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Research in Social & Administrative... Jan 2023The rising cost of medications has a disproportionate effect on community-dwelling older adults despite policy changes designed to improve medication access. Medicare... (Review)
Review
BACKGROUND
The rising cost of medications has a disproportionate effect on community-dwelling older adults despite policy changes designed to improve medication access. Medicare insurance counseling provided by pharmacists, including individualized plan comparison and enrollment assistance, improves medication adherence and health care utilization, yet only 15% of community dwelling older adults report using a pharmacy or pharmacist for Medicare information. To determine what information is available to inform expanding implementation of pharmacy as a resource for Medicare insurance counseling, a systematic review of published studies using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted.
METHODS
Articles meeting inclusion criteria were identified through a literature search using PubMed and GoogleScholar; 27 pharmacy Medicare insurance counseling studies were identified representing 13 unique programs in clinical, community outreach, and community pharmacy settings. Each article was coded by two researchers using the RE-AIM Coding Sheet for Publications and the extent of RE-AIM dimension reporting was determined using descriptive statistics at the program level. Discussions were used to arrive at coding consensus and concordance was measured with Krippendorff's alpha.
RESULTS
Across all studies (15 quasi experimental, 10 analytical case reports, and 2 case reports) more than half of the programs reported framework component dimensions for Reach (69%), Adoption (58%), Implementation (54%), and Maintenance (54%), and fewer than half reported comprehensively on Effectiveness (44%). Ten studies in 7 of 13 programs reported estimated out-of-pocket cost savings. Two studies measured patient-centered outcomes: medication adherence by proportion of days covered (PDC) and health care utilization by hospital admissions and emergency department visits. Gaps in the external validity of pharmacy Medicare education programs were identified including staff participation rates, methods to identify participating settings and program costs.
CONCLUSIONS
Based on this review, current research on pharmacy Medicare education is insufficient to guide broad implementation. Additional studies are needed to determine how Medicare education integrating pharmacists and pharmacies can be implemented to address cost-related non-adherence for community dwelling older adults.
Topics: Aged; United States; Humans; Medication Therapy Management; Medicare; Pharmacists; Medication Adherence; Health Services Accessibility
PubMed: 36085121
DOI: 10.1016/j.sapharm.2022.08.013 -
Systematic Reviews Aug 2022The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge...
BACKGROUND
The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary.
METHODS
A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected.
RESULTS
A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments.
CONCLUSIONS
Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD 42018099912.
Topics: Delivery of Health Care; Humans; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Psychometrics
PubMed: 35996155
DOI: 10.1186/s13643-022-02031-1 -
Journal of the American Medical... Sep 2022To summarize current evidence regarding facility and prescriber characteristics associated with potentially harmful medication (PHM) use by residents in nursing homes... (Review)
Review
OBJECTIVES
To summarize current evidence regarding facility and prescriber characteristics associated with potentially harmful medication (PHM) use by residents in nursing homes (NHs), which could inform the development of interventions to reduce this potentially harmful practice.
DESIGN
Scoping review.
SETTING AND PARTICIPANTS
Studies conducted in the United States that described facility and prescriber factors associated with PHM use in NHs.
METHODS
Electronic searches of PubMed/MEDLINE were conducted for articles published in English between April 2011 and November 2021. PHMs were defined based on the Beers List criteria. Studies testing focused interventions targeting PHM prescribing or deprescribing were excluded. Studies were characterized by the strengths and weaknesses of the analytic approach and generalizability.
RESULTS
Systematic search yielded 1253 articles. Of these, 29 were assessed in full text and 20 met inclusion criteria. Sixteen examined antipsychotic medication (APM) use, 2 anticholinergic medications, 1 sedative-hypnotics, and 2 overall PHM use. APM use was most commonly associated with facilities with a higher proportion of male patients, younger patients, and patients with severe cognitive impairment, anxiety, depression, and aggressive behavior. The use of APM and anticholinergic medications was associated with low registered nurse staffing ratios and for-profit facility status. No studies evaluated prescriber characteristics.
CONCLUSIONS AND IMPLICATIONS
Included studies primarily examined APM use. The most commonly reported facility characteristics were consistent with previously reported indicators of poor NH quality and NHs with patient case mix more likely to use PHMs.
