Pharmacy

9 pages, 208 KiB

Open AccessPerspective

Leveraging Community Pharmacies to Address Social Needs: A Promising Practice to Improve Healthcare Quality

by Tony Kuo, Noel C. Barragan and Steven Chen

Pharmacy 2024, 12(5), 139; https://doi.org/10.3390/pharmacy12050139 - 11 Sep 2024

Emerging research suggests that chronic conditions such as cardiovascular disease, diabetes, and asthma are often mediated by adverse social conditions that complicate their management. These conditions include circumstances such as lack of affordable housing, food insecurity, barriers to safe and reliable transportation, structural [...] Read more.

Emerging research suggests that chronic conditions such as cardiovascular disease, diabetes, and asthma are often mediated by adverse social conditions that complicate their management. These conditions include circumstances such as lack of affordable housing, food insecurity, barriers to safe and reliable transportation, structural racism, and unequal access to healthcare or higher education. Although health systems cannot independently solve these problems, their infrastructure, funding resources, and well-trained workforce can be realigned to better address social needs created by them. For example, community pharmacies and the professionals they employ can be utilized and are well-positioned to deliver balanced, individualized clinical services, with a focus on the whole person. Because they have deep roots and presence in the community, especially in under-resourced neighborhoods, community pharmacies (independent and chain) represent local entities that community members recognize and trust. In this article, we provide case examples from California, United States, to illustrate and explore how community pharmacies can be leveraged to address patient social needs as part of their core responsibilities and overall strategy to improve healthcare quality. Full article

12 pages, 739 KiB

Open AccessArticle

An Internationally Derived Process of Healthcare Professionals’ Proactive Deprescribing Steps and Constituent Activities

by Sion Scott, Natalie Buac and Debi Bhattacharya

Pharmacy 2024, 12(5), 138; https://doi.org/10.3390/pharmacy12050138 - 9 Sep 2024

Abstract

Proactive deprescribing is the process of tapering or stopping a medicine before harm occurs. This study aimed to specify and validate, with an international sample of healthcare professionals, a proactive deprescribing process of steps and constituent activities. We developed a proactive deprescribing process [...] Read more.

Proactive deprescribing is the process of tapering or stopping a medicine before harm occurs. This study aimed to specify and validate, with an international sample of healthcare professionals, a proactive deprescribing process of steps and constituent activities. We developed a proactive deprescribing process framework of steps which we populated with literature-derived activities required to be undertaken by healthcare professionals. We distributed a survey to healthcare professionals internationally, requesting for each activity the frequency of its occurrence in practice and whether it was important. Extended response questions investigated barriers and enablers to deprescribing. The 263 survey respondents were from 25 countries. A proactive deprescribing process was developed comprising four steps: (1) identify a patient for potential stop of a medicine, (2) evaluate a patient for potential stop of a medicine, (3) stop a medicine(s), and (4) monitor after a medicine has been stopped, and 17 activities. All activities were considered important by ≥70% of respondents. Nine activities required healthcare professionals to undertake in direct partnership with the patient and/or caregiver, of which seven were only sometimes undertaken. Deprescribing interventions should include a focus on addressing the barriers and enablers of healthcare professionals undertaking the activities that require direct partnership with the patient and/or caregiver. Full article

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13 pages, 223 KiB

Open AccessArticle

Exploring Barriers Faced by Community Pharmacists in Serving Patients with Disabilities in Saudi Arabia: Recommendations for Enhancing Healthcare Provisions

by Aisha F. Badr

Pharmacy 2024, 12(5), 137; https://doi.org/10.3390/pharmacy12050137 - 9 Sep 2024

Abstract

While several studies have explored the barriers to accessing community pharmacies for individuals with physical, hearing, visual, and learning disabilities, most have focused on the perspectives of disabled individuals. Therefore, this study aimed to examine the barriers faced by community pharmacists when serving [...] Read more.

