Pharmacist-Led Intervention

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Medication Management".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 15822

Special Issue Editor

Special Issue Information

Dear Colleagues, 

As healthcare advances, adverse drug reactions, drug–drug interactions, medication errors and the use of potentially inappropriate medications are increasing. Strategies to improve the effectiveness and safety of medications in clinical settings are well reported; however, most have focused on intervention studies of physicians.

The role of pharmacists extends beyond medication supply. Pharmacists possess the skills and knowledge to conduct a patient evaluation, collaborate with physicians to encourage appropriate prescribing, and give advice to patients regarding the use of medications. Pharmacist-led interventions are thought to be a significant strategy to optimize medication use.

This Special Issue of Healthcare seeks commentaries, original research, short reports, and reviews pertaining to the investigation of the effectiveness and safety of medications and the construction of health systems by pharmacists. An aim of the Special Issue is to highlight the importance of pharmacists in clinical settings, and it is envisioned that pharmacist-led interventions will be introduced.

Dr. Hideo Kato
Guest Editor

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Keywords

  • pharmacist
  • medication management
  • pharmaceutical care

Published Papers (8 papers)

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Research

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21 pages, 6354 KiB  
Article
Assessment of the Prescribing Pharmacist’s Role in Supporting Access to Prescription-Only Medicines—Metadata Analysis in Poland
by Artur Owczarek, Dominik M. Marciniak, Rafał Jezior and Bożena Karolewicz
Healthcare 2023, 11(24), 3106; https://doi.org/10.3390/healthcare11243106 - 5 Dec 2023
Viewed by 1292
Abstract
In 2020, pharmacists in Poland received additional authority to prescribe drugs. In this study, we analyzed prescribing after the implementation of this new responsibility. We assessed how the new regulation works in practice and what it means for the healthcare system in the [...] Read more.
In 2020, pharmacists in Poland received additional authority to prescribe drugs. In this study, we analyzed prescribing after the implementation of this new responsibility. We assessed how the new regulation works in practice and what it means for the healthcare system in the area of access to prescription-only medicines. Data analysis included information on the prescriptions written, the type of substance according to the ATC classification, and data on the prescribing pharmacists. The study used over 2.994 million e-prescriptions written by pharmacists in Poland, which were made available by the e-Health Center. The largest group of drugs prescribed were drugs used in the treatment of cardiovascular diseases, accounting for 25% of all prescribed medications during the time of the analysis. The next prescription groups were for drugs used in gastrointestinal diseases and metabolic disorders, and those acting on the central nervous system, the respiratory system, and the musculoskeletal system. Among pharmaceutical prescriptions, 73% were pharmaceutical prescriptions issued in pharmacies at full price to the patient. The results indicate that pharmacists are eager to use their permission to prescribe drugs in authority situations. Almost three million records showed improved patient access to medicines in the healthcare system (approximately 5% of repeat prescriptions for all patients during the study period). These data confirm the possibility of cooperation between physicians and pharmacists in strengthening the efficiency of the patient healthcare system. An important conclusion from this work is the need to create the possibility for the pharmacist to access the information resources of the implemented Internet Patient Account system, including therapeutic indications for the drugs used. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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11 pages, 1191 KiB  
Article
Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea
by Ha Young Jang, Yon Su Kim and Jung Mi Oh
Healthcare 2023, 11(18), 2597; https://doi.org/10.3390/healthcare11182597 - 21 Sep 2023
Viewed by 1108
Abstract
Background: The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics. Aim: The main purpose of this study is to [...] Read more.
Background: The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics. Aim: The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients. Methods: For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS. Results: A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m2 in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m2 (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26–0.96), indicating a significantly lower risk compared to the control group. Conclusion: Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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13 pages, 1604 KiB  
Article
Cost–Effectiveness Analysis of Pharmacist Adherence Interventions in People Living with HIV/AIDS in Pakistan
by Ali Ahmed, Juman Abdulelah Dujaili, Lay Hong Chuah, Furqan Khurshid Hashmi, Long Khanh Dao Le, Zeenat Fatima Chatha, Saval Khanal, Ahmed Awaisu and Nathorn Chaiyakunapruk
Healthcare 2023, 11(17), 2453; https://doi.org/10.3390/healthcare11172453 - 1 Sep 2023
Viewed by 2295
Abstract
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost–effectiveness of [...] Read more.
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost–effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost–effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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10 pages, 1529 KiB  
Article
The Bayesian-Based Area under the Curve of Vancomycin by Using a Single Trough Level: An Evaluation of Accuracy and Discordance at Tertiary Care Hospital in KSA
by Abdullah M. Alzahrani, Anjum Naeem, Rami M. Alzhrani, Manar A. Harbi, Sarah A. Alghamdi, Shahid Karim, Ahmed S. Ali, Ghusun Alsenaini, Hani Hasan, Ayed A. Alkatheeri, Samah S. Basudan and Yahya A. Alzahrani
Healthcare 2023, 11(3), 362; https://doi.org/10.3390/healthcare11030362 - 27 Jan 2023
Cited by 1 | Viewed by 2542
Abstract
The AUC0–24 is the most accurate way to track the vancomycin level while the Cmin is not an accurate surrogate. Most hospitals in Saudi Arabia are under-practicing the AUC-guided vancomycin dosing and monitoring. No previous work has been conducted to evaluate [...] Read more.
The AUC0–24 is the most accurate way to track the vancomycin level while the Cmin is not an accurate surrogate. Most hospitals in Saudi Arabia are under-practicing the AUC-guided vancomycin dosing and monitoring. No previous work has been conducted to evaluate such practice in the whole kingdom. The current study objective is to calculate the AUC0–24 using the Bayesian dosing software (PrecisePK), identify the probability of patients who receive the optimum dose of vancomycin, and evaluate the accuracy and precision of the Bayesian platform. This retrospective study was conducted at King Abdulaziz medical city, Jeddah. All adult patients treated with vancomycin were included. Pediatric patients, critically ill patients requiring ICU admission, patients with acute renal failure or undergoing dialysis, and febrile neutropenic patients were excluded. The AUC0–24 was predicted using the PrecisePK platform based on the Bayesian principle. The two-compartmental model by Rodvold et al. in this platform and patients’ dose data were utilized to calculate the AUC0–24 and trough level. Among 342 patients included in the present study, the mean of the estimated vancomycin AUC0–24 by the posterior model of PrecisePK was 573 ± 199.6 mg, and the model had a bias of 16.8%, whereas the precision was 2.85 mg/L. The target AUC0–24 (400 to 600 mg·h/L) and measured trough (10 to 20 mg/L) were documented in 127 (37.1%) and 185 (54%), respectively. Furthermore, the result demonstrated an increase in odds of AUC0–24 > 600 mg·h/L among trough level 15–20 mg/L group (OR = 13.2, p < 0.05) as compared with trough level 10–14.9 mg/L group. In conclusion, the discordance in the AUC0–24 ratio and measured trough concentration may jeopardize patient safety, and implantation of the Bayesian approach as a workable alternative to the traditional trough method should be considered. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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9 pages, 607 KiB  
Article
Usefulness of a Drug Information Resources Website (SAGASU-DI) Created Based on Inquiries to Clinical Pharmacists
by Toshiki Murasaka, Hideo Kato, Hirofumi Sudo and Takuya Iwamoto
Healthcare 2022, 10(8), 1541; https://doi.org/10.3390/healthcare10081541 - 14 Aug 2022
Cited by 1 | Viewed by 2142
Abstract
The use of drug information is increasing as the role of pharmacists expands. However, pharmacists spend a huge amount of time collecting drug information, and there has not been any drug information resource website that aims to improve the efficiency of community pharmacists [...] Read more.
The use of drug information is increasing as the role of pharmacists expands. However, pharmacists spend a huge amount of time collecting drug information, and there has not been any drug information resource website that aims to improve the efficiency of community pharmacists with regard to drug information operations. The purpose of this study was to evaluate the usefulness of a drug information resources website (SAGASU-DI). SAGASU-DI articles were created based on inquiries to clinical pharmacists. The usage statistics of the SAGASU-DI were monitored using Google Analytics between May and July 2021. In addition, a pop-up questionnaire was used to evaluate the usefulness of the SAGASU-DI in answering the questions of viewers. Statistics showed that our website had 25,447 users and 33,000 page views, with a browsing time of 29 s on average. Visitors accessed the website through desktop (51.9%) and mobile (44.3%) systems. Community pharmacists accounted for 40.2% of the visitors. The pop-up questionnaire showed that 23.2% of the viewers were satisfied with our website, and 1.5% of the viewers were not. Although 65.1% of the viewers refused to answer the questionnaire, the average percentage of the viewers who were satisfied with the site was 94.1%. The SAGASU-DI was found to be a valuable resource website for drug information services, mainly for community pharmacists. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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Review

