Optimizing pharmaceutical management of clinical trials.

OBJECTIVES: The clinical trials pharmacists have an essential role in managing the pharmaceutical part of interventional studies. The primary objective of this article was to provide a template for improving trials management for the growing number of studies without increasing personnel resources. MATERIAL AND METHODS: A retrospective study was conducted between 2016 and 2020 at the service of pharmacy at Lausanne University Hospital in Switzerland. RESULTS: The number of clinical trials (in progress) managed at the pharmacy increased from 77 to 115 (+49%) between 2016 and 2020. The majority of these studies were in oncology and were sponsored by industry. Therefore, different changes in routine tasks were decided during the 5 years term to meet the above challenge. These modifications allowed to improve pharmaceutical and administrative management of clinical trials, without increasing personnel resources. The management template was accepted by the sponsors, and no issues were mentioned by national and international audit authorities. CONCLUSION: Changes could be made in the routine practice of the clinical trials pharmacists to improve the management of studies, while the number of trials is increasing every year.

[Medication reconciliation and hospital-community transition securisation: Survey of community pharmacists]. / Conciliation médicamenteuse et sécurisation de la transition hôpital­ville : enquête auprès des pharmaciens d'officine.

OBJECTIVE: To collect the community pharmacists' perception on their role in the medication reconciliation's process. METHODS: We did an observational transverse study thanks to a survey of community pharmacists working in France, conducted in 2020. A digital questionnaire was submitted to Parisian community pharmacists before being shared on two Facebook groups. The responses were analysed with Microsoft Excel® software. We calculated percentages, used Chi2 or Fisher's exact tests and did qualitative analyses. RESULTS: We collected the perception of 135 community pharmacists, the majority was women (80%), relatively young (69.6% of 40 years old or less). They were 63.7% to claim knowing the medication reconciliation, but they could not define it properly. The subject's knowledge was statistically related to age (P-value<0.001) and previous contacts of the health care facilities (P-value<0.001). The majority of interviewed pharmacist considered the transmission of information to those health facilities as relevant and feasible and they expressed their willingness to get involved. However, they were limited by some obstacles such as the non-exhaustiveness of the medicinal record, the unsecured mail and the lack of feedbacks. CONCLUSIONS: Although the community pharmacists expressed interest for the medication reconciliation process and willingness to get involved, their role remained limited. Therefore, this process needs an improvement of its organisation and a generalisation of its practice to really benefit the hospital-community transition's safety.

TLC-Act: A Novel Tool for Managing Drug Interactions.

Background: Clinical decision support systems (CDSS) are used by pharmacists to assist in managing drug-drug interactions (DDIs). However, previous research suggests that such systems may perform suboptimally in providing clinically relevant information in practice. Objectives: The primary objective of this study was to develop a novel DDI management tool to reflect the clinical thought process that a pharmacist uses when assessing a DDI. The secondary objective was to investigate practitioners' perceptions of this tool. Methods: This study was conducted in 3 phases: development of the DDI management tool, implementation of the tool in clinical practice, and collection of practitioners' opinions of the tool through an online qualitative survey (although because of circumstances related to the COVID-19 pandemic, the study population for the survey phase included only pharmacy residents). A comprehensive literature search and analysis by an expert panel provided underlying context for the DDI management tool. The tool was validated through simulation against a known list of DDIs before implementation into practice by hospital pharmacists and pharmacy residents. Participating pharmacy residents were invited to provide feedback on the tool. Survey results were analyzed using descriptive statistics. Results: The novel tool that was developed in this study (called TLC-Act) consisted of components important to a pharmacist when assessing a DDI, including the duration of concomitant use of the interacting medications and patient-specific risk factors. Study participants implemented the tool in clinical practice for a total of 6 weeks. Of the 28 pharmacy residents surveyed, 15 (54%) submitted a response, of whom 11 (73%) found the TLC-Act tool to be slightly more useful for assessing a DDI than usual care with the CDSS alone. Conclusions: The TLC-Act tool maps out a pharmacist's clinical thought process when assessing a DDI in practice. This novel tool may be more useful than a CDSS alone for managing DDIs, as it takes into account other important factors pertinent to the assessment of a DDI.

