionnaire included questions that assessed the symptoms of patients with dementia, their status of taking medication through medication assistance from caregivers, and caregivers' psychological burden using the Kessler Psychological Distress Scale and the Japanese version of the Perceived Stress Scale. KEY FINDINGS: A total of 57 caregivers participated in the study. Higher Kessler Psychological Distress Scale scores were significantly associated with unsuccessful assistance with taking regular medication (ß = 0.35, 95% confidence interval [CI]: 2.23-12.0, P < .05), depressive symptoms (ß = 0.26, 95% CI: 0.10-8.53, P < .05), and irritability (ß = 0.38, 95% CI: 2.71-11.5, P < .05). Likewise, higher scores on the Japanese version of the Perceived Stress Scale were significantly associated with irritability (ß = 0.37, 95% CI: 1.87-12.5, P < .05) among patients with dementia. CONCLUSION: The findings suggest that caregiver psychological burden is associated with unsuccessful assistance with taking regular medication for patients with dementia.

Assessing accuracy of ChatGPT in response to questions from day to day pharmaceutical care in hospitals.

Background: The advent of Large Language Models (LLMs) such as ChatGPT introduces opportunities within the medical field. Nonetheless, use of LLM poses a risk when healthcare practitioners and patients present clinical questions to these programs without a comprehensive understanding of its suitability for clinical contexts. Objective: The objective of this study was to assess ChatGPT's ability to generate appropriate responses to clinical questions that hospital pharmacists could encounter during routine patient care. Methods: Thirty questions from 10 different domains within clinical pharmacy were collected during routine care. Questions were presented to ChatGPT in a standardized format, including patients' age, sex, drug name, dose, and indication. Subsequently, relevant information regarding specific cases were provided, and the prompt was concluded with the query "what would a hospital pharmacist do?". The impact on accuracy was assessed for each domain by modifying personification to "what would you do?", presenting the question in Dutch, and regenerating the primary question. All responses were independently evaluated by two senior hospital pharmacists, focusing on the availability of an advice, accuracy and concordance. Results: In 77% of questions, ChatGPT provided an advice in response to the question. For these responses, accuracy and concordance were determined. Accuracy was correct and complete for 26% of responses, correct but incomplete for 22% of responses, partially correct and partially incorrect for 30% of responses and completely incorrect for 22% of responses. The reproducibility was poor, with merely 10% of responses remaining consistent upon regeneration of the primary question. Conclusions: While concordance of responses was excellent, the accuracy and reproducibility were poor. With the described method, ChatGPT should not be used to address questions encountered by hospital pharmacists during their shifts. However, it is important to acknowledge the limitations of our methodology, including potential biases, which may have influenced the findings.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Background: Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. Methods: A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Results: Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Conclusion: Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Vancomycin population pharmacokinetics and dosing proposal for the initial treatment in obese adult patients.

Aim: The aim of this study was to develop a vancomycin population pharmacokinetic model in adult obese patients and propose covariate-based dosing individualization in order to maximize the achievement of the newly recommended PK/PD target, according to a revised consensus guideline from 2020. Methods: Therapeutic drug monitoring data from initial vancomycin therapy (first 3 days of treatment) in adult obese (BMI ≥ 30 kg/m2) patients from 2013 to 2022 were analyzed using a non-linear mixed-effects modeling method, and Monte Carlo simulations were then used to find the optimal dosage maximizing the PK/PD target attainment. Results: A total of 147 vancomycin serum levels obtained from 138 patients were included in the analysis. Based on the covariate model diagnosis among all tested variables, no reliable predictor of vancomycin volume of distribution (Vd) was identified, while clearance (CL) was positively correlated with eGFR and lean body mass. Creatinine-based eGFR predicted vancomycin CL better than cystatin C-based eGFR. The median (interquartile range) value from conditional modes of individual estimates of Vd, CL, and elimination half-life in our population was 74.0 (70.5-75.4) L, 6.65 (4.95-8.42) L/h, and 7.7 (6.0-10.0) h, respectively. Conclusion: We proposed dosing individualization based on the covariate found in order to maximize the achievement of the newly recommended PK/PD target of the AUC/MIC ratio of 400-600. Clinical pharmacy/pharmacology interventions may lead to an improvement in vancomycin dosing with a reflection in PK/PD target attainment.

Standardized Solutions of Catecholamines in Intensive Care Medicine: Application, Safety and Economic Aspects.

Background/Objectives: Catecholamines are among those agents that are indispensable in modern intensive care medicine. The rapid availability of hygienically impeccable and correctly concentrated injectable solutions, e.g., for syringe pumps, is becoming more and more important. However, little research has been conducted regarding how the use of catecholamines is distributed in different wards and what options can be used to achieve optimal availability. Methods: In a retrospective monocentric study from 2019 to 2022, all continuously applied catecholamines in intensive care units (ICU) and intermediate care units (IMC) were investigated. The focus was on potential optimization by utilizing manufactured ready-to-administer solutions in the context of the economization of patient care. Results: Norepinephrine syringes represented 81% of all syringes administered, appearing to be the most frequently used on all wards. Production by the in-house pharmacy showed both financial advantages and an increase in patient safety compared to syringes produced at the bedside. Discussion: Increasing numbers of critically ill patients coupled with growing staff shortages and an increased awareness of safety requirements are driving the move towards ready-to-use and ready-to-administer solutions in critical care medicine. In-house manufacturing by hospital pharmacies can be a promising option to optimize processes and improve the economics of patient care. Conclusions: Individual calculations of the required catecholamine preparations with regard to possible economic advantages should be carried out in hospitals. In particular, in-house production of ready-to-use and ready-to-administer preparations could significantly increase patient safety and seems to be economically viable.

Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses.

BACKGROUND: Dementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists' contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing. METHODS: This study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study. RESULTS: The analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care. CONCLUSIONS: This study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes.

Empowering pharmacists working in primary care through a cardiovascular disease clinical management course: Impact on practice.

INTRODUCTION: Cardiovascular disease (CVD) is currently the leading cause of mortality and morbidity worldwide. A competent healthcare workforce working in primary care delivering disease management services efficiently is the cornerstone of well performing health systems, impacting patient outcomes positively. The aim of this study was to evaluate the effectiveness of a training course to support pharmacists working in General Practitioner (GP) practices; and to evaluate its impact on practice. METHODS: A before and after evaluation model was employed to assess the effectiveness of training resorting to a survey exploring self-confidence and knowledge on clinical management of three CVD topics: Atrial Fibrillation (AF), Hypertension and hyperlipidaemia. Before and after training data (immediate and retained after 6 months) were analysed at the Primary Care Network (PCN) and GP Practice level of the pharmacists who took part in the training sessions. Data were analysed in IBM SPSS v.29 resorting to paired samples t-test and Cohen's d for estimation of the effect size. Independent samples t-tests were performed for a sample group of PCNs and GP practices with and without training (comparator group). RESULTS: An improvement with large effect size was observed in pharmacists' self-confidence and knowledge related to the hypertension topic, suggesting potential practical benefit. For the topics of AF and hyperlipidaemia, pharmacists' confidence also increased with a large effect size, but for knowledge, the effect size of the increase was medium or small. Data suggests that pharmacists' practice has improved in both groups after 6 months, which suggests that it was not a sole result of the training. CONCLUSIONS: This study provide evidence that the course improved pharmacists' knowledge and self-confidence, likely to contribute to performance in their clinical practice. Patients' clinical benefit is expected from pharmacists' improved capacity to effectively engage in medicines optimisation.