-
BMC Public Health Oct 2021Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income...
BACKGROUND
Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place.
METHODS
In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis.
RESULTS
A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement.
CONCLUSIONS
Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.
Topics: Anti-Bacterial Agents; Drugs, Essential; Humans; Indonesia; Pharmacies; Self Medication
PubMed: 34620152
DOI: 10.1186/s12889-021-11885-4 -
Journal of the American Medical... Jul 2021Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT),...
OBJECTIVE
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
MATERIALS AND METHODS
CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system's EHR and whether those prescriptions were successfully discontinued in the pharmacy's dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time.
RESULTS
There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software.
CONCLUSION
CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.
Topics: Biomedical Technology; Electronic Prescribing; Humans; Medical Informatics; Outpatients; Pharmacies
PubMed: 33835183
DOI: 10.1093/jamia/ocab038 -
BMC Health Services Research Mar 2019Worldwide community pharmacies are shifting their role in the healthcare system from simple medication dispensers to health care providers. High levels of satisfaction...
BACKGROUND
Worldwide community pharmacies are shifting their role in the healthcare system from simple medication dispensers to health care providers. High levels of satisfaction with pharmacy services were found in previous studies. This study has two main goals. The primary goal is to describe the levels of satisfaction and knowledge regarding pharmacy services in Portugal. The secondary goal is to explore the perceptions and the utilisation of pharmacy services by the Portuguese. This statement includes exploring the impact of a set of variables on both perceptions and uses of pharmacies in regard to services that are currently offered as well as to new services that may be provided in the future.
METHODS
A face-to-face survey of closed-ended questions was applied to a nationwide representative sample of the Portuguese population in September 2015. The sample was weighted based on population distribution across regions, habitat, age and gender. Data analysis comprises descriptive statistics and Multiple Correspondence Analysis to explore different typologies of respondent's orientation toward community pharmacy.
RESULTS
A total of 1114 interviews comprised the study. Of the respondents, 36% used the pharmacy as a first resource when seeking to treat a minor ailment, and 54% reported that they use the pharmacy as a first resource when seeking answers about medicines. Of those who visited their pharmacy at least once in the previous year, 94% were either globally satisfied or very satisfied. The level of acknowledgement of pharmacy services' was also high among the Portuguese. Of the participants, 29% considered there could be more services available in pharmacies that are currently provided by other health care facilities. The construction of a typology of orientations towards community pharmacy practice resulted in three outcome groups: "Motivated" (63%), those with a connection to a pharmacy; "Settled" (23%), mainly those who had a pharmacy nearby; and "Demobilised" (14%), those who are weakly tied to a pharmacy.
CONCLUSIONS
The vast majority of the Portuguese population has a strong positive attitude towards their community pharmacy, as expressed by the high levels of satisfaction with, and positive evaluation of, the pharmacy's services.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Community Pharmacy Services; Delivery of Health Care; Facilities and Services Utilization; Female; Humans; Male; Middle Aged; Patient Satisfaction; Perception; Pharmacies; Portugal; Public Opinion; Surveys and Questionnaires; Young Adult
PubMed: 30898124
DOI: 10.1186/s12913-019-3987-3 -
BMJ Sexual & Reproductive Health Jan 2021Over-the-counter provision of emergency contraception pills (ECP) has increased since deregulation of progestogen-only formulations and is now the most common public...
INTRODUCTION
Over-the-counter provision of emergency contraception pills (ECP) has increased since deregulation of progestogen-only formulations and is now the most common public health service provided by UK pharmacists. Important questions relate to women's perceptions of their experience of receiving ECPs from pharmacists.
METHODS
Qualitative study: in-depth interviews with young women reporting ECP use, recruited from clinic (10); pharmacy (6) and community settings (5) in London.
RESULTS
Key advantages of pharmacy provision were ease and speed of access and convenience. Disadvantages included a less personal service, inadequate attention to information needs and to prevention of recurrence of ECP need, and unsupportive attitudes of pharmacy staff. Suggested service improvements included increasing privacy, providing more contraceptive advice, adopting a more empathetic approach and signposting follow-up services.
CONCLUSION
Pharmacies are important in the choice of settings from which ECPs can be obtained and many aspects of pharmacy provision are appreciated by young women. There is scope to further enhance pharmacists' role.
Topics: Adolescent; Adult; Contraception, Postcoital; Female; Health Services Accessibility; Humans; Interviews as Topic; London; Pharmacies; Qualitative Research; Surveys and Questionnaires
PubMed: 32576555
DOI: 10.1136/bmjsrh-2019-200339 -
American Journal of Pharmaceutical... Sep 2018The first tenet of the Code of Ethics for Pharmacists of the American Pharmacists Association describes the relationship between the pharmacist and the patient as a...
The first tenet of the Code of Ethics for Pharmacists of the American Pharmacists Association describes the relationship between the pharmacist and the patient as a covenant. The central argument of this commentary is that the symbolic language of covenant, the metaphor used to describe the pharmacist-patient relationship, should be formally acknowledged as an ideal theory or concept. However, before committing to this ideal, there should be resonance with the realities of pharmacy practice. This commentary argues that the intimate nature of a covenantal relationship is not a good fit with most contexts in which pharmacists practice. The disconnection between the ideal of the covenantal relationship and context is important because codes of ethics apply regardless of context. By acknowledging the ideal of a covenantal relationship, transitional structures could then be developed to move the pharmacy profession toward this ideal.
