Pharmacy

The “breakthrough therapy” designation (BTD) is a recent mechanism implemented by the United States Food and Drug Administration (FDA) to expedite access to drugs that address unmet needs. The purpose of this study is to describe pharmacists’ knowledge of FDA drug-approval standards and knowledge and perceptions of the BTD. Pharmacists engaged in advanced clinical practice were identified through membership profiles of a professional pharmacy organization. Eligible participants were then sent a questionnaire to assess knowledge of FDA approval standards and the BTD. A total of 226 pharmacists responded. The majority of respondents were women (70.2%) and had completed post-graduate training (85.8%). Over half correctly answered at least two of three questions on FDA approval standards (58.1%) and the BTD (78.1%). Only 24.1% of respondents identified as being familiar with the BTD. The majority of pharmacists (62.8%) were certain that FDA-approved “breakthrough” drugs represented a major advance over currently approved therapies and most (88.5%) preferred the drug designated as “breakthrough” in a hypothetical scenario. In conclusion, pharmacists were able to correctly answer questions about FDA approval standards and the BTD. However, they were unfamiliar with the implications of a BTD and may overestimate the benefit demonstrated by these drugs. Future research should identify knowledge gaps in pharmacist understanding of regulatory mechanisms designed to expedite drug approval. Full article

This review looks at the factors that may influence practice in the future. Transformation could occur at 3 levels. Firstly, the traditional profession of the pharmacist as a dispenser of medicines is expanding. Secondly, the pharmacist’s activities are progressing into new healthcare fields. Thirdly, other changes are stimulated by global developments. This review may be helpful for pharmacy and healthcare leaders looking at the future configuration and aims of their pharmacy services. Full article

As the last step in the care pathway, pharmacies can significantly impact a patient’s medication adherence and the success of treatment. The potential impact of patient’s pharmacy choice on their medication adherence has yet to be established. This study aims to review the impact a pharmacies ownership model, either independent or chain, has on its users’ medication adherence. As a generalisation, independent pharmacies offer a more personal service and chain pharmacies offer medications at lower prices. A keyword search of EMBASE and MEDLINE databases in March 2022 identified 410 studies, of which 5 were deemed to meet our inclusion criteria. The studies mostly took place in North America, measured medication adherence using pharmacy records over a 12-month period. This review was unable to substantiate a difference in the rate of medication adherence between the users of independent and chain pharmacies. However, those with a lower income, greater medication burden, and increased age appeared to use an independent pharmacy more than a chain pharmacy and to have greater medication adherence when doing so. Establishing the differences in service provision between types of pharmacies and why people choose a pharmacy to frequent should be a focus of future research. Full article

Sickle-cell disease (SCD) is an inherited hemoglobinopathy, causing lifelong complications such as painful vaso-occlusive episodes, acute chest syndrome, stroke, chronic anemia, and end-organ damage, with negative effects on quality of life and life expectancy. Within the last five years, three new treatments have been approved: L-glutamine in 2017 and crizanlizumab and voxelotor in 2019. We conducted a literature search of these three medications, and of the 31 articles meeting inclusion criteria, 6 studied L-glutamine, 9 crizanlizumab, and 16 voxelotor. Treatment with L-glutamine was associated with decrease in pain crises, hospitalizations, and time to first and second crises, with a decrease in RBC transfusion rate. Barriers to filling and taking L-glutamine included insurance denial, high deductible, and intolerability, especially abdominal pain. Crizanlizumab was associated with a reduction in pain crises and time to first crisis, with reduction in need for opioid use. Adverse effects of crizanlizumab include headache, nausea, insurance difficulty, and infusion reactions. Voxelotor was associated with increased hemoglobin and decreased markers of hemolysis. Barriers for voxelotor use included insurance denial and side effects such as headache, rash, and diarrhea. These three medications represent exciting new therapies and are generally well-tolerated though price and insurance approval remain potential barriers to access. Other studies are ongoing, particularly in the pediatric population, and more real-world studies are needed. The objective of this article is to evaluate post-approval studies of crizanlizumab, voxelotor, and L-glutamine in SCD, with a focus on real-world efficacy, side effects, and prescribing data. Full article

Onsite and in-person experiential education has been well established to prepare practice-ready healthcare professionals, such as pharmacists. From COVID-19, the integration of remote educational delivery has occurred. As healthcare disciplines adjust to new experiential styles and innovate traditional methods, this paper highlights key areas for remote experiential education that can influence student experiences. Factors that are of importance to continuous quality improvement are described. A survey, utilizing the cloud-based software platform Qualtrics^® headquartered in the United States, was developed to evaluate whether remote rotation delivery was comparable to traditional onsite experiential education, to assist with quality improvement for virtual experiential education, and to ensure the redesigned educational model meets accreditation standards for two schools of pharmacy. Numerous factors including work, time zone, Office of Experiential Education and preceptor responsiveness, and technology, were examined. Chi-Square test, t-test for proportions and odds ratios were utilized to evaluate results. Students with technology concerns throughout a remote rotation had a more than two-fold increase in identifying the virtual experience as worse than most/all other in-person rotations (p = 0.01). Preceptor responsiveness to questions and concerns significantly impact student perceptions of educational quality (p < 0.05). The majority of students perceived remote experiential education is equal to onsite experiences. Since continuous quality improvement is required by pharmacy accreditors and many other healthcare programs offering clinical opportunities, identifying factors is of importance to make future interventions in the remote experiential education delivery. This type of experiential learning became essential with COVID-19 impacting onsite clinical placements, and information can be used across health science disciplines at large. Full article

