Assessment of the implementation of pharmacist prescribing: Challenges and pathways for ambulatory practice.

BACKGROUND: Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic. OBJECTIVE: We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications. METHODS: A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines. RESULTS: Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians. CONCLUSIONS: This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.

Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team.

Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.

Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial. / Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado.

OBJECTIVES: To evaluate a clinical pharmacist's inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. MATERIAL AND METHODS: Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient's discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. RESULTS: A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist's intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P .05). CONCLUSION: Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction.

OBJETIVO: Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. METODO: Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). RESULTADOS: Un total de 1.001 pacientes ingresaron al estudio (GI = 500 y GC = 501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p 0,05). CONCLUSIONES: La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios.

To collaborate or not-to-collaborate? Behavioral-antecedents and mediating role of intraprofessional collaborative behavior on performance of community pharmacists: A modeling study.

Extensive research exists on collaborative behavior between healthcare professionals with different skill sets (interprofessional collaboration). However, research is scarce and evolving on collaborative behavior among members of the same profession (intraprofessional collaboration), community pharmacists in particular. Based on the theory of reasoned action, a hypothetical structural model was developed to evaluate the impact of behavioral antecedents: competitive behavior (CB), knowledge-sharing behavior (KSB), and customer-focused behavior (CFB), and the mediating effects of collaborative behavior (CTB) on work performance (WP) of community pharmacists in southwestern Nigeria. We used a cross-sectional questionnaire-based survey of randomly selected community pharmacists (N = 646). Structural equation modeling was used to test hypotheses. The model had an acceptable fit and data quality. The model showed that CB, KSB, and CFB exert a significant direct influence on CTB. Only CFB significantly influenced WP compared to other antecedents and CTB. The absence of mediating effects of CTB suggests a gap in intraprofessional practice with implications for interprofessional collaboration and performance among community pharmacists. We conclude from our results that overall work performance is enhanced when community pharmacists encourage and adopt a collaborative culture. This culture strengthens the benefits of shared experiential knowledge, focus on patients' welfare, and healthy competition.

The impact of Covid-19 on community and hospital pharmacists: a thematic analysis study

Abstract There are a limited number of studies examining the effects of the pandemic on the daily lives of Turkish community pharmacists, and no research investigating the impact on the lives of Turkish hospital pharmacists has been found. This study aimed to examine the effects of the pandemic on the personal and professional lives of Turkish community pharmacists and hospital pharmacists. In this qualitative study design, a comprehensive set of interviews was conducted with a total of 13 community pharmacists and 7 hospital pharmacists, employing a semi-structured interview guide. Through thematic content analysis of the interviews, four main themes, 1) long-term impacts, 2) dealing strategies, 3) professional life impacts, 4) personal life impacts, have emerged for both community pharmacists and hospital pharmacists. In addition to the psychological impacts and supply chain issues commonly mentioned in the literature, the study revealed ongoing effects such as the inability to sell available products and economic difficulties. Also, the increased demand for over-the-counter products during the pandemic highlights the need for the government to develop policies to address this issue.

Assessing pharmaceutical consultations: Comparing pharmacy-recommended medications for minor ailments and regulatory compliance in a Latin American healthcare network.