Contexte: Les systèmes d'aide à la décision clinique (SADC) sont utilisés par les pharmaciens pour les aider à gérer les interactions médicamenteuses (IM). Cependant, des recherches antérieures indiquent que ces systèmes peuvent fonctionner de manière sous-optimale pour fournir des informations cliniquement pertinentes dans la pratique. Objectifs: L'objectif principal de cette étude consistait à développer un nouvel outil de gestion des IM pour reproduire le processus de réflexion clinique adopté par un pharmacien quand il les évalue. L'objectif secondaire consistait, quant à lui, à enquêter sur les perceptions des praticiens à l'égard de cet outil. Méthodes: Cette étude a été menée en 3 phases : développement de l'outil de gestion des IM; sa mise en place dans la pratique clinique; et recueil des avis des praticiens sur celui-ci au moyen d'une enquête qualitative en ligne (bien qu'en raison des circonstances liées à la pandémie de COVID-19, la population étudiée pour la phase de l'enquête ne comprenne que des résidents en pharmacie). Une recherche documentaire et une analyse approfondies effectuées par un groupe d'experts ont fourni le contexte sous-jacent de l'outil de gestion des IM. L'outil a été validé par simulation par rapport à une liste connue d'IM avant sa mise en pratique par les pharmaciens hospitaliers et les résidents en pharmacie. Les résidents en pharmacie qui participaient à l'étude ont été invités à donner leur avis sur l'outil. Les résultats de l'enquête ont été analysés à l'aide de statistiques descriptives. Résultats: Le nouvel outil développé dans le cadre de cette étude (le « TLC-Act ¼) se composait d'éléments d'évaluation des IM importants pour un pharmacien, y compris la durée de l'utilisation concomitante des médicaments en interaction et les facteurs de risque propres au patient. Les participants à l'étude ont mis en œuvre l'outil dans la pratique clinique pendant un total de 6 semaines. Sur les 28 résidents en pharmacie interrogés, 15 (54 %) ont soumis une réponse, et 11 (73 %) d'entre eux ont trouvé que l'outil TLC-Act était légèrement plus utile pour évaluer les IM que le SADC seul utilisé habituellement. Conclusions: L'outil TLC-Act cherche à reproduire le processus de réflexion clinique d'un pharmacien lorsqu'il évalue les IM dans la pratique. Ce nouvel outil peut être plus utile qu'un SADC utilisé seul pour gérer les IM, car il prend en compte d'autres facteurs importants qui sont pertinents pour leur évaluation.

Impact of Pharmacist-Directed Medication Reconciliation in Reducing Medication Discrepancies: A Randomized Controlled Trial.

Background: In hospital surgical wards, patients are at higher risk for medication errors, in part because physicians may not consider themselves sufficiently trained to prescribe medications. Hence, collaborative teamwork involving the pharmacist is needed. Objectives: To assess the impact of medication reconciliation directed by pharmacists on decreasing medication discrepancies after discharge from the surgical ward. Methods: Patients admitted to the surgical unit at a tertiary teaching hospital in Amman, Jordan, between July 2017 and July 2018 were selected and randomly assigned to either the control or the intervention group. Upon admission, the number and kinds of unintentional medication discrepancies were determined for both groups. Medication reconciliation was then provided to patients in the intervention group. The number of unintentional discrepancies was re-evaluated upon discharge for both groups. To assess differences between the control and intervention groups, the χ2 or Fisher exact test was used for categorical variables and an independent-sample t test for continuous data. A paired t test was conducted to determine whether the number of medication discrepancies was reduced as a result of pharmacists' recommendations. Results: A total of 123 patients met the inclusion criteria, 61 in the intervention group and 62 in the control group. Discrepancies of omission and wrong dose constituted 41 (77%) of the 53 discrepancies in the intervention group and 25 (76%) of the 33 discrepancies in the control group. The number of unintentional discrepancies was significantly reduced from admission to discharge in both the intervention group (p = 0.002) and the control group (p = 0.007). Of 53 recommendations made by pharmacists, 20 (38%) were accepted by the treating physician, and all of these discrepancies were resolved. Conclusions: This study sheds light on the existence of unintentional medication discrepancies upon admission for surgical patients, which may expose the patients to potential harm upon discharge from hospital. Additional studies with a larger sample size are needed to gain further insights on pharmacists' role in implementing medication reconciliation for surgical patients.

Contexte: Dans les services chirurgicaux des hôpitaux, les patients sont exposés à un risque d'erreurs de médication plus élevé, en partie parce que les médecins ne se considèrent pas suffisamment formés pour prescrire des médicaments. Par conséquent, un travail d'équipe collaboratif impliquant le pharmacien est nécessaire. Objectifs: Évaluer l'impact du bilan comparatif des médicaments dirigé par les pharmaciens sur la diminution des écarts médicamenteux après la sortie du service de chirurgie. Méthodes: Les patients admis à l'unité chirurgicale d'un hôpital d'enseignement tertiaire à Amman, en Jordanie, entre juillet 2017 et juillet 2018 ont été sélectionnés et affectés au hasard au groupe témoin ou au groupe d'intervention. Lors de l'admission, le nombre et les types de divergences médicamenteuses non intentionnelles ont été définis pour les deux groupes. Le bilan comparatif des médicaments a ensuite été fourni aux patients du groupe d'intervention. Le nombre d'écarts non intentionnels a été réévalué à la sortie pour les deux groupes. Pour évaluer les différences entre le groupe témoin et le groupe d'intervention, le test χ2 ou le test exact de Fisher a été utilisé pour les variables catégorielles et un test t pour échantillon indépendant, pour les données continues. Un test t apparié a été effectué pour déterminer si le nombre d'écarts de médicaments a été réduit à la suite des recommandations des pharmaciens. Résultats: Au total, 123 patients répondaient aux critères d'inclusion : 61 dans le groupe d'intervention et 62 dans le groupe témoin. Les divergences d'omission et de mauvaise dose constituaient 41 (77 %) des 53 divergences dans le groupe d'intervention et 25 (76 %) des 33 divergences dans le groupe témoin. Le nombre d'écarts non intentionnels a été significativement réduit de l'admission à la sortie à la fois dans le groupe d'intervention (p = 0,002) et dans le groupe témoin (p = 0,007). Sur 53 recommandations émises par des pharmaciens, 20 (38 %) ont été acceptées par le médecin traitant et toutes ces divergences ont été résolues. Conclusions: Cette étude met en lumière l'existence d'écarts médicamenteux non intentionnels lors de l'admission des patients chirurgicaux, ce qui peut exposer les patients à des risques au moment de leur sortie de l'hôpital. D'autres études avec un échantillon plus important sont nécessaires pour mieux comprendre le rôle des pharmaciens dans la mise en œuvre du bilan comparatif des médicaments pour les patients chirurgicaux.

