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Pharmacy, Volume 7, Issue 2 (June 2019)

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Open AccessArticle
A Theory Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Feasibility Study
Received: 27 May 2019 / Revised: 10 June 2019 / Accepted: 15 June 2019 / Published: 20 June 2019
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Abstract
Background: Management of minor ailments through self-care and self-medication brings both benefits and risks that can be mitigated if consumers and pharmacy personnel engage in information exchange during over-the-counter (OTC) consultations. Objective: Explore the feasibility of interventions using situational cues to promote information [...] Read more.
Background: Management of minor ailments through self-care and self-medication brings both benefits and risks that can be mitigated if consumers and pharmacy personnel engage in information exchange during over-the-counter (OTC) consultations. Objective: Explore the feasibility of interventions using situational cues to promote information exchange between pharmacy personnel and consumers, during OTC consultations. Methods: Intervention tools were developed prior to conducting the study, in two community pharmacies in Perth, Western Australia. The situational cues included two posters and individual position badges. Data were collected from audio-recording OTC consultations, consumer questionnaires and interviews, and pharmacy personnel interviews. Results: Space required for posters and for researchers conducting interviews was challenging in the retail environment. Pharmacy personnel perceived that the badges positively impacted -consumers’ ability to identify the position of personnel they engaged with. Data collection methods were deemed practical and acceptable. Conclusions: The proposed interventions and evaluation methods were feasible. The use of posters and badges as situational cues to address the barriers to information exchange during OTC consultations was found to be practical, in a community pharmacy setting. There is potential to use situational cues to address other barriers identified to information exchange, to add to the effectiveness of the intervention. With growing emphasis on self-care and self-medication, effective interventions are necessary to promote information exchange to enhance appropriate management in community pharmacies. Full article
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Open AccessArticle
Reviewing Competence in Practice: Reform of Continuing Professional Development for Irish Pharmacists
Received: 16 May 2019 / Revised: 14 June 2019 / Accepted: 16 June 2019 / Published: 20 June 2019
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Abstract
There has been significant reform of the Continuing Professional Development (CPD) requirements for Irish pharmacists over the past five years. In 2015, a new system was established that includes quality assurance of practitioner engagement in CPD and quality assurance of practitioner competence. Pharmacists [...] Read more.
There has been significant reform of the Continuing Professional Development (CPD) requirements for Irish pharmacists over the past five years. In 2015, a new system was established that includes quality assurance of practitioner engagement in CPD and quality assurance of practitioner competence. Pharmacists must now plan and document their learning activities in an electronic portfolio (ePortfolio) and they must participate in an ePortfolio Review process once every five-year period. A random sample is chosen each year to participate in a review of their practice for pharmacists in patient-facing roles. This paper provides an overview of the development and implementation of these quality assurance processes and it considers the outcomes that were observed in the first four years of implementation. By April 2019, almost 3000 pharmacists had participated in the ePortfolio Review process over the preceding three years, of which 96.2% demonstrated appropriate engagement in CPD. In the preceding two years, almost 200 pharmacists had participated in Practice Review, of which 97.5% have demonstrated the required level of competence across four competencies. All of the pharmacists who did not demonstrate the required level of competence in one or more competency area during Practice Review had previously demonstrated appropriate engagement in CPD through the ePortfolio Review process. This raises interesting questions regarding the use of engagement in continuing education (CE) or CPD as a surrogate measure for competence by professions. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and Beyond)
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Open AccessArticle
Development, Testing and Results of a Patient Medication Experience Documentation Tool for Use in Comprehensive Medication Management Services
Received: 1 May 2019 / Revised: 11 June 2019 / Accepted: 15 June 2019 / Published: 20 June 2019
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Abstract
The medication experience is an individual’s subjective experience of taking a medication in daily life and can be at the root of drug therapy problems. It is recommended that the patient-centered approach to comprehensive medication management (CMM) starts with an understanding of the [...] Read more.
The medication experience is an individual’s subjective experience of taking a medication in daily life and can be at the root of drug therapy problems. It is recommended that the patient-centered approach to comprehensive medication management (CMM) starts with an understanding of the patient’s medication experience. This study aims to develop a medication experience documentation tool for use in CMM services, and to understand the usefulness and challenges of using the tool in practice. The tool was developed based on previous research on patients’ medication experiences. It was tested in two rounds by ten CMM pharmacists utilizing the tool as they provided care to patients. Focus groups were conducted to revise the tool after each round and to understand pharmacists’ experiences. The tool was tested for 15 weeks in 407 patient encounters. There was at least one medication experience documented in the electronic medical record 62% of the time. Pharmacists found the tool helpful in raising awareness of the medication experience and motivational interviewing strategies, planning for follow-up visits, as a teaching tool, and making pharmacists realize the fluidity of the medication experience. The tool offered pharmacists a better way to recognize and address medication experiences affecting medication taking behaviors. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessArticle
The Perspectives of Patients and Health Professionals Regarding the Tuberculosis Control Programme in Recife, Brazil: A Contribution to Evaluation
Received: 26 March 2019 / Revised: 14 May 2019 / Accepted: 29 May 2019 / Published: 19 June 2019
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Abstract
The study objective is to describe patients and professionals’ perspectives on the Tuberculosis Control Program (PCT) in Recife, Brazil, contributing to the program evaluation. A cross-sectional study was conducted in three purposively selected sites, representing the three levels of care in the public [...] Read more.