Topics: Antipsychotic Agents; Cholinergic Antagonists; Drug Prescriptions; Female; Humans; Inappropriate Prescribing; Male; Nursing Homes; United States
PubMed: 35868350
DOI: 10.1016/j.jamda.2022.06.008 -
Research in Social & Administrative... Nov 2022Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being... (Review)
Review
BACKGROUND
Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes.
OBJECTIVES
To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.
METHODS
A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.
RESULTS
Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs.
CONCLUSIONS
This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.
Topics: Humans; Mental Health; Pharmacies; Pharmacists; Pharmacy; Students, Pharmacy; Education, Pharmacy; Controlled Clinical Trials as Topic
PubMed: 35778317
DOI: 10.1016/j.sapharm.2022.06.006 -
Journal of Acquired Immune Deficiency... Jul 2022Delivery and use of HIV pre-exposure prophylaxis (PrEP) are suboptimal in the United States. Previous reviews of barriers and facilitators have not used an...
BACKGROUND
Delivery and use of HIV pre-exposure prophylaxis (PrEP) are suboptimal in the United States. Previous reviews of barriers and facilitators have not used an implementation science lens, limiting comprehensiveness and the link to implementation strategies. To summarize the state of the science, we systematically reviewed determinants of PrEP implementation using the updated Consolidated Framework for Implementation Research (CFIR 2.0).
SETTING
PrEP-eligible communities and delivery settings in the United States.
METHODS
In January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer-reviewed articles related to HIV/AIDS, interventions, implementation, and determinants or strategies. We identified 286 primary research articles published after 1999 about US-based PrEP implementation. Team members extracted discrete "mentioned" and "measured" determinants, coding each by setting, population, valence, measurement, and CFIR 2.0 construct.
RESULTS
We identified 1776 mentioned and 1952 measured determinants from 254 to 239 articles, respectively. Two-thirds of measured determinants were of PrEP use by patients as opposed to delivery by providers. Articles contained few determinants in the inner setting or process domains (ie, related to the delivery context), even among studies of specific settings. Determinants across priority populations also focused on individual patients and providers rather than structural or logistical factors.
CONCLUSION
Our findings suggest substantial knowledge in the literature about general patient-level barriers to PrEP use and thus limited need for additional universal studies. Instead, future research should prioritize identifying determinants, especially facilitators, unique to understudied populations and focus on structural and logistical features within current and promising settings (eg, pharmacies) that support integration of PrEP into clinical practice.
Topics: Anti-HIV Agents; HIV Infections; Humans; Pre-Exposure Prophylaxis; United States
PubMed: 35703776
DOI: 10.1097/QAI.0000000000002984 -
American Journal of Preventive Medicine Oct 2022Community pharmacists are among the most accessible healthcare providers. Community pharmacist-led screening may facilitate the early detection of illnesses/medical risk... (Review)
Review
INTRODUCTION
Community pharmacists are among the most accessible healthcare providers. Community pharmacist-led screening may facilitate the early detection of illnesses/medical risk factors, optimizing health outcomes. However, it is important to assess the acceptability of screening services to ensure uptake by key stakeholders. The aim of this review was to explore the acceptability of community pharmacist-led screening by all stakeholders (i.e., patients, pharmacists, and other healthcare professionals) and identify the methods used to evaluate the acceptability of screening.
METHODS
A systematic search was conducted in Embase, MEDLINE, International Pharmaceutical Abstracts, and Scopus in April 2020 since inception. Studies that explored the acceptability of pharmacist-led screening for any risk factor/medical condition(s) within community pharmacies were included.
RESULTS
A total of 44 studies met the inclusion criteria. A total of 17 studies identified community pharmacies as appropriate screening locations. Seven studies reported that patients were comfortable with participating in pharmacist-led screening. Eight studies explored acceptability from the perspective of medical practitioners and other healthcare professionals, with 6 reporting high recommendation acceptance rates and/or acceptability of pharmacist-led screening. Barriers to pharmacist-led screening included time and privacy constraints, whereas adequate remuneration was considered an important enabler.
DISCUSSION
Community pharmacist-led screening appears to be acceptable to patients, pharmacists, and other healthcare professionals. However, no uniform psychometrically sound measure of acceptability was used consistently across studies, rendering comparisons difficult and showing the need for future research exploring the psychometric properties of acceptability measures. Findings, including barriers and enablers to pharmacist-led screening, are important to consider when providing screening services in community pharmacies.