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15 pages, 434 KiB  
Review
Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review
by Ali Ahmed, Maria Tanveer, Sunil Shrestha, Asmita Priyadarshini Khatiwada, Saval Khanal, Juman Abdulelah Dujaili and Vibhu Paudyal
Healthcare 2022, 10(9), 1630; https://doi.org/10.3390/healthcare10091630 - 26 Aug 2022
Cited by 7 | Viewed by 3030
Abstract
Pharmacists are essential members of the healthcare team. The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has led pharmacists to undertake additional clinical roles. We aim to conduct a systematic review on the interventions and impact of pharmacist-delivered services in managing [...] Read more.
Pharmacists are essential members of the healthcare team. The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has led pharmacists to undertake additional clinical roles. We aim to conduct a systematic review on the interventions and impact of pharmacist-delivered services in managing COVID-19 patients. We searched PubMed, Embase, Scopus, CINAHL plus, International Pharmaceutical Abstracts, and Web of Science from 1 December 2019 (the first case of COVID-19 emerged) to 13 January 2022 to retrieve the articles. Cochrane handbook and PRISMA guidelines were followed respectively to perform and report the review. The pharmacist-led interventions were reported following the Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2. The protocol of systematic review was registered on PROSPERO (CRD42021277128). Studies quality was assessed with the modified NOS scale. In total, 7 observational studies were identified from 10,838 studies. Identification of dosage errors (n = 6 studies), regimen modifications (n = 5), removal of obsolete/duplicate medications (n = 5), identification and management of adverse drug reactions (n = 4), drug interactions prevention (n = 2), and physicians acceptance rate (n = 3) of therapy-related services delivered in-person or via tele-pharmacy were among the pharmacist-delivered services. Common interventions delivered by pharmacists also included optimizing the use of antibacterial, antivirals, and anticoagulants in COVID-19 infected patients. The acceptance of pharmacist-delivered services by physicians was high (88.5–95.5%). Included studies have described pharmacists’ beneficial role in managing patients with COVID-19 including detection, resolution, and prevention of medication-related problems, with physicians demonstrating high trust in pharmacists’ advice. Future research should assess the feasibility and scalability of such roles in real-world settings. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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Other

