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1.
Int J Med Inform ; 129: 253-259, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31445264

RESUMEN

BACKGROUND: Qualitative studies have provided important insights into how hospital pharmacists' work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals' work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists' work pre- and post-EMM implementation in two countries. METHODS: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. RESULTS: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%-27.5%; England 27.1%-33.8%) and history-taking (Australia 7.6%-13.3%; England 19.5%-28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%-27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. CONCLUSIONS: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists' work in both countries. Anticipated reductions in medication review and history taking were not observed.


Asunto(s)
Registros Electrónicos de Salud , Australia , Inglaterra , Personal de Salud , Hospitales , Humanos , Sistemas de Medicación , Farmacéuticos/organización & administración , Estudios de Tiempo y Movimiento
2.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 551-559, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31305172

RESUMEN

Introduction: There is a lack of good quality economic evidence for the inclusion of pharmacists on hospital ward rounds in addition to, or as an alternative to, traditional ward-based clinical pharmacy services. There has been no systematic review of the cost or cost-effectiveness of pharmacists attending and contributing on ward rounds. Areas covered: A literature search was conducted in Medline, Embase, Cochrane, and CINAHL and reported in accordance with the PRISMA guidelines in May 2019. As well, a search using Google Scholar and a targeted hand search were undertaken. Studies that reported any estimate of the cost or cost-effectiveness were included if pharmacist participation on inpatient hospital ward rounds was the predominant focus of the intervention. The identified studies were subsequently screened by three reviewers who extracted data on their clinical and economic design. A bias assessment was completed using the ROBINS-I tool. Expert opinion: Seven studies were identified investigating a clinical pharmacist's inclusion on hospital ward rounds where there was a cost estimated. However, none were deemed to be a full economic evaluation and all were found to be open to a serious risk of bias. Future evaluations should include a comparator group and investigate the cost and cost savings of the service, alongside their clinical outcomes.


Asunto(s)
Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Rondas de Enseñanza/organización & administración , Sesgo , Análisis Costo-Beneficio , Humanos , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Rol Profesional , Proyectos de Investigación , Rondas de Enseñanza/economía
3.
BMC Health Serv Res ; 19(1): 282, 2019 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-31053135

RESUMEN

BACKGROUND: Pharmaceutical care is the pharmacist's contribution to the care of individuals to optimize medicines use and improve health outcomes. The primary tool of pharmaceutical care is medication review. Defining and classifying Drug-Related Problems (DRPs) is an essential pillar of the medication review. Our objectives were to perform a pilot of medication review in Hungarian community pharmacies, a DRP classification was applied for the first time. Also, our goal was the qualitative and quantitative description of the discovered DRPs, and of the interventions for their solution in order to prove the safety relevance of the service and to map out the competence limits of GPs and community pharmacists to drug therapy. METHODS: The project took place in Hungarian community pharmacies. The study was performed with patients taking vitamin K antagonist (VKA) and/or ACE inhibitor and NSAID simultaneously (ACEI-NSAID). 61 pharmacists and 606 patients participated in the project. Pharmacists reviewed the medication for 3 months and the classification of DRPs was performed (category of DRP1 - DRP6). Patient data were statistically analyzed. RESULTS: Patients consumed on average 7.9 ± 3.1 medications and other products. 571 DRPs were detected in 540 patients, averaging 1.06 DRPs per patient (SD = 1.07). The highest frequency category was DRP5 (non-quantitative safety problem; 51.0%). The most common root cause was an interaction (42.0%) and non-adherence (19.4%.). The most commonly used intervention was education (25.4%) and medication replacement by the pharmacist (20.1%). The changing of the frequency and dosage in any direction were negligible. CONCLUSIONS: Patients are struggling with many DRPs that can be assessed and categorized by this system and which remain unrecognizable without pharmacists. Further projects need to be developed to assist in the development of physician-pharmacist cooperation and the widespread dissemination of pharmaceutical care.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Utilización de Medicamentos/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Farmacéuticos/organización & administración , Anciano , Estudios de Evaluación como Asunto , Femenino , Humanos , Hungría , Masculino , Auditoría Médica , Persona de Mediana Edad , Proyectos Piloto , Investigación Cualitativa
4.
J Oncol Pharm Pract ; 25(4): 954-960, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30975067