Topics: Community Pharmacy Services; Humans; Mass Screening; Pharmacies; Pharmacists
PubMed: 35688723
DOI: 10.1016/j.amepre.2022.04.023 -
SAGE Open Medicine 2022This review is aimed to estimate the pooled prevalence of mothers' health care-seeking behavior and associated factors in Ethiopia. (Review)
Review
OBJECTIVE
This review is aimed to estimate the pooled prevalence of mothers' health care-seeking behavior and associated factors in Ethiopia.
METHODS
International databases were systematically searched for studies that were published between 2008 and 2019. Data were extracted in Microsoft Excel 2019 and then exported to STATA version 14 for further analysis. Publication bias was determined by funnel plot, Begg's test, and Egger's test. Heterogeneity between the studies was checked by I statistic. The pooled proportion was estimated using random-effects meta-analysis model.
RESULTS
This review and meta-analysis included 14 studies from a total of 581 papers that were screened. The pooled proportion of mothers' health care-seeking behavior in Ethiopia was 50.24% (95% CI: 37.13%, 63.35%). Health facility distance (OR = 2.07), awareness about common childhood illnesses (OR = 2.06), educational levels (OR = 1.82), and income (OR = 2.07) were significantly associated variables.
CONCLUSION
The overall health care-seeking behavior of mothers for common childhood illnesses in Ethiopia is low. Accordingly, educating mothers/caregivers about the importance of health care-seeking behavior and increasing the proximity of health facilities were recommended to improve health care-seeking behavior.
PubMed: 35615524
DOI: 10.1177/20503121221099019 -
Exploratory Research in Clinical and... Sep 2021There is an increase in the global prevalence of the human immunodeficiency virus (HIV). While it has been proven that pharmacist interventions improve the health... (Review)
Review
BACKGROUND AND OBJECTIVE
There is an increase in the global prevalence of the human immunodeficiency virus (HIV). While it has been proven that pharmacist interventions improve the health outcomes of people living with HIV/AIDS (PLWHA), the economic impact of these initiatives is uncertain. Consequently, we aim to systematically review and synthesize the evidence surrounding the economic impact of pharmacist care in PLWHA.
METHODS
PubMed, EMBASE, Scopus, IPA via ProQuest, the Cochrane Library, and the CINAHL Plus databases were systematically searched. Original studies evaluating the economic effect of pharmacist-managed services for PLWHA were included in the review. The quality of the economic studies was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist.
RESULTS
A search of databases yielded 4206 citations, four of which met the eligibility criteria. Three studies were conducted in a hospital-based outpatient facility, while one study was conducted in a community pharmacy setting. The types of "pharmacist-managed services" included targeted motivational education, pharmaceutical care, health screening for opportunistic infections, and referral to specialists. Two of the four economic evaluation studies had complete economic analyses and were rated as moderate in quality. In comparison with usual care, pharmacist services led to cost savings of (51.29 to 165.74 in 2021 USD$) per person per year, saving 18.5 h per patient per year, and a lower cost of generating 12 years of quality-adjusted life years. In addition, the benefit-to-cost ratio of the pharmacist service was 2.51:1.
CONCLUSIONS
The pharmacist-managed services demonstrated the benefits of improving overall PLWHA health outcomes in economic viability. However, future real world controlled, high-quality economic studies are required to determine the long-term cost-effectiveness of these services, given the pharmacist's growing role in the health care team managing PLWHA.
