Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce.

This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.

Impact of Pre-Advanced Pharmacy Practice Experience (APPE) Curriculum on Student Pharmacists' Professional Identity Formation.

OBJECTIVE: To (1) evaluate changes in student pharmacists' professional identity during a curriculum prior to advanced pharmacy practice experiences (APPEs) and (2) describe the components of a pre-APPE curriculum that positively and negatively influenced students' professional identity formation (PIF). METHODS: The University of Washington School of Pharmacy launched a new curriculum in 2019 featuring components intentionally designed to support students' PIF. The Macleod-Clark Professional Identity Scale (MCPIS) was administered to the class of 2023 before starting pharmacy school (pre) and upon completion of the pre-APPE curriculum (post). The postsurvey also contained 2 open-response questions asking students to identify the most positive and negative influences on their PIF. Mean pre- and post-responses were calculated for all MCPIS items and each MCPIS item and compared using paired t tests. Responses to the open-ended questions were sorted into categories using inductive thematic analysis and frequencies were calculated. RESULTS: A total of 99 students (96%) completed both surveys. Mean MCPIS pre-scores and post-scores were both 3.3, indicating no statistically significant change in professional identity. The most frequently reported positive influences on PIF were didactic coursework (40%), experiential learning (30%), and student organizations (27%). The most frequently reported negative influences were didactic coursework (27%), none (25%), and perceptions of the pharmacy profession (22%). CONCLUSION: Students' overall professional identity, as measured by the MCPIS, did not change during the pre-APPE curriculum. Didactic coursework had the most common positive and negative influence on professional identity prior to APPEs.

Community pharmacist intervention to optimize statin adherence in diabetes care: The GuIDE-S study.

BACKGROUND: Statin use in people with type 2 diabetes (T2D) reduces cardiovascular events, yet adherence remains suboptimal. OBJECTIVE: This study evaluated the impact of a community pharmacist intervention on statin adherence in new users with T2D. METHODS: As part of a quasi-experimental study, community pharmacy staff proactively identified adult patients with T2D who were not prescribed a statin. When appropriate, the pharmacist prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from another prescriber. Patients received individualized education and follow-up and monitoring for 1 year. Adherence was defined as the proportion of days covered (PDC) by a statin over 12 months. Linear and logistic regression were used to compare the effect of the intervention on continuous and a binary adherence threshold, defined as PDC ≥ 80%, respectively. RESULTS: Overall, 185 patients started statin therapy and were matched to 370 control patients for analysis. Adjusted average PDC was 3.1% higher in the intervention group (95% CI -0.037 to 0.098). Patients in the intervention group were 21.2% more likely to have PDC ≥ 80% (95% CI 0.828-1.774). CONCLUSION: The intervention resulted in higher statin adherence than usual care; however, the differences were not statistically significant.

Early outcomes from a national Train-the-Trainer Interprofessional Team Development Program.

The imperative need to train health professions faculty (educators and clinicians) to lead interprofessional education efforts and promote interprofessional team-based care is widely recognized. This need stems from a growing body of research that suggests collaboration improves patient safety and health outcomes. This short report provides an overview of a Train-the-Trainer Interprofessional Team Development Program (T3 Program) that equips faculty leaders with the skills to lead interprofessional education and interprofessional collaborative practice across the learning continuum. We also describe the history, approach, and early outcomes of this innovative program.

Community pharmacist intervention to close statin gaps in diabetes care: The GuIDE-S study.

