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BMC Health Services Research Sep 2020Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their...
BACKGROUND
Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers' drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge.
METHODS
A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. 'Pharmacy workers' include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers.
RESULTS
Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p < 0.001) and anticonvulsant drugs (MgSO) (82.2% vs 17.8%; p < 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3-12.3, P < 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3-18.1, P < 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training.
CONCLUSIONS
Pharmacy workers' knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants; Antihypertensive Agents; Bangladesh; Cross-Sectional Studies; Eclampsia; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Pharmaceutical Services; Pharmacies; Pharmacists; Pre-Eclampsia; Pregnancy; Surveys and Questionnaires; Young Adult
PubMed: 32894121
DOI: 10.1186/s12913-020-05685-6 -
Pharmacoepidemiology and Drug Safety Jan 2018Most medicinal products dispensed to patients have marketing authorization (MA) to ensure high quality of the product, safety, and efficacy. However, in daily practice,... (Review)
Review
Most medicinal products dispensed to patients have marketing authorization (MA) to ensure high quality of the product, safety, and efficacy. However, in daily practice, to treat patients adequately, there is a medical need for drugs that do not hold MA. To meet this medical need, medicinal products are used in clinical care without MA (unlicensed), such as products prepared by (local) pharmacies: the pharmaceutical preparations. Three types of pharmaceutical preparations are distinguished: (i) reconstitution in excess of summary of product characteristics; (ii) adaptation of a licensed medicinal product (outside its official labeling); (iii) medicinal products from an active pharmaceutical ingredient. Although unlicensed, patients may expect the same quality for these unlicensed pharmaceutical preparations as for the licensed medicinal products. To assure this quality, a proper risk-benefit assessment and proper documentation in (centralized) patient registries and linking to a national pharmacovigilance database should be in place. Based on a risk assessment matrix, requirements for quality assurance can be determined, which has impact on the level of documentation of a pharmaceutical preparation. In this paper, the approach for good documentation including quality assurance and benefit-risk assessment will be discussed and possibilities for patient registries are described to make these crucial preparations available for regular patient care. KEY POINTS Ensuring pharmaceutical quality and performing a proper benefit-risk assessment will guarantee safe use of pharmaceutical preparations. Good documentation of (ultra-)orphan treatments can be collected in centralized patient registries and should be combined with existing information in (inter)national databases and self-reflection of patients. Linking patient registries to a centralized database for adverse drug events is highly recommended as it increases safety control of the (ultra) orphan pharmaceutical preparations.
Topics: Adverse Drug Reaction Reporting Systems; Documentation; Drug Compounding; Drug-Related Side Effects and Adverse Reactions; Humans; Legislation, Drug; Marketing; Orphan Drug Production; Patient Safety; Pharmaceutical Preparations; Pharmacies; Quality Assurance, Health Care; Risk Assessment
PubMed: 29047193
DOI: 10.1002/pds.4335 -
American Journal of Pharmaceutical... Jan 2020To identify skills and attributes that pharmacy students need upon graduation if planning to pursue a career path as a community pharmacy practice care provider....
To identify skills and attributes that pharmacy students need upon graduation if planning to pursue a career path as a community pharmacy practice care provider. In-depth interviews with community pharmacy stakeholders were conducted, audio-recorded, and transcribed. Interview transcripts were thematically analyzed to identify the skills and attributes pharmacy students need upon graduation to be prepared to practice as a community pharmacy-based care provider. Forty-two participants were interviewed. Identified attributes that were deemed transformative for community pharmacy practice included three behaviors, five skills, and two knowledge areas. Behavioral attributes needed by future community pharmacists were an approach to practice that is forward thinking and patient-centric, and having a provider mentality. The most commonly mentioned skill was the ability to provide direct patient care, with other skills being organizational competence, communication, building relationships, and management and leadership. Critical knowledge areas were treatment guidelines and drug knowledge, and regulatory and payer requirements. Additional skills needed by community pharmacy-based providers included identification and treatment of acute self-limiting illnesses and monitoring activities for chronic health conditions. Essential attributes of community pharmacists that will allow practice transformation to take place include behaving in a forward-thinking, patient-centric manner; displaying a provider mentality through use of effective communication to build relationships with patients and other providers, and learning how to meet regulatory and payer requirements for prescribers. These attributes should be fostered during the student's experiential curriculum.
Topics: Community Pharmacy Services; Curriculum; Education, Pharmacy; Health Personnel; Humans; Pharmacies; Pharmacists; Professional Role; Students, Pharmacy
PubMed: 32292190
DOI: 10.5688/ajpe7125 -
Journal of the American Pharmacists... 2023Previous initiatives have described the feasibility of conducting point-of-care testing (POCT) for hepatitis C virus (HCV) within community pharmacies. Limited research...