PubMed: 35480597
DOI: 10.1016/j.rcsop.2021.100066 -
Pharmacy (Basel, Switzerland) Apr 2022: The patronage of online pharmacies is rapidly growing, driven by the convenience and cheaper costs of purchasing prescription drugs electronically, especially under... (Review)
Review
: The patronage of online pharmacies is rapidly growing, driven by the convenience and cheaper costs of purchasing prescription drugs electronically, especially under the lockdown situation. However, there are issues regarding the quality of the prescription drugs sold online and the legitimacy of online pharmacies. The use of prescription drugs without the supervision of a licensed health care practitioner may potentially harm consumers. : This systematic review was conducted to improve the body of knowledge on three main aspects of online pharmacies: (1) type and characteristics of the online pharmacies selling drugs; (2) the quality of pharmaceutical drugs purchased online; and (3) the characteristics of consumers of online pharmacies. : Based on a pre-defined search strategy, PubMed and Scopus were utilised to search articles written in the English language published between January 2009 and February 2020. Studies focusing on the sale of prescription drugs were included. The terms used for the literature search were "online pharmacy", "internet pharmacy", "e-pharmacy", "prescription", "quality", "medication safety", and "counterfeit medicine". These terms were used alone and in combination with Boolean operators. The institutional webpages including the World Health Organization (WHO) and the United States Food and Drug Administration (USFDA) were also examined for any additional studies. No methodological limitations in terms of study design were applied. A standardised data collection form was used to compile the data. : Based on the inclusion and exclusion criteria, a total of 46 articles were eligible and included in the final analysis. There were 27 articles on types and characteristic of online pharmacies, 13 articles on the quality of prescription drugs sold from online pharmacies, and 11 articles on consumers purchasing prescription drugs from online pharmacies. Readers should note that five articles discussed both the types and characteristics of online pharmacies, and the quality of the drugs sold from the outlets. The response rate (products received out of the number of orders) ranged from 20% to 100%, whereas the proportion of consumers buying prescription drugs online ranged from 2.3% to 13%. Reasons for online purchase of prescription drugs include the difficulty of obtaining a prescription for certain medications such as opioid analgesics, cheaper cost, since the costs associated with seeing a physician to obtain a prescription are reduced, and the need to obtain drugs such as opioid analgesics and benzodiazepine for misuse. : Almost half of the online pharmacies are not properly regulated and fraudulent issues were uncovered. To address this issue, stricter regulation by World Health Organization and implementation should be carried out together with frequent monitoring of the licensure system and pharmacy verification on every online pharmacy, this would reduce the number of illegal or illegitimate online pharmacy.
PubMed: 35448701
DOI: 10.3390/pharmacy10020042 -
Tropical Medicine and Health Apr 2022Provider-initiated HIV testing, and counseling (PITC) is a service in which health professionals provide HIV testing to all patients in health facilities....
BACKGROUND
Provider-initiated HIV testing, and counseling (PITC) is a service in which health professionals provide HIV testing to all patients in health facilities. Provider-initiated HIV testing, and counseling is an important opportunity for early screening of individuals, and it is fundamental for both HIV treatment and prevention. Although there are studies conducted in different parts of Ethiopia, their findings are variable. Therefore, this systematic review and meta-analysis aimed to summarize the pooled utilization of PITC in Ethiopia.
METHOD
All studies conducted on utilization of provider-initiated HIV testing and counseling at outpatient departments (OPD), inpatient departments (IPD), antenatal clinic care (ANC), and tuberculosis (TB) clinics in Ethiopia are eligible for these meta-analyses. A systematic search of the literature was conducted by the authors to identify all relevant primary studies. The databases used to search for studies were PubMed, Science Direct, POPLINE, HENARI, Google Scholar, and Scopus. The extracted data were imported into STATA version 14 software for statistical analysis. The risk of bias was assessed using the Joana Briggs Institute (JBI) criteria for prevalence studies. The heterogeneity among all included studies was assessed by I statistics and the Cochran's Q test. Pooled utilization along with its corresponding 95% CI was presented using a forest plot.
RESULT
About 1738 studies were retrieved from initial electronic searches using international databases and Google, and a total of 10,676 individual clients were included in the meta-analysis. The pooled utilization of PITC in Ethiopia using the random effects model was estimated to be 78.9% (95% CI 73.87-83.85) with a significant level of heterogeneity (I = 98.5%; P < 0.001). Subgroup analysis conducted on PITC showed the highest percentage among studies conducted in Addis Ababa (93.5%), while lower utilization was identified from a study conducted in the Tigray Region (35%).
LIMITATION OF THE STUDY
The drawbacks of this review and meta-analysis were being reported with significant heterogeneity, and the protocol was not registered.
CONCLUSION
About 21% of health facility clients missed opportunities for PITC in Ethiopia.
PubMed: 35436943
DOI: 10.1186/s41182-022-00420-9