While several studies have explored the barriers to accessing community pharmacies for individuals with physical, hearing, visual, and learning disabilities, most have focused on the perspectives of disabled individuals. Therefore, this study aimed to examine the barriers faced by community pharmacists when serving individuals with physical, visual, and hearing disabilities in Saudi Arabia, with the goal of recommending ways to enhance future healthcare provisions. Methods: A mixed-methods cross-sectional phenomenological study was conducted among community pharmacists in Saudi Arabia between March and April 2022. Both closed- and open-ended questions were utilized to identify themes related to community pharmacists’ barriers and experiences when providing care to individuals with disabilities. Results: A total of 40 community pharmacists participated in this study. Among them, 57.5% reported encountering difficulties when caring for patients with disabilities, with 65% indicating a lack of specialized services at their respective community pharmacies. Three major themes emerged from the findings: the need for pharmacist training and awareness, technology-guided methods for overcoming communication barriers, and improving overall pharmacy accessibility. Conclusion: This study reveals a significant gap in the provision of services for patients with disabilities in Saudi Arabia. Addressing physical accessibility, providing targeted training, and leveraging technology can enhance care delivery and promote inclusivity. Further research is warranted to assess the effectiveness of technological solutions and the integration of artificial intelligence in improving communication and patient-centered care for individuals with disabilities. Full article

(This article belongs to the Special Issue Pharmacy Workflow Optimization: Strategies for Enhancing Efficiency and Patient Satisfaction)

7 pages, 172 KiB

Open AccessCommentary

Drug Shortage and Ethical Issues: Integrating Multidisciplinary Perspectives with a Shared Ethical Framework

by Maya C. Wai

Pharmacy 2024, 12(5), 136; https://doi.org/10.3390/pharmacy12050136 - 6 Sep 2024

Abstract

Drug shortages can cause ethical dilemmas when no systematic, equitable allocation, or utilization schema is in place. During the COVID-19 pandemic, an ethical framework outlining moral values was proposed as way to approach allocating limited resources to patients. In addition to an ethical [...] Read more.

Drug shortages can cause ethical dilemmas when no systematic, equitable allocation, or utilization schema is in place. During the COVID-19 pandemic, an ethical framework outlining moral values was proposed as way to approach allocating limited resources to patients. In addition to an ethical perspective, it is prudent to consider costs. Examining existing economic frameworks and combining them with an ethical perspective may provide a practical, systematic process for decision makers when allocating drugs in short supply. Drug shortages continue to impact multiple areas across different subspecialties of medicine due to multiple factors, including limited manufacturers, regulatory issues, and costs. All of these factors make it difficult to anticipate and manage drug shortages effectively, but developing a combined framework may reduce some of the ethical and equitable ambiguity with regards to patient care. Full article

(This article belongs to the Special Issue Professional Ethics in Pharmacy: Exploring Contemporary Challenges and Future Directions)

11 pages, 586 KiB

Open AccessArticle

The Dispensing Error Rate in an App-Based, Semaglutide-Supported Weight-Loss Service: A Retrospective Cohort Study

by Louis Talay and Matt Vickers

Pharmacy 2024, 12(5), 135; https://doi.org/10.3390/pharmacy12050135 - 3 Sep 2024

Abstract

Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications [...] Read more.

Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications is unknown. This study retrospectively analysed the rate at which patients reported GLP-1 RA dispensing errors from patient-selected and partner pharmacies of Australia’s largest DWLS provider over a six-month period. The analysis found that 99 (0.35%) of the 28,165 dispensed semaglutide orders contained an error. Incorrect dose (58.6%) and unreasonable medication expiry window (21.2%) were the two most common error types. Most errors (84.9%) were deemed to have been of medium urgency, with 11.1% being considered high-urgency errors. Incorrect doses (45.5%) and supplies of the wrong medication (36.3%) comprised most errors reported in high-urgency cases. Female patients reported more dispensing errors than male patients (0.41% vs. 0.12%, p < 0.001). Similarly, reported dispensing error rates were highest among patients aged 18 to 29 years (0.6%) and 30 to 39 years (0.5%). This research provides preliminary evidence that GLP-1 RA dispensing errors within comprehensive Australian DWLSs are relatively low. Full article

(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)

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15 pages, 455 KiB

Open AccessArticle

An Evaluation of Oral Anticoagulant Safety Indicators by England’s Community Pharmacies

by Sejal Parekh, Lingqian Xu and Carina Livingstone

Pharmacy 2024, 12(5), 134; https://doi.org/10.3390/pharmacy12050134 - 29 Aug 2024

Abstract

Background: Anticoagulants are life-saving medicines that can prevent strokes for patients diagnosed with atrial fibrillation (AF) as well as treating patients with venous thromboembolism (VTE), but when used incorrectly, they are frequently associated with patient harm. Aim: To evaluate the impact of community [...] Read more.