Background: The importance of access to medicines in promoting global health cannot be overstated, particularly as an estimated 2 billion people lack access to basic medicines, particularly in developing nations. While over-the-counter (OTC) medications are relatively safe and cost-effective, there is a risk of misuse due to factors such as inaccurate self-diagnosis, inadequate dosing, addiction, adverse drug reactions, and drug interactions. To ensure proper use and prevent irrational self-medication, pharmacists can play a crucial role in guiding patients. However, the legislation in Costa Rica only covers OTC and prescription drugs, and health authorities are proposing a new decree to include a list of drugs that can be recommended by pharmacists without a prescription to treat minor ailments, which would be classified as behind-the-counter (BTC). Objective: Characterize the pharmaceutical consultation, compare the medications recommended by pharmacy professionals for minor ailments with the legislation in force in Costa Rica, and determine whether the current OTC medications are sufficient to treat minor ailments. Material and methods: This study is a descriptive, observational, cross-sectional study that focuses on a sample of the Costa Rican population that comes to consult with a pharmacist in one of the four pharmacies of the Hospital Clínica Bíblica (HCB) in San José, Costa Rica. Consultations included users over 18 years of age or caregivers of underage patients seeking advice or assistance from publicly accessible pharmacies, excluding consultations that involved information related to other hospital departments. This study aims to analyze the pharmaceutical consultation for minor ailments and compare the medications recommended by pharmacists with the list of medications allowed in Costa Rica. The study also aims to determine if the current OTC medications are adequate for treating minor ailments. Results: A total of 1537 consultations were gathered, which were divided into four categories: pharmaceutical recommendation (48%), medication information (31%), other consultations (18%), and referrals to another health professional (3%). Among the consultations classified as pharmaceutical recommendations, 90% were related to minor ailments. Prescription drugs accounted for 75.3% of the medications recommended and consulted. However, when the BTC category was included, the percentage of recommended prescription drugs decreased to 29.6%, while BTC drugs constituted 45.7%. Finally, the chi-square test rejected the null hypothesis that there was no association between the availability of OTC drugs and the minor ailments for which patients sought consultation. Conclusions: Most cases of pharmacy consultations involve minor illnesses such as digestive symptoms, joint pain, and respiratory issues. The proposed decree by health authorities in Costa Rica is noteworthy as it establishes standardized protocols for the prescription of BTC medications to ensure the safety of patients.

Role of community pharmacy and pharmacists in self-care in Brazil.

Global healthcare systems, including the National Health System in Brazil - one of the largest public models in the world -, continue to evolve, as well as populations' health needs, currently shaped on individuals feeling a greater desire to manage their own health. Self-care practices are part of several public policies and clinical guidelines in Brazil including the National Policy on Complementary and Integrative Practices, the National AIDS Control Program, the National Policy for Women's Health, and the Guidelines for Care of People with Chronic Diseases. There are over 100,700 community pharmacies, in the country (89.2% privately owned) employing 234,300 pharmacists, representing an important delivery point for self-care, as they are the first point of access to care for most patients. Self-medication is a common practice in Brazil (prevalence rates of self-medication ranging from 16.1% to 35.0%), especially with non-prescription/over-the-counter medicinal products (65.0%). In fact, these products represent over 25% of volume marketed of medicines, summing revenues of USD 1.9 billion per year. Studies demonstrated a positive budget impact as important savings for the National Health System due to reductions of unnecessary medical appointments and loss of working days. In addition to minor ailments management, other self-care services provided by community pharmacies that are frequently sought by Brazilian citizens (20-25% of cases) are smoking cessation and weight management (costs per service ranging from around USD 5.00-12.00). However, pharmacy services are not yet as fully integrated in Brazil to the same extent as in other countries. Barriers such as standardization of processes (from services' design, implementation, and evaluation in practice), pharmacist remuneration for the provision of services and the amount to be charged for the service are still a matter of controversy. For more rapid and sustainable advances in these practices, communication among various stakeholders, professional practice and healthcare regulations, standardization of services and financing of self-care (both publicly and privately) are urgently needed. This paper provides an overview of some self-care services provided by community pharmacies in Brazil and call attention to the ongoing challenges to move the National Health system forward.

The role of the pharmacist in the hospital discharge of cancer patients: an integrative review.

INTRODUCTION: Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step, because pharmacotherapy changes may occur during hospitalization, leading to potential medication-related problems at home. OBJECTIVE: To identify publications which describe the activities performed by the pharmacist at the hospital discharge of patients with cancer. METHOD: This is an integrative systematic literature review. A search was carried out in the MEDLINE databases, via Pubmed, Embase, and Virtual Health Library, using the following descriptors: "Patient Discharge", "Pharmacists", "Neoplasms." Studies that reported activities performed by the pharmacist at the hospital discharge of patients with cancer were included. RESULTS: Five hundred and two studies were identified, of which seven met the eligibility criteria. Most were conducted in the United States (n = 3), and the rest in Belgium, Brazil, Canada, and Italy. Among the services provided by the pharmacist at discharge, medication reconciliation was the most widely described. Other activities such as counseling, education, identification, and resolution of drug-related problems were also carried out. CONCLUSION: In the scenario of hospital discharge of patients with cancer, the participation of pharmacists is still to be seen as of significance in regards to publications. Despite this, the results suggest that the actions of this professional contribute to patient orientation and the safe use of prescription drugs for use at home.

