Reducing economic burden through split-shared care model for people living with uncontrolled type 2 diabetes and polypharmacy: a multi-center randomized controlled trial.

BACKGROUND: Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD: This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS: A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION: Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION: Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).

From comfort zone to front-line care: perspectives and reflections of community pharmacists entering home-based palliative care.

BACKGROUND: Palliative care requires a multidisciplinary team to assist patients and their families to obtain good quality care at the end of life. Typically, community pharmacists have fewer opportunities to provide services for patients with palliative care needs than hospital pharmacists. Moreover, home-based palliative care (HBPC) by pharmacists remains low and there is a lack of research regarding HBPC provided by pharmacists. Therefore, this study sought to understand the views and reflections of community pharmacists in the clinical frontline providing palliative home services. METHODS: Purposive sampling was used to recruit six community pharmacists for one-on-one, in-depth, semi-structured interviews and the data were analysed using thematic analysis. RESULTS: Five major themes emerged: [1] Engagement, [2] Challenge, [3] Mission, [4] Career metamorphosis, and [5] Outlook. The pharmacists described how they engaged in HBPC and faced the challenges. They regarded opioid management as a burden. Moreover, some mentioned that reimbursement for palliative home care is low or non-profitable. They suggested building a platform to exchange advice and legislation adjustments so that they could pass on their experiences to less experienced pharmacists in HBPC. CONCLUSIONS: The involvement of pharmacists is crucial to provide better palliative care. Although the present study was small and might not fully represent the whole situation, the findings could still inform future education, training, and policy planning to promote pharmacists' participation in palliative care to generalise community palliative care.

To collaborate or not-to-collaborate? Behavioral-antecedents and mediating role of intraprofessional collaborative behavior on performance of community pharmacists: A modeling study.

Extensive research exists on collaborative behavior between healthcare professionals with different skill sets (interprofessional collaboration). However, research is scarce and evolving on collaborative behavior among members of the same profession (intraprofessional collaboration), community pharmacists in particular. Based on the theory of reasoned action, a hypothetical structural model was developed to evaluate the impact of behavioral antecedents: competitive behavior (CB), knowledge-sharing behavior (KSB), and customer-focused behavior (CFB), and the mediating effects of collaborative behavior (CTB) on work performance (WP) of community pharmacists in southwestern Nigeria. We used a cross-sectional questionnaire-based survey of randomly selected community pharmacists (N = 646). Structural equation modeling was used to test hypotheses. The model had an acceptable fit and data quality. The model showed that CB, KSB, and CFB exert a significant direct influence on CTB. Only CFB significantly influenced WP compared to other antecedents and CTB. The absence of mediating effects of CTB suggests a gap in intraprofessional practice with implications for interprofessional collaboration and performance among community pharmacists. We conclude from our results that overall work performance is enhanced when community pharmacists encourage and adopt a collaborative culture. This culture strengthens the benefits of shared experiential knowledge, focus on patients' welfare, and healthy competition.

[Health promotion and prevention : what role for community pharmacists ?] / Prévention et promotion de la santé : quels rôles pour le pharmacien d'officine ?

Belgian community pharmacists play a pivotal role in both primary and tertiary preventive health activities. Their involvement extends beyond the pharmaceutical care associated with dispensing to include innovative services such as medication review. Additionally, they offer therapeutic education sessions to patients as part of the «Good Use of Medicines¼ programme. The recent pandemic has precipitated significant changes in pharmacists' responsibilities: they have been temporarily granted authority to prescribe and administer vaccines for COVID-19 and influenza, as well as to perform nasopharyngeal screenings for SARS-CoV-2. As frontline healthcare providers, pharmacists have the potential to expand their role in secondary prevention, particularly in screening and providing diagnostic guidance using in vitro diagnostic medical assays. The skills developed in the vaccination domain could be leveraged to enhance vaccination coverage for other diseases, emulating models used in other countries. Furthermore, the challenges posed by climate change present opportunities for pharmacists to contribute meaningfully to public health.

