Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis
Abstract
:1. Introduction
2. Method
2.1. Design
2.2. Search Strategy
2.3. Selection Process and Inclusion Criteria
2.4. Assessment of Methodological Quality
2.5. Data Extraction and Synthesis
2.6. Assessment of Confidence
2.7. Outcomes Assessed
3. Results
3.1. Descriptive Themes
3.1.1. Current Practice
- Knowledge of Corticosteroids and Other Treatments
- ii.
- The Frequency and Diagnosis of Atopic Dermatitis in Pharmacies
- iii.
- Continuing Training for Pharmacists
3.1.2. Impact of Pharmacists
- Outcomes between Pharmacists and Patients
- ii.
- Inter-professional Communication
3.2. Analytical Themes
3.2.1. Misleading Position
“Pharmacists should be the first port of call for patients with a skin problem”.[37] Quote 1
“In terms of formulations, over 60% did not know how many topical corticosteroid potency categories exist”.[36] Quote 2
“Of course, you have those fingertip units. Well, I must confess that we don’t really work with it to indicate how much you have to apply. We just say: apply thin. It is still a hormone cream”.[42] Quote 3 (Pharmacist)
“When directing the amount of TCS to be applied, 54% reported informing the patient that TCS should be used sparingly…”[41] Quote 4
“A more detailed history would have been helpful and may have supported making the diagnosis”.[38] Quote 5 (Dermatology Specialists)
“Maybe they weren’t told about the emollient at the GP. And then you give the advice to use a moisturizer…”[42] Quote 6 (Pharmacist)
3.2.2. Perceptions of Education and Training
“Of those (pharmacists) surveyed, 92% stated they would advise TCS be used until the eczema is clear, compared to 27% prior to education (p < 0.0001)”.[41] Quote 7
“Knowledge about eczema and treatment among pharmacy staff increased from baseline to follow-up 7.3 ± 1.7 to 8.4 ± 1.5 (p = 0.052)”.[43] Quote 8
“Also, parents were, in general, positive about the counseling session in the pharmacy […] 45.8% mentioned they started using the treatment differently afterwards (e.g., more frequent use of emollients and increased application of TCS, based on FTU)”.[43] Quote 9
4. Discussion
4.1. Summary of Findings
4.2. Implications for Practice and Policy
4.3. Strengths and Limitations of the Study
4.4. Further Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Author and Year | Country | Study Design | Methods of Data Collection | Participants | Number of Participants | Aim | Key Findings | Further Recommendations |
---|---|---|---|---|---|---|---|---|
Abed et al. [56], 2021 | Iraq | Cross-sectional | Questionnaire | Customers who asked for topical corticosteroids (TCs) without prescription | 212 customers | To assess the patients’ knowledge of TC use and education provided by pharmacists |
|
|
Carr et al. [34], 2009 | England | Pre-post educational intervention | Questionnaire | Patients and their parents | 50 children and their parents | To identify the effects of community pharmacists’ interventions on the use of emollients in children with eczema |
|
|
Cowdell et al. [35], 2019 | England | Qualitative study | Field notes and interviews | Community pharmacists and other health professionals | 2 community pharmacists | To create positive atopic dermatitis (AD)-related mindsets among healthcare practitioners to improve management of the condition |
|
|
Giua et al. [52], 2021 | Italy | Cross-sectional | Questionnaire | Community pharmacists | 154 community pharmacists | (1) To obtain information about pharmacists’ counseling activity regarding dermatological conditions; (2) to gain information about corticophobia among pharmacists; (3) to research the educational needs of pharmacists |
|
|
Hammarstrom et al. [44], 1995 | Sweden | Pre-post educational intervention | Questionnaire and drug sale statistics | Community pharmacies | 900 community pharmacies | To improve treatment management in patients with skin disorders |
|
|
Issa et al. [54], 2016 | Jordan | Cross-sectional | Questionnaire | Community pharmacists | 100 community pharmacists | To evaluate the disagreements in TCs prescription patterns and practice advices among different health workers and determine underlying causes |
|
|
Jairoun et al. [53], 2020 | United Arab Emirates | Cross-sectional | Questionnaire | Community pharmacists | 772 community pharmacists | To find out pharmacist knowledge, attitude, and practice in use of corticosteroids |
|
|
Kaneko et al. [46], 2014 | Japan | Cross-sectional | Questionnaire | Community and hospital pharmacists | 372 community, 109 hospital pharmacists | To investigate pharmacist practices regarding applying topical medications in the management of AD |
| To effectively counsel eczema patients, pharmacists should be aware of treatment guidelines for AD and are urged to follow these guidelines. |
Koster et al. [42], 2019 | Netherlands | Qualitative study | Interviews | Parents of children with AD, community pharmacists, and pharmacy technicians | 29 parents, 6 community pharmacists, and 12 pharmacy technicians | To explore the perspectives of both pharmacy staff and parents regarding the treatment of children with AD in the Netherlands |
|
|
Koster et al. [43], 2021 | Netherlands | Pre- and post-education interventions | Questionnaire | Parents of children with AD, community pharmacists, and pharmacy technicians | 48 parents, 6 community pharmacists, and 13 pharmacy technicians | To study the effects of pharmacy intervention on corticophobia among both pharmacy staff and parents of young AD patients |
|
|
Lambrechts et al. [51], 2019 | Belgium | Cross-sectional | Questionnaire | Pharmacists, paediatricians, GPs, dermatologists | 118 pharmacists, 100 paediatricians, 81 GPs, and 92 dermatologists. | To determine the frequency of corticophobia among pharmacists and other health professionals |
|
|