The study objective is to describe patients and professionals’ perspectives on the Tuberculosis Control Program (PCT) in Recife, Brazil, contributing to the program evaluation. A cross-sectional study was conducted in three purposively selected sites, representing the three levels of care in the public health system. All eligible PCT patients in sites A, B and C were invited to participate (n = 123). Physicians, nurses, pharmacists and community health agents providing care to PCT patients in these sites, plus their managers, were purposively selected. Data were collected by means of interviews with 44 patients and a questionnaire to 24 professionals. Instruments encompassed previously published items to capture stakeholders’ perspectives (16 and 12 closed-questions, respectively), grouped into categories. The overall evaluation by patients was unsatisfactory (median score 35%; third quartile below 50%; interquartile range 21.9%). Analysis of scores by categories showed that opinions about organizational accessibility were significantly worse than about economic and geographical accessibility, taken together. Overall the median score attributed by professionals was 52% (third quartile below 65%). Professionals had significantly worse opinions about diagnosis, clinical and laboratory assistance. Patients and professionals’ perspectives highlight potential opportunities for improvement. Our findings can be used by managers as a starting point for shared decision-making, potentially contributing to a better performance of the PCT in Recife and, consequently, reducing the risk posed by tuberculosis. Full article
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Open AccessReview
Strategies for Clarifying Penicillin Allergies When Skin Testing Is Not an Option
Received: 9 May 2019 / Revised: 10 June 2019 / Accepted: 17 June 2019 / Published: 19 June 2019
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Abstract
Patients with reported penicillin allergies have been proven to experience negative health consequences, such as increased cost, suboptimal antimicrobial therapy, and adverse reactions. Though skin testing has been proposed as a method to clarify penicillin allergies, many institutions may lack the resources to [...] Read more.
Patients with reported penicillin allergies have been proven to experience negative health consequences, such as increased cost, suboptimal antimicrobial therapy, and adverse reactions. Though skin testing has been proposed as a method to clarify penicillin allergies, many institutions may lack the resources to perform skin testing on a wide scale. This literature review describes the current literature surrounding the use of penicillin allergy interviews when skin testing is not an option. Specifically, the review highlights the steps in carrying out a successful antibiotic allergy patient interview, summarizes the clinical evidence surrounding antibiotic allergy clarifications, and addresses key advantages and disadvantages of clarifying antibiotic allergies without the availability of skin testing. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
Open AccessArticle
The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery
Received: 25 April 2019 / Revised: 6 June 2019 / Accepted: 17 June 2019 / Published: 19 June 2019
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Abstract
To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC [...] Read more.
To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge. Full article
(This article belongs to the Section Pharmacy Education and Student / Practitioner Training)
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Open AccessReview
Current Trends and Opportunities for Competency Assessment in Pharmacy Education–A Literature Review
Received: 29 May 2019 / Revised: 10 June 2019 / Accepted: 14 June 2019 / Published: 18 June 2019
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Abstract
An increasing emphasis on health professional competency in recent times has been matched by an increased prevalence of competency-based education models. Assessments can generate information on competence, and authentic, practice-based assessment methods are critical. Assessment reform has emerged as an academic response to [...] Read more.
An increasing emphasis on health professional competency in recent times has been matched by an increased prevalence of competency-based education models. Assessments can generate information on competence, and authentic, practice-based assessment methods are critical. Assessment reform has emerged as an academic response to the demands of the pharmacy profession and the need to equip graduates with the necessary knowledge, skills and attributes to face the challenges of the modern workforce. The objective of this review was to identify and appraise the range of assessment methods used in entry-level pharmacy education and examine current trends in health professional assessment. The initial search located 2854 articles. After screening, 36 sources were included in the review, 13 primary research studies, 12 non-experimental pharmacy research papers, and 11 standards and guidelines from the grey literature. Primary research studies were critically appraised using the Medical Education Research Study Quality Instrument (MERSQI). This review identified three areas in pharmacy practice assessment which provide opportunities for expansion and improvement of assessment approaches: (1) integrated approaches to performance assessment; (2) simulation-based assessment approaches, and; (3) collection of validity evidence to support assessment decisions. Competency-based assessment shows great potential for expanded use in pharmacy, but there is a need for further research and development to ensure its appropriate and effective use. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and Beyond)
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Open AccessArticle
An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy
Received: 5 April 2019 / Revised: 2 June 2019 / Accepted: 6 June 2019 / Published: 17 June 2019
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Abstract
For years many pharmacists have been performing ‘brown bag’ medication reviews for patients. While most pharmacists and student pharmacists are familiar with this process, it is important to determine the value patients receive from this service. Over the course of this study the [...] Read more.
