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Pharmacy, Volume 7, Issue 3 (September 2019)

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Open AccessArticle
Development of Pharmacist Independent Prescribing Clinics to Treat Opioid Analgesic Dependence in NHS Lanarkshire
Pharmacy 2019, 7(3), 119; https://doi.org/10.3390/pharmacy7030119 (registering DOI)
Received: 22 March 2019 / Revised: 7 August 2019 / Accepted: 9 August 2019 / Published: 22 August 2019
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Abstract
There has been an increase in opioid analgesic prescribing in general practice (GP). This is causing some concern around this contributing to dependency. NHS Lanarkshire have attempted to reduce the prescribing from GP surgeries through the development of specialised Pharmacist Independent Prescriber clinics [...] Read more.
There has been an increase in opioid analgesic prescribing in general practice (GP). This is causing some concern around this contributing to dependency. NHS Lanarkshire have attempted to reduce the prescribing from GP surgeries through the development of specialised Pharmacist Independent Prescriber clinics being delivered from the practices. This article looks at the development of these services with pharmacist independent prescribers and the results from developing the services. The article aims to provide advice and recommendations for the development of other services and strategies to minimise the risks associated with Opioid Analgesic Dependence for patients. Full article
(This article belongs to the Special Issue Misuse and Abuse of Medicines)
Open AccessArticle
Stakeholder-Guided Formation of a Statewide Community Pharmacy Practice-Based Research Network
Pharmacy 2019, 7(3), 118; https://doi.org/10.3390/pharmacy7030118
Received: 28 June 2019 / Revised: 1 August 2019 / Accepted: 8 August 2019 / Published: 17 August 2019
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Abstract
Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to [...] Read more.
Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to develop a practice-based research network (PBRN) in partnership with existing CINs to perform robust outcome evaluations. The objective of this study was to learn pharmacists’ opinions on participating in research to facilitate the formation of a community pharmacy PBRN in Pennsylvania. A 20-item survey gathered information on pharmacists’ research interests, perceived benefits of research participation, and preferences on communication and patient engagement. Descriptive statistics and Chi-square tests were used to analyze quantitative data. Seventy-three participants completed the survey, with 47% representing independent pharmacies. The majority (96%) were interested in research opportunities and 86% believed improving workflow and patient care was the most valuable benefit. Eighty percent of pharmacists reported it is very important to demonstrate that pharmacists care about making patients’ health better. Connecting pharmacists with other health care providers was reported as very important by 75% of respondents. Pharmacists reported face-to-face communication (76%) as their preferred way to approach patients about research and 72% supported using student pharmacists to assist with patient engagement. The results from this study can inform others who are structuring processes and developing communication strategies for community pharmacy PBRNs, particularly in partnership with CINs. Full article
(This article belongs to the Special Issue Pharmacy Practice-based Research Networks)
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Open AccessArticle
Impact of Completion of a Pre-Pharmacy Biochemistry Course and Competency Levels in Pre-Pharmacy Courses on Pharmacy Student Performance
Pharmacy 2019, 7(3), 117; https://doi.org/10.3390/pharmacy7030117
Received: 29 June 2019 / Revised: 1 August 2019 / Accepted: 8 August 2019 / Published: 16 August 2019
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Abstract
Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal [...] Read more.
Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal of the current study was to determine whether completion of a pre-pharmacy biochemistry course and/or performance on a biochemistry competency test (administered at the beginning of the pharmacy program) are associated with pharmacy student performance in foundational science courses and overall academic performance. A secondary goal was to determine whether performance in pre-pharmacy courses and/or student demographics are associated with pharmacy student performance. Prospective univariate analyses (n = 75) determined that completion of a pre-pharmacy biochemistry course is not associated with pharmacy student performance. However, performance on a biochemistry competency test was associated with performance in Biochemistry and Cell&Molecular Biology (p = 0.002). Furthermore, post-hoc analyses determined that pre-pharmacy cumulative chemistry GPA correlates with performance in both the Biochemistry and Cell&Molecular Biology and Medicinal Chemistry foundational science courses (p = 0.002 and p = 0.04, respectively) and can predict first year GPA (p = 0.002). The combined data indicate that further assessment of the impact of pre-pharmacy competency in biochemistry and chemistry on pharmacy student success is warranted. Full article
(This article belongs to the Section Pharmacy Education and Student / Practitioner Training)
Open AccessConcept Paper
Exploring the Implications of a Needs-Based Pharmacy Education Framework Modelled on Population Health: Perspective from a Developing Country
Pharmacy 2019, 7(3), 116; https://doi.org/10.3390/pharmacy7030116
Received: 31 May 2019 / Revised: 16 July 2019 / Accepted: 22 July 2019 / Published: 14 August 2019
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Abstract
Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource [...] Read more.
Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized. An evaluation framework to determine the pharmacy school’s effectiveness in strengthening the health system could be applied. A needs-based pharmacy educational approach modeled on population health could: Integrate resources from education, service, and research activities; follow a monitoring and evaluation framework that tracks educational outcomes; and engage with external stakeholders in curricular development and assessment. Full article
(This article belongs to the Section Pharmacy Education and Student / Practitioner Training)
Open AccessArticle
Impact of the 2016 Policy Change on the Delivery of MedsCheck Services in Ontario: An Interrupted Time-Series Analysis
Pharmacy 2019, 7(3), 115; https://doi.org/10.3390/pharmacy7030115
Received: 1 June 2019 / Revised: 1 August 2019 / Accepted: 6 August 2019 / Published: 12 August 2019
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Abstract
MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound [...] Read more.
MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound patients (MCH), and residents of long-term care homes (MCLTC). The Ontario government introduced an abrupt policy change effective 1 October 2016 that added several components to all MC services, especially those completed in the community. We used an interrupted time series design to examine the impact of the policy change (24 months pre- and post-intervention) on the monthly number of MedsCheck services delivered. Immediate declines in all services were identified, especially in the community (47%–64% drop MC, 71%–83% drop MCD, 55% drop MCH, and 9%–14% drop MCLTC). Gradual increases were seen over 24 months post-policy change, yet remained 21%–76% lower than predicted for MedsCheck services delivered in the community, especially for MCD. In contrast, MCLTC services were similar or exceeded predicted values by September 2018 (from 5.1% decrease to 3.5% increase). A more effective implementation of health policy changes is needed to ensure the feasibility and sustainability of professional community pharmacy services. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessArticle
Clinical Care Pharmacists in Urgent Care in North East England: A Qualitative Study of Experiences after Implementation
Pharmacy 2019, 7(3), 114; https://doi.org/10.3390/pharmacy7030114
Received: 2 July 2019 / Revised: 22 July 2019 / Accepted: 8 August 2019 / Published: 9 August 2019
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Abstract
Our objective was to explore the implementation of a novel NHS England (NHSE)-funded pilot project aimed at deploying clinical pharmacists in an integrated urgent care (IUC) setting including the NHS 111 service. Eight integrated urgent care clinical pharmacists (IUCCPs) within the participating North [...] Read more.
Our objective was to explore the implementation of a novel NHS England (NHSE)-funded pilot project aimed at deploying clinical pharmacists in an integrated urgent care (IUC) setting including the NHS 111 service. Eight integrated urgent care clinical pharmacists (IUCCPs) within the participating North East of England Trusts. Individuals participated in semi-structured 1-to-1 interviews by an experienced qualitative researcher, either face-to-face or via the telephone. Each recording was transcribed, and the five stages of framework analysis (familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation) took place to establish emerging themes. All interviews took place between November 2018–February 2019. Four higher-order themes were identified: 1. Personality Traits, 2. Integration, 3. Benefits, 4. Training. The IUCCP programme is an innovative NHSE initiative. It provides an opportunity to extend the role of clinical pharmacists into the hard-pressed clinical environment of urgent and emergency care. Our evaluation has highlighted the potential for this professional group to contribute clinically in this area. Better communications, standard operating procedures and induction will improve how individuals develop in these novel roles. Full article
Open AccessArticle
Training and Toolkit Resources to Support Implementation of a Community Pharmacy Fall Prevention Service
Pharmacy 2019, 7(3), 113; https://doi.org/10.3390/pharmacy7030113
Received: 28 June 2019 / Revised: 5 August 2019 / Accepted: 7 August 2019 / Published: 9 August 2019
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Abstract
Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, [...] Read more.
Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow. Full article
(This article belongs to the Special Issue Pharmacist Services in Community Pharmacies)
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Open AccessReview
Antimicrobial Desensitization: A Review of Published Protocols
Pharmacy 2019, 7(3), 112; https://doi.org/10.3390/pharmacy7030112
Received: 9 July 2019 / Revised: 5 August 2019 / Accepted: 7 August 2019 / Published: 9 August 2019
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Abstract
Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs [...] Read more.
Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
Open AccessArticle
A Cross-Sectional Investigation for Verification of Globalization of Falsified Medicines in Cambodia, Indicated by Tablets of Sildenafil Citrate
Pharmacy 2019, 7(3), 111; https://doi.org/10.3390/pharmacy7030111
Received: 20 June 2019 / Revised: 6 August 2019 / Accepted: 8 August 2019 / Published: 9 August 2019
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Abstract
Medicine falsification is a global issue. Viagra, an erectile dysfunction therapeutic (EDT) medicine consisting primarily of sildenafil citrate, is the most commonly falsified medicine worldwide. Recently falsified EDTs have been reported multiple times in developing countries. The globalization of falsified EDTs has become [...] Read more.
Medicine falsification is a global issue. Viagra, an erectile dysfunction therapeutic (EDT) medicine consisting primarily of sildenafil citrate, is the most commonly falsified medicine worldwide. Recently falsified EDTs have been reported multiple times in developing countries. The globalization of falsified EDTs has become a concern. In the present study, we selected sildenafil citrate tablets as an indicator and examined samples from a developing country, Cambodia, to investigate the availability of falsified sildenafil tablets in Cambodia and verify the current globalization status of falsified medicines from the standpoint of a developing country. Six samples of the originator Viagra, and 68 samples of generic sildenafil products were purchased from private drug outlets and wholesalers in Phnom Penh, Svay Rieng, and Battambang. The samples’ manufacturers were contacted to authenticate the samples. The quantities and dissolution rates of active ingredients were measured by a high-performance liquid chromatography system with photodiode array. Five generic samples were strongly suspected to be falsified medicines because of their extremely low quality; however, there was little distribution and no falsified medicine alleged to be produced by the originator of Viagra, which charges high prices. That finding indicates that falsification reflects local economic circumstances. Full article
(This article belongs to the Section Clinical Pharmacy)
Open AccessReview
Overview and Insights into Carbapenem Allergy
Pharmacy 2019, 7(3), 110; https://doi.org/10.3390/pharmacy7030110
Received: 26 June 2019 / Revised: 31 July 2019 / Accepted: 5 August 2019 / Published: 8 August 2019
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Abstract
Understanding antibiotic allergies and the risk of cross-sensitivity between and within antibiotic classes can have a substantial impact on patient care. The purpose of this review article is to provide insight into carbapenem allergies, describing the overall incidence, risk factors, and in-class cross-sensitivity. [...] Read more.
Understanding antibiotic allergies and the risk of cross-sensitivity between and within antibiotic classes can have a substantial impact on patient care. The purpose of this review article is to provide insight into carbapenem allergies, describing the overall incidence, risk factors, and in-class cross-sensitivity. A PubMed search was conducted using the following search terms: carbapenem, allergy, cross-sensitivity, incidence, imipenem/cilastatin, meropenem, ertapenem, and doripenem. Article bibliographies and relevant drug monographs were also reviewed. The overall reported incidence of carbapenem allergy is 0.3%–3.7%. Risk of cross-sensitivity between penicillins and carbapenems is less than 1% in patients with a positive penicillin skin test. Data on cross-sensitivity between cephalosporins and carbapenems are limited; however, the risk appears to also be low. No clinical studies have described cross-sensitivity between the carbapenem agents thus far. The limited data available from case reports demonstrates a lack of cross-sensitivity between the individual carbapenems, suggesting that an alternative carbapenem may cautiously be used in patients with a reported carbapenem allergy. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
Open AccessArticle
Financial Incentive Required for Pharmacy Students to Accept a Post-Graduation Position in Rural and Undesirable Pharmacy Settings
Pharmacy 2019, 7(3), 109; https://doi.org/10.3390/pharmacy7030109
Received: 31 May 2019 / Revised: 2 July 2019 / Accepted: 31 July 2019 / Published: 6 August 2019
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Abstract
Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. [...] Read more.
Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. Measures of interest included: subject characteristics and preference in a variety job offers. Discrete Choice Experiment methodology of questionnaire design was used and Conditional Logit models were conducted to analyze the data to determine the financial incentive required for pharmacy students to take a post-graduate job with particular traits. Conclusions: A total of 283 students completed questionnaires from Iowa, North Dakota, South Dakota, Saskatchewan, and Manitoba. The majority of subjects were female, P3 students, and from a non-rural hometown. American students would need to be paid an additional $18,738 in salary to practice in a rural area, while Canadian students would require an additional $17,156. Canadian respondents would require an additional $7125 in salary to work in a community pharmacy with a low level of patient interaction compared to a community position with a large amount of patient interaction. Overall, pharmacy student preferences in post-graduation job attributes vary significantly between states and provinces. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and beyond)
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Open AccessArticle
The Creation of a Practice-Based Network of Pharmacists Working in Family Medicine Groups (FMG)
Pharmacy 2019, 7(3), 108; https://doi.org/10.3390/pharmacy7030108
Received: 10 July 2019 / Revised: 31 July 2019 / Accepted: 2 August 2019 / Published: 5 August 2019
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Abstract
A needs assessment study of pharmacists working in family medicine groups (FMG) demonstrated the necessity to build a practice-based network. This network would foster a faster integration into FMG and a more efficient collaborative practice. It would also take advantage of an existing [...] Read more.