Efeito do aconselhamento farmacêutico na adesão à medicação do paciente e na erradicação do Helicobacter Pylori em pacientes ambulatoriais jordanianos / Effect of pharmacist counseling on patient medication compliance and helicobacter pylori eradication among jordanian outpatients

ABSTRACT Background: To examine the impact of pharmacist counseling and follow-up on patient's medication compliance and Helicobacter Pylori (H. pylori) eradication and evaluate the efficiency of an eradication regimen consisting of Clarithromycin 500 mg, Amoxicillin 1 g, and Lansoprazole 30 mg, twice daily for 14 days. Methods: Two hundred patients undergoing endoscopy and positive rapid urease tests were included in the present study. Patients were randomly divided into two groups: an intervention group (n=100) and a control group (n=100). The intervention patients obtained their medications from the hospital pharmacist and received sufficient counseling and follow-up. On the other hand, the control patients received their medications from another hospital pharmacist and went through the routine hospital procedure without good counseling and follow-up. Results: The intervention resulted in a statistically significant improvement in outpatient compliance with medication (45.0% vs 27.5%; P<0.05) and eradication of H. pylori (28.5% vs 42.5%; P<0.05) among those patients. Conclusion: This study reflects the importance of pharmacist counseling and patient compliance to medication, as the patients who received pharmacist counseling exhibited perfect compliance to medication, which led to the successful eradication of H. pylori.

RESUMO Contexto: Analisar o impacto do aconselhamento e acompanhamento farmacêutico na adesão medicamentosa do paciente e na erradicação do Helicobacter Pylori (H. pylori) e avaliar a eficiência de um regime de erradicação composto por Claritromicina 500 mg, Amoxicilina 1 g e Lansoprazol 30 mg, duas vezes ao dia por 14 dias. Métodos Duzentos pacientes submetidos à endoscopia e testes rápidos de urease positivos foram incluídos no presente estudo. Os pacientes foram divididos aleatoriamente em dois grupos: um grupo intervenção (n=100) e um grupo controle (n=100). Os pacientes de intervenção obtiveram seus medicamentos do farmacêutico do hospital e receberam aconselhamento e acompanhamento suficientes. Por outro lado, os pacientes do grupo controle receberam seus medicamentos de outro farmacêutico hospitalar e passaram pelo procedimento hospitalar de rotina sem um bom aconselhamento e acompanhamento. Resultados: A intervenção do farmacêutico resultou em melhora estatisticamente significativa na adesão ambulatorial à medicação (45,0% vs 27,5%; P<0,05) e na erradicação de H. pylori (28,5% vs 42,5%; P<0,05) entre esses pacientes. Conclusão Este estudo reflete a importância do aconselhamento farmacêutico e da adesão do paciente à medicação, uma vez que os pacientes que receberam aconselhamento farmacêutico apresentaram perfeita adesão à medicação, o que levou à erradicação bem-sucedida da H. pylori.

Fatores que predispõem o uso inadequado de insulinas em diabéticos em uma unidade de saúde no município de Jaguaruana-Ceará / Factors that predispose to the inappropriate use of insulin in diabetics in a health unit in the city of Jaguaruana- Ceará / Factores que predisponen al uso inadecuado de insulina en diabéticos de una unidad de salud de la ciudad de Jaguaruana-Ceará