BACKGROUND: Statin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. OBJECTIVE: To evaluate (1) the impact of a community pharmacist-led model for initiating statin therapy in people with type 2 diabetes (T2D) on statin initiation and (2) pharmacists' self-reported perceptions of the intervention feasibility and fidelity to the intervention. METHODS: This was a type 1 hybrid effectiveness-implementation study of 9 intervention and 18 control pharmacies within a community pharmacy chain. Pharmacy staff proactively identified patients with T2D not taking a statin and prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from the patient's preferred prescriber. The eligible population included patients aged 18-84 years with T2D, who had filled ≥60 days' supply of one, noninsulin, diabetes medication in a rolling 6-month period, and who had not filled a statin during the same period. A Cox proportional hazards model was used to compare time to statin initiation. Pharmacists at intervention pharmacies completed a survey at 6 and 12 months after implementation (March and August 2019, respectively) to assess intervention feasibility and fidelity. RESULTS: For the statin initiation analysis, 1670 intervention patients were matched to 3358 control patients. Overall, 26.3% (n=442) of intervention patients and 25.4% (n=854) of control patients initiated a statin within 12 months of their index date. There was no difference in statin initiation likelihood between intervention and control patients (hazard ratio: 1.00; 95% CI: 0.83, 1.21). Fifteen pharmacists completed the 6-month survey (33% response rate), and 12 completed the 12-month survey (26%). The intervention's feasibility score was 4.0 at 6 months and 4.2 at 12 months, indicating an increase in perceived feasibility. Fidelity decreased from 6 to 12 months. CONCLUSION: The community pharmacist-led intervention resulted in more patients initiating statin therapy as compared to usual care; however, the differences were not statistically significant. Pharmacists perceived the intervention to be feasible; however, fidelity decreased over time.

Strengthening pandemic preparedness through pharmacy and public health collaborations: Findings from a facilitated discussion exercise.

BACKGROUND: Community pharmacists are key partners to public health agencies during pandemics and other emergencies. Community pharmacy and public health agencies can establish memoranda of understanding (MOUs) for dispensing and administering medical countermeasures and providing related services to affected population(s) during a public health incident. OBJECTIVE: The objective of this facilitated discussion exercise was to identify the strengths and opportunities associated with the activation of a statewide pharmacy-public health agencies MOU with community pharmacists on the basis of a simulated pandemic influenza event. METHODS: A facilitated discussion exercise was held in the Puget Sound region of the State of Washington in May 2017. The participants included pharmacists from 2 community pharmacy organizations, emergency preparedness officials from 2 local health departments and the state health department, staff of the state pharmacy association, and faculty from a school of pharmacy. The evaluators recorded the discussions and observations, augmented by a postexercise telephone call with participants from each of the participating community pharmacy organizations. Key themes from the exercise are reported. RESULTS: Five themes were identified during the facilitated discussion exercise. Two themes described the strengths of the MOU and its operational plan: (1) collaboration strengthens preparedness and response planning, and (2) an MOU provides a framework for effective collaboration. Three themes acknowledged the opportunities to optimize activation of the existing MOU: (1) early and active engagement between health department personnel and community pharmacists, (2) establishing pharmacy policies and procedures to support readiness and response, and (3) addressing the training or other educational needs of community pharmacists. CONCLUSION: This exercise provided community pharmacists and public health agency personnel an opportunity to better plan for responding to a pandemic. The open dialogue in this facilitated discussion allowed the exercise participants to identify the strengths, priorities, and perspectives as well as the gaps in the MOU operational plan. The lessons learned in this exercise can inform the community pharmacy and public health response to the coronavirus disease pandemic.

Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE.

BACKGROUND: Project VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow. OBJECTIVE: The objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members' perceptions of work system factors that influenced the implementation of key intervention features. METHODS: Pharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems. RESULTS: A total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage. CONCLUSIONS: Several key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy-based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.

Impact of an immunization platform in community pharmacies.

OBJECTIVES: To assess the impact of incorporating a bidirectional immunization forecasting and reporting platform in the workflow of a regional community pharmacy chain with the use of time and motion methodologies. SETTING: Six Bartell Drugs Pharmacies in Seattle, Washington. PRACTICE DESCRIPTION: Bartell Drugs is a 63-store family-owned regional community pharmacy chain that offers all routine vaccinations and travel vaccinations. PRACTICE INNOVATION: Six pharmacies were selected based on immunization performance the previous year. These pharmacies were divided into 3 immunization performance groups. Within each performance group, one store had implemented the bidirectional immunization forecasting and reporting platform (intervention) and the other had not (control). EVALUATION: Observations were conducted for 4 to 8 hours at each store to determine the time required for each immunization encounter. Each encounter was divided into 7 time subcategories, which were assigned to the pharmacist, technician, or patient. Time and motion methodologies were used to estimate total pharmacist and technician time and the number of immunizations administered per patient encounter. All data were analyzed with the use of descriptive statistics. RESULTS: Ten vaccinations were administered during 5 patient encounters in the intervention group compared with 8 vaccinations during 8 patient encounters in the control group. The average time spent on each patient encounter in the intervention group was 24.8 minutes, compared with 18.5 minutes in the control group. In the intervention group, pharmacists spent an average of 9.3 minutes per patient encounter compared with 7.6 minutes in the control group. In the intervention group, technicians spent an average of 10.8 minutes per encounter compared with 9.1 minutes in the control group. CONCLUSION: Incorporation of a bidirectional immunization platform into the workflow of a community pharmacy increased staff time but also resulted in a greater number of immunizations per patient, suggesting enhanced immunization care in the intervention pharmacies.