[Roles of pharmacists in multidisciplinary protocols of medical homes in 2020: A multi-methods cross-sectional descriptive study]. / Rôle des pharmaciens d'officine dans les protocoles des maisons de santé pluriprofessionnelles en 2020 : étude descriptive transversale multi-méthodes.

OBJECTIVES: To describe and analyze the roles of pharmacists in the multi-disciplinary protocols of French medical homes (MHs). METHODS: Multi-methods study combining: (i) a descriptive cross-sectional study identifying the MHs with active pharmacists in Loire-Atlantique and Vendée in 2020, (ii) an analysis of the roles of the pharmacists within the multi-disciplinary protocols of these MHs, (iii) a qualitative study by semi-directed interviews with the pharmacists participating in these protocols. RESULTS: Among the 40 MHs in Loire-Atlantique and Vendée in 2020, 22 (55%) included a pharmacist and 8 (20%) reported at least one protocol between GPs and pharmacists. Three roles of the pharmacist were identified: identification of a target population according to the inclusion criteria of the protocols, counseling and education, and new missions of the pharmacist. The interviews carried out highlighted a gap between the actions stated in the protocols and the actions carried out with the patient. CONCLUSION: There are many barriers to the involvement of pharmacists in the protocols: significant administrative difficulties, low financial profitability, lack of time, and even persistent mistrust between general practitioners and pharmacists. Despite these barriers, pharmacists experience improvements in communication between professionals and in their practice conditions.

[Interest of the use of the "MYDEFI" smartphone application to help reduce alcohol consumption in the involvement of pharmacists in the prevention of at-risk consumption: Results of a survey in the Hauts-de-France]. / Intérêt de l'utilisation de l'application smartphone « MYDEFI ¼ d'aide à la réduction de la consommation d'alcool dans l'implication des pharmaciens dans la prévention de la consommation à risque : résultats d'une enquête dans les Hauts-de-France.

OBJECTIVES: Evaluate the interest in the MyDéfi application as a tool to help pharmacists identify and manage excessive alcohol consumption, as well as their perception and knowledge of alcohol and their possible role in its management. METHODS: Prospective mixed qualitative and quantitative study, based on face-to-face semi-directive interviews. RESULTS: The 101 pharmacists interviewed in Hauts-de-France region considered that the detection of alcohol consumption was part of their mission, even if it is a difficult subject, and that they had received specific training in alcohology during their university training. Only 12% were aware of early screening and brief intervention on alcohol. Several obstacles were mentioned, such as the lack of training and confidentiality, and difficulties related to patient specificities. Forty-one percent said that the pharmacy was not suitable and almost 72% said that the MyDéfi application could be useful for screening and 91% would recommend the application as one of the best supports, easy to advise with a personalised follow-up. For 32%, the application is accessible to patients (40% think that the main drawback of the application is inaccessibility and 27% its cost). CONCLUSION: Pharmacists consider that excessive alcohol use is a major problem that should mobilise them but many do not feel ready to offer brief interventions. After seeing how the MyDéfi application worked, the majority considered that it could help them in their prevention mission.

Health Care Professionals' Perceptions of the Role of the Clinical Pharmacist and Expanded Pharmacist Coverage in Critical Care.

BACKGROUND: During the first wave of the COVID-19 pandemic, coverage by critical care pharmacists (CCPs) was expanded in 2 medical-surgical intensive care units at the Queen Elizabeth II Health Sciences Centre, in Halifax, Nova Scotia, from 8 hours per day, 5 days per week, excluding holidays, to 8 hours per day, 7 days per week, including holidays. OBJECTIVES: To describe health care professionals' opinions about and perceived impacts of the expanded CCP coverage on patient care, as well as their opinions about the role of the CCP as a member of the critical care team. METHODS: An electronic 22-item survey was distributed to critical care health care professionals to capture opinions and perceived impacts of expanded CCP coverage. The perceived importance of 25 evidence-informed CCP activities was assessed using a 5-point Likert scale. RESULTS: Thirty-eight complete responses were included (15% response rate, based on distribution of the survey to 249 health care professionals). Most respondents agreed or strongly agreed with the following statements: CCPs are integral members of the critical care team (34/38 [89%]), CCPs play an important role in improving patient outcomes (34/38 [89%]), the presence of CCPs on the unit and on patient care rounds allows other health care professionals to concentrate on their own professional responsibilities (33/38 [87%]), and the expanded CCP coverage improved patient care (29/35 [83%]). Respondents most frequently categorized 23 of the 25 CCP activities as very important. CONCLUSIONS: Expanded CCP coverage was perceived to have a positive effect on both patient care and members of the critical care team. Most CCP activities were perceived as very important. Given the findings of this quality project, novel staffing models are being explored to optimize CCP coverage.