Background: Anticoagulants are life-saving medicines that can prevent strokes for patients diagnosed with atrial fibrillation (AF) as well as treating patients with venous thromboembolism (VTE), but when used incorrectly, they are frequently associated with patient harm. Aim: To evaluate the impact of community pharmacy teams on optimising patient knowledge and awareness and improving medication safety from the use of anticoagulants. Methods: Two national audits, consisting of 17 questions assessing and improving patients’ understanding of anticoagulant therapy, identifying high-risk patients, and contacting prescribers when clinically appropriate were incentivised for England’s community pharmacies in 2021–2022 and 2023–2024 using the Pharmacy Quality Scheme (PQS) commissioned by NHS England. Results: Approximately 11,000 community pharmacies audited just under a quarter of a million patients in total, whilst making almost 150,000 interventions for patients taking oral anticoagulants, i.e., identifying and addressing medication issues which could increase the risk of bleeding/harm. Out of the 111,195 patients audited in 2021–2022, only 24,545 (23%) patients were prescribed vitamin K antagonists. The remaining patients were prescribed direct oral anticoagulants (DOACs). By 2023–2024, this decreased to 17,043 (16%) patients. Most patients knew that they were prescribed an anticoagulant (95.6%, 106,255 in 2021–2022 and 96.5%, 101,006 in 2023–2024, p < 0.001). Discussion: The audits resulted in a statistically significant increase in patients with a standard yellow anticoagulant alert card, as identified in audit 2 (73,901 66.5% in 2021–2022 to 76,735, 73.3% in 2023–2024, p < 0.001). Furthermore, fewer patients were prescribed concurrent antiplatelets with an anticoagulant (6021; 4.6% in 2021–2022 to 4975; 4% in 2023–2024, p < 0.001). Although there was an increase in the number of patients prescribed NSAIDs with anticoagulants, more of these patients were also prescribed gastroprotection concurrently (927 77.2% in 2021–2022 to 1457 84.1% in 2023–2024, p < 0.05). The majority of patients on warfarin had their blood checked within 12 weeks. Further there was an increase for these patients in the percentage of people prescribed VKAs who knew dietary changes can affect their anticoagulant medicine (16,764 67.4% in 2021–2022 to 12,594 73.9% in 2023–2024 p < 0.001). Conclusions: Community pharmacy teams are well placed in educating and counselling patients on the safe use of anticoagulants and ensuring that all patients are correctly monitored. Full article

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7 pages, 365 KiB

Open AccessArticle

Evaluation of Anti-Xa Target Attainment with Prophylactic Enoxaparin Dosing Regimens for Venous Thromboembolism Prophylaxis in Morbidly Obese Patients

by Andrew Sabers, Emilie Langenhan, Sean N. Avedissian and Brandon Reynolds

Pharmacy 2024, 12(5), 133; https://doi.org/10.3390/pharmacy12050133 - 28 Aug 2024

Abstract

Subcutaneous enoxaparin has been shown to reduce the risk of venous thromboembolism (VTE) among hospitalized patients. However, alternative enoxaparin dosing strategies may be necessary in morbid obesity. The objective of this study was to assess the rate of target anti-Xa attainment with three [...] Read more.

Subcutaneous enoxaparin has been shown to reduce the risk of venous thromboembolism (VTE) among hospitalized patients. However, alternative enoxaparin dosing strategies may be necessary in morbid obesity. The objective of this study was to assess the rate of target anti-Xa attainment with three enoxaparin dosing regimens for venous thromboembolism (VTE) prophylaxis in morbidly obese patients. In this retrospective study, anti-Xa target attainment was assessed among adult patients with a body mass index (BMI) ≥ 40 kg/m² receiving enoxaparin 40 mg twice daily (BID), 60 mg BID, or 0.5 mg/kg BID. Univariate and multivariate analyses were conducted. Target anti-Xa levels were defined as a steady-state, peak level of 0.2–0.5 IU/mL. This study included 120 patients with 55 patients receiving 40 mg BID, 44 patients receiving 60 mg BID, and 21 patients receiving 0.5 mg/kg BID. Target anti-Xa levels were achieved in 29.1% of patients in the 40 mg BID arm, 54.5% in the 60 mg BID arm, and 90.5% in the 0.5 mg/kg BID arm. Anti-Xa target attainment was significantly increased in both the 60 mg BID arm (p = 0.01) and the 0.5 mg/kg arm (p < 0.0001), compared to the 40 mg BID arm. In morbidly obese patients, weight-based dosing was associated with a greater attainment of target anti-Xa levels. Further studies are needed to determine the impact of these dosing regimens on clinical outcomes. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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18 pages, 1133 KiB