For years many pharmacists have been performing ‘brown bag’ medication reviews for patients. While most pharmacists and student pharmacists are familiar with this process, it is important to determine the value patients receive from this service. Over the course of this study the authors attempted to modernize the medication reconciliation process and collect data on patient prescription drug and over-the-counter drug use, along with quantifying the types of interventions the pharmacy’s clinical staff performed for patients during this process. The pharmacy partnered with a Quality Improvement Organization to trial their Blue Bag Intervention (BBI) program. The BBI program offered several additional services to the traditional brown bag review. The BBI was instituted as a follow-up tool in the pharmacy’s diabetes self-management education/training clinic to aid in patient follow-up and help the clinical staff identify medication-related events such as medication adherence issues and drug–drug interactions. The clinical staff identified approximately 2.2 events per patient with over 50% being issues that affected patient safety. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessArticle
An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices
Received: 29 April 2019 / Revised: 7 June 2019 / Accepted: 11 June 2019 / Published: 14 June 2019
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Abstract
The high costs associated with pharmaceuticals and the accompanying stakeholders are being closely evaluated in the search for solutions. As a major stakeholder in the U.S. pharmaceutical market, the practices of pharmacy benefit manager (PBM) organizations have been under increased scrutiny. Examples of [...] Read more.
The high costs associated with pharmaceuticals and the accompanying stakeholders are being closely evaluated in the search for solutions. As a major stakeholder in the U.S. pharmaceutical market, the practices of pharmacy benefit manager (PBM) organizations have been under increased scrutiny. Examples of controversial practices have included incentives driving formulary status and prohibiting pharmacists from disclosing information on lower-cost prescription alternatives. Ethical investigations have been largely omitted within the debate on the responsibilities of these organizations in the health care system. Ethical analysis of organizational practices is justified based on the potential impact during health care delivery. The objective of this study was to analyze several specific PBM practices using multiple ethical decision-making models to determine their ethical nature. This study systematically applied multiple ethical decision-making models and codes of ethics to a variety of practices associated with PBM-related dilemmas encountered in the pharmaceutical environment. The assessed scenarios resulted in mixed outcomes. PBM practices were both ethical and unethical depending on the applied ethical model. Despite variation across applied models, some practices were predominately ethical or unethical. The point of sale rebates were consistently determined as ethical, whereas market consolidation, gag clauses, and fluctuation of pharmacy reimbursements were all predominantly determined as unethical. The application of using provider codes of ethics created additional comparison and also contained mixed findings. This study provided a unique assessment of PBM practices and provides context from a variety of ethical perspectives. To the knowledge of the authors, these perspectives have not been previously applied to PBM practices in the literature. The application of ethical decision-making models offers a unique context to current health care dilemmas. It is important to analyze health care dilemmas using ethics-based frameworks to contribute solutions addressing complexities and values of all stakeholders in the health care environment. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
Prescribing Patterns of Antihypertensive Medications in US Ambulatory Care Settings
Received: 29 April 2019 / Revised: 24 May 2019 / Accepted: 7 June 2019 / Published: 14 June 2019
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Abstract
Over 70 million Americans are diagnosed with hypertension. Adherence to current AHA/ACC 2017 hypertension guidelines and appropriate antihypertensive therapy is important for optimal treatment outcomes. This study investigates prescribing patterns for ambulatory care patients with hypertension and adherence to these guidelines. Data from [...] Read more.
Over 70 million Americans are diagnosed with hypertension. Adherence to current AHA/ACC 2017 hypertension guidelines and appropriate antihypertensive therapy is important for optimal treatment outcomes. This study investigates prescribing patterns for ambulatory care patients with hypertension and adherence to these guidelines. Data from the 2015 National Ambulatory Medical Care Survey (NAMCS) were used in the study. Patients with primary diagnoses of essential hypertension were extracted from the data using ICD-9 code “401”. A total of 595 patients were identified. Correlation among demographic variables, source of payment and prescriber specialty were examined. Chi-square and descriptive analysis were performed. 51.4% of the prescriptions were non-first-line medications. Primary care physicians and cardiologists adhered to the guidelines more, when compared to the other specialties. There was a significant difference between various geographic regions, as it relates to guidelines adherence. This study concluded that prescribers do not always adhere to the AHA/ACC 2017 hypertension guidelines. It is recommended to adhere to the guidelines if there are no contraindications. The study’s findings were limited to the ambulatory patients visiting providers in 2015 and by the operational definitions of the study. Full article
Open AccessOpinion
Alignment of Community Pharmacy Foundation Grant Funding and the Evolution of Pharmacy Practice in the United States of America
Received: 1 May 2019 / Revised: 4 June 2019 / Accepted: 5 June 2019 / Published: 14 June 2019
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Abstract
The Community Pharmacy Foundation is a non-profit organization dedicated to the advancement of community pharmacy practice and patient care delivery through grant funding and resource sharing. Since 2002, CPF has awarded 191 grants and over $9,200,000 (US dollars) in research and project grants. [...] Read more.