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16 pages, 627 KiB  
Systematic Review
Impact of the Clinical Pharmacist in Rheumatology Practice: A Systematic Review
by Eric Barat, Annaelle Soubieux, Pauline Brevet, Baptiste Gerard, Olivier Vittecoq, Thierry Lequerre, Catherine Chenailler, Rémi Varin and Claire Lattard
Healthcare 2024, 12(15), 1463; https://doi.org/10.3390/healthcare12151463 (registering DOI) - 23 Jul 2024
Viewed by 101
Abstract
This is a systematic literature review on the impact of pharmacists in rheumatology, conducted using the PubMed®, CINAHL®, Cochrane Library®, and Web of science® databases and using the PRISMA 2020 checklist. This review was conducted from [...] Read more.
This is a systematic literature review on the impact of pharmacists in rheumatology, conducted using the PubMed®, CINAHL®, Cochrane Library®, and Web of science® databases and using the PRISMA 2020 checklist. This review was conducted from 2000 to June 2024. A quality analysis was performed. The selection of articles, as well as all analyses, including quality analyses, were conducted by a pair of pharmacists with experience in rheumatology, and included 24 articles. This study highlights the growth of clinical pharmacy activities in rheumatology and the positive influence of clinical pharmacists on patient care. The implementation of such initiatives has the potential to improve medication adherence, reduce medication-related risks, and optimize associated healthcare costs. All these pharmaceutical interventions aim to make the patient care journey smoother and safer. Additionally, the diversity of available pharmaceutical services caters to the varied needs of rheumatology. Furthermore, outpatient clinical pharmacy is also explored in this field and garners interest from patients. The vast majority of studies demonstrate significant improvement in patient care with promising performance outcomes when pharmacists are involved. This review highlights the diverse range of interventions by clinical pharmacists in rheumatology, which is very promising. However, to better assess the benefits of clinical pharmacists, this activity needs further development and evaluation through controlled and randomized clinical research programs. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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6 pages, 580 KiB  
Brief Report
Safety Evaluation of Remdesivir for COVID-19 Patients with eGFR < 30 mL/min without Renal Replacement Therapy in a Japanese Single-Center Study
by Takumi Umemura, Yoshikazu Mutoh, Takahito Mizuno, Mao Hagihara, Hideo Kato, Tetsuya Yamada, Yoshiaki Ikeda, Hiroshige Mikamo and Toshihiko Ichihara
Healthcare 2022, 10(11), 2299; https://doi.org/10.3390/healthcare10112299 - 17 Nov 2022
Cited by 5 | Viewed by 2321
Abstract
There are limited reports on the safety of remdesivir for patients with severe kidney disease. We investigated the safety of remdesivir administration for COVID-19 patients with estimated glomerular filtration rate (eGFR) <30 mL/min. This single-center retrospective study was conducted between March 2020 and [...] Read more.
There are limited reports on the safety of remdesivir for patients with severe kidney disease. We investigated the safety of remdesivir administration for COVID-19 patients with estimated glomerular filtration rate (eGFR) <30 mL/min. This single-center retrospective study was conducted between March 2020 and April 2022 at Tosei General Hospital, Japan. Propensity score matching was performed between patients with eGFR ≤ 30 mL/min and eGFR >30 mL/min with remdesivir administration. The primary outcome was 30-day mortality after the first administration. Adverse events, including development of acute kidney injury (AKI), liver function disorder, anemia, and thrombocytopenia 48 h after the end of remdesivir administration, were evaluated. After propensity score matching, 23 patients were selected from each group. There were no differences in the 30-day mortality (risk ratio [RR] 1.00; 95% confidence interval [CI] 0.18–5.56). Development of AKI and liver function disorder was not statistically different between the two groups (RR 1.05; 95% CI 0.96–1.14 and RR 0.48; 95% CI 0.04–5.66, respectively). There was no trend toward a significant increase in adverse events in the eGFR < 30 mL/min group and severe renal dysfunction had little effect on the safety of remdesivir treatment. Full article
(This article belongs to the Special Issue Pharmacist-Led Intervention)
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