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International Journal of Environmental... Jan 2020Nowadays, the classic perception of the pharmaceutical profession in community pharmacies is facing worldwide extinction due to many factors. Among the numerous factors,... (Review)
Review
Nowadays, the classic perception of the pharmaceutical profession in community pharmacies is facing worldwide extinction due to many factors. Among the numerous factors, online pharmacies are increasingly gaining ground thanks to their ability to facilitate customer demand. Nevertheless, they are endangering "face-to-face" contact, affecting the building of customer loyalty based on direct "human" interaction, and consequently reducing pharmacists to mere commercial figures. Patient-centered care communication is emphasized as the essential element to build a solid and appropriate interpersonal relationship with the patient, to make the consultancy process effective, and to strengthen the pharmacist's professionalism in community pharmacy. This paper presents a narrative review of existing literature with the first aim of pinpointing the factors affecting pharmacy professional practice, and secondly, of how to improve patient-centered communication skills. A more widespread introduction of in-depth study and practice of behavioral, communication, educational, and sociological methodologies and techniques would allow for the development of more effective skills used for providing an efficient consultancy service, improving the capacity of future professionals to approach public relations.
Topics: Community Pharmacy Services; Education, Pharmacy; Health Communication; Humans; Patient-Centered Care; Pharmacists; Professional Role; Professional-Patient Relations
PubMed: 31952127
DOI: 10.3390/ijerph17020536 -
JAMA Internal Medicine May 2021The National Action Plan for Adverse Drug Event (ADE) Prevention identified 3 high-priority, high-risk drug classes as targets for reducing the risk of drug-related... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications: A Randomized Clinical Trial.
IMPORTANCE
The National Action Plan for Adverse Drug Event (ADE) Prevention identified 3 high-priority, high-risk drug classes as targets for reducing the risk of drug-related injuries: anticoagulants, diabetes agents, and opioids.
OBJECTIVE
To determine whether a multifaceted clinical pharmacist intervention improves medication safety for patients who are discharged from the hospital and prescribed medications within 1 or more of these high-risk drug classes.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial was conducted at a large multidisciplinary group practice in Massachusetts and included patients 50 years or older who were discharged from the hospital and prescribed at least 1 high-risk medication. Participants were enrolled into the trial from June 2016 through September 2018.
INTERVENTIONS
The pharmacist-directed intervention included an in-home assessment by a clinical pharmacist, evidence-based educational resources, communication with the primary care team, and telephone follow-up. Participants in the control group were provided educational materials via mail.
MAIN OUTCOMES AND MEASURES
The study assessed 2 outcomes over a 45-day posthospital discharge period: (1) adverse drug-related incidents and (2) a subset defined as clinically important medication errors, which included preventable or ameliorable ADEs and potential ADEs (ie, medication-related errors that may not yet have caused injury to a patient, but have the potential to cause future harm if not addressed). Clinically important medication errors were the primary study outcome.
RESULTS
There were 361 participants (mean [SD] age, 68.7 [9.3] years; 177 women [49.0%]; 319 White [88.4%] and 8 Black individuals [2.2%]). Of these, 180 (49.9%) were randomly assigned to the intervention group and 181 (50.1%) to the control group. Among all participants, 100 (27.7%) experienced 1 or more adverse drug-related incidents, and 65 (18%) experienced 1 or more clinically important medication errors. There were 81 adverse drug-related incidents identified in the intervention group and 72 in the control group. There were 44 clinically important medication errors in the intervention group and 45 in the control group. The intervention did not significantly alter the per-patient rate of adverse drug-related incidents (unadjusted incidence rate ratio, 1.13; 95% CI, 0.83-1.56) or clinically important medication errors (unadjusted incidence rate ratio, 0.99; 95% CI, 0.65-1.49).
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, there was not an observed lower rate of adverse drug-related incidents or clinically important medication errors during the posthospitalization period that was associated with a clinical pharmacist intervention. However, there were study recruitment challenges and lower than expected numbers of events among the study population.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02781662.
Topics: Aged; Aged, 80 and over; Female; Hospitalization; Humans; Male; Massachusetts; Medication Errors; Medication Systems; Middle Aged; Outcome Assessment, Health Care; Pharmacists
PubMed: 33646267
DOI: 10.1001/jamainternmed.2020.9285 -
Research in Social & Administrative... Sep 2019Control of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Control of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.
OBJECTIVE
To review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.
METHODS
Six databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.
RESULTS
Fifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) -0.68; 95% CI -0.79, -0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.
CONCLUSION
This finding supports the role of the pharmacist in diabetes care to enhance medication adherence.
Topics: Adult; Diabetes Mellitus; Humans; Medication Adherence; Pharmacies; Pharmacists; Professional Role; Randomized Controlled Trials as Topic
PubMed: 30685443
DOI: 10.1016/j.sapharm.2018.09.021 -
Yakugaku Zasshi : Journal of the... 2022I have been active as a professional basketball player at Hiroshima Dragonflies, which belongs to B.LEAGUE until 2018. At the beginning of my professional career, I...
I have been active as a professional basketball player at Hiroshima Dragonflies, which belongs to B.LEAGUE until 2018. At the beginning of my professional career, I started by balancing a pharmaceutical student and a professional life. I also obtained a pharmacist license during the B. LEAGUE season and was certified as a sports pharmacist to be involved in the team's anti-doping efforts. From my own experience of being subject to doping tests, I strongly felt that "athletes also need the cooperation of pharmacists", and many people recognized the need. I have a strong desire to change the status quo. Nowadays, young athletes are also connected to the Internet, and it has become easier to learn about efficient training methods, supplements and medicines. Furthermore, from marketing activities centered on advertising by companies, communication between consumers such as word-of-mouth influences decision-making. Under these circumstances, it is important to understand how athletes make decisions, engage in consultation services, and actively work with pharmacists. Athletes consult with us about "whether or not they can take supplements and medicines" is one of the athletes' wants (means). I think it is important to understand the needs (purposes) behind it. We do not think that it is our job to decide whether or not to take supplements and medicines, but we want to be a person who can be close to athletes. By understanding the hidden needs, various approaches become possible.