A needs assessment study of pharmacists working in family medicine groups (FMG) demonstrated the necessity to build a practice-based network. This network would foster a faster integration into FMG and a more efficient collaborative practice. It would also take advantage of an existing practice-based research network (PBRN)—the STAT (Soutien Technologique pour l’Application et le Transfert des pratiques novatrices en pharmacie) network. A working group of nine FMG pharmacists from the different regions of the province of Quebec, Canada, and a committee of partners, including the key pharmacy organizations, were created. Between January 2018 and May 2019, nine meetings took place to discuss the needs assessment results and deploy an action plan. The practice-based network first year activities allowed identifying pharmacists working in FMGs across the province. A directory of these pharmacists was published on the STAT network. The vision, mission, mandate, name («Réseau Québécois des Pharmaciens GMF») and logo were developed. The first few activities include: Bi-monthly newsletters; a mentorship program; short evidence-based therapeutic letters (pharmacotherapeutic capsules) and a start-up kit to facilitate integration of these pharmacists. The Quebec FMG pharmacist practice-based network has been launched. It is planned to evaluate the members’ satisfaction in late Spring 2020 with regards to activities and resources provided. Full article
(This article belongs to the Special Issue Pharmacy Practice-based Research Networks)
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Open AccessReview
A Review of Guidelines/Guidance from Various Countries Around the World for the Prevention and Management of Travellers’ Diarrhoea: A Pharmacist’s Perspective
Pharmacy 2019, 7(3), 107; https://doi.org/10.3390/pharmacy7030107
Received: 17 April 2019 / Revised: 20 June 2019 / Accepted: 23 July 2019 / Published: 4 August 2019
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Abstract
International travel is growing and pharmacists are well placed to provide travel health services for the prevention and management of travellers’ diarrhoea (TD). Legislation changes in many countries has enabled pharmacists to access prescription only medicines and vaccinations to provide advice and over [...] Read more.
International travel is growing and pharmacists are well placed to provide travel health services for the prevention and management of travellers’ diarrhoea (TD). Legislation changes in many countries has enabled pharmacists to access prescription only medicines and vaccinations to provide advice and over the counter medicines for the prevention and management for travel health services; this makes sense since pharmacies are easily accessible to the public and are the patient’s first port of call in the event of any illness. Currently, whilst many guidelines/guidance exist worldwide for the prevention and management of TD, there is no review that focuses on similarities and differences between these and between guidelines on TD and travel related and non-travel related acute diarrhoea. There is also a lack of publication on legislation and the need for evidence based training for all prescribers to provide travel health services. The aims of this work were to review guidelines/guidance for the prevention and management of TD from across the world which were compared with each other as were the TD guidelines compared to that for travel related and non-travel related acute diarrhoea for similarities and differences, with a focus on any relevant pharmacy legislation, needs assessments and training that may impact upon provision of travel health services by pharmacists focusing mainly on TD in adults. The PubMed, Google Scholar and Cochrane database were used to carry out an online search for publications on TD, acute diarrhoea and the guidance pharmacists have in the prevention and management of diarrhoea. The literature reviewed in this article indicates that where no specific guidelines/guidance existed, some pharmacists used the WHO guidelines (WHO), highlighting a need for local, regional and national evidence based guidelines in these countries. Full article
(This article belongs to the Special Issue Travel Medicine - Series Ⅱ)
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Open AccessReview
Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States
Pharmacy 2019, 7(3), 106; https://doi.org/10.3390/pharmacy7030106
Received: 1 June 2019 / Revised: 29 July 2019 / Accepted: 31 July 2019 / Published: 4 August 2019
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Abstract
Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy [...] Read more.
Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy to provide care to patients where they need it. Pharmacists involved in this transition are community-based pharmacist practitioners who are primarily involved in leading and advancing team-based patient care services in communities to improve the patient health. This paper will review community-based pharmacy practice innovations and the role of the community-based pharmacist practitioner in the United States. Full article
(This article belongs to the Special Issue Pharmacist Services)
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Open AccessArticle
Deprescribing of Medicines in Care Homes—A Five-Year Evaluation of Primary Care Pharmacist Practices
Pharmacy 2019, 7(3), 105; https://doi.org/10.3390/pharmacy7030105
Received: 6 May 2019 / Revised: 24 July 2019 / Accepted: 1 August 2019 / Published: 3 August 2019
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Abstract
(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. [...] Read more.
