Impact of educational intervention by community pharmacists on asthma clinical outcomes, quality of life and medication adherence: A systematic review and meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Community pharmacists can play an important role in controlling chronic diseases. This study aimed to evaluate the effects of pharmacists' educational interventions in the community pharmacy settings on asthma control and severity, quality of life (QOL) and medication adherence. METHODS: Databases PubMed, Scopus and Web of Science were searched for evidence regarding asthma severity and control, QOL, and medication adherence after pharmacists' interventions in community pharmacy settings. Twenty-one studies were eligible for qualitative and quantitative analysis. Indices and questionnaires were used in the studies, such as Asthma-related quality of life (IAQLQ), Asthma Control Test (ACT), Perceived Control of Asthma Questionnaire (PCAQ), inhaler technique (IT), Asthma Control Questionnaire (ACQ), 36-Item Short Form survey (SF-36) and peak expiratory flow rate (PEFR). The outcomes were extracted, pooled and analysed as percentages, means, standard deviations and errors, and 95% confidence intervals (CIs). RESULTS AND DISCUSSION: Community pharmacists in all studies educated and followed up the asthmatic patients, addressing the outcome measures. Pharmacists underwent training courses of at least a day. Standardized mean differences for the indices were pooled as follows: IAQLQ -0.241 (95% CI, -0.362 to -0.121), ACT 0.14 (95% CI, 0.02 to 0.27), PCAQ -0.15 (95% CI, -0.28 to 0.01), IT 0.79 (95% CI, 0.05 to 1.54), ACQ -0.50 (95% CI, -0.69 to -0.30), SF-36 0.39 (95% CI, 0.16 to 0.62), PEFR 0.13 (95% CI, 0.01 to 0.26) and asthma symptoms score -0.34 (95% CI, -0.49 to -0.18). WHAT IS NEW AND CONCLUSION: Pharmacists' educational interventions in community pharmacy settings could significantly improve asthma severity and control, QOL and medication adherence.

Pharmacist education in the era of genomic medicine.

Pharmacists are increasingly expected to incorporate an understanding of the genomic contributions to medication management in their daily practice,and a general consensus exists that many pharmacists are not adequately prepared to effectively make use of genomic information. In November 2011, the National Human Genome Research Institute of the National Institutes of Health convened a meeting to discuss the status of genomics education for pharmacists. A variety of pharmacist organizations and other stakeholder groups attended the 2-day event and explored the current status of pharmacist genomic education, barriers and facilitators to enhanced education, and important next steps to ensure that pharmacists are prepared for the coming decades. This report summarizes the background, content,and outcomes from this meeting.

Perceived barriers to provision of medication therapy management services (MTMS) and the likelihood of a pharmacist to work in a pharmacy that provides MTMS.

BACKGROUND: Recently, medication therapy management services (MTMS) has gained significant attention as an important type of pharmaceutical care designed to improve patient outcomes with more appropriate medication usage and monitoring. Although the provision of MTMS is increasing in pharmacies across the nation, and pharmacists are well equipped to administer MTMS, many community pharmacists are not currently providing these services. OBJECTIVE: To determine barriers to provision of MTMS perceived by pharmacists and factors associated with the likelihood of working in a pharmacy that provides MTMS. METHODS: Surveys were mailed to 906 community pharmacists licensed in West Virginia using a stratified random sample. The instrument was constructed and finalized following a review by experts and pilot tested in a convenience sample of pharmacists. Principal components analysis was performed to determine the factors that describe perceived barriers to provision of MTMS. Discriminant analysis using factor scores and other demographic and practice variables was performed to predict respondents' likelihood to work in a pharmacy that provides MTMS. RESULTS: A 3-factor model was extracted from the responses, which explained 53.3% of the total variance. The factors included perceived ability to respond to patient interest, pharmacy-related factors, and enabling factors. The discriminant function correctly classified 76.2% of cases and included comfort level with provision of services, perceived value of services to patients, perceived ability to respond to patient interest, and whether they currently offer MTMS. These variables were all positively correlated with pharmacists' likelihood of working in a pharmacy that provides MTMS. CONCLUSIONS: Comfort level and ability are important factors that influence pharmacists' likelihood of working in a pharmacy that provides MTMS. These findings highlight the importance of advanced practice experiences, certificate programs, and residencies to build pharmacists' confidence, and the role of targeted recruitment to attract pharmacists to community pharmacies that provide MTMS.

Training Australian pharmacists for participation in a collaborative, home-based post-discharge warfarin management service.