RESUMEN

INTRODUCTION: The development of immune checkpoint inhibitors has revolutionized cancer treatment and is now a part of the treatment paradigm for several malignancies. Although immune checkpoint inhibitors are generally well tolerated, treatment is associated with immune-related adverse events, some serious and potentially life threatening. Early identification and prompt appropriate management of immune-related adverse events are crucial to prevent morbidity and mortality. The complexity and severity of immune-related adverse events require interdisciplinary collaboration to optimize care. Patient and caregiver education and continued communication between patients and members of the oncology care team are vital for timely recognition and successful management of immune-related adverse events. The objective of this program is to provide a proof of concept; a pharmacist-led immune checkpoint inhibitor management program will increase early recognition and management of immune-related adverse events through patient and caregiver education and proactively assessing patients for toxicities. METHODS: At the University of Wisconsin Carbone Cancer Center, we developed and implemented a pharmacist-driven program, referred to as the immune checkpoint inhibitor program, which aimed to ensure patient and caregiver education and continuous monitoring of immune-related adverse events. This program utilized pharmacist-patient encounters to improve patient and caregiver education and follow-up monitoring. The design and implementation are detailed. Pharmacist interventions and patient outcomes were evaluated. RESULTS: At interim analysis, 47 patients were enrolled in the program and pharmacists completed 34 interventions on 26 patients. Pharmacists are well positioned to educate patients and caregivers on immune checkpoint inhibitor therapy and provide proactive monitoring to detect immune-related adverse events. We hypothesize that the interventions made by pharmacist may lead to earlier recognition and treatment of immune-related adverse events.


Asunto(s)
Antineoplásicos/efectos adversos , Antígeno B7-H1/antagonistas & inhibidores , Antígeno CTLA-4/antagonistas & inhibidores , Neoplasias/tratamiento farmacológico , Farmacéuticos , Servicio de Farmacia en Hospital , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/organización & administración
5.
Int J Clin Pharm ; 41(2): 434-444, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30879216

RESUMEN

Background Due to a shortage of emergency department doctors and nurses, hospitals have started to employ pharmacists who have additional clinical skills, known as Emergency Department Pharmacist Practitioners, to help deliver services. Objective To describe, compare and define the Emergency Department Pharmacist Practitioner role. Setting UK emergency departments. Method Using a purpose developed questionnaire hosted on a tablet computer, Emergency Department Pharmacist Practitioners were asked to report their contribution to patient care and the wider emergency department over 10 work days. Main outcome measure Emergency Department Pharmacist Practitioners' work. Results Twenty Emergency Department Pharmacist Practitioners from 15 UK hospitals were recruited. Of 682 patients cared for, 4.8% (n=33) were of blue triage category (least urgent) and 4.1% (n=28) red (immediate need). Specific activities to inform patient diagnosis included clinical examinations (264/682 patients, 38.7%) and the review of investigation/test/procedure results (270, 39.6%). For treatment, EDPPs prescribed a total of 603 medicines (for administration in the ED) to 266 patients (39.0%) and performed procedures for 63 (9.2%). Eleven of the practitioners also took on the role of designated care provider (i.e. the healthcare professional with overall clinical responsibility) for at least some of their patients. From application of the care typology, all 20 practitioners carried out both 'traditional' and 'practitioner' activity and 9/20 of them sometimes provided more 'practitioner' than 'traditional' care to individual patients. Seven key role attributes were identified including how these pharmacists support patients with medical complaints and injuries of any severity and at any stage of their visit. Conclusion Emergency Department Pharmacist Practitioners combine traditional clinical pharmacy activities with more hands-on medical practise including being designated care provider. The role is versatile in that care and support provided to patients and the wider emergency department professional team is varied and therefore somewhat adaptable to situations which present.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Desarrollo de Programa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Reino Unido , Adulto Joven
6.
Int J Clin Pharm ; 41(2): 391-407, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30879217

