Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease-Integration of palliative care with disease-specific care: From guidelines to practice.

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.

Interactions between selected over-the-counter drugs and food: clinical relevance and prevention.

The use of medicines is associated with both therapeutic and adverse effects and interactions. In particular, interactions between drugs and food are common, and can either enhance the action of drugs or diminish their effect. Health professionals have a responsibility to screen for and educate patients about food-drug interactions, as well as to assist in decreasing their occurrence. The aim of this study was to identify any interactions present between food and selected over-the-counter (OTC) drugs. Sixty-five publications out of a potential 1112 found in the search were included in the study and among them 28 concerned painkillers, 6 - antihistamines, 4 - nasal decongestants, 10 were for proton pump inhibitors and for iron and 8 for sildenafil. Interactions between food and OTC drugs do exist. These drugs should not be taken regardless of the meal. Providing relevant information to the patient will increase drug safety and efficacy.

Pharmaceutical Care in NICUs in Australia and Poland: Attitudes and Perspectives of Doctors and Nurses.

A multidisciplinary and collaborative team network is essential in ensuring positive health outcomes for critically ill neonatal patients. The objective of this study was to investigate the perceptions of neonatal intensive care unit (NICU) doctors and nurses in Australia and Poland toward pharmaceutical care services in the NICU. A cross-sectional, anonymous, electronic-based survey was distributed between January and April 2017 among a sample of NICU doctors, nurses, and midwives. A total of 77 participants from Australia and 93 from Poland completed the survey. Overall, from the perspectives of medical and nursing staff, it is apparent that clinical pharmacy practice on the NICU is more established in Australia than in Poland. Only 8.6% of Polish participants reported that a pharmacist worked directly on the NICU in comparison with 87% of Australian participants (P < .001). The main roles performed by pharmacists in Polish NICUs related to the provision of medicines, whereas Australian pharmacists were highly involved in all aspects of pharmacotherapy, particularly in the clinical and education domains. Future efforts should focus on how practice is structured in each country and what support can be implemented from educational, cultural, and legislative levels to enable better pharmacist integration into the NICU therapeutic team.

Pharmaceutical care in the neonatal intensive care unit: Perspectives of Polish medical and pharmacy students.

INTRODUCTION: The concepts of ward-based pharmaceutical care as well as collaborative practice are still relatively novel in Poland, particularly in specialty areas of practice such as the neonatal intensive care unit (NICU). The purpose of this study was to identify the opinions and perceptions of Polish medical and pharmacy students towards the provision of pharmaceutical care services in the NICU as well as pharmacist integration into the ward-based multi-disciplinary NICU treating team. METHODS: A cross-sectional, mixed-method survey was distributed among medical and pharmacy students at a large Polish medical university. RESULTS: A total of 147 students completed the survey (74 pharmacy and 73 medical). Overall, there were statistically significant differences between the perspectives of medical and pharmacy students towards the provision of pharmaceutical care services in the NICU. For 11 out of 15 proposed clinical roles, a significantly lower proportion of medical students (M) agreed that pharmacists should perform these in the NICU compared to pharmacy students (P). These roles included participation in ward rounds (P = 82.4%, M = 38.4%, p < 0.001), therapeutic drug monitoring (P = 98.6%, M = 78.1%, p < 0.001), and monitoring total parenteral nutrition (P = 87.8%, M = 37%, p ≤ 0.001). CONCLUSIONS: Further investigation is needed to develop educational strategies directed at clinical, patient-centered, collaborative roles, particularly for specialty areas of practice such as the NICU, that have the potential to facilitate the provision of a more advanced and comprehensive level of pharmaceutical care.

Perspectives of Hospital Pharmacists Towards Biosimilar Medicines: A Survey of Polish Pharmacy Practice in General Hospitals.

INTRODUCTION: There has been a significant increase in the volume of biosimilar medicines recently due to the expiries of patent protections of biologic medicines. Biosimilars are considered new medicines, and their usage in therapy is often associated with uncertainty from the perspectives of physicians, pharmacists and patients. OBJECTIVES: The purpose of this study was to identify hospital pharmacist opinions towards these new medicines and investigate their usage in practice. METHODS: A paper-based, self-administered questionnaire was distributed to Polish hospital pharmacists. RESULTS: Biosimilars were used in 77% of surveyed hospitals, whereas originator biologics were utilised within 90% of settings. The former medicines were found to consist of less than one-third of the entire course of biological pharmacotherapy used within Polish hospitals. A total of 88% of hospital pharmacists were concerned that the new drugs were not identical with the biologic versions, 48% with their immunogenicity and 44% with other pharmacokinetic properties. The majority of respondents (87%) stated that the most important advantage of biosimilars related to decreased costs. Furthermore, according to participants, pharmacist-led substitution is not appropriate. CONCLUSION: Due to the numerous concerns relating to the usage of biosimilars, their introduction into patient therapy requires special attention from healthcare providers. While pharmacists involved in the distribution of biosimilars are conscious of their impact in decreasing costs of therapy, they do not feel comfortable in recommending their substitution without a physician's permission. There is a need for more precise legal regulations relating to biosimilars, improved communication between physicians and pharmacists, as well as educational initiatives to improve the safe and effective usage of biosimilars.

Nationwide survey on volunteers' training in hospice and palliative care in Poland.