CONTEXTE: Au cours de la première vague de la pandémie de COVID-19, la couverture par les pharmaciens de soins intensifs (PSI) a été étendue dans 2 unités de soins intensifs médico-chirurgicaux du Queen Elizabeth II Health Sciences Centre, à Halifax (Nouvelle-Écosse) : de 8 heures par jour, 5 jours par semaine, hors jours fériés, la couverture est passée à 8 heures par jour, 7 jours par semaine, y compris les jours fériés. OBJECTIFS: Décrire les opinions des professionnels de la santé sur la couverture élargie des PSI et leurs perceptions des incidences de celle-ci sur les soins aux patients, ainsi que le rôle des PSI en tant que membres de l'équipe de soins intensifs. MÉTHODES: Un sondage électronique comportant 22 questions a été distribué aux professionnels de la santé en soins intensifs pour recueillir les opinions et les impacts perçus de l>élargissement de la couverture des PSI. L'importance perçue des 25 activités des PSI fondées sur des données probantes a été évaluée à l'aide d'une échelle de Likert à 5 points. RÉSULTATS: Trente-huit réponses complètes ont été incluses (taux de réponse de 15 %, basé sur une distribution de l'enquête à 249 professionnels de la santé). La plupart des répondants étaient d'accord ou fortement d'accord avec les affirmations suivantes : « les PSI font partie intégrante de l'équipe de soins intensifs ¼ (34/38, 89 %); « les PSI jouent un rôle important dans l'amélioration des résultats pour les patients ¼ (34/38, 89 %); « la présence des PSI dans l'unité et lors des tournées de soins aux patients permet à d'autres professionnels de la santé de se concentrer sur leurs propres responsabilités professionnelles ¼ (33/38, 87 %); et « la couverture élargie des PSI a amélioré les soins aux patients ¼ (29/35, 83 %). Les répondants ont le plus souvent classé 23 des 25 activités du PSI comme « très importantes ¼. CONCLUSIONS: L'élargissement de la couverture des PSI était perçu comme ayant un effet positif à la fois sur les soins aux patients et sur les membres de l'équipe de soins intensifs. La plupart des activités des PSI étaient perçues comme très importantes. Compte tenu des résultats de ce projet de qualité, de nouveaux modèles de dotation en personnel sont à l'étude pour optimiser la couverture des PSI.

[Knowledge and perceptions of biosimilar medicines by health professionals in Tunisia]. / Connaissances et perceptions des médicaments biosimilaires par les professionnels de santé en Tunisie.

INTRODUCTION: Biosimilar drugs occupy a strategic place in the global pharmaceutical market. However, there are brakes on their use. The objective of our study is to assess the knowledge and perceptions of healthcare professionals on biosimilar drugs in a developing country. MATERIAL AND METHODS: This is a prospective survey via an anonymous 18-question multiple-choice questionnaire developed and published online through the "Google Forms" application over a period of one month. This questionnaire is intended for Tunisian pharmacists and doctors of all ranks. RESULTS: A total of 240 health professionals responded to this questionnaire, including 158 pharmacists and 82 physicians. Among them, 73 are not informed about the biosimilar drugs and were excluded from the rest of the questionnaire. Questions regarding the definition of biosimilar drugs and their differences from generic drugs obtained the best rate of 76 % of correct answers. In contrast, the questions that generated the most errors mainly concerned the regulation of biosimilar drugs. Participants felt that they were under-informed about biosimilar drugs in 65 % of the cases. In addition, 92 % were in favor of the development of this class of drugs and 85 % estimated significant to very significant savings related to their use. CONCLUSION: Our study confirms the lack of information of pharmacists and physicians on biosimilar drugs. Sensitization of healthcare professionals on the safety and effectiveness of the use of these drugs seems to be necessary in order to allow their development.

[Use of self-tests and rapid diagnostic tests: Survey of dispensing pharmacists in the Auvergne-Rhône-Alpes region]. / Utilisation des TROD et autotests : enquête auprès des pharmaciens officinaux de la région Auvergne­Rhône-Alpes.

OBJECTIVES: RDT and self-tests are sold in pharmacies. These are medical biology procedures that are currently reserved for biologists. Nevertheless, their use is now being reinforced by the COVID-19 pandemic. What role should the dispensing pharmacist have in relation to the patient? What role can the biologist have in this system? METHODS: A survey was carried out in pharmacies in the Auvergne-Rhône-Alpes region, as well as in Cameroon during the summer of 2020, to evaluate the use of RDT and self-tests. The answers obtained to the 10 questions were discussed after a simple statistical analysis. RESULTS: Two hundred and eighty-three pharmacies and 13 Cameroonian pharmacies participated in our survey. Pharmacists want to develop the use of RDT and self-test, but agree that training is necessary. Some tests are dispensed despite their unproven clinical usefulness. CONCLUSIONS: The delivery of TRODs and self-tests is acquired in pharmacies despite the reluctance of biologists. Pharmacists should be trained by biologists to use these tests in a relevant and appropriate manner.