RESUMEN

Background Pharmacists are increasingly being included as members of general practice primary care teams. To date, there have been few published studies describing the competencies of general practice (GP) pharmacists and establishing their subsequent educational needs. Aim of the review The aim of this literature review is to establish the activities of pharmacists in general practice to inform the development of a comprehensive role description and competency map. Method A systematic literature search of EMBASE, MEDLINE, international pharmaceutical abstracts and the Cochrane database of systematic reviews was conducted from the start of the databases to August 2018. The search focused on studies investigating the roles performed by GP pharmacists. Full text peer-reviewed English language articles were included. A qualitative content analysis of included studies was performed. Two researchers reviewed studies to identify pharmacist roles. Subcategories of roles were then agreed by the research team and used to present the data. GP pharmacist's activities were mapped by two researchers to associated competencies. Any discrepancies between role descriptions and competency maps were resolved in consultation with a third member of the research team. Results The search conducted resulted in 5370 potential articles. Two hundred and twenty-seven full text articles were selected for review resulting in 34 articles that were included for analysis. Seven GP pharmacist role sub-categories and 48 GP pharmacist individual roles were identified. The seven GP pharmacist role sub-categories included medication management, patient examination and screening, chronic disease management, drug information and education, collaboration and liaison, audit and quality assurance and research. All FIP competency domains were included in the GP pharmacist competency map. Competencies related to compounding, dispensing and packaging of medications were not found relevant to the GP Pharmacist role. No roles were mapped to competencies relating to re-imbursement for medicines, procurement, or medication production. All areas of professional and personal competence were relevant to the GP pharmacist role. Conclusion A comprehensive role description and competency map for GP pharmacists is described and may be used to inform future research into the education of GP pharmacists.


Asunto(s)
Competencia Clínica , Evaluación de Necesidades , Grupo de Atención al Paciente/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Educación en Farmacia , Humanos
7.
BMC Health Serv Res ; 19(1): 156, 2019 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-30866925

RESUMEN

BACKGROUND: The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists' activities, including interactions with patients and health professionals, and their perceptions of medication safety risks. METHODS: A mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors. RESULTS: Observations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors. CONCLUSION: This study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists' activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure 'business as usual' by enhancing and adapting their role.


Asunto(s)
Prescripción Electrónica , Farmacéuticos/organización & administración , Inglaterra , Personal de Salud/organización & administración , Personal de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Errores de Medicación/prevención & control , Errores de Medicación/estadística & datos numéricos , Seguridad del Paciente , Percepción , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/organización & administración , Servicio de Farmacia en Hospital/estadística & datos numéricos , Rol del Médico , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos
8.
J Manag Care Spec Pharm ; 25(3): 358-365, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30816812

RESUMEN

BACKGROUND: Renin-angiotensin system (RAS) antagonists are recommended for people with diabetes and hypertension or with elevated urinary albumin excretion. RAS antagonists are beneficial for some, yet clinically inappropriate for others. The percentage of patients for whom RASs are clinically inappropriate has not been compared across health plans. OBJECTIVES: To (a) identify reasons why RAS therapy was not recommended and (b) compare exception percentages between health plans. METHODS: This retrospective, cross-sectional analysis included Medicare Part D beneficiaries with diabetes, enrolled in health plans (n = 96) participating in a university-based medication therapy management (MTM) program between January 1 and December 31, 2013. The MTM program evaluated patient eligibility for RAS therapy via (1) a clinically derived software system assessing demographics and medication history, and (2) telepharmacist-delivered medication reviews. The MTM program database calculated the number of patients with diabetes and percentage of RAS therapy exceptions. RESULTS: An average of 55% of patients with diabetes qualified for MTM (range: 19%-88%). Of the 218,589 eligible, 94,359 had 1 or more reasons contraindicating RAS therapy (exception). For an average of 29% of patients, it was inappropriate to recommend the addition of an RAS antagonist; the overall exception rate ranged from 3% to 83%, suggesting a wide variation of exception rates for all health plans. CONCLUSIONS: A substantial difference existed across health plans where RAS therapy was considered clinically inappropriate to recommend for patients with diabetes. Future research must examine variations in therapy exceptions to understand the effect of encouraging broad-population RAS antagonist use. DISCLOSURES: SinfoníaRx provided funding for this project. Wild, Boesen, and Werner are employed by SinfoniaRx, which provided grant funding to the University of Arizona College of Pharmacy for the conduct of this study. This project was presented at the AMCP 27th Annual Meeting and Expo; April 8-10, 2015; San Diego, CA.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Diabetes Mellitus/epidemiología , Hipertensión/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Masculino , Medicare Part D , Administración del Tratamiento Farmacológico/estadística & datos numéricos , Persona de Mediana Edad , Farmacéuticos/organización & administración , Estudios Retrospectivos , Estados Unidos
9.
J Manag Care Spec Pharm ; 25(3): 411-416, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30816815