Topics: Education, Pharmacy; Humans; Pharmaceutical Services; Pharmacies; Pharmacists; Professional Role; Professional-Patient Relations; United States
PubMed: 30323395
DOI: 10.5688/ajpe6806 -
Missouri Medicine 2023
Topics: Humans; United States; Pharmacy; Drug Costs; Pharmacies
PubMed: 37609464
DOI: No ID Found -
Systematic Reviews Nov 2019Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy... (Review)
Review
BACKGROUND
Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy interventions requires certain considerations which have some similarities to those of public health interventions and to economic evaluations alongside trials. The objective of this research is to perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of both public health interventions and alongside trials.
METHODS
(1) Exploratory review of recommendations on the economic evaluation of public health interventions, (2) exploratory review of recommendations for conducting economic evaluations alongside trials, (3) overview of systematic reviews of economic evaluations of pharmacy interventions (protocol registered with PROSPERO 2016 outlining information sources, inclusion criteria, appraisal of reviews and synthesis methods).
RESULTS
Fourteen systematic reviews containing 75 index publications were included. Reviews reported favorable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include the following: certain types of risk of bias, wider scope of study designs, and most economic quality criteria met but some issues unresolved or unclear. Triangulation revealed additional gaps. Limitations include choice of critical quality domains and potential biases in the overview process.
CONCLUSIONS
Economic evaluations of pharmacy-based public health interventions seem to follow most economic quality criteria, but there are still some issues in certain key areas to improve. These findings may assist in improving the design of pilot trials of economic evaluations in pharmacy, leading to robust evidence for payers. Based on the findings, we propose a methodological approach for the economic evaluation of pharmacy-based public health interventions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42016032768.
Topics: Humans; Cost-Benefit Analysis; Pharmaceutical Services; Pharmacies; Public Health Practice; Systematic Reviews as Topic
PubMed: 31711541
DOI: 10.1186/s13643-019-1177-3 -
PloS One 2022To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community...
OBJECTIVES
To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content.
METHODS
A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated.
RESULTS
A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively.
CONCLUSIONS
Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.
Topics: Computer Simulation; Humans; Patient Satisfaction; Pharmacies
PubMed: 35180273
DOI: 10.1371/journal.pone.0264224 -
PloS One 2021Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery...
Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery of healthcare. Common barriers include negative attitudes, professional stereotypes, professional cultures and power differentials between professional groups. The aim of this qualitative study was to explore how professional hierarchies and power differentials shape interprofessional interactions between preregistration pharmacy and medicine students. Data were gathered via semi-structured interviews and subject to thematic analysis. Four main themes were identified: Reproducing traditional hierarchies; Social norms around respect; Hierarchies in care values and goals; and Challenging the narrative is possible. Students' interactions with and views of the other profession largely reflected traditional stereotypes and power differentials. Hierarchy was evident in how respect was accorded and in how care values and goals were managed. Despite this, students overwhelmingly perceived and reported a sense of agency in changing the status quo. Emerging professional identity and conceptualisation of future roles is heavily influenced by the hierarchical relationship between the professions and can pose a significant barrier to collaborative practice. Greater support for collaborative interprofessional practice is needed at the level of policy and accreditation in health education and healthcare to ensure greater commitment to change.
Topics: Adult; Attitude of Health Personnel; Cooperative Behavior; Education, Pharmacy; Female; Humans; Interprofessional Relations; Male; Patient Care Team; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy; Students, Medical; Students, Pharmacy; Young Adult
PubMed: 34437641
DOI: 10.1371/journal.pone.0256776 -
Research in Social & Administrative... Nov 2022The Senior Section is a continuation of a previous intervention that aims to address a gap in medication safety, specifically related to older adult selection and use of... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The Senior Section is a continuation of a previous intervention that aims to address a gap in medication safety, specifically related to older adult selection and use of over-the-counter medications. The purpose of this paper is to describe the protocol of this study.
METHODS
This study will occur in three phases: an adaptation phase, an effectiveness phase using a randomized controlled trial, and a sustainment phase. This study will take place in conjunction with administrative leadership and pharmacy sites of a regional Midwest integrated health system. Eye tracking technology will inform the adaptation of the intervention and demonstrate effectiveness in the randomized controlled trial. Following the randomized controlled trial, the health system will implement the intervention without research team support. Fidelity and long-term effectiveness outcomes will be collected to demonstrate sustainment.
DISCUSSION
The potential implications of this study are a complete and sustained redesign of the pharmacy setting to include educational and directional materials on medication safety, leading to a decrease in over-the-counter medication misuse in older adults. This project could provide a road map for pharmacy organizations to tailor and adopt the Senior Section, to ultimately reduce inappropriate over-the-counter medication use in older adults.
Topics: Aged; Humans; Nonprescription Drugs; Pharmacies
PubMed: 35753964
DOI: 10.1016/j.sapharm.2022.06.008