OBJECTIVE: To describe the development, implementation and outcomes of an anticoagulation education program for pharmacists participating in a community-based post-discharge warfarin management service. SETTING: Australian community pharmacy practice. METHOD: Three education modules were developed in collaboration with medical experts and delivered electronically and via hands-on training sessions to pharmacists in three Australian states. Educational outcomes were assessed via a short answer assignment and evaluation of their warfarin dosing recommendations for five hypothetical scenarios. Consumer and pharmacist perceptions of the adequacy of the training were surveyed using a structured postal questionnaire. MAIN OUTCOME MEASURE: Pharmacists' score in the short answer assignment and evaluation of their responses to the hypothetical warfarin dosing scenarios. RESULTS: Sixty-two pharmacists successfully completed the training program with a mean score for the short answer assignment of 14.3 out of 15 (95.3%; 95% CI 13.8-14.7). The pharmacists' warfarin management recommendations were very similar to those of two experienced medical specialists. Pharmacists and consumers expressed confidence in the adequacy of the training program. CONCLUSION: This education program successfully up-skilled a cohort of pharmacists for involvement in a post-discharge warfarin management service. These findings support formalization and further development of the program to facilitate widespread implementation of home-based post-discharge warfarin care.

Continuous learning through platforms.

The health crisis situation we have experienced caused by the SARSCoV-2 virus  has changed our daily life in numerous aspects, including those related to  training (undergraduate, postgraduate, and continuing education, etc). Training  activities, conferences, lectures, face-to-face workshops were suspended until  the Health Situation was over. Alternatives to face-to-face training were needed  to guarantee the continuity of these activities. Online training, teaching and  evaluation emerged as a relatively fast, simple, operational and flexible solution. Universities and faculties promoted online teaching through virtual  classes. The Spanish Society of Hospital Pharmacy supported this initiative by  signing an agreement with the Board of Deans and Chancellors of Pharmacy to  make it possible for undergraduate students to continue their studies and  supervised practices in hospital pharmacy departments. Specialized training was  affected. Pharmacy residency programs were significantly modified by hospital  pharmacies to be able to provide the new clinical and research activities  required, everyday, by the pandemic situation. Postgraduate and residency  training were also negatively affected. Again, online activities made up for  restrictions to face-to-face teaching and training. The Spanish Society of Hospital Pharmacy promoted continuing education and provided updated information on  the SARS-CoV-2 virus through its website. Thus, numerous virtual sessions,  lectures and webinars have been held, and high-quality material was offered to  provide up-todate knowledge, on the pharmacological management of patients  with COVID-19. Online teaching and education has demonstrated to be an  invaluable tool for hard times. During the lockdown, technology has kept us  closer and has emerged as an ally. Many of us have found a new means of  communication, information, and training. The Spanish Society of Hospital  Pharmacy has substantially contributed to make it possible.

La situación de crisis sanitaria que hemos vivido con motivo de la pandemia causada por el virus SARS-CoV-2 ha cambiado nuestro día a día en muchos aspectos, incluidos los relacionados con nuestra formación (de  pregrado, especializada, continuada, etc.). Se suspendieron las actividades docentes, congresos, charlas y talleres presenciales hasta la  resolución de la situación sanitaria. Era necesario buscar alternativas a la  presencialidad que garantizasen la continuidad de estas actividades. La  formación, docencia y evaluación en línea se presentaba como una solución  relativamente rápida, sencilla, operativa y flexible. Desde las universidades y  facultades se promovía la docencia en remoto con material docente y clases  virtuales. La Sociedad Española de Farmacia Hospitalaria ha facilitado esta  iniciativa al firmar un convenio con la Conferencia de Decanos de Farmacia para  que estudiantes matriculados en Prácticas tuteladas, y en formación en un  servicio de farmacia hospitalaria, pudieran seguir con sus estudios de pregrado. La formación especializada resultó afectada. Los planes de formación de los farmacéuticos internos residentes requirieron cambios  importantes por la necesidad de dar respuesta desde los servicios de farmacia a  las nuevas actividades asistenciales y de investigación que se producían, cada día de manera cambiante, en la situación de pandemia. La formación continuada de los especialistas (y residentes) quedó también alterada. De nuevo, las  actividades en línea permitieron salvar, en cierto grado, el déficit de actividades  docentes y formativas. A través de su página web, la Sociedad Española de  Farmacia Hospitalaria promovió la formación continuada y el seguimiento de la  actualidad sobre la pandemia por el virus SARS-CoV-2; organizó sesiones  virtuales, jornadas y talleres en formato webinar y proporcionó material de alta  calidad que facilitaba el conocimiento, en tiempo real, de la gestión del  tratamiento farmacológico en pacientes con COVID-19. La aplicación de la  docencia y formación en línea ha demostrado ser una herramienta  imprescindible en tiempos complicados, como los vividos. Durante el  confinamiento, la tecnología nos ha acercado y se ha convertido en la gran  aliada. También ha supuesto el descubrimiento, para muchos de nosotros, de  una nueva manera de comunicarnos, informarnos y formarnos. La Sociedad  Española de Farmacia Hospitalaria ha colaborado de manera importante a que  esto sea así.