RESUMEN

BACKGROUND: The establishment of a formulary management system ensures that health care professionals work together in an integrated patient care process to promote clinically sound, safe, and cost-effective medication therapy. Pharmacists have a foundational role within this system. A pharmacist-adjudicated prior authorization drug request (PADR) consult service has the potential to optimize drug therapy by decreasing medication misuse, minimizing adverse drug events (ADEs), and preventing medication errors. OBJECTIVES: To (a) determine cost avoidance associated with pharmacist-adjudicated PADR safety interventions within the Durham Veterans Affairs Health Care System and (b) evaluate cost savings associated with pharmacist-adjudicated PADRs not approved due to a safety intervention, evaluate cost avoidance and direct cost savings based on clinical specialty of pharmacist adjudicating PADR, and characterize severity of avoided ADEs. METHODS: Pharmacist-adjudicated PADRs not approved between July 1, 2016, and June 30, 2017, because of safety interventions were retrospectively reviewed. Cost avoidance was determined by multiplying the probability of ADE occurrence in the absence of PADR safety intervention by the estimated cost avoided based on the type of intervention. Direct cost savings was calculated by totaling the cost of requested medications not approved for each PADR and subtracting the cost of recommended alternative therapies and cost of pharmacist PADR review. All potential ADEs avoided were reviewed by a panel of 3 clinical pharmacists to validate ADE classification and ADE probability and severity scores. Descriptive statistics were used for all analyses. RESULTS: Of the 910 PADRs that were not approved during the study period, 96 met inclusion criteria. Pharmacist-adjudicated PADR safety interventions resulted in a total cost avoidance of $24,485.34 (mean = $255.06) and a direct cost savings of $288,695.63 (mean = $3,007.25). The practice settings of anticoagulation and infectious diseases PADRs resulted in the largest contribution to cost avoidance and direct cost savings, respectively. Prevented ADEs were classified as major for 64.6% of the PADRs. CONCLUSIONS: Pharmacist-adjudicated PADR safety reviews resulted in substantial economic benefit and prevention of major ADEs. This analysis supports the pharmacist's role in a formulary management system to optimize medication therapy. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors. The authors have nothing to disclose.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Autorización Previa/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Consultores , Ahorro de Costo , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/economía , Femenino , Formularios de Hospitales como Asunto , Hospitales de Veteranos/economía , Hospitales de Veteranos/organización & administración , Humanos , Masculino , Errores de Medicación/economía , Errores de Medicación/prevención & control , Persona de Mediana Edad , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Autorización Previa/economía , Rol Profesional , Estudios Retrospectivos
10.
Pharm. pract. (Granada, Internet) ; 17(1): 0-0, ene.-mar. 2019.
Artículo en Inglés | IBECS | ID: ibc-184602

RESUMEN

Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers


No disponible


Asunto(s)
Humanos , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Servicios Comunitarios de Farmacia/organización & administración , Analgésicos/uso terapéutico , Rol Profesional , Farmacéuticos/organización & administración , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos sin Prescripción/uso terapéutico , Medicamentos bajo Prescripción/uso terapéutico , Australia/epidemiología
11.
BMC Health Serv Res ; 19(1): 118, 2019 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-30760276