The Community Pharmacy Foundation is a non-profit organization dedicated to the advancement of community pharmacy practice and patient care delivery through grant funding and resource sharing. Since 2002, CPF has awarded 191 grants and over $9,200,000 (US dollars) in research and project grants. The purpose of this manuscript is to highlight the evolution of pharmacy practice and pharmacy education in the United States through the presentation of exemplary cases of Community Pharmacy Foundation funding that is aligned with new care delivery models and approaches to the advancement of patient-centered pharmacy care. Pharmacy began in colonial America as the United States of America was just beginning to form with apothecary shops and druggists. Over time, the pharmacy industry would be revolutionized as America became urbanized, and drug products became commercially produced. The role of the pharmacist and their education evolved as direct patient care became a clear expectation of the general public. By the 1990s, the pharmacy profession had carved out a new path that focused on pharmacist-led, patient-centered pharmaceutical care and medication therapy management services. The Community Pharmacy Foundation grant funding has aligned with this evolution since its founding in 2000, and multiple exemplary grants are presented as support. As the role of pharmacists again transitions from a fee-for-service model to a value-based model, the Community Pharmacy Foundation continues to provide grant funding for research and projects that support the advancement of community pharmacy practice, education, and expanded training of pharmacists. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessBrief Report
Innovative Collaboration between a Medical Clinic and a Community Pharmacy: A Case Report
Received: 10 May 2019 / Revised: 3 June 2019 / Accepted: 11 June 2019 / Published: 14 June 2019
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Abstract
As value-based payments become more common in healthcare, providers can develop collaborative relationships to support performance. A medical clinic and community pharmacy worked together to deliver collaborative medication management services to targeted patients in an accountable care organization. The community pharmacy was paid [...] Read more.
As value-based payments become more common in healthcare, providers can develop collaborative relationships to support performance. A medical clinic and community pharmacy worked together to deliver collaborative medication management services to targeted patients in an accountable care organization. The community pharmacy was paid by the clinic to conduct comprehensive medication reviews (CMRs) for 116 patients. The CMRs initially were delivered to patients taking at least 10 medications and to patients rated as high cost/risk by the clinic. The most common medication-related problem types were Needs additional therapy (38.8%) and Suboptimal therapy (19.0%). The most common pharmacist actions were to Change medication (18.1%) and Initiate new therapy (13.8%). Financial analyses showed net savings in annual patient out-of-pocket expenses just over $15,000 for the cohort of patients, and net annual direct cost savings from a payer perspective of about $70,000. This innovative partnership between a medical clinic system and a regional pharmacy chain built upon initial discussions and planning. The partners were able to address problems that arose with their collaboration, changing their approach as needed. The outcomes were positive for the clinic and pharmacy, their patients and the payer(s). Interested providers are encouraged to pursue similar collaborations, which could be key to success in today’s healthcare environment. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessReview
The Prevalence of Unused Medications in Homes
Received: 24 February 2019 / Revised: 5 June 2019 / Accepted: 5 June 2019 / Published: 13 June 2019
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Abstract
The prevalence of unused medications in homes has dramatically increased in recent decades, which has resulted in medication wastage. The aim of this study is to review the prevalence of unused medications in homes and to determine the reasons behind this disuse, so [...] Read more.
The prevalence of unused medications in homes has dramatically increased in recent decades, which has resulted in medication wastage. The aim of this study is to review the prevalence of unused medications in homes and to determine the reasons behind this disuse, so as to help reduce such wastage. The review also sheds light on current methods of disposal of unwanted medications. Here, using a narrative review, we provide an overview of the issues of unused medications, medication wastage, and methods of disposal. We conducted an extensive literature search focusing on subject-related keywords, as given in the methods section below. A search was undertaken through indexing services available in the library of the authors’ institution. Full-text papers concerned with the prevalence of unused medications in homes, written in English language between 1992 and 2018, were retrieved and reviewed. Twenty-five related studies performed in different world regions were reviewed and included. The public, healthcare providers, and governments are all accused of promoting medication wastage in different ways, and thus, they need to be targeted to solve the problem. It was also noticed that the prevalence of unused medications is high in many countries. Non-steroidal anti-inflammatory drugs are among the most frequently wasted medications, and most of the public just dispose of their expired medications in the trash or toilet. Non-adherence, death, and medication change are among the main causes of medication accumulation and consequent wastage. A lack of policies to return unwanted medications in some countries, as well as public unawareness, carelessness, or illiteracy, are reasons for improper disposal of unused medications that may lead to adverse economic and environmental impacts. Various mitigation strategies (e.g., smart medicine cabinet) have emerged to reduce medication wastage. Joint work among the public, healthcare providers, and various governmental and private organizations is needed to adequately address the issue of medication wastage. Full article
(This article belongs to the Special Issue Medication Wastage)
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Open AccessCommentary
Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States
Received: 23 April 2019 / Revised: 1 June 2019 / Accepted: 6 June 2019 / Published: 13 June 2019
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Abstract
Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for [...] Read more.
Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for addiction treatment to help mitigate the opioid crisis. Objective: This commentary seeks to describe current and potential roles for pharmacists to combat the United States opioid crisis and identify key factors affecting service provision. Methods: The paper summarizes evidence-based studies describing current pharmacist roles and services, factors affecting service implementation, and strategies to further improve pharmacist roles and services related to promoting safe opioid use for patients. Results: Pharmacists recognize their roles and responsibilities to counsel patients on opioid risks, dispense naloxone, educate on opioid storage and disposal, utilize prescription drug monitoring programs (PDMPs), offer opioid deprescribing, and provide resources for addiction treatment. However, pharmacists express low confidence, time, and training as barriers to service provision. This suggests a need for structured training, resources, and organizational support for pharmacists to improve confidence and participation in such services. Conclusions: Although pharmacists are aware of roles and responsibilities to help reduce the opioid crisis, more training, education, organizational support and resources are needed to increase their ability to embody these roles. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
Systematic Analysis of the Service Process and the Legislative and Regulatory Environment for a Pharmacist-Provided Naltrexone Injection Service in Wisconsin
Received: 29 April 2019 / Revised: 31 May 2019 / Accepted: 6 June 2019 / Published: 12 June 2019
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Abstract
Community pharmacists are viewed by the public as convenient and trustworthy sources of healthcare and pharmacists likely can play a larger role in addressing the major public health issue of the opioid epidemic affecting Wisconsin residents. Approved medications, including long-acting injectable naltrexone, can [...] Read more.
Community pharmacists are viewed by the public as convenient and trustworthy sources of healthcare and pharmacists likely can play a larger role in addressing the major public health issue of the opioid epidemic affecting Wisconsin residents. Approved medications, including long-acting injectable naltrexone, can transform the treatment of individuals with opioid use disorder (OUD). Due to shortages of behavioral health providers in the U.S., and pharmacists’ knowledge about the safe use of medications, pharmacists can be a significant access point for treating OUD with naltrexone. Wisconsin’s pharmacy practice laws authorize pharmacists to administer medications via injection, and a small number of pharmacists currently are using this authority to provide a naltrexone injection service. This exploratory study had two objectives: (1) describe the pharmacist injection service process and identify barriers and facilitators to that service and (2) analyze the legislative/regulatory environment to ascertain support for expanding naltrexone injection service. Semi-structured pharmacist interviews (n = 4), and an analysis of Wisconsin statutes/regulations governing public health and social services, were undertaken to explore the objectives. Findings suggest that the service process requires considerable coordination and communication with practitioners, patients, and pharmacy staff, but many opportunities exist to broaden and sustain the service throughout Wisconsin. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessArticle
Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte
Received: 28 April 2019 / Revised: 28 May 2019 / Accepted: 6 June 2019 / Published: 12 June 2019
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Abstract
The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian [...] Read more.
The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)—use of five or more drugs—were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were ‘non-adherence’ (28.1%), ‘need for additional drug therapy’ (21.8%), and ‘low dose’ (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
Pharmacists’ Knowledge Regarding Drug Disposal in Karbala
Received: 26 March 2019 / Revised: 11 May 2019 / Accepted: 3 June 2019 / Published: 10 June 2019
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Abstract
Background: Consumers and caregivers should remove expired, or unwanted, medications to minimize the chance for misuse or accidentally using those medicines. This study investigated pharmacists’ knowledge regarding drug disposal in Karbala, Iraq. Methods: This study was a cross-sectional survey among pharmacists [...] Read more.
Background: Consumers and caregivers should remove expired, or unwanted, medications to minimize the chance for misuse or accidentally using those medicines. This study investigated pharmacists’ knowledge regarding drug disposal in Karbala, Iraq. Methods: This study was a cross-sectional survey among pharmacists in Karbala. It was performed from December 2018 until January 2019. A standardized, 12-item, self-administered questionnaire was designed, developed and validated to assess pharmacists’ knowledge when generating pharmaceutical waste in pharmacies. Results: One hundred twenty-nine participants enrolled in the study. The mean age of participants was 33 ± 9.3 years—more than two-thirds (65.9%)—agreed that the return of medications to the source would be appropriate drug disposal. A good proportion of participants agreed with disposing of drugs in the trash. Further, 63.6% believe that education is the main barrier opposing the implementation of a medicine–take–back program in Iraq. Conclusion: Pharmacists had relatively poor knowledge regarding drug disposal methods. Health care providers (not only pharmacists) need educational courses and workshops to improve their knowledge regarding medication disposal in Iraq. Full article
(This article belongs to the Special Issue Medication Wastage)
Open AccessArticle
Process Evaluation of the Community Pharmacist-Led Allergic Rhinitis Management (C-PhARM) Service in Singapore
Received: 29 April 2019 / Revised: 26 May 2019 / Accepted: 5 June 2019 / Published: 7 June 2019
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Abstract
A community pharmacist-led allergic rhinitis management (C-PhARM) service involving structured patient assessment, individualised recommendations and follow-up was developed in Watson’s Personal Care Stores Pte Ltd (Singapore) to ensure optimal allergic rhinitis (AR) self-management and appropriate use of intranasal corticosteroids (INC) in Singapore. This [...] Read more.