Introdução: O diabetes mellitus é um distúrbio metabólico crônico que afeta grande parcela da população mundial, no Brasil o número de diabéticos vem crescendo significativamente com o passar dos anos. A qualidade de vida destes pacientes está intimamente relacionada ao tratamento adequado que pode reduzir as complicações decorrentes da doença. O estudo teve como objetivo identificar dificuldades no uso de insulinas em pacientes da unidade de saúde do município de Jaguaruana-CE que possam estar relacionados a falhas no tratamento. Métodos: Tratou-se de uma análise do tipo descritivo, transversal e observacional com uma abordagem quantitativa, o questionário foi aplicado aos pacientes no momento da consulta na Unidade Básica de Saúde (UBS). A pesquisa ocorreu entre os meses de setembro a outubro de 2022 com mulheres e homens insulinodependentes acima de 18 anos. Resultados: Os dados mostraram maior prevalência de mulheres, 20 (67%), a maior faixa etária foi acima de 40 anos, 19 (63%) e a renda familiar prevaleceu de 1 à 2 salários mínimos, 14 (47%). O profissional de prestou maior orientação quanto ao uso da insulina foi o enfermeiro, citado por 12 (40%) pacientes, 20 (67%) relataram armazenar a insulina na porta da geladeira, 22 (74%) relataram desconhecer o motivo das aplicações dolorosas e 9 (30%) confirmam perder ou pular uma das aplicações diárias. Conclusão: Nota-se, portanto, a necessidade da atuação do farmacêutico na saúde da família, na avaliação e orientação quanto ao uso correto das insulinas, garantindo assim o uso racional e com maior eficácia.

Introduction: Diabetes mellitus is a chronic metabolic disorder that affects a large portion of the world population. In Brazil, the number of diabetics has been growing significantly over the years. The quality of life of these patients is closely related to adequate treatment that can reduce the complications arising from the disease. This study aimed to identify difficulties in the use of insulin in patients at the health care facility in the city of Jaguaruana-CE that may be related to treatment failure. Methods: This was a descriptive, cross-sectional and observational analysis with a quantitative approach, the questionnaire was applied to patients at the time of consultation in the Basic Health Unit (BHU). The research occurred between the months of September to October 2022 with insulin-dependent women and men over 18 years. Results: The data showed higher prevalence of women, 20 (67%), the highest age group was above 40 years, 19 (63%) and family income prevailed from 1 to 2 minimum wages, 14 (47%). The professional who provided the most orientation regarding insulin use was the nurse, mentioned by 12 (40%) patients, 20 (67%) reported storing insulin in the refrigerator door, 22 (74%) reported not knowing the reason for the painful applications, and 9 (30%) confirmed missing or skipping one of the daily applications. Conclusion: Therefore, it is noted the need for the role of the pharmacist in family health, in the evaluation and guidance on the correct use of insulin, thus ensuring the rational use and with greater efficacy.

Introducción: La diabetes mellitus es un trastorno metabólico crónico que afecta a gran parte de la población mundial, en Brasil el número de diabéticos viene creciendo significativamente a lo largo de los años. A qualidade de vida destes pacientes está estreitamente relacionada com um tratamento adequado que permita reduzir as complicações decorrentes da doença. O estudo teve como objetivo identificar dificuldades no uso de insulinas em pacientes da unidade de saúde do município de Jaguaruana-CE que possam estar relacionadas a falhas no tratamento. Método: Se trató de un análisis descriptivo, transversal y observacional con abordaje cuantitativo, el cuestionario fue aplicado a los pacientes en el momento de la consulta en la Unidad Básica de Salud (UBS). La investigación ocurrió entre los meses de septiembre a octubre de 2022 con mujeres y hombres insulinodependientes mayores de 18 años. Resultados: Los datos mostraron mayor prevalencia de mujeres, 20 (67%), el grupo de mayor edad fue superior a 40 años, 19 (63%) y la renta familiar prevaleció de 1 a 2 salarios mínimos, 14 (47%). El profesional que más orientó sobre el uso de la insulina fue la enfermera, mencionada por 12 (40%) pacientes, 20 (67%) relataron haber guardado la insulina en la puerta del refrigerador, 22 (74%) relataron no saber el motivo de las aplicaciones dolorosas y 9 (30%) confirmaron haber omitido o saltado una de las aplicaciones diarias. Conclusión: Se constata, por lo tanto, la necesidad del papel del farmacéutico en la salud familiar, en la evaluación y orientación en cuanto al uso correcto de las insulinas, garantizando así el uso racional y con mayor eficacia.