Open AccessArticle

Effective Supply Chain Strategies in Addressing Demand and Supply Uncertainty: A Case Study of Ethiopian Pharmaceutical Supply Services

by Arebu Issa Bilal, Umit Sezer Bititci and Teferi Gedif Fenta

Pharmacy 2024, 12(5), 132; https://doi.org/10.3390/pharmacy12050132 - 28 Aug 2024

Abstract

Background: Ensuring the consistent availability of essential medicines is crucial for effective healthcare systems. However, Ethiopian public health facilities have faced frequent stockouts of crucial medications, highlighting systemic challenges such as inadequate forecasting, prolonged procurement processes, a disjointed distribution system, suboptimal data quality, [...] Read more.

Background: Ensuring the consistent availability of essential medicines is crucial for effective healthcare systems. However, Ethiopian public health facilities have faced frequent stockouts of crucial medications, highlighting systemic challenges such as inadequate forecasting, prolonged procurement processes, a disjointed distribution system, suboptimal data quality, and a shortage of trained professionals. This study focuses on the Ethiopian Pharmaceutical Supply Services (EPSS), known for its highly unstable and volatile supply chain, aiming to identify risks and mitigation strategies. Methods: Using a mixed-method approach involving surveys and interviews, the research investigates successful and less successful strategies, key success factors, and barriers related to pharmaceutical shortages. Results: Proactive measures such as communication, stock assessment, supervision, and streamlined procurement are emphasized as vital in mitigating disruptions, while reactive strategies like safety stock may lack long-term efficacy. The study highlights the importance of aligning supply chain strategies with product uncertainties, fostering collaboration, and employing flexible designs for resilience. Managerial implications stress the need for responsive structures that integrate data quality, technology, and visibility. Conclusions: This study contributes by exploring proactive and reactive strategies, elucidating key success factors for overcoming shortages in countries with unstable supply chains, and offering actionable steps for enhancing supply chain resilience. Embracing uncertainty and implementing proactive measures can help navigate volatile environments, thereby enhancing competitiveness and sustainability. Full article

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16 pages, 2478 KiB

Open AccessArticle

What Do Younger and Well-Educated Adults Think about Self-Medication? Results of a Survey during a Public Science Event at Leipzig University

by Ines Gebert, Sabine Hundertmark and Thilo Bertsche

Pharmacy 2024, 12(5), 131; https://doi.org/10.3390/pharmacy12050131 - 23 Aug 2024

Abstract

Background: Consecutive visitors to a public science event at Leipzig University were asked about their opinions/attitudes regarding their personal use of self-medication. Methods: A written questionnaire survey addressed (i) participants’ characteristics, (ii) frequency of self-medication use in the last 12 months, (iii) symptoms/complaints [...] Read more.

Background: Consecutive visitors to a public science event at Leipzig University were asked about their opinions/attitudes regarding their personal use of self-medication. Methods: A written questionnaire survey addressed (i) participants’ characteristics, (ii) frequency of self-medication use in the last 12 months, (iii) symptoms/complaints most frequently considered applicable, (iv) preconditions, (v) limitations, (vi) risks, (vii) fears, (viii) medication information sources, (ix) influencing factors, and (x) reasons for decision making. Results: (i) A total of 189 visitors (median age: 29.0 years; Q25/Q75: 22.0/44.0) participated, of whom 64.0% were female, 38.6% had a university degree, 20.1% were in training, and 14.8% were licensed in a healthcare profession. (ii) A total of 59.3% of participants stated that they had used self-medication regularly in the last 12 months. The most common answers in the respective questions were (iii) headache, 86.2%; (iv) mild complaints/symptoms, 94.7%; (v) duration, 91.6%; (vi) “self-medication may cause adverse drug reactions”, 94.2%; (vii) “developing a habituation effect”, 58.7%; (viii) pharmacists, 93.7%; (ix) “physician’s recommendation”, 89.3%; (x) “intensity of complaints”, 92.6%; and (vi) 61.3% believed that they could choose an appropriate self-medication. Conclusion: Younger and well-educated adults report using self-medication frequently and rate their expertise as high. Healthcare professionals are the preferred source of information. Full article

(This article belongs to the Topic The Promotion and Development of Community Health for Personal Health: Theories and Applications)

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9 pages, 1504 KiB

Open AccessArticle

Enhancing Operational Efficiency and Service Delivery through a Robotic Dispensing System: A Case Study from a Retail Pharmacy in Brazil

by Karen Basile, Monserrat Martínez, Julia D. Lucaci, Claudia Goldblatt and Idal Beer

Pharmacy 2024, 12(5), 130; https://doi.org/10.3390/pharmacy12050130 - 23 Aug 2024

Abstract

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a [...] Read more.