RESUMEN

BACKGROUND: The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A collaborative care approach, such as providing medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care. METHODS: In a retrospective observational medical chart review study, patients aged 65 years or more in the period 2012-2014 who received 10 or more medications concomitantly and who were screened by a CP were included. Data on pharmacotherapy and CPs' interventions were obtained from the patients' medical records (non-electronic chart review). Potential drug-drug interactions (pDDIs) were determined with Lexicomp Online™ 3.0.2. Only potential X-type DDIs (pXDDIs) were included. Potentially inappropriate medications in the elderly (PIMs) were identified using the PRICUS list. RESULTS: Ninety-one patients were included. The CPs suggested 625 interventions, of which 304 (48.6%) were accepted by the general practitioners (GPs). After adopting the CPs' interventions, the number of total medications decreased by 11.2% (p <  0.05) and the number of pXDDIs decreased by 42% (p <  0.05). The number of clinically important pXDDIs decreased by 50% (3 cases). The number of prescribed PIMs decreased by 20% (p = 0.069). The acceptance of CP's recommendations reduced the number of pXDDIs (p < 0.05) and improved the adherence to heart failure treatment guidelines. CONCLUSIONS: A collaborative care approach offering a CP medication review service significantly improved the quality of pharmacotherapy by reducing the total number of medications and pXDDIs. The results support the implementation of this service in the Slovenian healthcare system.


Asunto(s)
Médicos Generales/organización & administración , Relaciones Interprofesionales , Farmacéuticos/organización & administración , Anciano , Anciano de 80 o más Años , Servicios Comunitarios de Farmacia/organización & administración , Interacciones de Drogas/fisiología , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Polifarmacia , Lista de Medicamentos Potencialmente Inapropiados/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Estudios Retrospectivos , Eslovenia
12.
Am J Health Syst Pharm ; 76(Supplement_1): S21-S27, 2019 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-30753314

RESUMEN

Purpose: The purpose of this survey-based research project is to identify factors, including prior training, institution demographics, and pharmacist prioritization of services that may impact variability in practice among emergency medicine (EM) pharmacists. Methods: An electronic survey was available for 6 weeks. Participants were contacted through professional membership directories. Survey questions addressed EM pharmacist training and institution demographics. Pharmacists were asked to define the frequency with which they performed ASHP-identified best practice services. Results: Responses were received by 208 pharmacists (response rate = 9.4%) who were primarily from academic (48.1%) or community (47.6%) emergency departments (EDs). Pharmacists working in an academic ED were more likely to have EM postgraduate year 2 training (27.8%) compared to a community ED (11.2%) (p = 0.0182). Pharmacists practicing in an academic emergency department (ED) reported participating in traumas, care for boarded patients, and performing scholarly activities more frequently (p < 0.01) and medication reconciliations less frequently (p < 0.01) than those in a community ED. Most EM pharmacists reported postgraduate year 1 training (45.7%) as compared to postgraduate year 2 EM (18.3%) or critical care (13.7%) pharmacy residency training. Conclusion: Institution and ED demographics as well as pharmacist level of training can affect the frequency of services provided in the ED setting.


Asunto(s)
Servicios Médicos de Urgencia/organización & administración , Medicina de Emergencia , Farmacéuticos , Educación en Farmacia , Medicina de Emergencia/educación , Medicina de Emergencia/métodos , Medicina de Emergencia/organización & administración , Prioridades en Salud , Humanos , Farmacéuticos/organización & administración , Encuestas y Cuestionarios
13.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 569-574, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30658041

RESUMEN

Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure.


Asunto(s)
Medicamentos Genéricos/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Facultades de Farmacia , Estudiantes de Farmacia/estadística & datos numéricos , Estudios Transversales , Medicamentos Genéricos/efectos adversos , Medicamentos Genéricos/economía , Femenino , Grecia , Humanos , Masculino , Farmacéuticos/organización & administración , Rol Profesional , Encuestas y Cuestionarios , Equivalencia Terapéutica
14.
J Oncol Pharm Pract ; 25(7): 1699-1704, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30616470