A community pharmacist-led allergic rhinitis management (C-PhARM) service involving structured patient assessment, individualised recommendations and follow-up was developed in Watson’s Personal Care Stores Pte Ltd (Singapore) to ensure optimal allergic rhinitis (AR) self-management and appropriate use of intranasal corticosteroids (INC) in Singapore. This retrospective study aimed to evaluate the C-PhARM service processes and identify areas for improving the quality of service. Relevant data was extracted from archived clinical forms, customer satisfaction surveys and pharmacist quality improvement surveys to evaluate the “reach”, “recruitment”, “context” and “fidelity” of service implementation, as well as the “intervention delivered” and “received”. Over the nine months since the launch of the C-PhARM service in April 2016, 45 customers were enrolled, and 32 (71.1%) customers had received at least one follow-up. Recommendations provided at baseline included oral antihistamines (32, 71.1%), INC sprays (28, 62.2%) and counselling on non-pharmacological strategies (27, 60.0%). Among the 29 customers who exited the service, 20 (69%) responded to a satisfaction survey. Although customers deemed pharmacists to be professional and knowledgeable in providing clear and detailed information about AR, pharmacists reported a lack of protected time and interest from customers as service barriers. Sufficient protected time is required for pharmacists to effectively provide clinical service in a community pharmacy. Full article
(This article belongs to the Section Clinical Pharmacy)
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Open AccessArticle
Prevalence and Duration of Use of Medicines Recommended for Short-Term Use in Aged Care Facility Residents
Received: 21 May 2019 / Revised: 4 June 2019 / Accepted: 5 June 2019 / Published: 6 June 2019
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Abstract
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications [...] Read more.
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. Methods: Australian Government Department of Veterans’ Affairs (DVA) administrative claims data were used for this study. Veterans eligible for all health services subsidised by DVA were followed for one year from 1 July 2015 to 30 June 2016. The number of days covered for each medicine was calculated by multiplying the number of prescriptions dispensed during the year by the pack duration for the medicine. The pack duration was calculated by dividing the quantity supplied at each dispensing by the usual number of doses per day in older people according to Australian prescribing guidelines. The proportion of patients using each medicine and the number of days covered during the study period were determined. Results: 14, 237 residents met the inclusion criteria. One in five participants were dispensed antipsychotics, and the median duration of use was 180 days in the one-year period. More than one-third were dispensed a benzodiazepine, and the median duration of use was 240 days in the year. Half were dispensed an opioid analgesic with a median duration of use of 225 days in the year. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. A quarter received an antibiotic recommended for the management of urinary tract infection, with a median duration of use of 14 days in the year. Conclusion: Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm. Full article
(This article belongs to the Special Issue Quality Use of Medicine in Aged Care Homes)
Open AccessPerspective
The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives
Received: 5 April 2019 / Revised: 21 May 2019 / Accepted: 21 May 2019 / Published: 5 June 2019
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Abstract
The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and [...] Read more.
The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession’s role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists’ roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists’ roles have had a significant positive cost-effective impact on the population’s health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans. Full article
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Open AccessCommentary
The International Pharmacists-as-Immunizers Partnership (IPIP)—Advancing Research on Pharmacist-Administered Immunizations Worldwide
Received: 15 April 2019 / Revised: 23 May 2019 / Accepted: 30 May 2019 / Published: 4 June 2019
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Abstract
This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada [...] Read more.
This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada to discuss published and in-progress research on the topic, identify gaps and priorities for future research, and share implementation strategies used in different jurisdictions. Twelve researchers from five countries attended this initial meeting, identified from both personal networks and from authorship lists from published research. Small- and large-group discussions addressed a number of themes, including: clinical, economic and educational outcomes of the service; the perspectives of pharmacists, patients, and other health professionals; operational and policy factors influencing uptake; safety; and the immunizing pharmacist’s role in disaster preparedness. Feedback on our first meeting and outcomes achieved were evaluated on the basis of participant feedback. Key components of the meeting that were considered successful and important lessons learned are summarized, so that other like-minded researchers with a shared pharmacy practice research interest could consider leveraging funding opportunities to establish other international pharmacy practice research networks. Full article
(This article belongs to the Special Issue Pharmacy Practice-based Research Networks)
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Open AccessArticle
Perceptions of UK Community Pharmacists on Current Consultation Skills and Motivational Interviewing as a Consultation Approach: A Qualitative Study
Received: 30 April 2019 / Accepted: 30 April 2019 / Published: 31 May 2019
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Abstract
Objectives: Community pharmacists’ roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists’ views on their current communication skills in pharmacist-patient facing [...] Read more.