Educação permanente para farmacêuticos preceptores que atuam na atenção primária no Sistema Único de Saúde: um estudo qualitativo / Lifelong learning for pharmacist preceptors in primary healthcare in the Brazilian health system: a qualitative study

Resumo O bom exercício da preceptoria exige educação permanente dos profissionais de saúde. Nesse contexto, foi desenvolvido curso para preceptores farmacêuticos em um município do leste de Minas Gerais, visando promover o desenvolvimento de competências clínicas. O objetivo do estudo é descrever a experiência educacional desenvolvida e a perspectiva dos participantes sobre a mesma. Trata-se de estudo qualitativo, com coleta de dados por observação participante, entrevistas semiestruturadas e análise documental. Os dados transcritos foram submetidos a análise temática. O planejamento da atividade educacional, realizado a partir de diagnóstico com os farmacêuticos, resultou em satisfação por parte dos mesmos, que ressaltaram a relevância dos temas abordados para sua prática cotidiana. O curso teórico-prático com estudos de casos que objetivava desenvolver competências clínicas iniciais demonstrou-se satisfatório na perspectiva dos participantes. Problemas na gestão do sistema de saúde local dificultaram a realização da fase de apoio in loco, prevista inicialmente. Além disso, evidenciaram-se fatores que influenciam na possibilidade de aplicação de tais competências no cotidiano profissional. Os conhecimentos gerados podem ser subsidiar outras experiências de integração universidade-serviço de saúde para educação permanente de farmacêuticos, com aproveitamento dos aspectos positivos e desenvolvimento de estratégias de prevenção dos problemas identificados.

Abstract A good preceptorship practice requires lifelong education. In this context, a course was developed for pharmacist preceptors aiming to promote the development of clinical skills. This study aims to describe the educational experience developed and the participants' perspective on it. This is a qualitative study, with data collection through participant observation, semi-structured interviews and document analysis. The transcribed data were submitted to thematic analysis. The planning of the educational activity, carried out based on a diagnosis with the pharmacists, resulted in satisfaction on the part of the pharmacists, who stressed the relevance of the topics addressed for their daily practice. The theoretical-practical course with case studies that aimed to develop initial clinical skills proved to be satisfactory from the perspective of the participants. Problems in the management of the local health system made it difficult to carry out the on-site support phase, initially planned. In addition, factors that influence the possibility of applying such competences in professional daily life were evidenced. The knowledge generated can be used to support other university-health service integration experiences for the lifelong education of pharmacists, taking advantage of the positive aspects and developing strategies to prevent the identified problems.

Impact of an Electronic Alert in Combination with a Care Bundle on the Outcomes of Acute Kidney Injury.

Early diagnosis is essential for the appropriate management of acute kidney injury (AKI). We evaluated the impact of an electronic AKI alert together with a care bundle on the progression and mortality of AKI. This was a single-center prospective study that included AKI patients aged ≥ 18 years, whereas those in palliative care, nephrology, and transplantation departments were excluded. An AKI alert was issued in electronic medical records and a care bundle was suggested. A series of classes were administered to the multidisciplinary teams by nephrologists, and a clinical pharmacist audited prescriptions. Patients were categorized into pre-alert and post-alert groups. The baseline characteristics were comparable between the pre-alert (n = 1613) and post-alert (n = 1561) groups. The 30-day mortality rate was 33.6% in the entire cohort and was lower in the post-alert group (30.5% vs. 36.7%; p < 0.001). Age, pulmonary disease, malignancy, and ICU admission were associated with an increase in 30-day mortality. The electronic AKI alert together with a care bundle and a multidisciplinary education program was associated with a reduction in 30-day mortality in patients with AKI.

Pharmacists knowledge, perception and practice regarding medication disposal.