Background: Identifying and quantifying potentially inappropriate prescribing (PIP) practices remains a time-consuming and challenging task, particularly among the pediatric population. In recent years, several valuable tools have been developed and validated for assessing PIP. This study aimed to determine the prevalence of PIP and related risk factors in pediatric patients at a tertiary care hospital in Oman. Materials and Methods: A retrospective study was conducted by reviewing the medical records of pediatric patients (<18 years) from 1 October to 31 December 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) were assessed using an internationally validated pediatric omission of prescriptions and inappropriate prescriptions (POPI) tool. Results: A total of 685 patients were included; 57.5% were male, and 30.5% had at least one comorbidity. Polypharmacy was identified in 70.2% of these patients, with a median of 2 (1–3) medications. PIM was observed in 20.4% of the cohort, with the highest in ENT-pulmonary disease (30.5%), followed by dermatological disorders (28.6%). PPO was identified in 6.9% of the patients with digestive and neuropsychiatric disorders, with the highest rate of 54% and 24%, respectively. Age (p = 0.006), number of medications (p = 0.034), and prescriber rank (p = 0.006) were identified as significant predictors of PIM, whereas age (p = 0.044) was the only significant predictor for PPO. Conclusions: The rates of PIM and PPO were high in this study population. In light of these findings, educational and interventional activities and programs are needed. Full article

The COVID-19 pandemic has had a negative impact on patients’ mental health. The aim of this study was to explore whether the pandemic influenced the use and prescription of benzodiazepines and increased the need for community pharmacist involvement in counselling on deprescribing. Electronic prescription-related data from one pharmacy in Croatia were retrospectively collected for the COVID-19 period (April 2020 to March 2021) and compared with pre-COVID-19 (April 2019 to March 2020) data. Data were collected for patients diagnosed with anxiety disorders who filled out more than one prescription for benzodiazepines, and included age, sex, number of medicines, benzodiazepines, and comorbidities. A total of 1290 benzodiazepine users were identified; of these, 32.87% started using benzodiazepines during the COVID-19 period, while 35.2% continued with benzodiazepine use. More than half of all benzodiazepine users were identified as potential deprescribing candidates (dispensed more than three prescriptions). Women, older patients, multimorbid individuals, and patients with polypharmacy were more likely to use benzodiazepines for a prolonged period. The results show a negative trend of benzodiazepine usage among community-dwelling patients during the pandemic. Community pharmacists can identify potential candidates for deprescribing and initiate a process that ensures more rational use of benzodiazepines and increases the safety of treatment. Full article

There emerged a need to develop and implement a new healthcare database analysis course for Health Economics and Outcomes Research (HEOR) graduate students, which would allow students to apply their biostatistics and study design skills to answer healthcare-related research questions using large datasets. This communication establishes the need for this course, describes how the course was conceptualized, provides an overview of the course content, course cohort, and course outcomes, and discusses lessons learned from this process. This course was developed to meet the need of HEOR graduates to perform real-world data studies. The course required students to conceptualize a study, apply their data analysis skills to analyze the data, and develop their scientific writing skills by preparing a conference abstract and research report that should be submitted for publication. Lessons learned include focusing more on developing advanced research methodologies and less time on preparing dissemination materials, which can instead be done in subsequent courses or for independent study credit. Full article

A drop in confidence in Advanced Pharmacy Practice Experience (APPE) readiness was observed in students in the Class of 2022 prior to starting APPEs. We aim to investigate potential causes of students’ low confidence in APPE preparedness to provide solutions and to prevent this outcome with future students. We evaluated students’ perceived confidence to start APPEs and compared this to curricular changes, employment obligations, and the impact of COVID-19 on delivery of the pre-APPE and APPE curriculum. Students’ low confidence with APPE readiness was not indicative of the following factors: (1) delivery of the didactic curriculum, (2) students’ performance in the didactic curriculum, or (3) number of summative assessments in key didactic courses. Rather, the low confidence perception may have been due to differences such as a fully remote didactic experience in the P3 year, more virtual Introductory Pharmacy Practice Experiences (IPPEs), a reduced course load in the P3 spring semester, and changes to a pre-APPE preparatory course compared to other class years. The students’ self-reported midpoint scores during their first APPE block and preceptor’s evaluations on their performance contrasted their pre-APPE perceptions. Frequent in-person and on-site skills assessments throughout the didactic curriculum seem to reinforce confidence before APPEs. Full article