BACKGROUND
Previous initiatives have described the feasibility of conducting point-of-care testing (POCT) for hepatitis C virus (HCV) within community pharmacies. Limited research has been conducted to evaluate the role of student pharmacists and technicians in providing these services.
OBJECTIVE
Describe the implementation of a student pharmacist-run HCV POCT initiative within an independent community pharmacy and evaluate the linkage to care process.
PRACTICE DESCRIPTION
One specialty and 3 community pharmacies managed by one independent pharmacy chain.
PRACTICE INNOVATION
Pharmacy students screened participants for HCV and referred those with a reactive result or reporting untreated HCV to a partnering medical facility for confirmatory testing. Individuals with confirmed HCV had the option to receive their prescriptions, along with monthly telephonic monitoring services from the independent pharmacy's specialty pharmacy.
EVALUATION METHODS
Researchers evaluated the number of participants who screened reactive or reported current HCV infection, successful referrals to medical care, and prescriptions dispensed by the specialty pharmacy for HCV treatment.
RESULTS
From September 2020 to September 2022, 236 individuals were screened for HCV at the pharmacy, of whom 11 screened reactive (4.7%) and 4 participants reported untreated HCV infection. In total, 15 participants were referred to care and 4 of these participants (26.7%) were successfully linked. One participant received prescriptions and telephonic monitoring for HCV treatment from the specialty pharmacy as a direct result of Project IMPACT (Innovating the Model for Student Pharmacists to Increase Access to Hepatitis C Testing).
PRACTICE IMPLICATIONS AND CONCLUSIONS
Project IMPACT demonstrated that community pharmacies can increase access to HCV screenings by using student pharmacists and technicians. Potential strategies to improve the linkage to care process include enhancing the quality of patient education and implementing telehealth services.
Topics: Humans; Pharmacists; Community Pharmacy Services; Hepatitis C; Hepacivirus; Point-of-Care Testing; Pharmacies
PubMed: 37037394
DOI: 10.1016/j.japh.2023.04.001 -
Journal of Managed Care & Specialty... Jun 2019Formularies that Include prior authorization and utilization management are widely used by managed care organizations (MCOs), Including health plans and pharmacy benefit...
Formularies that Include prior authorization and utilization management are widely used by managed care organizations (MCOs), Including health plans and pharmacy benefit management companies. Utilization management criteria are essential to optimizing patient outcomes and reducing waste, error, unnecessary drug use, and cost. The Academy of Managed Care Pharmacy (AMCP) Professional Practice Committee has developed the following 9 specific concepts for effective prior authorization practices by MCOs: (1) patient safety and appropriate medication use, (2) clinical decision making, (3) evidence-based review criteria, (4) automated decision support, (5) transparency and advanced notice, (6) emergency access, (7) provider collaboration, (8) need for timeliness and avoiding disruptions in therapy, and (9) cost-effectiveness and value. AMCP supports these concepts to allow for further collaboration between prescribers and payers in order to ensure that patients receive appropriate and timely access to drugs, devices, and other therapeutic agents. DISCLOSURES: No funding was received for the conceptualizing, writing, and/or editing of this manuscript. The Professional Practice Committee is composed of volunteers selected from current Academy of Managed Care Pharmacy members in good standing. Concepts presented in this document were developed by request of the Academy of Managed Care Pharmacy and are not intended to represent the views of committee members' employers or affiliated organizations.
Topics: Cost-Benefit Analysis; Drug Utilization Review; Humans; Insurance, Pharmaceutical Services; Managed Care Programs; Pharmaceutical Services; Pharmacies; Prescription Drugs; Prior Authorization
PubMed: 30977701
DOI: 10.18553/jmcp.2019.19069 -
The Annals of Pharmacotherapy Apr 2021To fully engage in the Pharmacists' Patient Care Process, pharmacists must be able to (1) participate in a Collaborative Practice Agreement, (2) order and interpret... (Review)
Review
To fully engage in the Pharmacists' Patient Care Process, pharmacists must be able to (1) participate in a Collaborative Practice Agreement, (2) order and interpret laboratory tests, (3) prescribe certain medications, (4) adapt medications, (5) administer medications, and (6) effectively delegate tasks to support staff. Each of these activities is dependent on state scope of practice laws, but these laws are not binary. Various state-level restrictions allow us to view these activities on a continuum from more restrictive to less restrictive. This continuum will allow pharmacy and public health stakeholders to identify priorities for action in their states.
Topics: Cooperative Behavior; Humans; Patient Care; Patient Care Team; Pharmaceutical Services; Pharmacies; Pharmacists; Professional Role
PubMed: 32787618
DOI: 10.1177/1060028020950193 -
The Annals of Pharmacotherapy Jan 2020
Review
Topics: Education, Pharmacy; Humans; Implementation Science; Models, Organizational; Pharmaceutical Services; Pharmacies
PubMed: 31353925
DOI: 10.1177/1060028019867253 -
American Journal of Health-system... Jul 2016Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal... (Review)
Review
PURPOSE
Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal hospitals, clinics, and overall (all sectors).
