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Background: Medicine-related problems are common in older people living in residential aged care facilities (RACFs). Recognising the significant medicine-related problems, the Australian government has announced a $345 million funding package to employ on-site pharmacists in RACFs starting in 2023. The new on-site pharmacists are to provide a range of clinical services to reduce medicine-related adverse events, promote quality use of medicines, and improve clinical governance and education. Underpinning these services, the authors argue that pharmacists play the critical role as resident advocates. Objective: This study aims to demonstrate how pharmacists can enhance their advocacy responsibility within and beyond the clinical environment to not only reduce medicine-related adverse events but also improve residents' overall health and quality of life. Methods: This study uses a case series methodology to demonstrate pharmacists' diverse roles in advocating for residents and their families. The case studies were based on participants enrolled in the Reducing Medicine-Induced Deterioration and Adverse Reactions (ReMInDAR) trial, a randomised controlled trial testing the effects of a regular pharmacist service across the Australian RACFs. Results: Pharmacists' advocacy ranged from persistence in follow-up with a resident's general practitioner (GP) to ensure the GP was aware that a patient was experiencing bleeding and bruising while on an anticoagulant, to advocating for a new bed for a resident with peripheral oedema who had been sleeping in his chair due to fear of falling out of his current bed. Conclusions: Our trial focussed on pharmacists serving as the residents' advocate to improve their overall health and quality of life, rather than just addressing a list of medicine-related problems. The pharmacist model used in the ReMInDAR trial supports pharmacists to work to their full scope of practice, helps guide the Australian government's new on-site pharmacist program, and serves as an exemplar pharmacist in aged care model internationally.
RESUMO
BACKGROUND: Professional organisations exist as international or national organisations, with each country establishing at least one national professional association. There remains a knowledge gap about factors that influence professional organisational involvement of pharmacists and pharmaceutical scientists. This study aims to explore the motivators and barriers of pharmacy professionals holding organisation membership from a global perspective. METHODS: An online questionnaire was developed and disseminated between May and July 2021. The survey was open to all pharmacists and pharmaceutical scientists. The survey consisted of four sections; demographic information, questions about professional organisations, about the International Pharmaceutical Federation (FIP) and its impact on the members. Data were analysed descriptively. RESULTS: A total of 1033 complete survey responses were received and included in the analysis. Of all respondents, 761 (73.7%) respondents were current members of a professional organisation and 272 (26.3%) were not members of any professional organisation. Overall, findings demonstrated networking, education, training and professional development opportunities as the main interests and anticipated activities, while the lack of clarity or need to join organisation, time, and financial constraints as the main barriers of pharmacy professionals holding membership. The majority of FIP members are satisfied with current FIP activities, and anticipate further networking opportunities, educational resources and grants made available to members. CONCLUSIONS: Understanding the perceptions and needs, as well as factors that influence engagement of pharmacists and pharmaceutical scientists is the key to enhancing membership. Professional organisations are highly encouraged to strengthen and target activities according to the identified motivators and barriers.
RESUMO
Cognitive side effects of anticholinergic medications in older adults are well documented. Whether these poor cognitive outcomes are observed in children has not been systematically investigated. We aimed to conduct a systematic review and meta-analysis on the associations between anticholinergic medication use and cognitive performance in children. Systematic review was conducted using Medline, PsychInfo, and Embase, identifying studies testing cognitive performance relative to the presence versus absence of anticholinergic medication(s) in children. We assessed effects overall, as well as relative to drug class, potency (low and high), cognitive domain, and duration of administration. The systematic search identified 46 articles suitable for meta-analysis. For the most part, random effects meta-analyses did not identify statistically significant associations between anticholinergic exposure and cognitive performance in children; the one exception was a small effect of anticholinergic anti-depressants being associated with better cognitive function (Hedges' g = 0.24, 95% CI 0.06-0.42, p = 0.01). Anticholinergic medications do not appear to be associated with poor cognitive outcomes in children, as they do in older adults. The discrepancy in findings with older adults may be due to shorter durations of exposure in children, differences in study design (predominantly experimental studies in children rather than predominantly epidemiological in older adults), biological ageing (e.g. blood brain barrier integrity), along with less residual confounding due to minimal polypharmacy and comorbidity in children.