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a retail pharmacy. Through observational techniques, we measured the time required for the following pharmacy workflows before and after implementing the robotic dispensing system: customer service, receiving stock, stocking inventory, separation, invoicing, and packaging of online orders for delivery. Time savings were observed across all workflows within the pharmacy, notably in receiving stock and online order separation, which experienced 70% and 75% reductions in total time, respectively. Furthermore, customer service, stocking, invoicing, and packaging of online orders, also saw total time reductions from 36% to 53% after implementation of the robotic dispensing system. This study demonstrates an improvement in the pharmacy’s operational efficiency post-implementation of the robotic dispensing system. These findings highlight the potential for such automated systems to streamline pharmacy operations, improve staff time efficiency, and enhance service delivery. Full article

(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice II)

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12 pages, 572 KiB

Open AccessReview

Evaluating the Risk–Benefit Profile of Corticosteroid Therapy for COVID-19 Patients: A Scoping Review

by Daniel Hsiang-Te Tsai, Emma Harmon, Jan Goelen, Heather E. Barry, Li-Yang Chen and Yingfen Hsia

Pharmacy 2024, 12(4), 129; https://doi.org/10.3390/pharmacy12040129 - 22 Aug 2024

Abstract

Background: The 2019 coronavirus (COVID-19) outbreak was declared a global pandemic in March 2020. It quickly spread across all continents, causing significant social, environmental, health, and economic impacts. During the pandemic, there has been consideration of repurposing and repositioning of medications, such as [...] Read more.

Background: The 2019 coronavirus (COVID-19) outbreak was declared a global pandemic in March 2020. It quickly spread across all continents, causing significant social, environmental, health, and economic impacts. During the pandemic, there has been consideration of repurposing and repositioning of medications, such as corticosteroids, for the treatment of hospitalised COVID-19 patients. Objective: To assess and summarise corticosteroid regimens used for hospitalised COVID-19 patients, focusing on dosage, route of administration, and clinical outcome from clinical trials. Methods: PubMed and Embase databases and the grey literature were searched to identify randomised controlled trials (RCTs) that evaluated the efficacy of corticosteroids in hospitalised patients with COVID-19 between January 2020 and January 2023. This scoping review was conducted in line with the PRISMA extension for scoping reviews (PRISMA-ScR) checklist. Key findings: A total of 24 RCTs were eligible for inclusion. There was variation in the steroid regimens used for treatment across COVID-19 trials. Despite the heterogeneity of included RCTs, the overall results have shown the benefits of improving lung function and a lower all-cause mortality rate in hospitalised COVID-19 patients treated with systematic corticosteroids. Conclusions: Corticosteroids have proven to be an effective treatment for COVID-19 patients in critical condition. However, comparative effectiveness studies should be conducted to assess the efficacy and safety of optimal corticosteroid treatment at the population level. Moreover, the global burden of long COVID is significant, affecting millions with persistent symptoms and long-term health complications. Thus, it is also necessary to evaluate the optimal steroid regimen for long COVID treatment. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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28 pages, 6053 KiB

Open AccessArticle

Development and Evaluation of Interprofessional High-Fidelity Simulation Course on Medication Therapy Consultation for German Pharmacy and Medical Students—A Randomized Controlled Study

by Ahmed Reda Sharkas, Bushra Ali Sherazi, Shahzad Ahmad Sayyed, Florian Kinny, Melina Steichert, Holger Schwender and Stephanie Laeer

Pharmacy 2024, 12(4), 128; https://doi.org/10.3390/pharmacy12040128 - 21 Aug 2024

Abstract

Recently, there has been a remarkable move towards interprofessional collaboration in response to the COVID-19 pandemic and the care of comorbidities. In Germany, there has been a gradual increase in interprofessional learning in medical and pharmacy education, aiming to enhance patient care. To [...] Read more.