Objectives: Community pharmacists’ roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists’ views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30–60 minutes in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges. Full article
Open AccessArticle
A Study to Identify Medication-Related Problems and Associated Cost Avoidance by Community Pharmacists during a Comprehensive Medication Review in Patients One Week Post Hospitalization
Received: 29 April 2019 / Revised: 21 May 2019 / Accepted: 22 May 2019 / Published: 29 May 2019
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Abstract
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community [...] Read more.
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients’ medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessReview
Fulfilling Educational Competencies through Global Pharmacy Experiences
Received: 25 April 2019 / Revised: 9 May 2019 / Accepted: 14 May 2019 / Published: 26 May 2019
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Abstract
Many Colleges of Pharmacy in the United States offer international education and practice experiences to their students. Multiple publications have described these offerings and related them back to the CAPE 2013 Outcomes. This article describes the multiple international programs offered by one College [...] Read more.
Many Colleges of Pharmacy in the United States offer international education and practice experiences to their students. Multiple publications have described these offerings and related them back to the CAPE 2013 Outcomes. This article describes the multiple international programs offered by one College of Pharmacy, including international Advanced Pharmacy Practice Experiences, Short Study Abroad Programs, and International Health Outreach Trips. The article also details the relevant competencies associated with these international experiences. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and Beyond)
Open AccessDiscussion
Deprescribing: Fashion Accessory or Fig Leaf?
Received: 30 March 2019 / Revised: 15 May 2019 / Accepted: 17 May 2019 / Published: 23 May 2019
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Abstract
Deprescribing is the general practice fashion accessory that no prescriber can be seen without. However, it is in danger of becoming a “fig leaf” substitute for the entire medication review suite. Full article
(This article belongs to the Special Issue Deprescribing of Problematic Polypharmacy)
Open AccessArticle
A Qualitative Study on Danish Student Pharmacists’ Attitudes Towards and Experience of Communication Skills Training
Received: 27 March 2019 / Revised: 26 April 2019 / Accepted: 16 May 2019 / Published: 21 May 2019
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Abstract
As the pharmacy profession evolves, good communication skills are vital for securing the safer and more rational use of medicines. Currently there is a lack of qualitative studies researching European student pharmacists’ and their experience with communication skills training (CST). This qualitative study [...] Read more.
As the pharmacy profession evolves, good communication skills are vital for securing the safer and more rational use of medicines. Currently there is a lack of qualitative studies researching European student pharmacists’ and their experience with communication skills training (CST). This qualitative study aimed to fill this gap by exploring Danish student pharmacists’ attitudes towards, and experiences of, CST. Focus group interviews were conducted with a heterogeneous sample of Danish student pharmacists in 2016. Interviews were audio recorded, transcribed verbatim and analyzed inductively. Fifteen students participated in three focus groups. Five categories identified as key aspects were: professional communication vs. normal conversation, motivation to engage in training, how to learn communication skills, experience with CST and universities’ role in teaching communication skills. In conclusion, there were both positive and negative attitudes towards CST among the participants. However, they had little experience with CST. Bloom’s taxonomy of the affective domain and Kolb’s experiential learning model appear to be useful in understanding students’ attitudes towards CST. Pharmacy educators can use this study to structure and improve their CST curricula by knowing what influences students’ attitudes towards CST. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and Beyond)
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Open AccessCommentary
Preparing Pharmacists for Collaborative/Integrated Health Settings
Received: 24 April 2019 / Revised: 14 May 2019 / Accepted: 16 May 2019 / Published: 20 May 2019
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Abstract
Pharmacy practice is changing to accommodate the need for pharmacists to be better team members in newly emerging collaborative care and integrated health systems. Pharmacy schools could lead this change by educating students to be effective participants in these relatively new models of [...] Read more.