Medication therapy management services in West Virginia: pharmacists' perceptions of educational and training needs.

BACKGROUND: The Medicare Modernization Act of 2003 recognizes the challenges associated with drug therapy in elderly patients with multiple chronic diseases, and requires the development of medication therapy management services (MTMS) for such beneficiaries. OBJECTIVE: To assess pharmacists' perception of educational and training needs necessary to implement MTMS in community pharmacies in West Virginia, USA. METHODS: Self-administered mail surveys with an explanatory cover letter were mailed to the designated pharmacist-in-charge (PIC) of each licensed community pharmacy (506) in West Virginia. Main outcome measures included pharmacists' comfort level, perceptions of value to patients, barriers to provision of services, and pharmacists' interest in receiving education and training related to MTMS. RESULTS: Of the 503 surveys that were deliverable, 203 (40.4%) usable responses were received. Fifty-five (27.1%) PICs reported that MTMS are currently being provided in their pharmacy. Respondents were likely to use services that aid in the development of MTMS and disease-state management, felt relatively comfortable in providing MTMS, and had a favorable view of the value of services to patients, but reported that lack of time tended to be a barrier. CONCLUSION: PICs in West Virginia are interested in and open to their pharmacists receiving education and training for implementation of MTMS.

Enhancing patient care via a pharmacist-managed rural anticoagulation clinic.

Integrating specialized pharmacist services and follow-up with the laboratory, home care nursing, retail pharmacy and physicians can ensure optimal outcomes for patients receiving anticoagulation, or "blood thinner," therapy. Improved patient education and discharge care planning can bridge disconnects, enable patients to better manage their care and ensure better patient outcomes and more effective use of health system resources. Specially trained pharmacists can provide safe and effective management of a high-alert medication to help prevent potentially life-threatening clots or bleeding. With advanced prescribing authorization, the pharmacist can seamlessly provide this service both locally in a community and via Telehealth to surrounding areas, potentially for any Albertan. Warfarin therapy may be lifelong or short-term (three to six months), but all patients require regular monitoring with blood tests. Many variables, both lifestyle and medication related, can impact therapy, and through extensive education and access via telephone to an "expert" for questions and follow-up of blood tests, patients are empowered to better regulate their anticoagulants. Anticoagulation pharmacists, as part of an AMS (anticoagulation management service), can provide a continuum of care for patients while in hospital, when discharged home, as an outpatient in the community or as a resident of a long-term care facility or seniors' home.

Establishing an investigational drugs and research residency at an academic medical center.

PURPOSE: The development, structure, and implementation of an innovative residency program designed to help meet a growing need for pharmacists with specialized expertise in investigational drug use and clinical research are described. SUMMARY: Clinical research has become an increasingly complex field, but prior to 2017 there were no U.S. specialty residency training programs focused on pharmacists' role in drug development and the care of patients enrolled in clinical trials. In 2016 Johns Hopkins Hospital (JHH) launched an initiative to develop residency training standards specific to the areas of investigational drug use and clinical research. The residency development process consisted of creation of a residency development committee; a needs assessment, including formation of a diverse panel of internal and external experts to guide identification of key competency areas and development of residency goals and objectives; design of the program's structure, including a framework for required and elective rotations; submission of an application for pre-candidate status to the ASHP Commission on Credentialing; and recruitment efforts. CONCLUSION: The JHH investigational drugs and research residency, a combined PGY1 and PGY2 program with 5 competency areas, 14 goals, and 49 objectives, was granted pre-candidate status by ASHP in November 2016. The first resident began the program in June 2017.

Potential roles for pharmacists in pharmacogenetics.