RESUMEN

PURPOSE: Ethiopia is home to a growing population of more than 100 million people. Healthcare in the region functions with a shortage of oncologists. Pharmacists as well as other healthcare providers can assist with expanding patient access to cancer care. A pilot project was proposed to provide education, determine areas to expand pharmacy services in oncology, and recommend interventions at Tikur Anbessa Specialized Hospital and Addis Ababa University. METHODS: A layered learning practice model comprising of a clinical pharmacist, a post-graduate year two oncology pharmacy resident, and two fourth-year student pharmacists was constructed for the experience. Through collaboration with the College of Pharmacy at Addis Ababa University, an international experience was developed to provide education and advance pharmacy practice at Tikur Anbessa Specialized Hospital. RESULTS: Based on findings from a needs assessment, the participants collaborated with key stakeholders to develop practices and procedures for the implementation of high-dose methotrexate and for comprehensive chemotherapy order review. In addition, 17 didactic lectures were provided to nine students enrolled in the Master of Pharmacy in Pharmacy Practice at the College of Pharmacy at Addis Ababa University. CONCLUSION: This experience provided educational and clinical impact using a layered learning practice model, consisting of a clinical pharmacist, pharmacy resident, and pharmacy students in an international setting. There is significant potential for clinical pharmacy to positively impact patient care in the oncology setting in Ethiopia. Future initiatives for advancement include the safe handling of hazardous agents, additional therapeutic drug monitoring, and outpatient oncology pharmacist practice.


Asunto(s)
Educación en Farmacia/organización & administración , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Estudiantes de Farmacia , Prestación de Atención de Salud/organización & administración , Etiopía , Humanos , Proyectos Piloto
15.
BMC Health Serv Res ; 19(1): 5, 2019 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-30611264

RESUMEN

BACKGROUND: Community pharmacists' (CPs') interventions have a positive impact on managing respiratory patients. However, methods used by CPs to assess patients' inhaler technique and adherence are subjective. New technologies to objectively assess inhaler technique and adherence were introduced to address such a gap. This study aimed to explore CPs' perceptions towards the management of respiratory patients regarding inhaler technique and adherence. In addition, it explored the views of CPs and their need of technologies to objectively assess inhaler technique and adherence. CPs were probed with a new technology called Inhaler Compliance Assessment (INCA) device, designed to objectively monitor both inhaler technique and adherence of patients using a dry powder inhaler, as an example. METHODS: A qualitative study employing semi-structured interviews was conducted. A convenience and snowballing sampling strategy was employed to recruit CPs working in independent community pharmacies within West and South London. Twenty-three pharmacists were interviewed between August and November 2015. Data was analysed thematically using the framework methodology and coded using NVivo10 software. RESULTS: Analysis revealed five main themes: services and limitations of patient support, the need and acceptability of new technologies to support respiratory patients, fragmented primary care, the need to promote the clinical role of CPs, and professional identity. Patient support was patchy and affected by several barriers related to pharmacists and patients. In addition, lack of communications with different healthcare professionals in primary care and inaccessibility to clinical records were identified as problematic issues. Some CPs perceived their clinical role to be lacking within the patient care pathway. Interestingly, CPs showed positive a attitude towards the use of technologies, such as the INCA technology to support patients and were willing to provide new services. However, remuneration appeared to be a major driver for willingness to offer new services or promote existing services. CONCLUSION: The current study highlighted some measures that can augment CPs' clinical practice while managing patients, such as having accessibility to patients' medical records and the use of technologies such as the INCA technology to promote objective counselling of patients.


Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Enfermedades Pulmonares/tratamiento farmacológico , Comunicación , Servicios Comunitarios de Farmacia/organización & administración , Femenino , Humanos , Londres , Masculino , Cumplimiento de la Medicación , Nebulizadores y Vaporizadores , Percepción , Farmacias/organización & administración , Farmacéuticos/organización & administración , Atención Primaria de Salud/organización & administración , Práctica Profesional , Rol Profesional , Relaciones Profesional-Paciente , Investigación Cualitativa
16.
J Oncol Pharm Pract ; 25(4): 777-786, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29375014

RESUMEN

BACKGROUND: In recent years, there has been a changing paradigm in the management of oncologic disease states from the use of intravenous therapies, requiring a visit to the infusion center or hospitalization, to new therapies that can be administered orally.1,2 Several publications have evaluated the role pharmacists may play in the initial prescribing of oral chemotherapy, however the impact of a formalized pharmacist follow-up program has not been well defined. This study evaluates the impact of a pilot pharmacist-run oral antineoplastic monitoring program. METHODS: This retrospective cohort analysis evaluated patients prescribed an oral antineoplastic in the genitourinary oncology clinic at an academic medical center between 1 July 2014 and 15 March 2017. Patients enrolled in the program were compared to a historical control group. The primary objective was adherence to pre-defined standards for monitoring. Secondary objectives include persistence on therapy, need to seek medical care, analysis of pharmacist interventions, patient satisfaction, and financial impact for the on-site retail pharmacy. RESULTS: In total, 33 patients were evaluated (11 cases, 22 controls). Average adherence to monitoring recommendations was significantly higher in the case group compared to controls (89% vs. 61%; p = 0.008). In total, 67 interventions were made by the clinical pharmacist with an average of 6 per patient. CONCLUSIONS: This study shows that formalized pharmacist follow-up programs can improve patients' adherence with antineoplastic monitoring standards. Additionally, pharmacists made clinically significant interventions and had high patient satisfaction, providing justification for expansion into other disease states.