Le pharmacien d'officine belge participe activement aux activités de prévention primaire et tertiaire, non seulement par le biais des soins pharmaceutiques accompagnant la délivrance de médicaments ou dispositifs médicaux, mais aussi via les nouveaux services, comme la revue de la médication. Il réalise aussi des séances d'éducation thérapeutique des patients dans le cadre des entretiens d'accompagnement de Bon Usage des Médicaments (BUM). La récente pandémie a mené à une évolution rapide des missions confiées au pharmacien : il est maintenant (temporairement) autorisé à prescrire et à administrer les vaccins contre la COVID-19 et la grippe et à effectuer le dépistage nasopharyngé du SARS-CoV-2. Professionnel de santé de première ligne, le pharmacien pourrait remplir davantage de missions de prévention secondaire, notamment en matière de dépistage et d'orientation diagnostique au moyen de dispositifs médicaux de diagnostic in vitro. Les nouvelles compétences acquises en matière de vaccination pourraient être mises à profit pour contribuer à étendre la couverture vaccinale vis-à-vis d'autres pathologies, à l'instar des missions exercées par les pharmaciens d'officine à l'étranger. Enfin, les enjeux climatiques offrent de nouvelles perspectives.

Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada.

Background: Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada. Methods: Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics. Results: The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative. Conclusions: This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.

Knowledge and attitudes of community pharmacists regarding dementia: A nationwide cross-sectional study in Vietnam.

OBJECTIVE: To investigate Vietnamese community pharmacists' knowledge and attitudes towards dementia. METHODS: 1066 community pharmacists in eight provinces/centrally-governed cities were recruited using a non-probability convenience sampling technique. Their dementia knowledge was measured using a set of 14 questions developed through a literature review. The Approaches to Dementia Questionnaire was used to assess pharmacists' attitudes towards dementia. Cronbach's alpha was 0.88 for the overall questionnaire (0.70 for the knowledge part and 0.81 for the attitude part). RESULTS: Participants were mostly female (74.2%), 20-39 years old (79.1%), and had work experience in pharmacies of less than 10 years (77.0%). Medicines for dementia were available in only 40 community pharmacies (3.8%), including galantamine (3.0%) and donepezil (0.8%). Pharmacists' average knowledge and attitude scores were 8.03 ± 2.61 and 64.81 ± 7.34, respectively. There were considerable differences in pharmacists' knowledge and attitudes between rural and urban areas and among eight provinces (p < 0.001). Higher knowledge and attitude scores were found among those with higher education levels and longer work experience (p < 0.001). Using reliable sources to seek information on dementia, such as books and scientific articles, also helped pharmacists to have better knowledge and more positive attitudes (p < 0.001). There was a positive relationship between knowledge and attitude scores (r = 0.326, p < 0.001). CONCLUSION: Community pharmacists demonstrated moderate levels of knowledge and attitudes towards dementia. Their knowledge about the symptoms of dementia was inadequate. Educational interventions and training programs are urgently needed to enhance their dementia knowledge and attitudes.

Community pharmacists preparedness and barriers for cancer health promotion in North Cyprus.

INTRODUCTION: The role of a community pharmacist is well recognized in the literature as the most accessible health care provider that promotes health wellness and disease prevention. Evidence supports their role in cancer health promotion though this is not seen yet in practice. The aim of the study was to assess community pharmacists' preparedness in terms of knowledge, role perception and barriers for providing cancer health promotion in North Cyprus. METHODS: A cross-sectional face-to-face questionnaire-based study was carried among a randomly selected representative sample of community pharmacists in North Cyprus between June 2020 and August 2020. A pre-validated 31-item questionnaire tool was revised by an expert panel and adopted for purpose of this study. RESULTS: 200 (64.5%) out of 310 approached community pharmacists' have accepted and responded to the questionnaire of which 183 were fully answered. The community pharmacists' awareness of cancer was moderate, as 70% answered correctly. Most respondents (93.4%) agree that pharmacists should be involved in cancer health promotion. Most respondents (> 90%) agree that pharmacist's lack of interest in oncology, lack of educational material and pharmacist's hesitancy about their knowledge of cancer are respectively the most important barriers for cancer health promotion. CONCLUSION: The study shows that community pharmacist well perceives their role in cancer health promotion despite moderate awareness of cancer related facts and hesitancy of their knowledge necessary for assuming their role. Lack of interest, motivation and cancer educational materials availability are also major barrier to address.

Community Pharmacists' Knowledge on Cancer and Screening Methods.