Recently, there has been a remarkable move towards interprofessional collaboration in response to the COVID-19 pandemic and the care of comorbidities. In Germany, there has been a gradual increase in interprofessional learning in medical and pharmacy education, aiming to enhance patient care. To adapt the pharmacy curriculum for collaborative practice between pharmacy and medical students, we developed an immersive interprofessional collaboration course for pharmacy students using adult and pediatric high-fidelity simulators (HFS) to assess and train medication consultation skills. In a randomized controlled trial, we investigated whether interprofessional training between pharmacy and medical students results in differences in pharmacy students’ performance of medication therapy consultation compared to the case of mono-professional training of pharmacy students only. Before and after inter/mono-professional training, each pharmacy student performed an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire. Additionally, an attitude survey towards interprofessional learning was completed by pharmacy and medical students at the end of the training. As expected, interprofessional as well as mono-professional training showed a statistically significant increase in medication consultation skills. Of importance, the performance in the interprofessional training group was significantly better than in the mono-professional group, particularly in drug therapy counselling and consultation behaviors. There was a significant difference between the intervention and control groups in self-assessment scores, and all study participants had positive attitudes toward interprofessional collaboration and training. Therefore, interprofessional training using HFS has been shown to appropriately train pharmacy students for collaborative practice and consultation skills. Full article

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7 pages, 169 KiB

Open AccessCommunication

Description and Evaluation of a Pharmacy Graduate Health Services Research Methods Course

by David R. Axon

Pharmacy 2024, 12(4), 127; https://doi.org/10.3390/pharmacy12040127 - 21 Aug 2024

Abstract

The purpose of this paper is to provide a description and evaluation of a graduate-level Health Services Research Methods course offered at the University of Arizona R. Ken Coit College of Pharmacy. This three-credit, round-table discussion-style course introduces students to fundamental concepts in [...] Read more.

The purpose of this paper is to provide a description and evaluation of a graduate-level Health Services Research Methods course offered at the University of Arizona R. Ken Coit College of Pharmacy. This three-credit, round-table discussion-style course introduces students to fundamental concepts in healthcare study design and teaches them how to design and critique example studies for a variety of commonly encountered study designs. The course is assessed through essay-style examinations, development of a research proposal, and low-stakes weekly assignments. Twenty-seven students have completed the course in the past five years. Feedback from student course surveys was almost unanimously positive, with few meaningful suggestions for improvement. The description and evaluation of a graduate-level Health Services Research Methods course at one institution indicates that students had a largely favorable experience with the course. Considerations for future revisions to the course are discussed alongside other lessons learned. Full article

(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)

17 pages, 724 KiB

Open AccessReview

Supporting Patients with Nontuberculous Mycobacterial Pulmonary Disease: Ensuring Best Practice in UK Healthcare Settings

by Toby Capstick, Rhys Hurst, Jennie Keane and Besma Musaddaq

Pharmacy 2024, 12(4), 126; https://doi.org/10.3390/pharmacy12040126 - 21 Aug 2024

Abstract

Nontuberculous mycobacterial pulmonary disease (NTM-PD) results from opportunistic lung infections by mycobacteria other than Mycobacterium tuberculosis or Mycobacterium leprae species. Similar to many other countries, the incidence of NTM-PD in the United Kingdom (UK) is on the rise for reasons that are yet [...] Read more.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) results from opportunistic lung infections by mycobacteria other than Mycobacterium tuberculosis or Mycobacterium leprae species. Similar to many other countries, the incidence of NTM-PD in the United Kingdom (UK) is on the rise for reasons that are yet to be determined. Despite guidelines established by the American Thoracic Society (ATS), the Infectious Diseases Society of America, and the British Thoracic Society, NTM-PD diagnosis and management remain a significant clinical challenge. In this review article, we comprehensively discuss key challenges in NTM-PD diagnosis and management, focusing on the UK healthcare setting. We also propose countermeasures to overcome these challenges and improve the detection and treatment of patients with NTM-PD. Full article

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9 pages, 233 KiB

Open AccessReview

Administration of Levetiracetam via Subcutaneous Infusion for Seizure Control in the Palliative Care Setting: A Narrative Review

by Fern Beschi, Rachel Hughes and Jennifer Schneider

Pharmacy 2024, 12(4), 125; https://doi.org/10.3390/pharmacy12040125 - 16 Aug 2024

Abstract

This narrative review aims to summarise the information available on the use of subcutaneous (SC) levetiracetam (LEV) in the adult palliative care setting using clinical texts, databases, journals, and grey literature. A search strategy utilising Embase, Medline CINALH and Cochrane databases, as well [...] Read more.