Background: Medications that are improperly disposed contribute to environmental contamination with proven negative impacts on biological ecosystems. The role of the pharmacist in providing medication disposal advice is paramount to reducing this effect. Objective: To investigate pharmacists' knowledge, perception and practices regarding medication disposal in Trinidad. Methods: A cross-sectional study was conducted electronically over 4 months amongst public and private sector pharmacists using a self-administered questionnaire. The questionnaire comprised 32 questions and four sections - demographics, knowledge, perception and practice regarding medication disposal. Ethical approval was obtained from the Ethics Committee, the University of the West Indies, the four Regional Health Authorities in Trinidad, and the Ministry of Health, Government of the Republic of Trinidad and Tobago. Data were analysed using IBM SPSS Statistics Version 24. Chi-squared tests sought to detect significant associations between demographics and responses. Results: Of 400 pharmacists, (response rate 52.0%) most were female (63.0%), had <5 years experience (47.1%), and worked in a community pharmacy (68.0%). Most (79.3%) believed that improperly disposed medications can negatively affect the environment but only 45.2% thought that improperly disposed antibiotics could lead to antimicrobial resistance. Most returned expired drugs to the pharmaceutical distributor (80.8%), or disposed of through the Drug Inspectorate (63.9%), but 32.3% still disposed of expired medicines in the workplace garbage, with community pharmacies being more likely to carry out this practice (p = 0.011). Most pharmacists (36.5%) do not counsel patients on medication disposal and 64.4% would not recommend flushing expired drugs down the toilet. Only 20.7% would recommend flushing narcotics, which is considered the best practice to prevent accidental poisoning. Conclusions: Continuing education for pharmacists is needed to increase awareness of the best practices of medication disposal, along with an awareness campaign on medication disposal.

Intervenções farmacêuticas em Unidade de Pronto Atendimento: uma análise farmacoterapêutica e farmacoeconômica / Pharmaceutical interventions in Emergency Care Unit: a pharmacotherapeutic and pharmacoeconomic analysis

Objetivo: Esclarecer o impacto farmacoterapêutico e farmacoeconômico das intervenções farmacêuticas em serviços de urgência e emergência. Métodos: Estudo de intervenção conduzido em uma Unidade de Pronto Atendimento. Os pacientes admitidos na pesquisa receberam acompanhamento farmacoterapêutico por meio de avaliação e intervenção na farmacoterapia. Resultados: Participaram do estudo 197 pacientes majoritariamente feminino, comórbidos, com média de idade de 43 anos ± 13. Foram realizadas intervenções em 130 destes, com aceitação de 83% por parte da equipe de assistência. As intervenções também repercutiram na farmacoeconomia, proporcionando uma redução de custos de 35% em comparação ao semestre anterior. Conclusão: Nossos resultados expressaram que a presença do farmacêutico clínico é essencial para farmacoterapias otimizadas e redução de custos hospitalares.

Objective: To clarify pharmaceutical interventions' pharmacotherapeutic and pharmacoeconomic impact on urgent and emergency services. Methods: Intervention study conducted in an Emergency Care Unit. Patients enrolled in the research received pharmacotherapeutic follow-up through evaluation and intervention in pharmacotherapy. Results: One hundred and ninety seven patients, mostly female, with comorbid conditions, with a mean age of 43 years ± 13, participated in the study. Interventions were performed in 130 of them, with an acceptance of 83% by the care team. The interventions also impacted pharmacoeconomics, providing a cost reduction of 35% compared to the previous semester. Conclusion: Our results expressed that the presence of the clinical pharmacist is essential for optimized pharmacotherapies and hospital cost reduction.

Instruments to assess the role of the clinical pharmacist: a systematic review.

BACKGROUND: The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary. METHODS: A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected. RESULTS: A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments. CONCLUSIONS: Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD 42018099912.