METHODS
Drug expenditure data through calendar year 2015 were obtained from the IMS Health National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2016, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2016 were based on a combination of quantitative analyses and expert opinion.
RESULTS
Total U.S. prescription sales in the 2015 calendar year were $419.4 billion, which was 11.7% higher than sales in 2014. Prescription expenditures in clinics and nonfederal hospitals totaled $56.7 billion (a 15.9% increase) and $33.6 billion (a 10.7% increase), respectively, in 2015. In nonfederal hospitals, growth in spending was driven primarily by increased prices for existing drugs. The hepatitis C combination drug ledipasvir-sofosbuvir was the top drug overall in terms of 2015 expenditures ($14.3 billion); in both clinics and nonfederal hospitals, infliximab was the top drug. Individual drugs with the greatest increases in expenditures in 2015 were specialty agents and older generics; these agents are likely to continue to influence total spending in 2016.
CONCLUSION
We project an 11-13% increase in total drug expenditures overall in 2016, with a 15-17% increase in clinic spending and a 10-12% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug utilization patterns in projecting their own organization's drug spending in 2016.
Topics: Ambulatory Care Facilities; Drug Approval; Drug Costs; Economics, Hospital; Health Expenditures; Humans; Pharmaceutical Services; Pharmacies; Prescription Drugs; United States
PubMed: 27170624
DOI: 10.2146/ajhp160205 -
Research in Social & Administrative... Nov 2019Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory...
BACKGROUND
Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory design (PD), a method that utilizes the involvement of patients and other stakeholders, is well-suited for the design of multifaceted interventions in complex work systems, such as community pharmacies, that have diverse and dynamic end-users.
OBJECTIVE
The objective is to describe a blueprint for how to use PD when designing a community pharmacy intervention. This paper outlines the steps of PD and highlights the advantages and disadvantages of this method.
METHODS
PD is explained step-wise to underscore the considerations required of researchers unfamiliar with PD. This includes the development of a tailored PD approach, PD session preparatory work, data collection, and intervention development and evaluation. The stakeholders recruited for the community pharmacy intervention were pharmacy staff and older adult patients who received prescriptions at the pharmacy corporation in which the intervention was being implemented. The PD process was a series of six adaptive sessions: (1) problem identification, (2) solution generation, (3) convergence, (4) prototyping, (5) initial evaluation, and (6) formative evaluation.
RESULTS
A description of the PD process to design a community pharmacy intervention is provided. The process led to the development of a patient-centered prototype. The advantages of using PD included the opportunity to clarify problems faced by stakeholders, generation of novel solutions to incorporate into the intervention, and the ability to vet and fine-tune stakeholder design ideas in an iterative fashion. The insight gained was unprecedented and invaluable to the researchers. The biggest challenge of employing PD was the time-sensitive and time-intensive nature of developing each session, collecting data, and reflecting on the results in order to design subsequent sessions.
CONCLUSIONS
The PD process led to the development of a patient-centered prototype. PD enabled stakeholders to generate creative solutions and provide unique insight on addressing issues faced in healthcare redesign research and specifically in community pharmacies.
Topics: Humans; Patient Participation; Patient-Centered Care; Pharmacies; Stakeholder Participation
PubMed: 30509852
DOI: 10.1016/j.sapharm.2018.11.012 -
Pneumonologia I Alergologia Polska 2016The pharmaceutical care is a pharmacist's contribution to the care of individual patients and leads to optimize the use of drugs. The pharmaceutical care may improve... (Review)
Review
The pharmaceutical care is a pharmacist's contribution to the care of individual patients and leads to optimize the use of drugs. The pharmaceutical care may improve adherence, clinical effectiveness of providing therapy and improve the health-related quality of life. The conducted literature review confirmed that pharmaceutical care and advanced pharmaceutical services are clinical effective in asthma. The implementation of pharmaceutical care under Polish conditions is currently insufficient and remains challenging for the future. Herein we should admit, that the polish government has recently put an effort to appoint specially dedicated team establishing a program of reimbursed pharmaceutical care. This move should be considered as a new phase for amendments community pharmacy in Poland. The experience of different health care systems, including for instance United Kingdom, Australia or Canada, might be used in the process of changing Polish perspective. Herein, we have reviewed the literature and highlighted the services creating the program of pharmaceutical care in asthma. This unique work describes the complex nature of optimal pharmaceutical services emphasizing the strong necessity of multidimensional approach in this field.
Topics: Asthma; Australia; Canada; Delivery of Health Care; Humans; Pharmaceutical Services; Pharmacies; Poland; Quality of Life; Telemedicine; United Kingdom
PubMed: 27435349
DOI: 10.5603/PiAP.2016.0028