This narrative review aims to summarise the information available on the use of subcutaneous (SC) levetiracetam (LEV) in the adult palliative care setting using clinical texts, databases, journals, and grey literature. A search strategy utilising Embase, Medline CINALH and Cochrane databases, as well as Google Scholar, was conducted with the mapped search terms “levetiracetam”, “subcutaneous” and “palliative”. LEV intravenous (IV) proprietary products are used subcutaneously, including as continuous subcutaneous infusions (CSCIs), in the adult palliative care setting. The total LEV daily dose ranged from 250 mg to 5000 mg and LEV was administered with various diluents at varying volumes. The data identified a clinical desire to mix LEV with other medications; however, the current evidence on combination compatibility is observational only and drug stability in combinations is lacking. The majority of information in the literature on SC LEV use is based on case reports and retrospective audits. Case reports, whilst at times offering more clinical detail, represent specific circumstances not necessarily applicable to a larger patient cohort. The findings of retrospective audits are limited by the documentation and detail reported at the time of patient care that may not be designed for data collection. Full article

(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)

9 pages, 192 KiB

Open AccessArticle

Examining Delineated Competencies within Blended Hospital/Health System Pharmacy and General Medicine Advanced Pharmacy Practice Experiences

by Jennifer L. Prisco, Yulia A. Murray, Tewodros Eguale and Jennifer D. Goldman

Pharmacy 2024, 12(4), 124; https://doi.org/10.3390/pharmacy12040124 - 13 Aug 2024

Abstract

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly [...] Read more.

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly utilizing blended or longitudinal APPE models to offer experiential opportunities; however, there is a gap in the literature to support programs with delineating rotation-specific competencies when integrating two or more rotations together. Utilizing a survey instrument, PharmD students at two C/SOPs reported their onsite inpatient rotation sub-competency activities achieved within the four competency areas of Hospital/Health Pharmacy Systems, Medication Safety and Quality, Clinical Applications, and Professional Practice, which are listed in Appendix C of the 2016 Accreditation Council for Pharmacy Education Standards Guidance Document. Unpaired two-sample t-tests were performed to compare proportions of sub-competency activity occurrence in the two rotation settings. In total, 168 students reported inpatient activities related to the four competency areas, with 95–100% reporting their involvement in one or more sub-competency opportunities within each area. Of the 26 sub-competencies compared, 73% significantly facilitated the development of competency to a greater extent for one APPE inpatient rotation type over the other (p < 0.05). The findings can be utilized by C/SOPs to support the delineation of rotation-specific competencies when blending inpatient experiential opportunities. Full article

(This article belongs to the Special Issue Advances in Experiential Learning in Pharmacy)

9 pages, 429 KiB

Open AccessArticle

Adherence to Cysteamine Therapy Among Patients Diagnosed with Cystinosis in Saudi Arabia: A Prospective Cohort Study

by Reem Algasem, Nedaa Zainy, Essam Alsabban, Hamad Almojalli, Khalid Alhasan, Tariq Ali, Deiter Broering and Hassan Aleid

Pharmacy 2024, 12(4), 123; https://doi.org/10.3390/pharmacy12040123 - 8 Aug 2024

Abstract

Cystinosis is a rare autosomal recessive disorder in which cystine crystals accumulate within the cellular lysosomes, causing damage to multiple organs. Due to challenges with the stringent cysteamine treatment regimen and side effects, adherence is often sub-optimal. This study aimed to assess the [...] Read more.

Cystinosis is a rare autosomal recessive disorder in which cystine crystals accumulate within the cellular lysosomes, causing damage to multiple organs. Due to challenges with the stringent cysteamine treatment regimen and side effects, adherence is often sub-optimal. This study aimed to assess the level of adherence to cysteamine therapy among cystinosis patients in Saudi Arabia and its impact on their quality of life. Electronic medical record data of 39 cystinosis patients from the Department of Nephrology at King Faisal Specialist Hospital and Research Center in Saudi Arabia were reviewed, and 25 patients were included in this study. Out of the 25 patients included in the final analysis, 64% (n = 16) were female. The mean age was 19.04 years. Almost all patients (23/25, 92%) were on oral IR cysteamine therapy, and 52% (13/25) were on topical cysteamine eye drop treatment. Of the 15 patients who responded to the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire, only 4 (26.7%) were highly adherent to cysteamine therapy. Most of the respondents (7/15, 46.7%) showed a medium level of treatment adherence. Based on the medication possession ratio for oral cysteamine, only 6 out of 23 patients (26.1%) were found to be 96–100% adherent. For the cysteamine eye drops, only 5/13 patients (38.4%) were 76–95% adherent. The 36-Item Short Form Health Survey (SF-36) used to assess patients’ health-related outcomes showed that their quality of life was affected in the domains of ‘social functioning’ and ‘energy/fatigue.’ Despite a small sample size, this study shows sub-optimal adherence to cysteamine treatment in patients from Saudi Arabia. The possible reasons for low treatment adherence could be a high frequency of administration and treatment-related side effects. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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10 pages, 525 KiB