OBJECTIVES: To highlight areas of pharmacogenetics in which pharmacists may play a role and to describe those roles in the context of specific examples from a major academic medical center. DATA SOURCES: Literature search (PubMed) and personal interviews for the University of California at San Francisco case examples. DATA SYNTHESIS: The field of pharmacogenetics presents a wide range of opportunities for pharmacists. Specific roles for pharmacists are likely to fall within three major domains: developing research methodologies and setting research directions, establishing the value of pharmacogenetic testing in clinical practice, and participating in education and infrastructure development that moves pharmacogenetic technologies toward implementation. CONCLUSION: As drug therapy experts, pharmacists are in a unique position to push the frontiers of pharmacogenetics in both the research and clinical practice environments.

Factors affecting job and career satisfaction among community pharmacists: a structural equation modeling approach.

OBJECTIVES: To investigate the effects of continuing pharmacy education (CPE), preceptorship, and the relationship between intrinsic and extrinsic factors affecting job and career satisfaction. DESIGN: Cross-sectional study. SETTING: Two grocery store pharmacy chains located in Indiana between May 2002 and February 2004. PARTICIPANTS: 108 community pharmacists. INTERVENTION: Self-administered survey. MAIN OUTCOME MEASURES: Structural equation modeling was used to determine the effects of intrinsic and extrinsic factors, perceived benefits of CPE, advanced training, and being a preceptor on community pharmacists' job and career satisfaction. RESULTS: Job satisfaction predicted career satisfaction (regression weight 0.49, P = 0.007). The final model comprised extrinsic factors only (regression coefficient = 0.897, P = 0.013) with reasonable-fit indices (X2 ratio = 1.38, root mean square error of approximation = 0.07 [90% CI 0.05-0.09], Bentler comparative fit index 0.915). Intrinsic factors were omitted because of insignificant regression weight (B) in the initial model (B = 0.24, P = 0.278). CPE and preceptorship provided significantly positive effects on extrinsic factors, with coefficients of 0.30 (P = 0.029) and 0.27 (P = 0.027), respectively. While perceived value of being a preceptor contributed significantly to extrinsic factors related to job satisfaction, it was associated with a negative impact on career satisfaction (B = -0.41, P = 0.005). Advanced training had a negative impact on career satisfaction (B = -0.21, P = 0.114). CONCLUSION: Job and career satisfaction are significantly influenced by extrinsic factors and may increase when pharmacists enroll in CPE programs and/or precept students. Pharmacists may engage in precepting in an attempt to increase job satisfaction. Further research in this area is needed.

Implementation of a pharmacogenomics education program for pharmacists.

PURPOSE: The development, implementation, and evaluation of a pharmacogenomics education program for pharmacists in a large, integrated multicampus health system are described. SUMMARY: Pharmacogenomics has been described as tailoring medications to each patient's unique genetic sequence with the goals of minimizing harmful effects and optimizing therapeutic effects. Pharmacists are uniquely trained to lead the implementation of pharmacogenomics in clinical care. After assessment of pharmacists' comfort with pharmacogenomics, different approaches were explored to develop, pilot test, and disseminate pharmacogenomics education across a multicampus academic medical center. Limited success with large-audience, single-lecture didactic education led to development and delivery of targeted, competency-based online modules using the institution's academic virtual learning environment and course management system. Implementation steps included (1) collaboration with the Mayo Clinic Center for Individualized Medicine to create an interprofessional development team and project charter, (2) galvanizing pharmacy leadership support across multiple campuses, (3) development of competency-based interactive modules, and (4) assessment of the quality of and learner satisfaction with the modules. Significant improvements in competency scores were observed with each module and across the multiple campuses. Satisfaction with the education program was assessed at the end of a 4-module series. CONCLUSION: A pharmacogenomics educational program targeting pharmacists was developed through interprofessional collaboration and provided a novel opportunity to construct an educational infrastructure to support enterprise health-system campuses with limited educational resources.

The implementation of a harm minimisation model for the identification and treatment of over-the-counter drug misuse and abuse in community pharmacies in Northern Ireland.