BACKGROUND AND OBJECTIVE: The aim of the study is to evaluate the knowledge of community pharmacists on cancer and screening methods. SETTING AND METHOD: This study was a descriptive cross-sectional study and was conducted between January-June 2020 in Istanbul/Turkey. a structured questionnaire was applied to pharmacists as online. The questionnaire was prepared by the researchers and consisted of 49 questions; basic information about cancer (15 items), signs and symptoms (11 items), causes and risk factors (14 items), cancer screening methods (9 items). RESULTS: It was determined that the majority (>90%) of the pharmacists did not receive any education on cancer and/or cancer screening methods after graduation. The sufficient knowledge level of the pharmacists about cancer basics, signs and symptoms, and risk factors were found to be as 80%, 77%, and 67%, respectively. The internal consistency level of the questionnaire was calculated (Cronbach's alpha = 0.814). The item "Every woman should perform breast self-examination and notify a health professional when there is a change in breast appearance or feeling," was answered correctly by 98% of the pharmacists. It was determined that 71% of the pharmacists gave the correct answer to the item "Women aged 21-30 years should have a PAP smear every 3 years". CONCLUSION: According to the results of the study, while the rate of sufficient knowledge level on cancer was found to be low, knowledge on cancer screening was found to be sufficient. We think that pharmacists should receive training on cancer and screening methods and to follow the guidelines closely.

Investigating effective methods of clinical pharmacy training on oncology for community pharmacists: An observational study.

INTRODUCTION: Kitasato University Hospital offers a training course for community pharmacists that focus on advanced pharmacy management care in outpatient cancer chemotherapy. The objective of this training program is to facilitate the transition from general to oncology certification for community pharmacists with limited experience in outpatient oncology to support the acquisition of an oncology specialty. AIM: To evaluate the relationship between the changes in awareness, knowledge, and self-assessment that advanced pharmacy management care traineeship in an outpatient oncology unit for community pharmacists brings to trainees and the duration of training. METHODS: A quantitative text analysis was conducted of the daily training reports of six community pharmacists who had participated previously in the training course and had received in-service training in oncology for at least 30 days. The pre- and post-training results of the knowledge tests and self-assessments of confidence, understanding, and performance were compared. This study was approved by the Research Ethics Committee of Kitasato Institute Hospital in October 2019 (Study No. 19044). RESULTS: The terms Prescription, Recommendation were extracted from the daily report after the 21st day of oncology in-service training. Furthermore, factors such as knowledge of cancer pharmacotherapy, confidence in patient education regarding the side effects of chemotherapy, and understanding of the work of pharmacists in outpatient cancer chemotherapy significantly increased at the end of the training. CONCLUSIONS: Community pharmacists with limited experience in outpatient oncology could improve their knowledge, understanding, and awareness of outpatient oncology patient care through 30 days of in-service oncology training in a hospital setting. The issues that emerged included training pharmacists to send follow-up documents on the patients' side effects and medication status as well as developing the literature search environment in community pharmacies.

Practice of pharmaceutical care by community pharmacists in response to self-medication request for a cough: a simulated client study.

BACKGROUND: Community pharmacy practice worldwide has been shifting from product-focused to patient-oriented. However, due to the absence of separation between prescribing and dispensing in Malaysia, community pharmacists may have limited roles in the provision of pharmaceutical care to patients with chronic diseases. Therefore, the main functions of community pharmacists in Malaysia are related to self-medication requests for minor ailments and the supply of non-prescription medications. The objective of this study was to determine the practice of pharmaceutical care by community pharmacists within the Klang Valley, Malaysia in response to self-medication requests for a cough. METHODS: This study utilised a simulated client method. A research assistant, acting as a simulated client, visited community pharmacies in the Klang Valley, Malaysia to consult the pharmacists on the treatment of a cough experienced by his father. Upon leaving the pharmacy premise, the simulated client entered the pharmacist's responses in a data collection form which was structured based on pharmacy mnemonics for the response to symptoms, OBRA'90 on counselling elements, the five practice principles of pharmaceutical care by the American Pharmacists Association and literature review. Visits to the community pharmacies were conducted from September to October 2018. RESULTS: The simulated client visited a total of 100 community pharmacies. None of these community pharmacists practised adequate patients' data collection, with only a low proportion who practised all the components studied under medication information evaluation (13%), formulating a drug therapy plan (15%) and monitoring and modifying the plan (3%). Of the 100 community pharmacists, 98 recommended treatment but none of them provided all the counselling elements studied in implementing the drug therapy plan. CONCLUSION: The present study showed that community pharmacists within the Klang Valley, Malaysia were not providing adequate pharmaceutical care services to patients seeking self-medication for a cough. Such practice may compromise patient safety if inappropriate medicines or advice are given.