[Moroccan pharmacy students' knowledge and perceptions about pharmacovigilance]. / Connaissances et perception de la pharmacovigilance par les futurs pharmaciens marocains.

OBJECTIVE: The aim of this study was to evaluate the impact of an educational work groups on the knowledge and perception of 2nd year pharmacist students towards pharmacovigilance in a moroccan faculty of medicine and pharmacy. METHOD: A descriptive study conducted in pharmacology laboratory of the faculty of medicine and pharmacy of Rabat on 2nd year pharmacist students, to assess their knowledge and perception towards PV via questionnaire before and after an educational work groups. RESULTS: Among the 122 invited students, 108 responded to the questionnaire distributed before working group with a participation rate of 88,5 %. This rate increased to 95,9 % (n=117) after work groups sessions. Pre-work groups, students showed an overall low knowledge, where only 27.7 % knew the ADRs reporting sheet. In addition, most students were not well prepared to report ADR in their future practice (n=82, 75.92 %). Work groups partially offsetting this deficit, and helped to better explain to the students the reporting system. Resulting in only 28 participants maintained their declaration of inability to report ADR in their future practice (25.92 %). On the other hand, students showed a favorable perception. CONCLUSION: In this study, students expressed the desire to learn more about PV during their university education. This result led to the introduction of a system of PV working groups for 3rd and 4th year pharmacy students for the 2018-2019 academic year.

Impact on mental health of the COVID-19 outbreak among community pharmacists during the sanitary lockdown period.

OBJECTIVES: COVID-19 outbreak can impact mental health including health care workers. The aim of this study was to assess the psychological impact of COVID-19 in French community pharmacists. MATERIAL AND METHODS: We carried out a postal-based survey to assess the psychological impact of COVID-19 in French owner community pharmacists based on three validated self-report questionnaires: Perceived Stress scale, Impact of Event Scale-revised and Maslach Burnout Inventory. RESULTS: The sample consists of 135 community pharmacists. Twenty-three pharmacists reported significant post-traumatic stress symptoms (17%). High burnout symptoms were found in 33 (25%), 46 (34.9%) and 4 (3%) participants. Females scored higher than males for all questionnaires (P=0.01). CONCLUSIONS: This study is the first study which showed the psychological impact of COVID-19 in community pharmacists. Based on validated self-report questionnaires, up to 35% of pharmacists reported psychological disturbances. Interventions to promote psychological well-being of healthcare workers need to be developing.

[Optimization of post-surgical wound by a multidisciplinary team: pilot feasibility study]. / Optimisation de la prise en charge de la plaie post-chirurgicale par une équipe pluridisciplinaire : étude pilote de faisabilité.

OBJECTIVES: The management of post-surgical wounds is complex and suffers from a lack of coordination between the hospital and the community. The pharmacist could improve the efficiency of the care pathway by optimizing the compliance of discharge orders (DO) with current standards and reducing the associated expenditures. The objective of this study was to evaluate the impact of a multidisciplinary intervention on the quality and cost of acute post-surgical wound management. METHODS: This is a pilot study, monocentric, prospective, before/after. Non-conformities (NC) of DO for post-surgical wounds were analyzed before and after a multidisciplinary intervention (development of protocols, provision of prescription aid supports, training) in 3 surgical departments. The cost of each OS filled in the community was collected and the satisfaction of community pharmacists was evaluated. RESULTS: Out of 120 OS collected, 576 NC were detected. The intervention halved the number of DO with at least 1 NC and divided the median number of NC per order by 7. Community pharmacists were 4 times more satisfied with the quality of DO after the intervention. The cost of the multidisciplinary intervention was estimated at 787 euro. This intervention did not change the average cost per prescription. CONCLUSION: The multidisciplinary intervention improved the quality of post-surgical wound management by making the hospital-city pathway more fluid. The intervention requires a low investment in human resources and could be economically interesting if the costs avoided by the prevention of complications were valued.

[Recommendations for performing pharmacogenetic tests in drug monographs in Canada, France and the United States]. / Recommandations relatives à la réalisation de tests de pharmacogénétique dans les monographies de médicaments au Canada, en France et aux États-Unis.

INTRODUCTION: Pharmacogenetics represents an opportunity in pharmaceutical practice. There are many documentary resources to support the pharmacist's work in this area. OBJECTIVE: To compare the recommendations for carrying out pharmacogenetic tests from a documentary source in three countries: the United States, Canada and United France. METHOD: This is a cross-sectional descriptive study. Based on the recommendations of the Clinical Pharmacogenetics Implementation Consortium type A (the highest threshold justifying the use of a pharmacogenetic test), we identified the drug-gene pairs (23 pairs). The proposed pairs involve a total of 47 separate international nonproprietary names and 18 genes. For each drug-gene pair, we consulted three open access documentary sources (one for each target country), namely the pharmaceutical products database (DPD) for Canada, the product characteristic summary (SPC) for France and the Micromedex® monograph (IBM, Truven Health Analytics, MI, USA) for the United States. The study was conducted in September 2019. RESULTS: About a third of the drug-gene pairs are explicitly mentioned by the gene to be targeted and by the test suggested in the documentary sources consulted. Of the 23 pairs identified by the CPIC, thirteen pairs contain "consistent" recommendations between the three documentary sources. CONCLUSION: There is great heterogeneity regarding the recommendations for pharmacogenetic tests from three documentary sources used by pharmacists to monitor drug therapy in the United States, Canada and France. There is an urgent need to standardize the requirements for nomenclature, description and the need to use pharmacogenetic tests to ensure proper use of drugs and these tests in the clinic.