OBJECTIVE: This study tested an intervention model which sought to minimise over-the-counter (OTC) drug misuse and abuse in community pharmacies. METHOD: Pharmacists in six community pharmacies in the Greater Belfast area volunteered to participate in the study. The intervention model consisted of client identification and recruitment, treatment and referrals, and finally follow-up data collection and outcome measurements. All pharmacists participated in semi-structured interviews to explore their views and experiences of the study. RESULTS: Pharmacists identified 196 cases of suspected abuse/misuse. Pharmacists approached 70 of the identified clients during the six-month study; some clients agreed to stop using the product of abuse/misuse, used an alternative, or had been switched to a maintenance prescription under general practitioner (GP) supervision. No client proceeded to completion of the follow-up phase (e.g. health-related quality of life). Analysis of the interviews revealed that pharmacists had encountered some difficulties in approaching potential clients, but had used skills gained in the study in other aspects of their practice. CONCLUSIONS: Some difficulties were encountered in implementing the harm minimisation model, but these may be alleviated by further training and greater collaborative working. PRACTICE IMPLICATIONS: Notwithstanding the challenges faced in the study, this approach to harm minimisation should be considered for wider implementation in community pharmacy.

Evaluating the online platform of a blended-learning pharmacist continuing education degree program.

BACKGROUND: Distance-based continuing education opportunities are increasingly embraced by health professionals worldwide. METHODS: To evaluate the online component of a blended-learning degree program for pharmacists, we conducted a structured self-assessment and peer review using an instrument systematically devised according to Moore's principles of transactional distance. The web-based platform for 14 courses was reviewed by both local and external faculty, followed by shared reflection of individual and aggregate results. RESULTS: Findings indicated a number of course elements for modification to enhance the structure, dialog, and autonomy of the student learning experience. CONCLUSION: Our process was an important exercise in quality assurance and is worthwhile for other health disciplines developing and delivering distance-based content to pursue.

Digital literacy knowledge and needs of pharmacy staff: A systematic review.

OBJECTIVE: To explore the digital literacy knowledge and needs of pharmacy staff including pharmacists, graduate (pre-registration) pharmacists, pharmacy technicians, dispensing assistants and medicine counter assistants. METHODS: A systematic review was conducted following a pre-published protocol. Two reviewers systematically performed the reproducible search, followed by independent screening of titles/abstracts then full papers, before critical appraisal and data extraction. Full articles matching the search terms were eligible for inclusion. Exclusions were recorded with reasons. Kirkpatrick's 4 level model of training evaluation (reaction, learning, behaviour and results) was applied as an analytical framework. RESULTS: Screening reduced the initial 86 papers to 5 for full review. Settings included hospital and community pharmacy plus education in Australia, Canada and the US. No studies of pharmacy staff other than pharmacists were identified. Main findings indicate that pharmacy staff lack digital literacy knowledge with minimal research evidenced at each level of Kirkpatrick's model. CONCLUSIONS: As a society, we acknowledge that technology is an important part of everyday life impacting on the efficiency and effectiveness of working practices but, in pharmacy, do we take cognisance, 'that technology can change the nature of work faster than people can change their skills'? It seems that pharmacy has embraced technology without recognised occupational standards, definition of baseline skills or related personal development plans. There is little evidence that digital literacy has been integrated into pharmacy staff training, which remains an under-researched area.

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.

BACKGROUND: There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. METHODS: This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. RESULTS: Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. CONCLUSIONS: Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact.

Implementation of a professional program in Finnish community pharmacies in 2000-2002.

The aim was to assess implementation of a national 4-year project to promote professional strategy in Finnish community pharmacies during the 2.5 years of program's action in 2000-2002. A survey of random sample of 734 community pharmacists in Finland was conducted in 2002 (response rate 51%, n = 376). The questionnaire included an implementation scale and two open-ended questions on patient counselling. Many of the actions were not optimally implemented 2.5 years after starting the project. Some individual actions may have been taken, but the systematic long-term development process has not yet been started in many pharmacies. Future challenges in implementation will be a better commitment of the pharmacy owners to the goals of the national professional strategy and a better access to Internet-based drug information sources while counselling patients.

Making a Curricular Commitment to Continuing Professional Development in Doctor of Pharmacy Programs.

As outlined in the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, colleges and schools of pharmacy must provide an environment and culture that promotes self-directed lifelong learning. Continuing professional development (CPD) serves as a model that can foster and support self-directed, lifelong learning. The benefits of adopting a CPD model include assistance with attaining Center for the Advancement of Pharmaceutical Education (CAPE) 2013 Outcomes, such as self-awareness. This model can also support the individualization of experiential learning and student action on feedback from curricular-level assessments. The major skills involved in CPD, such as reflection and documentation, are frequently addressed in pharmacy curricula. However, these skills may be developed in isolation or exercised for purposes other than learning. The aim of this statement is to aid schools in creating "CPD ready" practitioners by defining the skill sets involved in CPD and making recommendations for advancing CPD in curricula.