Asunto(s)
Antineoplásicos/uso terapéutico , Monitoreo de Drogas , Farmacéuticos , Neoplasias Urogenitales/tratamiento farmacológico , Administración Oral , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Farmacéuticos/organización & administración , Proyectos Piloto , Estudios Retrospectivos
17.
J Oncol Pharm Pract ; 25(3): 584-598, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29338572

RESUMEN

PURPOSE: To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. METHODS: A descriptive, cross-sectional survey of all oncology pharmacists in Alberta was conducted using a web-based questionnaire over four weeks between March and April 2016. Pharmacists were identified from the Cancer Services Pharmacy Directory and leadership staff in Alberta Health Services. Descriptive statistics were used to describe the practice setting, prescribing practices, motivators to apply for additional prescribing authorization, and the facilitators and barriers of prescribing. Logistic regression was used to explore factors associated with having additional prescribing authorization. RESULTS: The overall response rate was 41% (71 of 175 pharmacists). Oncology pharmacists with additional prescribing authorization made up 38% of respondents. They primarily worked in urban, tertiary cancer centers, and practiced in ambulatory care. The top 3 clinical activities they participated in were medication reconciliation, medication counseling/education, and ambulatory patient assessment. Respondents thought additional prescribing authorization was most useful for ambulatory patient assessment and follow-up. Antiemetics were prescribed the most often. The median number of prescriptions written in an average week of clinical work was 5. Competence, self-confidence, and the potential impact on patient care/perceived impact on work environment were the strongest facilitators of prescribing. The strongest motivators to apply for additional prescribing authorization were relevancy to practice, the potential for increased efficiency, and advancing the profession. CONCLUSION: The current majority of oncology pharmacist prescribing in Alberta occurs in ambulatory care with a large focus on antiemetic prescribing. Pharmacists found additional prescribing authorization most useful for ambulatory patient assessment and follow-up.


Asunto(s)
Atención Ambulatoria/organización & administración , Neoplasias/tratamiento farmacológico , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Adulto , Alberta , Antieméticos/uso terapéutico , Estudios Transversales , Prescripciones de Medicamentos/estadística & datos numéricos , Humanos , Conciliación de Medicamentos , Percepción , Rol Profesional , Encuestas y Cuestionarios , Adulto Joven
18.
J Pharm Pract ; 32(1): 54-61, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29096570

RESUMEN

OBJECTIVE:: Following a California law expanding pharmacists' scope of practice to include directly providing self-administered hormonal contraception to patients pursuant to a statewide protocol, this study aimed to assess California pharmacists' intentions to provide this new service prior to the protocol development and implementation. DESIGN:: Descriptive, nonexperimental, cross-sectional study. SETTING:: California between August and September 2014. PARTICIPANTS:: California pharmacists working in community pharmacies. INTERVENTION:: Invitations to participate in the online survey were sent to 1774 pharmacists. MAIN OUTCOME MEASURES:: Main outcomes included pharmacists' current practices, intentions to prescribe hormonal contraception, comfort performing various activities, knowledge about contraceptive methods, training needs, and barriers to prescribing. RESULTS:: A total of 257 responses (14.5% response rate) were received. Of those, 121 respondents met inclusion criteria and were included in the analysis. About half of the respondents (49.6%) reported working in a community chain pharmacy, 46.3% in an independent pharmacy, and 4.1% in other community pharmacy settings. The majority (72.7%) of pharmacists reported that they would likely provide this new service. Respondents reported being comfortable educating patients on short-acting (94.2%) and long-acting reversible contraception (81.7%), as well as identifying drug interactions with hormonal contraception (96.7%). Respondents indicated time constraints (74.4%), lack of reimbursement (63.6%), and liability concerns (62.0%) as barriers to prescribing hormonal contraception. CONCLUSIONS:: California pharmacists expressed strong intentions and comfort in prescribing hormonal contraception. Pharmacists' additional training needs and barriers should be addressed for successful implementation. This new service has great potential to increase access to contraception, potentially fostering increased use and adherence.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Anticonceptivos Hormonales Orales/administración & dosificación , Prescripciones de Medicamentos/estadística & datos numéricos , Farmacéuticos/organización & administración , Adulto , Actitud del Personal de Salud , California , Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , Intención , Masculino , Persona de Mediana Edad , Farmacéuticos/legislación & jurisprudencia , Farmacéuticos/estadística & datos numéricos , Rol Profesional
19.
J Pharm Pract ; 32(1): 68-76, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29183253