[Community pharmacists, students in pharmacy, and requests of codeine-based medicines: Observational study]. / Pharmaciens d'officine, étudiants en pharmacie et demandes de médicaments à base de codéine : étude observationnelle.

INTRODUCTION: The case of purple drank motivated a study to investigate the way community pharmacists and students in pharmacy managed, with patients, the abuse risk of non-prescription codeine-based medicines. METHODS: This prospective descriptive study was conducted, between September and October 2016, within a 170 community pharmacies network of Aquitaine and 437 pharmacy students of Bordeaux university (fourth, fifth and sixth year students, without selection of the pharmacies where they were able to work). It used a common survey questionnaire, which was sent to students through their own "Facebook" (Facebook Inc.) groups. RESULTS: Pharmacists advised codeine-based medicines in self-medication mostly as a second line pain treatment (96.2%), students also (72.1%). The opinions of pharmacists were almost equally shared concerning their ability to identify dependent patients or to raise the subject of addiction with them (57.7% and 53.8% of positive responses). This seemed to be more difficult for students (57.4% doubted about their ability of identification, 73.8% felt unable to address this issue with patients). Successful experiences concerning help to pharmacodependent patients were rare (11.5% of pharmacist, 4.9% of students). All were involved in patient information on these medicines use. Their opinions about an evolution toward a mandatory prescription status for all codeine-based medicines were almost equally split: 50% of pharmacists were favourable to it, 44.3% of students. They expressed the need for information tools in the care of these patients (46.2% of community pharmacists, 63.9% of students). CONCLUSION: These results illustrated the interest of pharmacists, and students in pharmacy, toward pharmacodependent patients; they also showed the complexity of this relation. Thus, they could help the elaboration of information tools in the care of these patients, with an adaptation for students who nevertheless presented a good maturity about this question.

[Assessment of the use by hospital pharmacists of the opinions issued by the Haute Autorité de santé and the economic analysis tools proposed to them]. / Évaluation de l'utilisation par les pharmaciens hospitaliers des avis émis par la Haute Autorité de santé et des outils économiques qui leur sont proposés.

BACKGROUND: In French hospitals, the supply and management of drugs are missions of pharmacists. The aim of this study is to assess the use of efficacy and economics opinions of the Haute Autorite de santé (HAS) in hospital referencing of drugs in France in 2017. METHODS: A questionnaire for hospital pharmacists was developed to establish their knowledge and their uses of Transparency Commission and Economic and Public Health Evaluation Committee opinions. This survey was distributed by the ADIPH association in July 2017. This questionnaire included 35 questions. RESULTS: Despite the health professional are more and more interesting by economics analysis, only 30 % of hospitals pharmacists of this panel declared to use HAS economic opinions (versus 80% for Transparency Commission opinions). Among these pharmacists, 86% used this report in the hospital referencing of drugs. CONCLUSION: Through this analysis, some prospects for improvement can be seen in the health professional formation, cost-effectiveness report publication and the use of cost-effectiveness analysis. This study is an overview of the use of opinions provided by the HAS. This thesis established a basis to reflection on the use of economics reports and models in the hospital decisions.

[Pharmaceutical interviews for rheumatoid arthritis patients: Perceptions and expectations of community pharmacists]. / Entretiens pharmaceutiques destinés aux patients atteints de polyarthrite rhumatoïde : perceptions et attentes des pharmaciens d'officine.

INTRODUCTION: Rheumatoid arthritis has a low level of medication adherence. Abroad, the community pharmacist has a positive impact on the patients' adherence in several chronic diseases. In France, community pharmacists' missions are developing with the implementation of pharmaceutical interviews. OBJECTIVE: To evaluate community pharmacists' perceptions on the interest and feasibility of pharmaceutical interviews targeting patients with rheumatoid arthritis. METHOD: Semi-structured interviews were conducted between August and October 2017, with pharmacists in the Auvergne-Rhône-Alpes region. The inductive analysis of the interview verbatim was realized by two independent persons. RESULTS: Fifteen community pharmacists highlighted barriers in recruiting patients for the interviews currently possible at the pharmacy, the complexity of the organization and the financing, a weakness of the hospital-to-community liaison. Nevertheless pharmacists were motivated to expand the service to other pathologies. Regarding rheumatoid arthritis, pharmacists would see them in the form of structured interviews preferentially at the pharmacy, in connection or even "prescribed" by physicians for optimal and multi-professional information sharing. Prior training and funding for these interviews should be considered to motivate pharmacists to this activity. CONCLUSION: This study allowed to discuss with community pharmacists their expectations and needs to widen the service of pharmaceutical interviews in the rheumatoid arthritis. These results will have to be taken into account to build a support interviews model for rheumatoid arthritis patients who can be integrated in their daily pharmaceutical activity.

Provincial Comparison of Pharmacist Prescribing in Canada Using Alberta's Model as the Reference Point.