Pharmacy practice is changing to accommodate the need for pharmacists to be better team members in newly emerging collaborative care and integrated health systems. Pharmacy schools could lead this change by educating students to be effective participants in these relatively new models of care. Schools are encouraged to follow the approach outlined in the recent guidance published by the Health Professions Accreditors Collaborative (HPAC) for interprofessional practice and education (“the new IPE”). This approach includes articulating an IPE plan, establishing goals, assessing student achievement of the necessary IPE competencies, developing educational plans that are multi-faceted and longitudinal, and modifying the existing assessment/evaluation process to ensure the quality of the IPE effort. These curricular decisions should be based on existing and new research on the effectiveness of IPE on student’s attitudes, knowledge, skills, and behavior. A key decision is how to create effective interactions between pharmacy students and those of other professions. Educational emphasis should be directed toward team building skills, not just individual competencies. The pharmacy faculty probably need to enhance their teaching abilities to accommodate this change, such as learning new technology (e.g., simulations, managing online exchanges) and demonstrating a willingness to teach students from other professions. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
Gender and Age Variations in Pharmacists’ Job Satisfaction in the United States
Received: 26 April 2019 / Revised: 10 May 2019 / Accepted: 13 May 2019 / Published: 17 May 2019
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Abstract
While several studies have attested the presence of systematic gender and age variations in pharmacists’ satisfaction with their jobs, only a few of them have considered both classifications simultaneously. None have done so while systematically examining multiple facets of practitioners’ work. This article [...] Read more.
While several studies have attested the presence of systematic gender and age variations in pharmacists’ satisfaction with their jobs, only a few of them have considered both classifications simultaneously. None have done so while systematically examining multiple facets of practitioners’ work. This article estimated U.S. pharmacists’ satisfaction levels with various facets of their work, compared them simultaneously between genders and among age groups, and tested for the presence of gender–age interaction effects. The study was based on self-reported survey data collected from 701 pharmacists (31.0% response rate). Mean and standard deviation values for 18 indices related to pharmacists’ work were calculated. When age groups were controlled, female pharmacists expressed overall higher levels of satisfaction with their job than male pharmacists; they also expressed greater satisfaction with multiple specific facets and with the profession, as well as greater workload and stress than male pharmacists. The findings revealed few significant differences among age groups and a limited gender–age interaction effect for pharmacists’ satisfaction with key facets of their work. These findings should contribute to the development and refinement of rational criteria for increasing sources of satisfaction in pharmacy settings. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
Analysis of Disposed Unused Medications at a Village Community Pharmacy
Received: 1 April 2019 / Revised: 28 April 2019 / Accepted: 30 April 2019 / Published: 12 May 2019
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Abstract
Background: The aim of this study was to determine the type, quantity, and cost of medications being disposed of by clients in a specifically-set pharmaceutical disposal bin at a village community pharmacy. Methods: Medicines placed in a medication disposal bin by clients were [...] Read more.
Background: The aim of this study was to determine the type, quantity, and cost of medications being disposed of by clients in a specifically-set pharmaceutical disposal bin at a village community pharmacy. Methods: Medicines placed in a medication disposal bin by clients were examined during a nine-month period from April to December 2018. The data recorded included the active ingredient, trade name, dose, dosage form, disposed quantity, and the actual expiry date on the pack. The medications were classified according to ATC (Anatomical Therapeutic Chemical Classification System) code, and the cost of the amount wasted was calculated using the pharmacy’s price list. Descriptive statistics were used to analyze the data. Results: A total of 411 medications were collected, amounting to a total cost of approximately €2600. The largest group of medications belonged to the alimentary group, and this also represented the group with the highest monetary value. The number of months that medicinal products were retained by patients beyond the expiry date ranged from 1 to 232. Conclusion: This small study provides a glimpse of what clients dispose of in a medication bin when this is readily available in their community pharmacy, a simple measure which, if adopted on a national level, could aid in ensuring the appropriate disposal of wasted medication. Full article
(This article belongs to the Special Issue Medication Wastage)
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Open AccessArticle
Impact of Dispensing Services in an Independent Community Pharmacy
Received: 27 March 2019 / Revised: 2 May 2019 / Accepted: 7 May 2019 / Published: 10 May 2019
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Abstract
With approximately 300 prescriptions dispensed per day in a typical community pharmacy, several activities take place to ensure the safe dispensing of medicines. While some of these activities are common for all prescriptions, others need further activities such as prescription clarification. These activities [...] Read more.
With approximately 300 prescriptions dispensed per day in a typical community pharmacy, several activities take place to ensure the safe dispensing of medicines. While some of these activities are common for all prescriptions, others need further activities such as prescription clarification. These activities are important to avoid any potential harm to the patient and improve medication adherence. The objective of this study was to measure the impact of these additional dispensing services in a community pharmacy by evaluating the documented patient notes. Two-hundred patients with annotations on their profiles between 1 July and 31 August 2018 were randomly selected and 322 notes were analyzed. The average number of notes per patient was 1.6. The majority of the notes were about contacting the patient/caregiver for prescription clarification (86.8%). When analyzed based on Medication Therapy Problems, 54.7% were related to adherence and 35.4% to safety. Using the cost saving estimate from the literature for each averted adverse event, these activities resulted in a minimum cost saving of $10,458. This study was able to show the positive impacts that everyday dispensing services in an independent community pharmacy have on ensuring the safe use of medication, thus potentially preventing adverse drug events and reducing health care costs. Full article
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