Correction: Amin et al. Evaluation of Medication Prescribing Applications Available in Australia. Pharmacy 2023, 11, 49.

The authors wish to make the following corrections to this paper [...].

Pharmacists' use of guidelines for the supply of non-prescription medicines: a cross-sectional survey.

OBJECTIVES: Guidelines support best practice for healthcare practice. In Australia, some non-prescription medicines are only accessible after consultation with a pharmacist and are known as Pharmacist Only medicines. Guidelines for providing some Pharmacist Only medicines are available, however, it is currently unknown if and how these guidelines are used in practice.The objective was to characterise pharmacists', intern pharmacists and pharmacy students' use of guidelines for Pharmacist Only medicines. METHODS: A cross-sectional electronic survey of Australian registered pharmacists, intern pharmacists and pharmacy students was administered in July 2020. Questions explored the participants' use of Pharmacist Only medicine guidelines (available both in print and online; available online only) in the preceding 12 months. Data were analysed descriptively (i.e. frequencies, percentages). KEY FINDINGS: In total, 574 eligible respondents completed the survey. Overall, 396 (69%) reported accessing the online and in-print guidelines in the previous 12 months with 185 (33%) accessing online-only guidelines. The guideline on emergency contraception was used the most out of all guidelines in the past 12 months (278, 48%). Overall, respondents reported accessing guidelines to update knowledge, check their practice reflected best practice and content familiarisation. Respondents' reasons for not accessing guidelines were due to respondents stating they did not need the information or that they had previously accessed the guidelines more than 12 months ago. These reasons varied between respondent groups. CONCLUSIONS: Access and use of the Pharmacist Only medicines guidelines varied between pharmacists, interns and students. Further understanding of the influences of the use of these guidelines will help inform professional bodies on how best to develop guidelines to increase consistent use in practice and implement interventions to increase use.

Use of a reference text by pharmacists, intern pharmacists and pharmacy students: a national cross-sectional survey.

BACKGROUND: Reference texts assist pharmacists by addressing knowledge gaps and enabling evidence-based decisions when providing patient care. It is unknown whether reference text utilisation patterns differ between pharmacists, intern pharmacists and pharmacy students. To describe and compare the self-reported use and perceptions of a reference text, namely the national formulary, by pharmacists, intern pharmacists and pharmacy students. METHODS: Registered pharmacists, intern pharmacists and pharmacy students living in Australia were surveyed in July 2020. The survey was electronic and self-administered. Questions considered self-reported use of a specific reference text in the preceding 12 months. KEY FINDINGS: There were 554 eligible responses out of 774 who commenced the survey: 430 (78%) pharmacists, 45 (8%) intern pharmacists and 79 (14%) pharmacy students. Most participants (529/554, 96%) reported historical use of the text, though pharmacists were significantly less likely than intern pharmacists and students to use it frequently (52/422, 12% versus 16/43, 37% versus 23/76, 30%, P < 0.001). Pharmacists (44%, 177/404) reported using the text as a tool to resolve a situation when providing a service or patient care (177/404, 44%) or as a teaching resource (150/404, 38%). In contrast, intern pharmacists and students most commonly use these to familiarise themselves with the contents (30/43, 70%; 46/76, 61%) or update their knowledge (34/43, 79%; 53/76, 70%). CONCLUSIONS: Access and use patterns varied significantly across career stages. A broader understanding of the use of reference texts may help develop interventions to optimise the content and usability. Varying usage patterns across the groups may inform the tailoring of texts for future use.

Behaviours that contribute to pharmacist professionalism: a scoping review.