Open AccessArticle

Medication Reconciliation as Part of Admission Management—A Survey to Improve Drug Therapy Safety in a Urology Department

by Yvonne Remane, Luisa Pfeiffer, Leonie Schuhmann, Annett Huke, Jens-Uwe Stolzenburg and Thilo Bertsche

Pharmacy 2024, 12(4), 122; https://doi.org/10.3390/pharmacy12040122 - 6 Aug 2024

Abstract

Complete medication reconciliation during hospital admission is the rationale for further treatment decisions. A consecutive, controlled intervention study was conducted to assess discrepancies in medication reconciliation performed by nurses of the Urology Department compared to the Best Possible Medication History (BPMH) established by [...] Read more.

Complete medication reconciliation during hospital admission is the rationale for further treatment decisions. A consecutive, controlled intervention study was conducted to assess discrepancies in medication reconciliation performed by nurses of the Urology Department compared to the Best Possible Medication History (BPMH) established by pharmacists. This study included pre-intervention (control group, CG), nursing training as a pharmaceutical intervention, and post-intervention (intervention group, IG) groups. The discrepancies were classified as “Missing” (not recorded but taken), “Added” (additionally recorded) “Strength” (incorrect documented dosage), “Intake” (incorrect intake time/schedule), “Double” (double prescription), and “Others” (no clear assignment). Additionally, high-risk drug subgroup discrepancies were particularly prevalent and were evaluated. Training success was compared concerning discrepancies in the CG and IG. Generally, the percentage of discrepancies per patient found was lower in the IG than in the CG (78.1% vs. 87.5%, significantly). The category most identified was “Missing” (IG, 33.3% vs. CG, 35.2%). Overall, a discrepancy of 7.4% each (discrepancies: IG, 27 vs. CG, 38) was determined for high-risk drugs while “Missing” occurred (77.8% vs. 52.6%, out of 7.4%). Despite nursing training only partially reducing discrepancies, the implementation of medication reconciliation using BPMH by pharmacists could improve the process, especially for high-risk drugs. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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11 pages, 470 KiB

Open AccessArticle

Student Stress, Coping, and APPE Readiness at Two Public Institutions before and during the Pandemic

by Tram B. Cat, Shareen Y. El-Ibiary and Kelly C. Lee

Pharmacy 2024, 12(4), 121; https://doi.org/10.3390/pharmacy12040121 - 5 Aug 2024

Abstract

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted pharmacy students’ education and well-being. The primary aim of this study was to evaluate the effects of the pandemic on students’ perceived stress by comparing third- and fourth-year students from the pre-pandemic Class of 2019 [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted pharmacy students’ education and well-being. The primary aim of this study was to evaluate the effects of the pandemic on students’ perceived stress by comparing third- and fourth-year students from the pre-pandemic Class of 2019 with mid-pandemic Class of 2021 at two public institutions. Secondary aims were to evaluate the pandemic effects on students’ academic and professional development skills and practice readiness. The Perceived Stress Scale (PSS) and the Brief Coping Orientation to Problems Experienced (COPE) scale were used to measure student well-being. Students’ self-rated problem-solving, time management, and study skills were used to measure their academic and professional development; practice readiness was measured using students’ self-rated confidence levels. PSS scores were significantly higher in mid-pandemic than pre-pandemic students, and the Brief COPE avoidant coping subscale differed between pre-pandemic and mid-pandemic students. No differences were found in any academic and professional development skills between the pre- and mid-pandemic students, and there were significant improvements in student confidence levels for practice readiness among the mid-pandemic students. In conclusion, the pandemic appeared to affect students’ stress and avoidant coping mechanism but had variable effects on academic and professional development and practice readiness. Full article

(This article belongs to the Special Issue Pharmacy: State of the Art and Perspectives in USA (2nd Edition))

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