Lau et al. [36], 2017 | England | Mixed-methods | Interviews and questionnaire | Community pharmacists | 5 community pharmacists were interviewed and 105 community pharmacists filled out the questionnaire. | To investigate the knowledge of community pharmacists regarding corticosteroid use in the treatment of AD, as well as their information supply, attitudes, and patient counseling behavior |
|
|
Lindblad et al. [45], 2006 | Sweden | Qualitative | Focus groups | Patients and health providers (community pharmacists, dermatology nurses, and dermatologists) | 12 patients and 12 health providers (the number of pharmacists was not applicable) | To determine the views of health providers and patients regarding the role of providers in the management of dermatological conditions |
|
|
Manahan et al. [40], 2011 | Australia | Cross-sectional | Questionnaire | Community pharmacists and pharmacy interns | 17 community pharmacists and 3 pharmacy interns | To identify community pharmacists’ roles in the management of skin conditions and assess their opinions of teledermatology services |
|
|
Oishi et al. [47], 2019 | Japan | Cross-sectional | Questionnaire | Community pharmacists | 300 community pharmacists | To investigate the effectiveness of community pharmacists’ instructions regarding the use of FTU and the effects of following practice guidelines on treatment |
|
|
Raffin et al. [49], 2016 | France | Cross-sectional | Questionnaire | Community pharmacists, technicians and students | 176 community pharmacists, 10 pharmacy technicians, and 5 pharmacy students | To evaluate corticophobia among pharmacists in relation to AD in children |
|
|
Salzmann et al. [50], 2020 | Germany | Cross-sectional | Questionnaire | Community pharmacists and dermatologists | 351 community pharmacists and 53 dermatologists | To acquire data about daily prescription habits related to compounded preparations (CPs) in dermatology and compare them using standardized questionnaires, as well as to overcome the lack of interdisciplinary collaboration |
| Future studies should concentrate on CPs to increase the quality of prescriptions. |
Smith et al. [41], 2016 | Australia | Pre-post educational intervention | Survey | Pharmacists (including community pharmacists) | 292 pharmacists | To evaluate pharmacists’ beliefs and knowledge regarding the use of topical corticosteroids in paediatric eczema |
| Pharmacist education throughout initial education and pharmacy journals should be supported by dermatology specialists to enhance pharmacists’ knowledge of the use of TCs in AD. |
Teixeira et al. [48], 2021 | Portugal | Cross-sectional | Questionnaire | Community pharmacists and patients | 149 community pharmacists, 44 patients | To find the association between pharmacists’ knowledge and their conveyance of information to patients with dermatoses and create a proper guide for patients about dosage instructions |
| Proper guidelines must be prepared to enhance communication of dosage instructions to patients. Moreover, continued training courses should be implemented to help pharmacists to solve problems. |
Thandar et al. [55], 2019 | South Africa | Cross-sectional | Questionnaire | Community pharmacists | 82 community pharmacists | To identify community pharmacists’ attitudes and practices regarding the use of complementary and alternative therapies in patients with AD |
| It was revealed that pharmacists had insufficienct knowledge of CAMs, meaning that they needed further ongoing education. |
Tucker et al. [37], 2012 | England and Wales | Cross-sectional | Questionnaire | Community Pharmacists | 870 community pharmacists | To find out which types of skin diseases pharmacists come across in pharmacies and which training sessions they attend to gain more knowledge of dermatological diseases |
| Use of pharmacists’ advice in the management of skin conditions should be studied in future studies. |
Tucker et al. [39], 2013 | England and Wales | Cross-sectional | Questionnaire | Community Pharmacists | 870 community pharmacists | To identify pharmacists’ roles in medicine use review (MUR) and evaluate pharmacists’ understanding of long-term skin diseases |
| Further studies should be conducted to identify whether these reviews contribute to better disease-related outcomes. |
Tucker et al. [38], 2017 | England | Mixed methods | Questionnaire- and assessment-based feedback | Patients, dermatology specialists, and community pharmacists | 40 patients, 3 dermatology specialists, and 9 community pharmacists | To assess the clinical convenience of pharmacists’ diagnoses and management of dermatitis and acne, as well as to obtain patients’ self-reported perceptions regarding the effectiveness of pharmacy intervention |
| Patient assessment-related education for pharmacists should be considered, with particuar focus on dermatology. |
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Population | Patients with atopic dermatitis (all ages) |
Intervention | Practices and perceptions of community pharmacists in the management of atopic dermatitis |
Control | None |
Outcome | Main: Pharmacists’ knowledge, recommendations, attitudes, and experiences regarding the management of atopic dermatitis Secondary: Perspectives of others (healthcare providers, patients, and parents) regarding the practices of pharmacists |
Study design | Qualitative, quantitative, and mixed methods studies |
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Cayci, A.B.; Rathbone, A.P.; Lindsey, L. Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis. Healthcare 2023, 11, 2159. https://doi.org/10.3390/healthcare11152159
Cayci AB, Rathbone AP, Lindsey L. Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis. Healthcare. 2023; 11(15):2159. https://doi.org/10.3390/healthcare11152159
Chicago/Turabian StyleCayci, Abdi Berk, Adam Pattison Rathbone, and Laura Lindsey. 2023. "Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis" Healthcare 11, no. 15: 2159. https://doi.org/10.3390/healthcare11152159
APA StyleCayci, A. B., Rathbone, A. P., & Lindsey, L. (2023). Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis. Healthcare, 11(15), 2159. https://doi.org/10.3390/healthcare11152159