OBJECTIVES: Clearly understanding and describing professional behaviours of pharmacists allows the profession, researchers and policy-makers to observe and monitor the professionalism of pharmacists, and design interventions to improve it where needed. The primary objective of this review was to identify which behaviours are discussed to contribute to professionalism in registered pharmacists in peer-reviewed literature. The secondary objective was to review the identified behaviours using a behavioural specification framework to understand how they are expressed. DESIGN: A scoping literature review was conducted. DATA SOURCES: An electronic database search of Scopus, Embase, PsycINFO, PsychArticles, Emcare and Medline limited to articles published in English from 1 January 2000 to 21 October 2022 was conducted. ELIGIBILITY CRITERIA: Eligible articles contributed behaviourally relevant content with reference to registered pharmacists' professionalism. DATA EXTRACTION AND SYNTHESIS: Extracted behaviourally relevant content was subject to researcher's familiarisation, then deductive coding to one of two overarching definitions of technical or non-technical behaviour. Data were then inductively coded through assignment of a descriptive code to identify categories of professional behaviour within these two overarching types of behaviour. RESULTS: Seven articles were identified and included in the final analysis. From the extracted behaviourally relevant content, 18 categories of behaviours were identified. All articles identified behaviours in categories titled 'establishes effective relationships' and 'complies with regulations codes and operating procedures'. Identified behaviours were often broadly described and merged with descriptions of influences on them and broader outcomes that they contribute to. CONCLUSIONS: Behaviours described to contribute to pharmacists' professionalism in the literature are broad and non-specific.

Who would be a pharmacist? A national representative cross-sectional survey of pharmacists and students to explore personality traits and associations with job satisfaction and career outlook.

OBJECTIVES: Pharmacists' response to practice change tends to range from apprehension to excitement. It is unknown if these varying responses are related to differing personality traits. This study aimed to describe the personality traits of Australian pharmacists, pharmacist interns and pharmacy students and any potential associations with their career satisfaction and/or outlook. METHODS: Australian pharmacy students, pre-registration and registered pharmacists were eligible to participate in the cross-sectional online survey that consisted of participant demographics, personality traits (using a reliable validated instrument, the Big Five Inventory) and career outlook statements (three optimistic and three pessimistic statements). Data were analysed descriptively and using linear regression. KEY FINDINGS: The 546 respondents scored highly for agreeableness (4.0 ± 0.6) and conscientiousness (4.0 ± 0.6) and lowest in neuroticism (2.8 ± 0.8)). Pessimistic career outlook statements were predominantly neutral or disagreement, in contrast to the responses to the optimistic outlook statements that were predominantly neutral or agreement. Just over half (198 out of 368, 53%) of the registered pharmacists stated that they intended to practice in the profession for more than 10 years. For pharmacists, age had significant positive associations with the three optimistic career outlook statements and significant inverse relationships with three pessimistic career outlook statements. Neuroticism had significant inverse associations with optimistic statements and positive relationships with pessimistic statements. CONCLUSIONS: All demographics tested was overall optimistic about the pharmacy profession with pharmacists scoring highly in agreeableness, conscientiousness and openness.

Is It Safe to Buy Medications from an App? Evaluation of Medication Prescribing Applications Available in Australia.

Prescription request applications (apps) have changed the way consumers can obtain prescription-only medications. However, there is a lack of research surrounding such apps and their potential risks to consumers. We conducted an Australian study to (1) identify and characterise prescription request apps available in Australia and (2) assess whether prescription request apps in Australia adhere to guidelines for safe prescribing. Three online platforms (iOS App Store, Google Play store and Google search engine) were searched using 14 different search terms. Prescription request apps were identified based on pre-defined inclusion criteria. To determine whether the prescription request apps adhere to a safe prescribing framework, five medications were selected, and their corresponding consultation questionnaires were assessed against the Australian National Prescribing Service MedicineWise 12 core competencies for safe prescribing. A total of seven prescription request apps were identified. Assessment of the prescription request apps revealed that none of the apps provided prescribers with sufficient information to meet all the competencies required for safe prescribing; rather, they inconsistently adhered to the safe prescribing framework. Thus, consumers and healthcare professionals should consider the implications and safety concerns of obtaining medications via prescription request apps.

A vision to advance gender equality within pharmacy leadership: Next steps to take the profession forward.

