ABSTRACT
BACKGROUND: Pharmacist-led management of urinary tract infections has been introduced as a service in the United Kingdom, Canada, United States of America, New Zealand, and Australia. The management of acute uncomplicated urinary tract infections by community pharmacists has gained increasing attention as a potential avenue to alleviate the burden on primary healthcare services. AIM: The objectives of the review were to: (1) identify protocols for community pharmacist management of acute uncomplicated urinary tract infections in women aged 16-65 years; (2) outline their key components; and (3) appraise the quality of protocols. METHOD: A grey literature search was undertaken for protocols intended for use by community pharmacists for the management of acute uncomplicated urinary tract infections in women aged 16-65 years, met the definition of a clinical management protocol and written in English. Their quality was appraised using the Appraisal Guidelines for Research and Evaluation version II instrument. RESULTS: Forty of the 274 records screened were included. Content analysis identified ten key components: common signs/symptoms, differential diagnosis, red flags/referral, choice of empirical antibiotic therapy, nonprescription medications, nonpharmacological/self-care advice, patient eligibility criteria, patient follow-up, dipstick testing recommendations, and recommendations on antimicrobial resistance. The lowest scoring domains in the quality assessment were 'Editorial Independence' and 'Rigour of Development'. Only four protocols were deemed high-quality. CONCLUSION: The review demonstrates that clinical management protocols for pharmacist-led management of urinary tract infections consist of similar recommendations, despite variation in international practice. However, the findings highlight a deficiency in the quality of most clinical management protocols governing pharmacist-led urinary tract infection management.
ABSTRACT
BackgroundIn Australia, medications can be prescribed by medical practitioners, dentists, nurses, and dispensed by pharmacists. Until recently, pharmacists have been limited to prescribing Schedule 2 and 3 medications, and optometrists, podiatrists, and nurse practitioners can prescribe medications under their scope of practice in some areas of Australia. Recently, the New South Wales (NSW) Government initiated a trial where approved pharmacists in NSW and Australian Capital Territory have an expanded scope of practice to prescribe further medications for urinary tract infections, dermatology conditions (mild to moderate atopic dermatitis, herpes zoster (shingles), impetigo, and mild plaque psoriasis), and resupply of contraceptives. This protocol is for a sub-study of the larger research trial and will explore the perspectives of Aboriginal and Torres Strait Islander peoples and communities including clinicians, healthcare services, and community members about the expanded scope of pharmacists' practice.Methods and analysisYarning circles (group) and individual yarns (semi-structured interviews) will be conducted with leaders, clinicians working with Aboriginal and Torres Strait Islander peoples (general practitioners, nurses, Aboriginal health workers, community pharmacists), Aboriginal Elders, and community members to understand perspectives of the risks, benefits, opportunities, and issues associated with pharmacists prescribing for these specific conditions. Ethics approval was obtained through the Aboriginal Health and Medical Research Council of NSW.ConclusionThe findings of this sub-study will clarify Aboriginal and Torres Strait Islander peoples' unique perspectives, including perception of risks and opportunities.
ABSTRACT
BACKGROUND: Many countries are experiencing an increased demand for health care and a shortage of health professionals in rural areas, impacting an individual's ability to receive timely treatment. The management of uncomplicated urinary tract infections by community pharmacists is usual practice in some regions of the United Kingdom and Canada, and Queensland, Australia. AIM: To systematically gather, assess, and synthesize the available peer-reviewed published literature on the management of uncomplicated UTIs by community pharmacists in women aged 16-65 years, provide an understanding of the clinical and economic evidence, while also identifying the essential components of interventions employed. METHOD: A systematic review was conducted to identify primary studies detailing interventions for the management of uncomplicated UTIs by community pharmacists. PubMed, PsycINFO, Scopus, Cochrane, CINAHL, EMBASE, and Web of Science were searched to February 2023. Non-primary and qualitative studies were excluded. Study details were recorded in a tailored data extraction form. The quality of studies was assessed using the Joanna Briggs Institute tools. RESULTS: Ten publications were included following review of 2129 records. High self-reported cure rates between 84 and 89% and referral rates of about 7% were reported. A single study found pharmacist management was cost effective compared to general practitioner management. No randomized controlled trials were found and papers were of variable quality. CONCLUSION: Preliminary evidence suggests pharmacist-led management of uncomplicated UTIs is safe and effective, however no firm conclusion can be provided since the methodologies reported in included studies have significant limitations.