Assistência farmacêutica brasileira no primeiro ano da pandemia da Covid-19: uma revisão integrativa / Brazilian pharmaceutical care in the first year of the Covid-19 pandemic: an integrative review / Asistencia farmacéutica brasileña en el primer año de la pandemia del Covid-19: una revisión integradora

O objetivo deste artigo foi identificar os desafios e oportunidades vivenciados pela assistência farmacêutica do Brasil no primeiro ano da pandemia da covid-19. Foi realizada revisão integrativa da literatura com base nos artigos de periódicos científicos, buscando identificar trabalhos relacionados à assistência farmacêutica no Brasil, publicados no período de março de 2020 a março de 2021. Foram incluídos nos resultados desta pesquisa 11 artigos elegíveis, que após análise foram agrupados em duas categorias com a finalidade de facilitar o entendimento quanto às diferentes áreas de atuação do profissional farmacêutico: atividades gerenciais; atividades clínicas, tendo esta como subcategorias a experiência em home care e ambulatorial; e atividades clínicas voltadas para orientação quanto ao uso racional de medicamento (URM). Os achados apontam como desafios mais frequentes os relacionados às atividades gerenciais e clínicas do farmacêutico, com destaque para aqueles referentes à orientação dos pacientes quanto ao uso racional de medicamentos, reestruturação dos serviços farmacêuticos, treinamento da equipe, adoção de novos protocolos farmacêuticos, planejamento da aquisição de medicamentos em larga escala para atender a demanda pandêmica, complexidade na farmacoterapia da covid-19, atuação na equipe multiprofissional, aquisição de novos conhecimentos, uso de novas tecnologias e implementação de novas práticas farmacológicas e não farmacológicas para o cuidado farmacêutico no contexto da covid-19.

This article aimed to identify the challenges and opportunities experienced by pharmaceutical assistance in Brazil in the first year of the COVID-19 pandemic. An integrative literature review was carried out based on publications in articles in scientific journals, seeking to identify works related to pharmaceutical care in Brazil, published from March 2020 to March 2021. A total of 11 eligible articles were included in the results of this research, which after analysis were grouped into two categories to facilitate the understanding of the different areas of activity of the pharmacist: managerial activities; clinical activities, with the following subcategories: experience in homecare and outpatient care; and clinical activities aimed at guidance on the rational medicine use (RMU). The findings indicate that the most frequent challenges are those related to the managerial and clinical activities of the pharmacist, especially those related to patient guidance on the rational medicine use, restructuring of pharmaceutical services, team training, adoption of new pharmaceutical protocols, acquisition planning of large-scale medicines to meet the pandemic demand, complexity in the pharmacotherapy of COVID-19, actuation in the multiprofessional team, acquisition of new knowledge, use of new technologies, and implementation of new pharmacological and non-pharmacological practices for pharmaceutical care in the context of COVID-19.

El objetivo de este artículo fue identificar los desafíos y oportunidades experimentados por la asistencia farmacéutica en Brasil en el primer año de la pandemia del covid-19. Se realizó una revisión integradora de la literatura basada en publicaciones en revistas científicas para identificar trabajos relacionados con la atención farmacéutica en Brasil, publicados entre marzo de 2020 y marzo de 2021. Como resultado de esta investigación se obtuvieron 11 artículos elegibles, que después del análisis se agruparon en dos categorías para facilitar la comprensión de las diferentes áreas de actividad del farmacéutico: actividades directivas; actividades clínicas, con las siguientes subcategorías: experiencia en atención domiciliaria y ambulatoria; y actividades clínicas dirigidas al uso racional de medicamentos (URM). Los hallazgos indican que los desafíos más frecuentes son los relacionados con las actividades gerenciales y clínicas del farmacéutico, especialmente los relacionados con la orientación del paciente sobre el uso racional de los medicamentos, la reestructuración de los servicios farmacéuticos, la formación de equipos, la adopción de nuevos protocolos farmacéuticos, la planificación de adquisiciones de medicamentos a gran escala para atender la demanda pandémica, complejidad en la farmacoterapia del covid-19, actuación en el equipo multiprofesional, adquisición de nuevos conocimientos, uso de nuevas tecnologías e implementación de nuevas prácticas farmacológicas y no farmacológicas para la atención farmacéutica en el contexto del covid-19.

Economic impact of pharmaceutical services on polymedicated patients: A systematic review.

BACKGROUND: Polypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge. OBJECTIVE: This Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective. METHODS: Systematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data. RESULTS: 3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up). CONCLUSIONS: Considering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation.