BACKGROUND: Volunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings. METHODS: A cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis. PARTICIPANTS: A total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey. RESULTS: All hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support-for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%). CONCLUSIONS: Overall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive.

Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach.

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice.

OBJECTIVES: To describe and compare the pharmaceutical services and clinical pharmacy roles performed in neonatal intensive care units (NICUs) in Australian versus Polish hospitals. METHODS: A 26-item survey was distributed electronically to directors of pharmacy as well as neonatal pharmacists in hospitals in Poland and Australia. Most questions were fixed 'agree/disagree' answers, supplemented by open-ended questions. The survey was distributed between January and May 2017. RESULTS: Overall, 30 Australian pharmacists and 22 Polish pharmacists completed the survey. Significant differences were observed in the types of pharmaceutical care services provided to NICUs between Australia and Poland. A higher proportion of Australians than Poles performed clinical roles: for example, providing medication recommendations (Aus=96.6%, Pol=9.1%, P<0.001); pharmaceutical interventions to resolve drug therapy problems (Aus=93.1%, Pol=18.2%, P<0.001); and general patient medication chart review (Aus=96.6%, Pol=13.6%, P<0.001). All (100%) Polish pharmacists did not consider themselves members of the NICU team and the majority (59.1%) felt that pharmaceutical care on the NICU was practically non-existent. CONCLUSION: Future research should focus on bringing practice in countries such as Poland closer in line with practice in countries such as Australia.

Clinical and conventional pharmacy services in Polish hospitals: a national survey.

BACKGROUND: Pharmacist-led care services within the hospital pharmacy setting have a significant impact on efficient drug management processes. The work of pharmacists is directly associated with the provision of drugs and medical supplies along with additional clinical, administrative, organizational and educational duties. Depending on the country, these practice roles may differ to a significant extent. OBJECTIVE: The aim of this research was to explore the role of the hospital pharmacist and the provision of both clinical and traditional pharmaceutical services for patients and medical staff in Polish general hospitals. SETTING: Hospital pharmacies from all general hospitals in Poland. METHOD: A cross-sectional study was conducted, utilizing an anonymous questionnaire as the research instrument. Heads of hospital pharmacies were requested to participate in this study and complete the questionnaire. The survey was initially piloted to improve the research method. MAIN OUTCOME MEASURE: The types of pharmaceutical services performed in Polish general hospitals. RESULTS: 166 hospital pharmacies took part in this survey. The overall response rate was 60.8 %. The total number of full-time equivalent (FTE) professionals employed within the surveyed hospital pharmacies was approximately 833. The procurement and distribution of drugs were identified as pharmaceutical services performed by most of the participants. The significant majority of pharmacists were also involved in compounding, adverse drug reaction monitoring and rational drug management services. Eleven (7 %) of the responding pharmacists had direct contact with patients and 7 (4 %) pharmacists took part in ward rounds. More precise legal regulations regarding hospital pharmacy practice were measures indicated by most pharmacists as necessary changes required in the hospital pharmacy system. CONCLUSION: Polish hospital pharmacists provide various pharmaceutical services. Their work is closely related with direct provision of drugs. There is an observed inadequate level of clinical services provided in comparison to clinical settings in other countries.

The role of a pharmacist in a hospice: a nationwide survey among hospice directors, pharmacists and physicians.

BACKGROUND: Palliative care requires the collaborative efforts of an interdisciplinary team, and as such a range of health professionals should be involved in supporting patients with life-threatening diseases. As a part of this therapeutic network, pharmacists at residential hospices should be thoroughly involved in care, cooperate with other medical staff and perform pharmaceutical services in order to deliver safe and efficient pharmacotherapy. AIM: To provide an overview of the current state of pharmacy practice at Polish residential hospices. METHODS: A cross-sectional study was applied and three types of anonymous questionnaires were developed to collect data. Hospice directors, pharmacists and physicians from all residential hospices in Poland were invited to participate. RESULTS: 19 (61%) hospices collaborate with at least one pharmacist, who performs pharmaceutical services on the premises. 12 (75%) pharmacists provide advice concerning medicines and 11 (69%) are involved in various roles related to procurement, dispensing and storage of drugs, as well as creating procedures for these activities. Despite pharmacists' great level of involvement in drug policy, most of them are not members of the therapeutic team and they do not participate in ward rounds. Furthermore, the provision of clinical pharmaceutical services forms a minority of Polish hospital pharmacy practice. CONCLUSIONS: Although the role of a hospice-based pharmacist is focused on the provision of drugs, it should become more clinical, that is, more patient oriented. The data obtained should be used as a source of information for implementing potential changes to palliative care pharmacy.

Pharmacoeconomic considerations regarding hospice and palliative care according to pharmacists and hospice managers.

This study focused on pharmacoeconomic issues affecting pharmacists in residential hospices in Poland. We conducted a questionnaire survey among hospice pharmacists and their managers. The results revealed that the amount of money received from the National Health Fund is insufficient for drug purchasing and therefore hospices often raise additional funds from external sources. Because of the limited financing, pharmacists and hospice directors undertake various activities to reduce costs. Generic drug reimbursement, pharmacoeconomic analysis and participating in tenders to purchase drugs are the most common measures undertaken to decrease expenditure.