(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines. Full article
(This article belongs to the Special Issue Optimising Medicines in Care Homes)
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Open AccessReview
Tetracycline Allergy
Pharmacy 2019, 7(3), 104; https://doi.org/10.3390/pharmacy7030104
Received: 29 June 2019 / Revised: 25 July 2019 / Accepted: 30 July 2019 / Published: 3 August 2019
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Abstract
Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated [...] Read more.
Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated tetracycline analogs, minocycline was attributed to the greatest overall number and severity of serious adverse events reported in the literature, with notable reactions primarily reported as respiratory and dermatologic in nature. Reactions to tetracycline have also been well described in the literature, and although dermatologic reactions are typically less severe in comparison with minocycline and doxycycline, various reports of anaphylactic reactions exist. Although doxycycline has been noted to have had the fewest reports of severe allergic reactions, rare descriptions of life-threatening reactions are still reported in the literature. Allergic reactions regarding tetracyclines are rare; however, adverse reaction type, severity, and frequency among different tetracycline analogs is somewhat variable. A consideration of hypersensitivity and adverse reaction incidence should be performed prior to the selection of individual tetracycline entities. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
Open AccessReview
Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity
Pharmacy 2019, 7(3), 103; https://doi.org/10.3390/pharmacy7030103
Received: 27 June 2019 / Revised: 24 July 2019 / Accepted: 26 July 2019 / Published: 29 July 2019
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Abstract
Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite [...] Read more.
Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
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Open AccessReview
Adverse Drug Reactions in Norway: A Systematic Review
Pharmacy 2019, 7(3), 102; https://doi.org/10.3390/pharmacy7030102
Received: 28 June 2019 / Revised: 20 July 2019 / Accepted: 22 July 2019 / Published: 25 July 2019
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Abstract
Prescription medicines aim to relieve patients’ suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important cause of hospital admissions and a financial burden on healthcare systems across the globe. There is little integrative [...] Read more.
Prescription medicines aim to relieve patients’ suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important cause of hospital admissions and a financial burden on healthcare systems across the globe. There is little integrative and collective knowledge on ADR reporting and monitoring in the Norwegian healthcare system. Accordingly, this systematic review aims to investigate the current trends in ADR reporting, monitoring, and handling in the Norwegian healthcare system and describe related interventions. Appropriate keywords, with regard to ADRs in both English and Norwegian languages, were used to retrieve articles published from 2010 to 2019. Six articles met the inclusion criteria. The findings offer a comprehensive picture of ADR reporting and monitoring in the Norwegian healthcare system. Psychotropic medicines were most commonly implicated by patients, while professionals most commonly reported ADRs associated with anticoagulants. The current ADR systems were compiled with the involvement of both patients and healthcare providers to record all types of drugs and ADRs of various severities, and aimed at improving ADR tracking. However, there is a need to improve current initiatives in terms of feedback and quality, and more studies are needed to explore how ADR profiles, and the associated vigilance, can improve the safety of medicines management in Norway. Full article
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Open AccessCommunication
Person-Centred Care Including Deprescribing for Older People
Pharmacy 2019, 7(3), 101; https://doi.org/10.3390/pharmacy7030101
Received: 24 May 2019 / Revised: 10 July 2019 / Accepted: 16 July 2019 / Published: 25 July 2019
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Abstract
There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, [...] Read more.
There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies. Full article
(This article belongs to the Special Issue Deprescribing of Problematic Polypharmacy)
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Open AccessArticle
Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines
Pharmacy 2019, 7(3), 100; https://doi.org/10.3390/pharmacy7030100
Received: 11 June 2019 / Revised: 1 July 2019 / Accepted: 15 July 2019 / Published: 22 July 2019
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Abstract
Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s [...] Read more.
Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s dementia for a maximum twelve-week duration. We aimed to determine whether the rate and duration of risperidone use for BPSD decreased following the regulatory changes. Methods: we conducted a study using the Australian Government Department of Veterans’ Affairs administrative claims data and Pharmaceutical Benefits Scheme (PBS) 10% sample data. We included people aged 65 years or older and compared the rate and duration of risperidone use before and after the TGA labelling changes. Results: There was a sustained decrease in the trend of risperidone use for BPSD following the TGA labelling changes, with a monthly decrease of 1.7% in the aged care population, 0.5% in the community living population and 1.5% in the general older Australian population. Overall, in the 24 months post the TGA changes the reduction in the rate of use of risperidone ranged from 20% to 28% lower than compared to what the rate would have been without the TGA changes. The median duration of use of risperidone in aged-care residents decreased from 338 days in the year prior to the TGA labelling changes, to 240 days per person in the year after the changes. Conclusion: The TGA labelling changes were associated with a significant reduction in the rate of use of risperidone for BPSD in veterans living in both the aged care and community settings, and in the general older Australian population. The labelling changes were also associated with a reduced duration of risperidone use in aged care residents, although for most people the duration of use still exceeded the recommended 12-week maximum duration. Full article
(This article belongs to the Special Issue Quality Use of Medicine in Aged Care Homes)
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Open AccessCommentary
Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services
Received: 8 June 2019 / Revised: 13 July 2019 / Accepted: 18 July 2019 / Published: 20 July 2019
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Abstract
Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using [...] Read more.
Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using appropriate theory-based paradigms. Many of the more important management theories for pharmacy services consider the “servicescape” of these services recognizing the uniqueness of each patient and service encounter that vary based upon health needs and myriad other factors. In addition, implementation science principles help ensure the financial viability and sustainability of these services. This commentary reviews some of the foundational management theories and provides a number of examples of these theories that have been applied successfully resulting in a greater prevalence and scope of value-added services being offered. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessReview
Towards a Greater Professional Standing: Evolution of Pharmacy Practice and Education, 1920–2020
Received: 31 May 2019 / Revised: 17 July 2019 / Accepted: 18 July 2019 / Published: 20 July 2019
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Abstract
The history of community pharmacy in America since the 1920s is one of slow progress towards greater professional standing through changes in pharmacy education and practice. The history of American community pharmacy in the modern era can be divided into four periods: 1920–1949 [...] Read more.
The history of community pharmacy in America since the 1920s is one of slow progress towards greater professional standing through changes in pharmacy education and practice. The history of American community pharmacy in the modern era can be divided into four periods: 1920–1949 (Soda Fountain Era), 1950–1979 (Lick, Stick, Pour and More Era), 1980–2009 (Pharmaceutical Care Era), and 2010–present (Post-Pharmaceutical Care Era). As traditional compounding has waned, leaders within community pharmacy have sought to shift focus from product to patient. Increasing degree requirements and postgraduate training have enhanced pharmacists’ ability to provide patient care services not directly associated with medication dispensing. However, the realities of practice have often fallen short of ideal visions of patient-focused community pharmacy practice. Positive trends in the recognition of the impact of community pharmacists on healthcare value and the need for more optimal medication management suggest that opportunities for community pharmacists to provide patient care may expand through the 21st century. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessReview
Quinolone Allergy
Received: 28 June 2019 / Revised: 16 July 2019 / Accepted: 17 July 2019 / Published: 19 July 2019
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Abstract
Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. [...] Read more.
Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
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Open AccessArticle
Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion
Received: 24 February 2019 / Revised: 21 June 2019 / Accepted: 16 July 2019 / Published: 18 July 2019
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Abstract
In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a [...] Read more.
In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction. Full article
(This article belongs to the Special Issue The Role of Community Pharmacists in Public Health)
Open AccessArticle
Managing Medical Emergencies in Hungarian Pharmacies
Received: 30 April 2019 / Revised: 11 July 2019 / Accepted: 13 July 2019 / Published: 17 July 2019
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Abstract
To amass a body of knowledge for managing emergency situations in pharmacies, we surveyed the occurrence and nature of medical problems in Hungarian pharmacies. The occurrence of real or suspected emergencies in pharmacies was markedly different and varied from 1–52 per year, with [...] Read more.