RESUMEN

BACKGROUND:: Pharmacists may assist with reducing 30-day readmission rates for patients with heart failure (HF) exacerbation or acute myocardial infarction (AMI) by promoting medication adherence. OBJECTIVE:: To determine the change in 30-day readmission rates for patients with HF exacerbation or AMI after implementation of a "high-touch" standard of care. METHODS:: Patients admitted with HF exacerbation, non-ST-segment elevation AMI, or ST-segment elevation AMI from August 1, 2013, to June 30, 2015, were included in this prospective study. Patients were educated while in the inpatient setting and followed up in the outpatient setting through telephone contact and scheduling a medication therapy management (MTM) appointment with a pharmacist. Data were collected by pharmacy personnel involved in the implementation of the intervention. RESULTS:: Within the HF and AMI arms, 100 and 93 patients, respectively, were included in the study. The 30-day readmission rates were 24% and 17.2% for HF and AMI, respectively, which were not statistically significant when compared to historical institutional readmission rates prior to study initiation (18.2% for HF, P = .238; 11.4% for AMI, P = .252). CONCLUSION:: A "high-touch" pharmacist-driven transitions of care program may affect 30-day readmission rates for patients with HF exacerbation or AMI; potential processes for initiating transitions of care programs are provided.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Infarto del Miocardio sin Elevación del ST/tratamiento farmacológico , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/organización & administración , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Administración del Tratamiento Farmacológico/organización & administración , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Readmisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Proyectos Piloto , Rol Profesional , Estudios Prospectivos
20.
J Oncol Pharm Pract ; 25(3): 558-566, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29207938

RESUMEN

BACKGROUND: Current workforce shortages within the hematopoietic stem cell transplant field necessitate capitalizing on the role of oncology-trained pharmacists. Working within an agreed-upon protocol, pharmacists are able to expand patient care delivery through optimal medication therapy management. METHODS: An electronic survey was developed by the Advocacy & Policy Working Committee of the American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group and distributed to pharmacists involved in the care of hematopoietic stem cell transplant patients. The primary objective was to assess the current state of collaborative practice agreements in the hematopoietic stem cell transplant setting. RESULTS: Forty-eight responses representing 41 institutions were returned. Respondents were mostly female (67%) and practiced in the adult setting (83%). Reponses represented a range of practice experience in hematopoietic stem cell transplant with the majority of the hematopoietic stem cell transplant positions (83%) funded by the department of pharmacy at an academic medical center. Of the 48 responses, 22 (46%) respondents reported having collaborative practice agreements in place; 10 (21%) respondents did not currently have collaborative practice agreements, but were planning to implement them; and 16 (33%) respondents did not have collaborative practice agreements at their institution. Clinical activities performed under a collaborative practice agreement included medication selection and dosing modifications, therapeutic drug monitoring, supportive care management, and management of comorbid conditions and chronic diseases. The most commonly cited barrier to establishing collaborative practice agreements was the inability to secure reimbursement for services provided. No respondents reported a negative impact on job satisfaction. CONCLUSIONS: The results of this survey provide the pharmacy community with a robust understanding of the current landscape of hematopoietic stem cell transplant pharmacy collaborative practice agreements.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas/métodos , Administración del Tratamiento Farmacológico/organización & administración , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Adulto , Conducta Cooperativa , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Estados Unidos
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