Topics: Athletes; Doping in Sports; Health Education; Humans; Pharmacists; Professional Role
PubMed: 35110444
DOI: 10.1248/yakushi.21-00169-1 -
American Journal of Pharmaceutical... Feb 2018The value of the arts and humanities in becoming an "educated" pharmacist is reviewed in this commentary. The term "patient care literacy" is defined as becoming a more... (Review)
Review
The value of the arts and humanities in becoming an "educated" pharmacist is reviewed in this commentary. The term "patient care literacy" is defined as becoming a more humane pharmacist. This implies not only using heads but HARTSS (humanities, arts and social sciences) for developing the necessary skills. A conceptual framework for curricular reform that focuses on using the arts and humanities is proposed for advancing patient care literacy. Methods for enhancing use of arts and humanities for developing pharmacy graduates is specifically proposed. The need for more empiric research to demonstrate the value of the arts and humanities in developing a patient care literate professional is highlighted.
Topics: Health Literacy; Humans; Literacy; Patient Advocacy; Patient Care; Pharmacists; Professional-Patient Relations
PubMed: 29491507
DOI: 10.5688/ajpe6884 -
British Journal of Clinical Pharmacology Feb 2022Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of... (Review)
Review
AIMS
Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes.
METHODS
Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by community-based pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes.
RESULTS
A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions.
CONCLUSION
This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.
Topics: Adult; Delivery of Health Care; Deprescriptions; Humans; Pharmacists; Quality of Life
PubMed: 34155673
DOI: 10.1111/bcp.14947 -
American Journal of Pharmaceutical... Mar 2019The purpose of this commentary is to attempt to provide some insight into conscience-clause cases from the perspective of a pharmacist and an academician. Health...
The purpose of this commentary is to attempt to provide some insight into conscience-clause cases from the perspective of a pharmacist and an academician. Health professionals, including pharmacists, have a social contract with the patients we serve in which the patients give us a level of status not given to non-professionals, and, in return, we agree to put the interests of our patients above our own. Therefore, any discussion of a right-to-refuse service needs to begin with a discussion of the duties and responsibilities of the health professional to the patient.
Topics: Codes of Ethics; Conscience; Education, Pharmacy; Ethics, Pharmacy; Ethics, Professional; Health Occupations; Humans; Pharmacists
PubMed: 30962646
DOI: 10.5688/ajpe7301 -
American Journal of Pharmaceutical... Apr 2022In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14... (Review)
Review
In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14 states and the District of Columbia. Training and education requirements for this expanded scope of practice vary between states and are changing rapidly. The objective of this review is to examine how student pharmacists are taught to provide contraceptive care, specifically for prescribing ongoing hormonal contraception and emergency contraception, and to identify potential gaps in the United States pharmacy curricula related to contraception. Despite steady adoption into community pharmacy practice, there is sparse literature assessing educational methods used to teach contraceptive care. This review offers recommendations to promote consistent and comprehensive student pharmacist education in providing contraceptive care across institutions, regardless of state policy status.
Topics: Contraceptive Agents; Education, Pharmacy; Health Services Accessibility; Hormonal Contraception; Humans; Pharmacists; Students; United States
PubMed: 34385172
DOI: 10.5688/ajpe8667 -
Journal of the American Pharmacists... 2022A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with... (Review)
Review
BACKGROUND
A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs.
PURPOSE
This research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date.
METHODS
In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer.
RESULTS
A total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction.
CONCLUSION
This review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.
Topics: Humans; Pharmacies; Pharmacists; Pharmacy Service, Hospital; Pharmacy Technicians; Professional Role; Vaccination
PubMed: 34663566
DOI: 10.1016/j.japh.2021.09.016 -
Currents in Pharmacy Teaching & Learning Oct 2022Clinical reasoning is considered a core competency for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment. This scoping... (Review)
Review
BACKGROUND
Clinical reasoning is considered a core competency for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment. This scoping review was conducted to identify, map, and examine evidence on used cognitive processes and their conceptualization of clinical reasoning by pharmacists.
METHODS
In March 2021, seven databases were searched for relevant primary research studies. Included were studies that examined cognitive processes in pharmacists while addressing a clinical scenario in a pharmacy-related setting. Using descriptive analysis, study characteristics, conceptualizations, operationalizations, and key findings were mapped, summarized, and examined. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
RESULTS
From 2252 abstracts, 17 studies were included that examined clinical reasoning in the context of forming a diagnosis (n = 9) or determining medication appropriateness (n = 4). Most studies conceptualized clinical reasoning as a context-dependent cognitive process whereby pharmacists apply and integrate knowledge and clinical experience to interpret available clinical data. Different terms labelled pharmacists' reasoning that showed analytical and intuitive approaches to clinical scenarios, either separately or combined. Medication review studies reported a predominance of analytical reasoning. The majority of diagnosis-forming studies in primary care identified no distinct cognitive reasoning pattern when addressing self-care scenarios.
IMPLICATIONS
This overview reflects a small but growing body of research on clinical reasoning by pharmacists. It is recommended that this competence be taught by explicating and reflecting on clinical reasoning as separate stage of the clinical decision-making process with transparent cognitive processes.
Topics: Humans; Clinical Reasoning; Delivery of Health Care; Pharmacies; Pharmacists; Professional Role
PubMed: 36123233
DOI: 10.1016/j.cptl.2022.09.011