Patients' knowledge of the indications for their medications - a scoping review.

BACKGROUND: Inadequate medication knowledge may contribute to inappropriate medication use and treatment harms. We aimed to map and synthesise the existing evidence on patients' knowledge of the indications for their medications. METHOD: We searched MEDLINE, Embase, CINAHL, PsychInfo and the Cochrane Library for studies that assessed patients' knowledge of the indications for their medications from inception to June 16, 2022. A pair of reviewers independently screened and extracted data on study characteristics, aims, and methods used to assess and report patients' knowledge of the indications for their medications. RESULTS: We included 99 studies conducted in 33 countries, published between 1979 and 2021, with 42,377 participants in total (median 126 participants [Interquartile range: 63-338]). Studies were observational (n = 77), experimental (n = 18), or qualitative interviews (n = 4). The exact question used to assess knowledge of the indications was reported in 27 studies and was phrased in 25 different ways. Knowledge of the indications was reported as a proportion of either 1) all participants (n = 65) or 2) the total number of medications used by all patients (n = 13). Sixteen studies used both reporting methods, while five only reported a proportion without specifying the denominator. Fourteen studies in various populations reported the number of participants with correct knowledge of all their medications, ranging from 19% (long-term psychiatric in-patients) to 87% (general practice patients). CONCLUSION: We did not identify any established scientific standard for assessing patients' knowledge of the indications for their medications. The wide range of study methodologies and reporting styles observed call for a methodological consensus in this research field. Estimates of correct knowledge varied widely between studies, but whether this was due to differences in study populations or study methodology could not be determined. Furthermore, we did not identify any study investigating whether participants' knowledge of the indications for their medications was associated with the quality, e.g. appropriateness, of their treatment.

Development of a medication review intervention by seconding a hospital pharmacist to primary care.

Background: Medication reviews (MRs) are a well-described initiative that improves health outcomes for polypharmacy patients. However, there is limited knowledge about the performance of medication reviews carried out in general practice especially under the leadership of hospital clinical pharmacists. When developing complex interventions, such as MRs, it is essential to describe the development process to ensure transparency and avoid research waste. Objective: Thus, this study aimed to describe the steps of developing a new MR intervention targeting general practice to ensure transparency and transferability. Methods: A stepwise approach inspired by the Medical Research Council framework was utilised in the process, covering two of the phases, i.e., development and feasibility, divided into four steps: 1) intervention drafting by a literature search, 2) expert opinion, 3) pilot testing in general practice clinics, and 4) evaluation of quantitative MR data. Results: Based on the results from the first three steps, four main themes which influenced the success of the MR intervention were identified: general practitioner resources, patient involvement, implementation difficulties and interdisciplinarity. These themes guided the pilot evaluation in step four. Conclusion: A new feasible, complex MR intervention utilising clinical pharmacists in general practice involving hospital clinical pharmacists in a real-life setting was developed.

The Awareness and Adherence of the Valproate Pregnancy Prevention Program: A Questionnaire Survey among Healthcare Professionals, Pharmacists, and Patients in Denmark.

BACKGROUND: The European Medicine Agency (EMA) provided additional recommendations regarding the use of valproate during pregnancy in 2018 by introducing a pregnancy prevention program (PPP). This study aimed to investigate the adherence and the impact of the PPP and the awareness of valproate teratogenicity among Danish healthcare professionals (HCPs) and patients. METHODS: As part of the EMA initiated multi-country survey, web-based questionnaires were distributed among Danish general practitioners (GPs), medical specialists, pharmacists, and patients. RESULTS: A total of 90 prescribers, 98 pharmacists, and 103 patients were included in the study. Some 95.0% of the prescribers, 78.6% of the pharmacists, and 81.6% of the patients were aware of the teratogenic risks of valproate. The patient guide (27.8%), the HCP guide (23.3%), direct healthcare professional communication (23.3%), and the warning sign on the outer medication package (23.5%) were the most applied measures from the PPP. A total of 54.4% of the prescribers and 32.7% of the pharmacists informed patients about the importance of effective contraception during the use of valproate. CONCLUSION: The study showed that in Denmark HCPs and patients are highly aware of the teratogenic effects of valproate. However, adherence to and the impact of the measures included in the PPP were low.

A systematic review of pharmacogenetic testing in primary care: Attitudes of patients, general practitioners, and pharmacists.

BACKGROUND: Pharmacogenetic testing enhances patient safety by improving medical treatment and reducing side effects. It has shown potential in both primary and secondary care. However, implementation in healthcare, particularly in primary care, is slow. OBJECTIVE: The objective was to review articles published on the attitudes towards, and knowledge on pharmacogenetic testing in primary care, among general practitioners, pharmacists, and patients. METHODS: The review was performed according to the PRISMA checklist. A systemized literature search was followed by a 2-step screening process. Apart from the content of articles being within the scope of the review, inclusion criteria included: articles in English; primary research articles; qualitative, quantitative, or mixed methods. Content analysis was conducted as a qualitative meta-synthesis. The methodological rigor of included articles was assessed. RESULTS: Fifteen studies were included. The analysis resulted in the following main themes: i) benefits of pharmacogenetic testing, ii) barriers to pharmacogenetic testing, iii) pharmacists' role in pharmacogenetic counselling, and iv) pharmacists' knowledge on pharmacogenetics. Methodological rigor was generally medium/high. CONCLUSIONS: More studies are needed in this area, and there is a need for more education on pharmacogenetic testing for healthcare professionals. Issues like patient autonomy, economy, and access to tests also need to be addressed.