Effect and associated factors of a clinical pharmacy model in the incidence of medication errors in the hospital Pablo Tobón Uribe eacpharmodel study: stepped wedge randomized controlled Trial (NCT03338725).

Background The World Health Organization considers medication errors to be an issue that requires attention at all levels of care, to reduce the severe and preventable harm related to drug therapy. Different standards for clinical pharmaceutical practices have been proposed by various organizations across the world, where the pharmacist, as part of the multidisciplinary health team, can help improve patient safety. Objective To assess the impact of the introduction of a clinical pharmacy practice model on medication error in patients of a university hospital. Setting The study was conducted in a tertiary care hospital, Medellín, Colombia. Methods A randomized, controlled cluster-wedge staggered trial with a duration of 14 months was conducted to compare the clinical pharmacy practice model with the usual care process in the hospital. Five hospital health care units were included, which were initially assigned to the control group, and after an observation period of 2 months, they were randomly assigned to the intervention group. The trial protocol was registered in ClinicalTrials.gov (identifier NCT03338725). Main outcome measure The incidence of medication errors in hospitalized patients was the main outcome measure. Results The incidence of medication error was 13.3% and 22.8% for the intervention group and control group, respectively. The probability of presenting a medication error was 48% lower when the patient was in the intervention group (RR 0.52; 95% CI: 0.34-0.79). The probability of presenting a medication error over time was 44% lower in the intervention group (p = 0.0005); meanwhile, the resolution of a medication error over time was 70% higher in the intervention group (p = 0. 0029). Conclusion The clinical pharmacy practice model, made up of strategies focused on reducing medication errors, significantly reduces medication errors in patients during hospitalization compared with usual practice. This work assessed the effect of a clinical pharmacy model on the incidence of medication errors and demonstrated its effectiveness in reducing these errors in hospitalized patients. Trial registration ClinicalTrials.gov, NCT03338725. Registered on 9 November 2017. First patient randomized on February 2, 2018.

Effectiveness of a continuing education program of drugs with fiscalized substance to improve pharmacy staff competencies: A multicenter, cluster-randomized controlled trial.

Background: Drugs with fiscalized substances without a correct prescription may lead to undesirable side effects. Pharmacy staff needs to improve their competencies (knowledge, skills, and attitudes) to contribute to providing ambulatory pharmacy services and minimizing medication errors. Continuing education programs (CEP) could favor access to relevant and quality information on health promotion, disease prevention, and the rational use of drugs. Objective: To evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies to enhance the use of drugs with fiscalized substances. Methods: A multicenter, prospective, parallel-group, cluster-randomized, controlled clinical trial was conducted in drugstores and pharmacies in Colombia (ambulatory retail establishments). The intervention group (IG) received a CEP: a web-based social networking site, a virtual course, a dispensing information system, and face-to-face training. The control group (CG) received general written material on the correct use of drugs. We measured pharmacy staff's skills, attitudes, and knowledge self-reported scores, and the simulated patient technique was used to assess the participant skills and attitudes in real practice. We used a questionnaire designed for this study, which was evaluated by a group of experts and piloted and showed a Cronbach's alpha of 0.96. Results: Three hundred five drugstores and pharmacies were enrolled in two groups: IG (n = 153) and CG (n = 152). Out of the 750 potential participants, 88% (n=659) agreed to participate. The pharmacy staff's skills, attitudes, and knowledge self-reported scores post-intervention were higher than baseline in both groups; however, the IG had statistically significantly higher scores than the CG. Post-intervention, the self-efficacy skills and attitudes in the IG improved by 88% (22 of 25) and in six of the seven assessed knowledge components (p<0.001). However, the dispensing criteria evaluated with simulated patient methodology showed no statistically significant differences between groups in the pharmacy staff's skills and attitudes in real practice. Conclusions: Providing a continuing education program using different educational strategies improved the pharmacy staff's competencies (assessed knowledge and self-reported skills and attitudes) to enhance the use of drugs with fiscalized substances. However, there were no improvements in skills and attitudes in real practice. These findings could show that pharmacy staff needs additional and continuous training/sustainability.