BACKGROUND: In the past decade, pharmacist practice has evolved tremendously in Canada, but the scope of practice varies substantially from one province to another. OBJECTIVE: To describe pharmacists' scopes of practice relevant to prescribing within various jurisdictions of Canada, using the prescribing model in Alberta (authors' province) as the reference point. METHODS: This cross-sectional survey consisted of clinical scenarios for emergency prescribing, adapting or renewing a prescription, and initial-access prescribing for a chronic disease. Pharmacists were asked about their ability to administer injections and to order or access the results of laboratory tests, as well as certification and training requirements and reimbursement models. RESULTS: Thirteen pharmacists representing Canadian provinces other than Alberta were surveyed in late 2015, for comparison with Alberta. With specific reference to the scenarios presented, pharmacists were able to prescribe in an emergency in 9 of the 10 provinces, renew prescriptions in all provinces, and adapt prescriptions in 6 provinces. Three provinces required that pharmacists have collaborative practice agreements identifying a specific practice area in order to initiate a prescription for a chronic disease (with 6-12 pharmacists per province having such agreements). Alberta required pharmacists to have authorization, based on a detailed application, in order to initiate any provincially regulated drug (with about 1150 pharmacists having this authorization). Pharmacists were allowed to administer vaccines in 9 provinces, and 5 provinces allowed pharmacists to administer drugs by injection. Three provinces had systems in place for pharmacists to access laboratory test results, and 2 allowed pharmacists to order laboratory tests. Five provinces had government-reimbursed programs in place for select prescribing services; however, all 9 provinces with public vaccination programs reimbursed pharmacists for this service. CONCLUSIONS: Pharmacist prescribing differs among Canadian provinces. Although most provinces allow emergency prescribing and renewal or adaptation of prescriptions by pharmacists, only 4 provinces allow prescription initiation, with variable criteria and scope. Despite some progress to enhance patient flow through the health care system (e.g., by allowing pharmacists to extend prescriptions), further work should be pursued to harmonize clinical practices across Canada and to enable pharmacists to initiate and manage drug therapy.

CONTEXTE: Au cours de la dernière décennie, la pratique des pharmaciens a énormément évolué au Canada; or, le champ de pratique est très différent d'une province à l'autre. OBJECTIF: Décrire les champs de pratique des pharmaciens en ce qui touche au droit de prescrire dans les différentes provinces canadiennes en utilisant le modèle de prescription en Alberta (province d'appartenance des auteurs) comme point de référence. MÉTHODES: La présente enquête transversale s'appuyait sur des scénarios cliniques pour la prescription en situation d'urgence, l'ajustement ou la prolongation d'une ordonnance et la prescription initiale en cas de maladie chronique. On a demandé aux pharmaciens de parler de leur capacité d'administrer des substances injectables; de prescrire des examens de laboratoire ou d'en accéder aux résultats; des exigences en matière de certification et de formation; et des modèles de remboursement. RÉSULTATS: Treize pharmaciens représentant les provinces canadiennes autres que l'Alberta ont été sondés à la fin de l'année 2015 pour comparer leurs champs de pratique à celui de l'Alberta. En fonction de détails précis des scénarios préétablis, les pharmaciens étaient en mesure de prescrire en situation d'urgence dans 9 des 10 provinces, de prolonger des ordonnances dans toutes les provinces et d'ajuster des ordonnances dans 6 provinces. Trois provinces exigeaient des pharmaciens qu'ils aient des ententes de pratique en collaboration spécifiant un domaine de pratique afin d'initier une thérapie médicamenteuse en cas de maladie chronique (6 à 12 pharmaciens par province possédaient de telles ententes). L'Alberta exigeait des pharmaciens qu'ils aient une autorisation en fonction d'une demande détaillée pour amorcer un traitement à l'aide d'un médicament réglementé par la province (environ 1 150 pharmaciens détenaient une telle autorisation). Les pharmaciens pouvaient administrer des vaccins dans 9 provinces et des médicaments injectables dans 5 provinces. Trois provinces possédaient des systèmes permettant aux pharmaciens de consulter les résultats d'examens de laboratoire et 2 provinces les autorisaient à prescrire de tels examens. Cinq provinces avaient en place des programmes de remboursement pour certains services de prescription; cependant, les 9 provinces dotées de programmes publics de vaccination remboursaient les pharmaciens pour ce service. CONCLUSIONS: Le droit de prescrire des pharmaciens varie d'une province canadienne à l'autre. Bien que la majorité des provinces permettent aux pharmaciens de prescrire en situation d'urgence et de prolonger ou d'ajuster une ordonnance, seules 4 provinces leur permettaient d'initier une thérapie médicamenteuse, et le champ et les critères encadrant cette activité étaient variables. Malgré des progrès visant à améliorer l'accès des patients aux soins et aux services de santé (notamment à l'aide de la prolongation des ordonnances par les pharmaciens), il est nécessaire d'harmoniser davantage les pratiques cliniques dans l'ensemble du Canada et de permettre aux pharmaciens d'amorcer et de gérer la pharmacothérapie.

Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

BACKGROUND: As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. OBJECTIVE: To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. METHODS: A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. RESULTS: Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. CONCLUSIONS: Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing home-based care. Such evidence is needed to justify the expansion of this service nationally, including consistent and adequate remuneration from governments or other payers.

CONTEXTE: Au fur et à mesure que la population vieillit et que les gens désirent rester le plus longtemps possible à leur domicile, on s'attend à une croissance des besoins de soins à domicile. Or, les pharmaciens ont rarement été inclus dans les études de soins à domicile et l'on connaît peu de choses sur la prévalence et l'efficacité des services de soins à domiciles prodigués par des pharmaciens au Canada. OBJECTIFS: Recenser les pharmacies au Canada qui prodiguent régulièrement des soins à domicile et déterminer précisément quels sont les services fournis, la rémunération obtenue et les éléments qui font obstacle ou facilitent la prestation de soins à domicile. MÉTHODES: Un lien menant à un sondage en ligne a été inclus dans les infolettres d'associations provinciales, territoriales et nationales de pharmacie au Canada. De plus, les chercheurs ont communiqué directement avec les pharmaciens dont ils savaient qu'ils offraient des services cliniques à domicile. Le sondage était accessible d'octobre à décembre 2015. Les pharmacies ou les organismes qui faisaient au moins une visite à domicile par semaine à des fins cliniques et qui consignaient les services fournis étaient admissibles à l'étude. Une réponse par pharmacie ou par organisme était permise. RÉSULTATS: Dix-sept pharmacies répondant aux critères d'inclusion ont été recensées. Elles provenaient de milieux communautaire, hospitalier et clinique. Les visites à domicile étaient le plus souvent faites auprès de personnes ayant une pharmacothérapie complexe ou n'observant pas le traitement médicamenteux. Les services les plus fréquents étaient : établir des bilans comparatifs des médicaments, procéder à des évaluations de la pharmacothérapie et offrir de l'information aux patients sur l'observance pharmacothérapeutique. Aucune pharmacie ou aucun organisme n'a facturé ces services aux patients; or, l'absence de rémunération représentait un des principaux obstacles selon bon nombre de répondants. Bien que 12 (71 %) des répondants aient recueilli des données à des fins d'évaluation, on effectuait rarement la cueillette de données sur les résultats cliniques ou du système de santé. CONCLUSIONS: On a pu recenser que peu de pharmacies canadiennes qui offrent des soins à domicile aux patients au moins une fois par semaine. On a noté qu'on réalisait trop peu fréquemment la collecte de données permettant de fournir un fondement à ce service. De telles données probantes sont nécessaires pour justifier le fait d'étendre ce service à l'ensemble du pays et de dégager une rémunération uniforme et adéquate provenant des gouvernements ou d'autres payeurs.

[A pilot study of the professional ethical thinking of Quebec hospital pharmacists and pharmacy students]. / Étude pilote du niveau d'accord à des énoncés sur l'éthique pharmaceutique d'étudiants en pharmacie et pharmaciens hospitaliers québécois.

OBJECTIVE: The main objective was to assess the position of Quebec pharmaceutical community about pharmaceutical ethics statements. The second objective was to compare the level of agreement of pharmacy students and hospitals pharmacists. METHOD: Survey conducted one day given in 2012 and 2013 for students in 2013 and from 29/08/2014 to 02/09/2014 for pharmacists. A questionnaire of eight themes and 43 statements was developed: training and education (5 questions), clinical research (7) advertising and marketing (5) evaluation (5) dispensing medication (4), pharmaceutical care (9) economic aspect (6) and code of ethics (2). A Likert scale with four choices was used to measure the level of agreement. The primary outcome was the difference between the level of agreement of pharmacy students and hospital pharmacists. The Chi2 test was used. RESULTS: A total of 347 students and 398 pharmacists responded to the survey. There was a statistically significant difference regarding the level of agreement with 28 statements on 43. The differences focused on eight themes of the questionnaire, or training and education (3/5 significantly different questions), clinical research (2/7), advertising and marketing (2/5), Evaluation (4/5) dispensing medication (4/4), pharmaceutical care (5/9), economic aspect (6/6) and ethics (2/2). CONCLUSION: This study shows that there is a difference between pharmacists and pharmacy students about pharmaceutical ethics statements.

Publications presenting negative impacts of pharmacists.

OBJECTIVES: The main objective was to evaluate the rate of publications with at least one indicator of the negative impact of clinical pharmaceutics activity. METHODS: This is a descriptive and retrospective literature review. A literature search was conducted using Pubmed. Articles published between 2009-2014 that described the role and impacts of pharmacists were included. We calculated the rate of publication containing at least one negative indicator. We collected the indicators with negative results. RESULTS: A total of 203 articles were included. Nine articles (4%) that had at least one indicator of negative impact were identified. A total of 66% (6/9) were conducted in the United States. The study designs of the articles included were a meta-analysis (n=1), a systematic review (n=1), randomized studies (n=2), pre-post studies (n=3), a cohort study (n=1) and a survey (n=1). Nine indicators of negative impact were identified. CONCLUSION: There were nine publications with at least one negative indicator of the impact of clinical pharmacy activity. While there are a large number of studies about the positive impact of clinical pharmacy activities; the publication of negative results should be encouraged.