ABSTRACT
BACKGROUND: Since June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab. OBJECTIVE: This study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program. METHODS: The methodology is based on Kirkpatrick's model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3). RESULTS: The HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists. CONCLUSIONS: This study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43091.
ABSTRACT
BACKGROUND: Headaches are common and often lead patients to seek advice from a pharmacist and consequently self-medicate for relief. Computerized pharmacy decision support systems (PDSSs) may be a valuable resource for health care professionals, particularly for community pharmacists when counseling patients with headache, to guide treatment with over-the-counter medications and recognize patients who require urgent or specialist care. OBJECTIVE: This observational pilot study aimed to evaluate a newly developed PDSS web app for the management of patients seeking advice from a pharmacy for headache. This study examined the use of the PDSS web app and if it had an impact on patient or pharmacy personnel counseling, pharmacy personnel perception, and patient perception. METHODS: The PDSS web app was developed according to Francophone des Sciences Pharmaceutiques Officinales (SFSPO) recommendations for headache management, and was made available to pharmacies in 2 regions of France: Hauts de France and New Aquitaine. Pharmacy personnel received 2 hours of training before using the PDSS web app. All people who visited the pharmacies for headache between June 29, 2020, and December 31, 2020, were offered an interview based on the PDSS web app and given information about the next steps in the management of headaches and advice on the proper use of their medication. Patients and pharmacy personnel reported satisfaction with the PDSS web app following consultations or during a follow-up period (January 18 to 25, 2021). RESULTS: Of the 44 pharmacies that received the PDSS web app, 38 pharmacies representing 179 pharmacy personnel used the PDSS web app, and 435 people visited these pharmacies for headache during the study period. Of these, 70.0% (305/435) asked for immediate over-the-counter analgesics for themselves and consulted with pharmacy personnel with the use of the PDSS web app. The majority of these patients were given advice and analgesics for self-medication (346/435, 79.5%); however, 17.0% (74/435) were given analgesics and referred to urgent medical services, and 3.5% (15/435) were given analgesics and referred to their general practitioner. All pharmacy personnel (n=45) were satisfied or very satisfied with the use of the PDSS web app, and a majority thought it improved the quality of their care (41/44, 93.2%). Most pharmacy personnel felt that the PDSS web app modified their approach to management of headache (29/45, 64.4%). Most patients were very satisfied with the PDSS web app during their consultation (96/119, 80.7%), and all felt mostly or completely reassured. CONCLUSIONS: Use of the PDSS web app for the management of patients with headache improved the perceived quality of care for pharmacy personnel and patients. The PDSS web app was well accepted and effectively identified patients who required specialist medical management. Further studies should identify additional "red flags" for more effective screening and management of patients via the PDSS web app. Larger studies can measure the impact of the PDSS web app on the lives of patients and how safe or appropriate pharmacy personnel recommendations are.