The United Nations Sustainable Development Goal 5 to 'achieve gender equality and empower all women and girls' aims to eliminate all forms of discrimination against women and girls and ensure their full and effective participation in all spheres of life. In alignment with this, several key international initiatives are making progress towards gender equality in the pharmacy profession. The pharmacy profession must support women and accelerate the progress of women in leadership positions in pharmacy. International and national pharmacy professional bodies can play a critical role in fostering the change required to improve gender equality in all regions and countries. The ongoing development, evaluation and implementation of policies and initiatives are critical to a profession that is increasingly becoming feminised. Furthermore, there is an imperative to deeply understand the gender-based barriers and develop evidence-based strategies and solutions to support women in pharmacy leadership. There is extensive literature and research on gender inequality and its impact on leadership outside pharmacy which could be used strategically for the profession to develop its own evidence based strategic position. Robust initiatives are needed to ensure that women at all levels including women in pharmacy leadership are empowered and encouraged to participate in their profession. This commentary seeks to generate and contribute to the debate to ensure the profession is proactive and deliberate in tackling the challenges that have traditionally impeded women reaching leadership positions and several critical actions as next steps are proposed. Action is needed to improve gender equality in pharmacy leadership and a profession-wide discussion on ways to progress the above proposed actions is critically needed.

How are groups of early career pharmacists and pharmaceutical scientists contributing to global health and policy development: A cross-sectional survey.

BACKGROUND: Early career pharmacists and pharmaceutical scientist groups (ECPGs) can make valuable contributions to addressing global health challenges and policy development. There is limited information describing their contribution to this topic. This study describes initiatives and activities related to global health and policy development led by ECPGs. METHODS: An online questionnaire was disseminated between July and October 2020 through the International Pharmaceutical Federation Young Pharmacists Group (FIP YPG) mailing list and its social media network. The survey consisted of questions about ECPGs' involvement in global health and policy development activities. In addition to groups or organisations, the FIP YPG also invited individual pharmacists and pharmaceutical scientists to explore their needs and views on the role of the ECPGs, and themselves as individuals in global health. Data were analysed descriptively. RESULTS: Thirty national ECPGs across six regions of the World Health Organisation (WHO) participated in the survey. Most of the initiatives led by ECPGs focused on health and wellbeing, quality of education and partnership. The most common activities were webinars, social events and partnerships with other organisations. In terms of global health challenges listed by the WHO, the most common initiatives led by ECPGs were related to medicines access and medicines safety. There was some involvement of early career pharmacists, pharmaceutical scientists, and ECPGs in the policy and regulation in their countries across various topics. CONCLUSION: To the best of the authors' knowledge, this is the first global study exploring initiatives conducted by ECPGs. This study informed initiatives that have been implemented across regions, which could be useful for other ECPGs to initiate in their country according to their needs and priorities. Fostering engagement and collaboration between ECPGs is encouraged to provide opportunities and share learning across ECPGs, which could accelerate progress towards tackling global health challenges.

Identifying rates and risk factors for medication errors during hospitalization in the Australian Parkinson's disease population: A 3-year, multi-center study.

BACKGROUND: Admission to hospital introduces risks for people with Parkinson's disease in maintaining continuity of their highly individualized medication regimens, which increases their risk of medication errors. This is of particular concern as omitted medications and irregular dosing can cause an immediate increase in an individual's symptoms as well as other adverse outcomes such as swallowing difficulties, aspiration pneumonia, frozen gait and even potentially fatal neuroleptic malignant type syndrome. OBJECTIVE: To determine the occurrence and identify factors that contribute to Parkinson's medication errors in Australian hospitals. METHODS: A retrospective discharge diagnosis code search identified all admissions for people with Parkinson's disease to three tertiary metropolitan hospitals in South Australia, Australia over a 3-year period. Of the 405 case notes reviewed 351 admissions met our inclusion criteria. RESULTS: Medication prescribing (30.5%) and administration (85%) errors during admission were extremely common, with the most frequent errors related to administration of levodopa preparations (83%). A higher levodopa equivalent dosage, patients with a modified swallowing status or nil by mouth order during admission, and patients who did not have a pharmacist led medication history within 24 hours of admission had significantly higher rates of medication errors. CONCLUSIONS: This study identified 3 major independent factors that increased the risk of errors during medication management for people with Parkinson's disease during hospitalization. Thus, targeting these areas for preventative interventions have the greatest chance of producing a clinically meaningful impact on the number of hospital medication errors occurring in the Parkinson's population.

Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework.

BACKGROUND: Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. AIM: To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. METHODS: Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. RESULTS: A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. CONCLUSION(S): The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.

Use of professional practice guidance resources in pharmacy: a cross-sectional nationwide survey of pharmacists, intern pharmacists, and pharmacy students.

BACKGROUND: Variations in practice are commonplace in healthcare where health professionals, such as pharmacists act as autonomous practitioners. This is evident in simulated patient studies, where pharmacists practice does not meet widely accepted standards for medicines supply or treatment of an ailment. To promote best pharmacy practice a myriad of guidance resources including practice guidelines, codes and standards are produced by professional organisations. These resources provide a framework for pharmacy practice and endeavour to facilitate consistency in provision of pharmacy-based services to consumers. Despite their role in specifying essential pharmacist behaviours, there is limited research exploring if and how these resources are used in practice. OBJECTIVE: To characterise Australian pharmacists' use of the Pharmaceutical Society of Australia's Code of Ethics, Professional Practice Guidelines and Professional Practice Standards. METHODS: A cross-sectional, self-administered, electronic survey of registered pharmacists, intern pharmacists and pharmacy students living in Australia was conducted in July 2020. Questions considered use of professional practice resources (by resource group) in the preceding 12 months. Data were analysed descriptively. RESULTS: Of 601 responses included in the analysis 462 (76.9%) of respondents were registered pharmacists, 88 (14.6%) pharmacy students and 51 (8.5%) intern pharmacists. Interns and students accessed overarching practice resources, such as the Professional Practice Standards, Code of Ethics and Dispensing Practice Guidelines more frequently than practising pharmacists. Pharmacists accessed professional practice guidelines, such as Practice Guidelines for the Provision of Immunisation Services Within Pharmacy, more often than students. More pharmacists than interns and students indicated that they would access guidelines to resolve practice and patient care issues. All resources except the Professional Practice Standards for Pharmacists (67.4%) were accessed by less than 50% of respondents in the preceding 12-month period. Reasons for not accessing resources varied between participant and resource groups, and generally were due to a lack of awareness of the resource or not considering them necessary for the individual's practice. CONCLUSION(S): Access and use patterns for professional practice guidance resources change with experience. Professional organisations responsible for developing resources should consider these patterns when designing and reviewing resources and related policies. To ensure resources are meeting the needs of the profession, students, interns, and pharmacists should be involved in the review of and design of further resources.

Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review.

BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting. METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study. RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective. CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

Let's talk virtual! Online focus group facilitation for the modern researcher.

BACKGROUND: Focus group discussions typically involve face-to-face facilitation. There is growing interest in utilising digital technologies to facilitate aspects of focus group research. To date, no study in the pharmacy profession has comprehensively described and evaluated a fully virtual process to focus group research, from recruitment to reimbursement. OBJECTIVE(S): This study aims to describe an entirely online approach to: recruiting for and facilitating virtual focus group discussions, and reimbursement of participants within the pharmacy profession. Specifically, our objectives were to identify 1) the dropout rate, 2) the geographic diversity of focus group participants, and 3) the occurrence of technological issues. METHOD: Traditional face-to-face focus group recruitment and facilitation methods were adapted, pre-tested, and conducted using online platforms for advertising, participant expressions of interest, participant consent, focus group facilitation, and participant reimbursement. Populations of interest included community pharmacists, specialty practice pharmacists, hospital pharmacists, and pharmacy assistants and technicians across Australia. RESULTS: Of the 153 potential participants who either completed an expression of interest to participate (135/153) or agreed to participate after direct contact (18/153), 59 confirmed that they would attend the focus group discussion (39%); 49 of the 59 (dropout rate: 17%) participated in one of eight focus groups. Collectively, there was representation from all States and Territories in Australia, as well as representation in each of the populations of interest. Three of 49 participants (6%) experienced minor technological issues during the process; no participant encountered major technological issues that precluded successful participation. CONCLUSIONS: Our study demonstrates that an entirely online approach to focus group methodology is possible, has the potential to recruit demographically and geographically-diverse participants with low dropout rates, and can be successfully conducted with minimal technological issues. Despite the recent COVID-19 pandemic making physical focus group facilitation untenable, this fully-online approach enables research to be completed uninterrupted.