The effects of vaccination forecasts and value-based payment on adult immunizations by community pharmacists.

BACKGROUND: The prevalence of vaccine-preventable diseases in adults remains a significant public health issue in the United States. The objectives of this demonstration project were to increase the number of influenza, pneumococcal, pertussis, and herpes zoster immunizations administered to adults by community pharmacists, evaluate the percentage of immunizations documented in the state immunization information system (IIS), and design and pilot a value-based payment model. METHODS: A one-year prospective, observational demonstration project was conducted in 70 community pharmacies in western Washington State from September 1, 2016 to August 31, 2017. An immunization interface was integrated into workflow at each pharmacy to enable "forecasting" of and proactive recommendation to patients about their vaccine needs and documentation of vaccines administered in the state IIS. Categorical value-based payment models were developed and implemented in a subgroup of 12 community pharmacies from March 1 to November 30, 2017. The change in the number of immunizations administered in comparison to the baseline period and the percentage of immunizations documented in the state IIS during the demonstration period were analyzed using descriptive statistics. RESULTS: There was a 15% total increase in the collective number of influenza, pneumococcal, pertussis, and herpes zoster vaccines administered in the demonstration year in the 70 pharmacies, due to increases in influenza and pertussis vaccinations. Eighty-three percent of the vaccines administered were documented in the state IIS. Pneumococcal, pertussis, and herpes zoster performance appeared to be unaffected by the value-based payment models while influenza performance improved across the 12 pilot pharmacies. CONCLUSIONS: This work demonstrated that community pharmacists contribute to improving adult immunizations through vaccine "forecasting" and proactive recommendation. Meaningful quality measures with both positive and negative incentives could further drive adoption of best immunization practices. Further implementation and outcomes research is needed to fully examine the impact and scalability of these strategies.

Interprofessional education and practice guide: interprofessional team writing to promote dissemination of interprofessional education scholarship and products.

Collaborations to develop, implement, evaluate, replicate, and write about interprofessional education (IPE) activities within and across institutions are wonderful opportunities to experience teamwork, team communication, ethics and values, and the roles and responsibilities of interprofessional team writing. Just as effective communication in interprofessional team-based care is essential for providing safe, high-quality health care, similar communication strategies are necessary to produce high-quality scholarship of IPE curricula and activities. Relationship and communication issues that affect health care teams' abilities to work together effectively (e.g., hierarchy, exclusion, assumptions, non-responsiveness, biases, stereotypes and poor hand-offs of information) can also occur in interprofessional team writing. Between 1970 and 2010, interprofessional practice research publications increased by 2293%. Although there has been tremendous growth in the IPE literature, especially of articles that require collaborative writing, there have not been any papers addressing the challenges of interprofessional team writing. As more teams collaborate to develop IPE, there is a need to establish principles and strategies for effective interprofessional team writing. In this education and practice guide, a cross-institutional team of faculty, staff, and graduate students who have collaborated on externally funded IPE grants, conferences, products, and workshops will share lessons learned for successfully collaborating in interprofessional team writing.

Comparison of two training methods in community pharmacy: Project VACCINATE.