To amass a body of knowledge for managing emergency situations in pharmacies, we surveyed the occurrence and nature of medical problems in Hungarian pharmacies. The occurrence of real or suspected emergencies in pharmacies was markedly different and varied from 1–52 per year, with five cases per year on average. The most frequent problems were bleeding (69%) and dizziness (55%), but other more serious problems (allergic reaction (32%), collapse (23%), and chest pain (25%)) also occurred. Sometimes more than one symptom was reported by a patient. People appear to consider pharmacies to be an appropriate site for receiving first aid for minor ailments, including common medical problems (e.g., fever (12%)). Unfortunately, the range of interventions was very limited because of local legal regulations and the lack of appropriate guidelines for emergencies in pharmacies. The most frequent interventions were wound treatment, control of bleeding (78%), alleviation of anxiety (68%), and providing patients with a glass of water (55%). Very often, more than one intervention was reported for the same case. Whereas 76.3% of pharmacists provided interventions only for adults, 21% of pharmacists provided interventions for all types of patients (adults, co-workers in pharmacies, and children). Pharmacists appeared to be reluctant to treat children, owing to the special issues related to pediatrics. This poor range of intervention should encourage responsible officials to develop guidelines for pharmacists to ensure pharmacists’ familiarity with the appropriate interventions in emergency situations. Such knowledge could also provide a good basis for preparing pharmacists to perform vaccinations in the future. The pharmacists had a positive attitude toward providing first aid, and 88% of respondents requested more postgraduate education on medical first aid issues. Full article
(This article belongs to the Special Issue Travel Medicine - Series Ⅱ)
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Open AccessReview
The Basics of Penicillin Allergy: What A Clinician Should Know
Received: 5 June 2019 / Revised: 11 July 2019 / Accepted: 14 July 2019 / Published: 17 July 2019
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Abstract
Antimicrobials in the penicillin class are first line treatments for several infectious diseases in the pediatric and adult population today. In the United States, patients commonly report having a penicillin allergy, with penicillin being the most frequent beta-lactam allergy. However, very few patients [...] Read more.
Antimicrobials in the penicillin class are first line treatments for several infectious diseases in the pediatric and adult population today. In the United States, patients commonly report having a penicillin allergy, with penicillin being the most frequent beta-lactam allergy. However, very few patients experience a clinically significant immune-mediated allergic reaction to penicillin. If a true penicillin allergy exists, cross-reactivity to other beta-lactam antimicrobials may occur. Mislabeling patients with penicillin allergy can lead to a higher utilization of second line antimicrobial agents, potentially increasing costs and resistance due to a larger spectrum of activity. Pharmacists play an essential role in inquiring about patient specific reactions to presumed medication allergies and developing a further assessment plan, if needed, to determine if the medication allergy is real. Full article
(This article belongs to the Special Issue Antibiotic Allergies)
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Open AccessCase Report
Balancing Assessment with “In-Service Practical Training”: A Case Report on Collaborative Curriculum Design for Delivery in the Practice Setting
Received: 10 May 2019 / Revised: 8 July 2019 / Accepted: 11 July 2019 / Published: 16 July 2019
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Abstract
Three Higher Education Institutions (HEIs) in Ireland are accredited to provide education and training, successful completion of which, entitles one to register as a pharmacist with the Pharmaceutical Society of Ireland (PSI). Legislation (2014) mandated that these HEIs replace their existing structure (four-year [...] Read more.
Three Higher Education Institutions (HEIs) in Ireland are accredited to provide education and training, successful completion of which, entitles one to register as a pharmacist with the Pharmaceutical Society of Ireland (PSI). Legislation (2014) mandated that these HEIs replace their existing structure (four-year degree followed by a one-year internship), with a five-year ‘integrated Master’s programme’. Integration includes ‘in-service practical training’ (placement) at the beginning of Year 4 (four months), and the end of Year 5 (eight months). Year 4 placements do not have to be ‘patient-facing’. Students receive a Bachelor’s degree at the end of Year 4. The Affiliation for Pharmacy Practice Experiential Learning (APPEL), established by the HEIs, manages student placements, training establishments, preceptor training, the preceptors’ competency assessment process, and the virtual learning environment (VLE) that enables delivery of co-developed online modules aligned with placements in Years 4 and 5. This case report aims to describe the process by which this integration has taken place across and within these HEIs and the challenges faced by educators, students, preceptors, and other stakeholders along the way. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and beyond)
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Open AccessArticle
Reinforcement of the Framework for Experiential Education in Healthcare in Serbia: Post-Implementation Project Review within Pharmacy Education
Received: 30 April 2019 / Revised: 28 June 2019 / Accepted: 3 July 2019 / Published: 15 July 2019
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Abstract
Background: The Erasmus+ project “Reinforcement of the Framework for Experiential Education in Healthcare in Serbia” (ReFEEHS) has been undertaken with the aim to: (i) reinforce and modernize experiential education (ExEd) in the health sciences curricula, (ii) introduce interprofessional education (IPE), and (iii) promote [...] Read more.