A comparison between Parkinson's medication errors identified through retrospective case note review versus via an incident reporting system during hospital admission.

OBJECTIVE: To compare the frequency and type of inpatient Parkinson's medication errors reported through an incident report system versus those identified through retrospective case note review in a tertiary teaching hospital. METHODS: A search of inpatient medication-related incident reports identified those pertaining to Parkinson's medication. A discharge diagnoses search identified admissions for patients with Parkinson's disease over the same time period. A retrospective case note and incident report review were performed to describe and quantify medication-related events. KEY FINDINGS: Substantially, more medication-related problems were identified via case note review (n = 805) versus incident reporting system (n = 19). A significantly different pattern of error types was identified utilising case note review versus incident reporting, with case note review more likely to identify delayed dosing, and incident reports more likely to identify wrong dose or formulation administered errors. CONCLUSIONS: Retrospective incident report and case note review can be used to characterise medication administration errors encountered in an inpatient setting. Incident report review alone is insufficient in estimating error rates, and dual data collection methods should be used.

Managing acute pain in patients who report lactose intolerance: the safety of an old excipient re-examined.

Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population. A case study is presented detailing a patient reporting lactose intolerance who insists on treatment with the lactose-free product codeine/ibuprofen (Nurofen Plus) rather than other codeine-free analgesics. It is important to assess the likelihood of lactose as an excipient inducing symptoms in this scenario, as reluctance to cease codeine could suggest codeine dependence, an issue that is becoming increasingly common in countries such as Australia and Canada. Given codeine dependence is associated with serious sequelae including hospitalization and death, the patient must either be reassured the lactose component in their prescribed analgesics will not induce symptoms or an alternative treatment strategy must be confirmed. General recommendations applying theory from the literature to the management of acute pain in lactose-intolerant patients are discussed and specific treatment options are outlined. Although large inter-individual variability is reported, most lactose-intolerant patients can tolerate the small quantities of lactose found in pharmaceutical preparations. Cumulative lactose exposure can be assessed in patients taking multiple medications while also consuming lactose in the diet. In those sensitive to small quantities of lactose, lactase supplements can be trailed. Additionally, for the analgesic drug classes employed for the management of acute pain, lactose-free formulations, including most oral liquids and dispersible tablets and some oral tablets and capsules, are available.

Counting the cost of over-the-counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period.

INTRODUCTION AND AIMS: Combination analgesics containing codeine (CACC) are currently available over-the-counter (OTC) in many countries following a pharmacist's advice. Published case reports detail life-threatening morbidities associated with OTC-CACC misuse, although the cost of treating such patients has not been quantified. This study aims to: (i) identify and detail patients admitted to an Australian tertiary teaching hospital over a 5 year period with sequelae of OTC-CACC misuse; and (ii) estimate the costs of identified hospital admissions. DESIGN AND METHODS: Using International Classification of Diseases (10th revision) diagnostic codes, a structured search was performed to identify admissions to a tertiary teaching hospital, relating to CACC misuse, over the defined period. A retrospective case note review provided data detailing patient characteristics, presenting morbidities and resultant interventions, and an approximate cost was calculated for identified admissions. RESULTS: Ninety-nine OTC-CACC-related admissions (for 30 individual patients) were identified. Most related to gastrointestinal morbidities secondary to ibuprofen/codeine misuse. Mean length of stay per admission was 5.9 days, with 10.1% of admissions requiring intensive care. Patients consumed a daily mean of 28 OTC-CACC tablets for a mean of 606 days prior to admission. These 99 admissions were estimated to cost the health system AU$1 008 082 with a mean cost per admission of AU$10 183. DISCUSSION AND CONCLUSIONS: The outcomes of OTC-CACC misuse are serious and come at a significant cost to patient health and the Australian health-care system. Identification and management of this cohort appears sub-optimal with delays in diagnosis and high readmission rates.