OBJECTIVE: To compare the impact of a whole-staff training strategy with a train-the-trainer strategy on 1) the number of influenza, pneumococcal, herpes zoster, and pertussis vaccines administered by community pharmacists to adults; 2) staff confidence; and 3) fidelity to the intervention. SETTING: Eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. PRACTICE DESCRIPTION: QFC Pharmacy is a grocery store division of The Kroger Co. with 30 pharmacies located in Washington State. QFC provides all routine and travel vaccines to adolescents and adults and has a culture of improving vaccine access to its community. PRACTICE INNOVATION: Pharmacists and pharmacy technicians from 8 QFC pharmacies received training to enhance their immunization care for adults. The entire staff from 4 pharmacies received whole-staff training, and staff members from the other 4 pharmacies received a train-the-trainer approach. The whole-staff training group had all staff members attend a live, 2-hour training. The train-the-trainer group sent 1 pharmacist and 1 pharmacy technician champion to attend the live training and then return to their pharmacy to train the other staff members. EVALUATION: The number of immunizations administered, staff confidence, and self-reported fidelity to the intervention were measured before and after training. All data were analyzed using descriptive statistics. RESULTS: The number of total influenza, pneumococcal, herpes zoster, and pertussis vaccines administered increased 12.6% in the whole-staff training group and 15.2% in the train-the-trainer group. Both training strategies increased confidence in identifying patients eligible for vaccines, talking to patients about vaccine needs, and using the bidirectional immunization platform. Pharmacy staff members in both groups indicated fidelity to key steps in the intervention process. CONCLUSION: Both whole-staff training and train-the-trainer approaches were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service. The train-the-trainer strategy may be less resource intensive.

The relationship between neuropsychological assessment, numeracy, and functional status in older adults with type 1 diabetes.

While data are accumulating on the association between neuropsychological performance and real-world endpoints, less is known about the association with medical self-management skills. The self-management of type 1 diabetes (T1D) is often complex, and mismanagement can result in hypoglycaemia and hyperglycaemia and associated morbidity and mortality. The T1D Exchange conducted a case-control study evaluating factors associated with severe hypoglycaemia in older adults (≥ 60 years old) with longstanding T1D (≥ 20 years). A battery of neuropsychological and functional assessments was administered, including measures of diabetes-specific self-management skill (diabetes numeracy) and instrumental activities of daily living (IADL). After adjusting for confounding variables, diabetes numeracy was related to memory and complex speeded attention; while IADL were associated with simple processing speed, executive functioning, complex speeded attention and dominant hand dexterity. The severity of overall cognitive deficit was uniquely associated with both diabetes numeracy and IADL, when controlling for age, education, frailty and depression. This study demonstrates that the cognitive deficits in older adults with T1D have functional implications for both diabetes management and IADL. Further research is needed to determine specific interventions to maximise diabetes self-management in older adults with declining cognition.

Interprofessional Error Disclosure Training for Medical, Nursing, Pharmacy, Dental, and Physician Assistant Students.

INTRODUCTION: Errors that harm patients often have many contributing factors and ideally should be disclosed by a team rather than an individual provider. However, most health professions students learn about errors and error disclosure in a single-profession class. METHODS: We developed a 2-hour small-group session in which our students practice discussing and disclosing a medical error that involves several professions, following a communication map. As they practice, students gain an understanding of the roles, skills, and perspectives of the other professions represented in the group. RESULTS: Over the last 5 years, student evaluations have been very positive. In 2016, our students strongly agreed that "The small group skills practice was a useful and interesting learning opportunity," "Learning with other professional students was valuable," and "Thinking about error disclosure from a team perspective was helpful." Student comments consistently indicated that they learned both about disclosing medical errors as well as other professionals' roles and perspectives. DISCUSSION: This activity has met both of our major goals. The first was to bring health professions students together to learn with, from, and about each other. The second was to practice a critical and challenging communication skill. This activity has been successfully implemented at other institutions, and can be adapted to fit other groups of students.

An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program.

Objective. To develop and assess the impact of an elective course aimed at improving student knowledge of and confidence in delivering a group diabetes prevention program. Design. Two colleges of pharmacy collaborated to develop a 2-credit elective course using didactic and active-learning strategies to prepare students to serve as lifestyle coaches offering a proven group diabetes prevention program. Assessment. Students' confidence in their ability to deliver a group diabetes prevention program increased as a result of the class. However, their knowledge of diabetes prevention facts was unchanged from baseline. Conclusion. A diabetes prevention elective course improved students' confidence in their ability to teach a diabetes prevention program.

Enhancing Access to Diabetes Self-management Education in Primary Care.