Background: The Erasmus+ project “Reinforcement of the Framework for Experiential Education in Healthcare in Serbia” (ReFEEHS) has been undertaken with the aim to: (i) reinforce and modernize experiential education (ExEd) in the health sciences curricula, (ii) introduce interprofessional education (IPE), and (iii) promote teaching competency development of academic staff and teacher practitioners/clinician educators. The aim of this paper is a post-implementation review of the project activities and outcomes with the emphasis on the impact and sustainability in pharmacy education. Methods: Project Logical framework matrix has been employed as planning, monitoring and evaluation tool which summarizes the main project objectives, project outcomes, relevant activities, indicators of progress, sources of verification, assumptions and risks. Results: The key project outcomes are: (i) update of competency-based curricula and development of quality assurance framework for students professional practice placements; (ii) development and introduction of interprofessional teaching and learning activities through joint curriculum delivery; and (iii) development and implementation of Teaching Certificate in Health Professions Education (TCinHPE) study program. The short-term impact of project activities and outcomes has been assessed based on the feedback received from relevant stakeholders, as well as self-evaluation of participants enrolled in new/updated curricula. Sustainability of project results is necessary in order to achieve long-term impact envisioned as increased level of professional competency of health science students; increased level of teaching competency of academic staff and teacher practitioners; improved patient healthcare and harmonisation with the EU practice and policies. Conclusions: The project outcomes contributed to building capacity at the Serbian universities involved in terms of collaboration between the healthcare professions and, in curriculum and academic staff development. It is expected that improved curricula will positively impact professional competency development of pharmacy students, graduates employability and increased workforce mobility. Meeting the quality standards of the European Higher Education Area will contribute to visibility of Serbian universities and their internationalisation, which is one of the strategic aims of improvement. Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and beyond)
Open AccessArticle
Feasibility of a Coordinated Human Papillomavirus (HPV) Vaccination Program between a Medical Clinic and a Community Pharmacy
Received: 28 April 2019 / Revised: 5 July 2019 / Accepted: 8 July 2019 / Published: 14 July 2019
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Abstract
Human papillomavirus (HPV) vaccination coverage could be enhanced by community pharmacies working with medical clinics to coordinate completion of the HPV vaccination series. The objective for this study was to assess the feasibility of a coordinated model of HPV vaccine delivery in which [...] Read more.
Human papillomavirus (HPV) vaccination coverage could be enhanced by community pharmacies working with medical clinics to coordinate completion of the HPV vaccination series. The objective for this study was to assess the feasibility of a coordinated model of HPV vaccine delivery in which a clinic gives the first dose and refers patients to a partnering community pharmacy to receive subsequent doses. A medical clinic-community pharmacy team was established in a Midwestern state to develop and operate a coordinated care model for HPV vaccinations. Under the coordinated model, the clinic identified patients needing HPV vaccination(s), administered the first dose and described the option to complete the vaccination series at the pharmacy. Interested patients then had an information sheet faxed and electronic prescriptions sent to the pharmacy. The pharmacy contacted the patients to schedule administration of 2nd and 3rd doses of the HPV vaccine. Over a 12-month period, 51 patients were referred to the pharmacy by the clinic. Of these, 23 patients received a total of 25 vaccinations. Clinic and pharmacy personnel mostly rated the coordinated program favorably. An initial study of a coordinated HPV vaccination program between a medical clinic and a community pharmacy supported patients getting HPV vaccinations. Full article
(This article belongs to the Special Issue Pharmacist Services)
Open AccessArticle
“It Made a Difference to Me”: A Comparative Case Study of Community Pharmacists’ Care Planning Services in Primary Health Care
Received: 28 May 2019 / Revised: 3 July 2019 / Accepted: 7 July 2019 / Published: 11 July 2019
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Abstract
In some jurisdictions, governments and the public look to community pharmacies to provide expanded primary health care services, including care plans with follow-up. Care planning services, covered by the Compensation Plan in Alberta, Canada, require pharmacists to assess an eligible patient’s health history, [...] Read more.
In some jurisdictions, governments and the public look to community pharmacies to provide expanded primary health care services, including care plans with follow-up. Care planning services, covered by the Compensation Plan in Alberta, Canada, require pharmacists to assess an eligible patient’s health history, medication history, and drug-related problems to establish goals of treatment, interventions, and monitoring plan. Follow-up assessments are also covered by the Compensation Plan. A comparative case study method facilitated an in-depth investigation of care planning services provided by four community pharmacy sites. Data from 77 interviews, 61 site-specific documents, and 94 h of observation collected over 20 months were analyzed using an iterative constant comparative approach. Using a sociomaterial theoretical framework, the perceived value of care planning services was examined through an investigation of the relationships and interactions between people and information. Patients perceived the value of care planning as related to waiting time to access care and co-creating individualized plans. Physicians and other health care professionals valued collaboration, information sharing, and different perspectives on patient care. Pharmacists valued collaboration with patients and other health care professionals, which renewed their sense of responsibility, increased satisfaction, and gave meaning to their role. Full article
(This article belongs to the Special Issue Pharmacist Services)
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