Subject(s)
Community Pharmacy Services , Pharmacists , Professional Role , Urinary Tract Infections , Humans , Urinary Tract Infections/drug therapy , Urinary Tract Infections/economics , Female , Pharmacists/economics , Community Pharmacy Services/economics , Middle Aged , Adolescent , Adult , Aged , Young Adult , Cost-Benefit AnalysisABSTRACT
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
ABSTRACT
La tecnología surgida de la transformación digital ha traído consigo cambios en la asistencia sanitaria. En los próximos años, la Telefarmaciaprevisiblemente se convertirá en uno de los aspectos más importantes dela Telemedicina, ya que ofrece a los pacientes un acceso más inmediato ala atención farmacéutica, supone una reducción de costes tanto para lospacientes como para los sistemas sanitarios, y deriva en una mayor satisfacción, experiencia y comodidad de los pacientes, mejorando así losresultados clínicos. Debido en gran medida a la pandemia de COVID-19,la Telefarmacia ha adquirido gran importancia en el ámbito de la atención farmacéutica, ya que esta crisis ha provocado una enorme presiónsobre los sistemas sanitarios de todo el mundo. Se pueden encontrar multitud de experiencias publicadas en la literatura científica sobre modelos deTelefarmacia en diferentes países del mundo. Existen algunos modelosinnovadores de servicios de Telefarmacia orientados a optimizar y mejorar el acceso a la atención farmacéutica, lo que se traduce en una mejorade la seguridad y los resultados de los pacientes. Entre las ventajas dela Telefarmacia se incluye el aumento del valor para las farmacias y losfarmacéuticos y la adaptación a las necesidades de los pacientes, lamejora de la atención interprofesional, el aumento de la eficiencia de los sistemas sanitarios y la mayor prestación de servicios centrados enel paciente, entre otras. Sin embargo, a pesar de presentar múltiplesventajas, siguen existiendo importantes barreras para la implantación dela Telefarmacia, como la confidencialidad del paciente y la privacidadde la información clínica. Estas barreras para la implantación de la Telefarmacia pueden dividirse en cuatro ámbitos: tecnológico, organizativo,humano y económico. La prestación de atención y servicios farmacéuticosa través de medios digitales es una prioridad clave de la FederaciónInternacional Farmacéutica. (AU)
Digital transformation impacts health care through technology. Telepharmacy is set to become one of the most important aspects of Telemedicinein the years to come with its ability to provide patients with increased andmore timely access to pharmaceutical care, reduced costs for individualsand health systems, improved patient satisfaction, experience and convenience, and better health outcomes. Telepharmacy has gained increasingimportance in the delivery of pharmaceutical care, largely due to theCOVID-19 pandemic which has placed enormous pressures on healthcaresystems globally. There is a significant amount of published literature fromdifferent countries around the world that provide examples of Telepharmacy. There are some innovative models of Telepharmacy services aimedat optimizing and improving access to pharmaceutical care, resulting inimproved patient safety and outcomes. The benefits of Telepharmacyinclude increased value for pharmacies and pharmacists and adaptingto patients´ needs, enhanced interprofessional care and increased efficiency of health systems and increased provision of patient-centred services, among others. However, despite these benefits, major barriers forimplementation of Telepharmacy remain such as patient confidentialityand privacy of health information. These barriers to the implementation of Telepharmacy have been identified and can be divided into four differentenvironments: technological, organizational, human and economic. Delivering pharmaceutical care and services through digital media is identified as a key priority for the International Pharmaceutical Federation. (AU)
Subject(s)
Humans , Pharmacy , Patient Safety , Severe acute respiratory syndrome-related coronavirus , Telemedicine , Patient Satisfaction , TechnologyABSTRACT
There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government's Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists' roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia's Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia's future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government's 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles
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