PURPOSE: The purpose of this continuous quality improvement project was to improve access to diabetes self-management education (DSME) and to evaluate the impact on glycemic and weight control by translating an academic medical center's DSME program, accredited per the Education Recognition Program (ERP) of the American Diabetes Association, into a program offered at primary care clinics (PCCs). METHODS: Certified diabetes educators from the medical center trained PCC registered dietitian nutritionists, registered nurses, and social workers to provide DSME in their community-based clinic. Main outcomes of this retrospective, pretest/posttest, observational project were to evaluate enrollment in DSME classes and change in A1C and weight as patients underwent a combined intervention of diabetes education classes with or without consultation and support from a PCC registered dietitian nutritionist or registered nurse. RESULTS: PCC DSME was associated with increased enrollment in DSME classes and a significant reduction of A1C and weight at 3 and 6 months post-DSME. Greatest A1C and weight reductions were observed in patients with newly diagnosed diabetes. Reductions were also seen in patients with diabetes duration ≥10 years, participants taking insulin, and those with depression. CONCLUSIONS: PCC DSME availability increased access to group diabetes education and resulted in reduced A1C and weight for participants. This model was successful in translating an established academic accredited DSME-ERP into a PCC. Results have implications for increasing access to diabetes education programs and improving diabetes control for patients not located near major hospital-based DSME programs.

Medication Adherence With Diabetes Medication: A Systematic Review of the Literature.

PURPOSE: The primary purpose of this systematic review is to synthesize the evidence regarding risk factors associated with nonadherence to prescribed glucose-lowering agents, the impact of nonadherence on glycemic control and the economics of diabetes care, and the interventions designed to improve adherence. METHODS: Medline, EMBASE, the Cochrane Collaborative, BIOSIS, and the Health and Psychosocial Instruments databases were searched for studies of medication adherence for the period from May 2007 to December 2014. Inclusion criteria were study design and primary outcome measuring or characterizing adherence. Published evidence was graded according to the American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines. RESULTS: One hundred ninety-six published articles were reviewed; 98 met inclusion criteria. Factors including age, race, health beliefs, medication cost, co-pays, Medicare Part D coverage gap, insulin use, health literacy, primary nonadherence, and early nonpersistence significantly affect adherence. Higher adherence was associated with improved glycemic control, fewer emergency department visits, decreased hospitalizations, and lower medical costs. Adherence was lower when medications were not tolerated or were taken more than twice daily, with concomitant depression, and with skepticism about the importance of medication. Intervention trials show the use of phone interventions, integrative health coaching, case managers, pharmacists, education, and point-of-care testing improve adherence. CONCLUSION: Medication adherence remains an important consideration in diabetes care. Health professionals working with individuals with diabetes (eg, diabetes educators) are in a key position to assess risks for nonadherence, to develop strategies to facilitate medication taking, and to provide ongoing support and assessment of adherence at each visit.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital.

BACKGROUND: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however. OBJECTIVE: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. METHODS: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs). RESULTS: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively. CONCLUSIONS: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.

Medication adherence program: adherence challenges and interventions in type 2 diabetes.

OBJECTIVES: To describe medication adherence problems for adults with type 2 diabetes and to assess the nature and frequency of pharmacist activities in addressing them and proximate outcomes. DESIGN: Pre-post analysis. SETTING: Four community chain pharmacies located in Seattle, WA, from April 2008 to October 2009. PATIENTS: 120 patients (mean age >60 years) with type 2 diabetes taking oral diabetes medications and who were 6 or more days late for refills. INTERVENTION: Pharmacist telephone-initiated adherence support. MAIN OUTCOMES MEASURES: Nature and frequency of adherence-related problems and intervention activities and impact on reduction in refill gaps. RESULTS: The primary adherence challenge was difficulty taking medications (27.1%). Failure to remember doses and forgetting refills were reported by 24.6% and 26.3% of patients at baseline, respectively. Pharmacists provided support through some form of patient education (35.6% of encounters) or other adherence support (40.7%). Pharmacist time averaged slightly greater than 5 minutes per intervention and 12.6 ± 10.7 minutes (mean ± SD) over 12 months, with 3.4 ± 2.4 interventions per patient. Patient-specific education and adherence support by pharmacists and total intervention time were positively correlated, with a modest but significant reduction in refill gaps during 12 months of follow-up. CONCLUSION: Not remembering to refill medications was the most commonly reported problem. Patient encounters averaged 4 to 6 minutes for the first visit and 12 to 13 minutes over 12 months. Phone calls by pharmacists to adults who were late for oral diabetes medication refills were effective in identifying adherence-related problems and developing support strategies to promote medication self-management in busy urban community chain pharmacy settings.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital / Implantación de servicios de farmacia clínica en los departamentos de un hospital universitario etíope

Background: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however. Objective: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. Methods: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma niversity Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs). Results: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively. Conclusion: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes (AU)

Antecedentes: El ejercicio de la farmacia clínica se ha desarrollado internacionalmente para expandir el papel del farmacéutico más allá de los papeles tradicionales de formulación, dispensación y distribución de medicamentos a papeles más directamente relacionados con los cuidados de los pacientes. Sin embargo, son escasos los estudios de las actividades del farmacéutico clínico en los departamentos en establecimientos de recursos escasos. Objetivo: Evaluar los servicios de farmacia clínica en un departamento de medicina interna del hospital universitario especializado de Jimma. Métodos: El estudio fue realizado en el departamento de medicina interna desde marzo a abril de 2011 en el hospital Universitario especializado de Jimma. El diseño del estudio fue observacional prospectivo donde se documentaron los servicios de atención farmacéutica proporcionados por un farmacéutico clínico a pacientes internados durante un periodo de dos meses. Se documentaron intervenciones como la optimización del uso racional y la aceptación de los médicos de estas recomendaciones. Un equipo independiente (1 internista y 1 farmacólogo clínico) evaluó la significación clínica de estas intervenciones usando un método estandarizado de clasificar los problemas relacionados con medicamentos (PRM). Resultados: Se realizó un otal de 149 intervenciones para 48 pacientes.; de ellos, 133 (83,9%) fueron intervenciones iniciadas por el farmacéutico clínico y 16 (10,7%) fueron iniciadas por otros profesionales de la salud. Los PRM más frecuentes subyacentes a cada intervención fueron medicación innecesaria 36 (24,2%); necesidad de medicación adicional 34 (22,8%); e incumplimiento 29 (19,5%). El tipo de intervención más frecuente fue el cambio de dosis/instrucciones de uso 23(15.4%). La tasa de aceptación por médicos fue del 68,4%. Entre las intervenciones que fueron calificadas de clínicamente significativas, 46 (48,9%) y 25 (26,6%) tuvieron grande y moderada importancia clínica, respectivamente. Conclusión: Envolver a un farmacéutico clínico en el equipo de salud lleva a la optimización clínicamente relevante y aceptada del uso de medicamentos en un establecimiento de recursos limitados. Este abordaje puede, probablemente, generalizarse a otros establecimientos en el país para mejorar los resultados de la medicación (AU)

Pharmacists' journey to clinical pharmacy practice in Ethiopia: Key informants' perspective.

OBJECTIVE: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding and supplying drugs to roles more directly in caring for patients and providing medication consultation to staff. This area of practice is at the infant stage in Ethiopia. The aim of this study was to explore key informants' perspective in the implementation of clinical pharmacy practice in Jimma University Specialized Hospital, Ethiopia. METHOD: A qualitative study was conducted through in-depth interviews with the heads of departments (internal medicine, paediatrics, surgery, nurse, pharmacy, medical director, administration) and pharmacy student representatives. Qualitative data analysis was done after audiotapes were transcribed verbatim and notes were compiled. RESULTS: All of the respondents interviewed express diverse and conflicting perspectives on pharmacists' role, varying from a health-care professional to a business man. Despite this, the current pace of change worldwide takes the professions' mission to that of a provider of clinical pharmacy services. The data ascertained the change in pharmacy practice, and integrating clinical pharmacy services within the health-care system should be seen as a must. Pharmacists should delineate from a business perspective and focus on widening the scope of the profession of pharmacy and should come close to the patient to serve directly. CONCLUSIONS: Although the perception of people on traditional roles of pharmacists was weak, there were promising steps in developing clinical pharmacy practice within the health-care system. Moreover, the results of this study revealed a high demand for this service among health-care providers.