Background: The NHS Community Pharmacist Consultation Service (CPCS) offers patients requiring urgent care a consultation with a community pharmacist, following referral from general practice or urgent care. The study explored the impact of undertaking a Centre for Pharmacy Postgraduate Education (CPPE) CPCS learning programme, and barriers and enablers to CPCS delivery. Methods: CPPE distributed an online survey to those who had undertaken their CPCS learning. The survey explored participants’ knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record keeping, transfer of care, and Calgary-Cambridge, L(ICE)F and SBARD communication tools. Details on barriers and enablers to CPCS delivery were also included. Results: One-hundred-and-fifty-nine responses were received (response rate 5.6%). Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. Barriers to CPCS included a lack of general practice referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. Conclusion: This study demonstrates that community pharmacists can extend their practice and contribute to the enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation. Full article

Strategies that introduce students to unconscious bias and social determinants of health (SDOH) are critical to develop them as effective health care providers. We developed a semester-long activity that utilizes disease-relevant scientific literature to implement cultural humility training in a second-year rheumatology pharmacy course. Students were first re-introduced to implicit bias and then completed an anonymous survey at the beginning and conclusion of the course using a 5-point Likert scale to assess their perceptions of the role of biases and SDOH in patient care. Throughout the semester, five journal articles were assigned that relate to course material and focus on one characteristic (e.g., gout—gender). Students’ evolved perceptions of SDOH were compared to baseline data and characteristics of assigned articles indicate an improved understanding of SDOH including race/ethnicity (3.0 to 4.4, p < 0.0001); gender (2.8 to 4.0, p < 0.0001); and religion (2.3 to 2.9, p < 0.01). Among characteristics that were not directly discussed in the assignments, only education showed a significant increase (3.0 to 3.6, p < 0.01). Scientific articles that focus on health inequities relevant to course-specific diseases provide a strategy to integrate discussions that help students evaluate their biases and SDOH with the goal of improving patient care. Full article

As research defines new treatments and policies to improve the health of patients, an increasing challenge has been to translate these insights into routine clinical practice to benefit patients and society. An important exploration is how theories of human behavior change fit into the science of implementation and quality improvement. In this paper, we begin with a brief review of the intellectual roots of implementation science and quality improvement, followed by a discussion of how theories and principles of behavior change can inform both goals and challenges in using behavior change theories. The insights offered through health behavior change theory have led to changes in how we plan for implementation and select, develop, design and tailor implementation interventions and strategies. While the degree to which organizational and external contexts influence the behavior of providers in these organizations varies widely, some degree of context external to the individual is important and needs adequate consideration. In short, health behavior change theory is essential but not sufficient to integrate in most implementation efforts, where priority must be given to both individual factors and contexts in which individuals operate. Full article

Objective: The objective of this study was to examine (1) the difference in perceived stress in first-year pharmacy students before and during the COVID-19 pandemic and (2) the difference in perceived stress among pharmacy students working different numbers of hours. Methods: Perceived Stress Scale (PSS), via an electronic survey, was administered throughout 2016–2021 using Qualtrics. End-of-year PSS scores were compared between the pre-pandemic group (2016–2018) and mid-pandemic group (2019–2021) using independent t-test and ANCOVA. All analyses were conducted using IBM SPSS Statistic Version 28.0. Results: A total of 209 first-year pharmacy students participated (response rate of 88%). No significant difference in mean PSS score was detected in the mid-pandemic cohort when compared to pre-pandemic. The mean PSS score was greater in those who worked greater than 10 h weekly compared to those who worked less. Those who did not work had an even greater mean PSS score than those who worked. Conclusions: No significant difference was observed in perceived stress between the pre-pandemic and mid-pandemic cohorts, and an increased perceived stress score was observed in pharmacy students who did not work in comparison to students who worked 1–9 h and 10–29 h. Full article

This article describes the design, implementation, and evaluation of five faculty development sessions focused on inclusive teaching strategies in pharmacy education. Inclusive strategies ensure that every student can clearly understand and engage in meaningful learning opportunities. Three sessions were implemented in fall 2020 and two in spring 2021. Sessions focused on experiential, didactic, and graduate education. A convergent parallel mixed methods evaluation was conducted using descriptive statistics and thematic analysis. Sessions were highly rated, and participants provided suggestions for curriculum improvement (e.g., creating resources, surveying students, and peer auditing syllabi for aspects of inclusiveness). Given the increasing emphasis on inclusion in pharmacy education, this work is timely for sharing strategies aimed at faculty development and teaching practices. Full article

Objectives: To assess the impact of an electronic prescribing template with decision support upon the frequency of prescription errors, guideline adherence (relating to dose ranges), and prescription legality when prescribing continuous subcutaneous infusions (CSCI) in a palliative demographic. Design, setting, and participants: Before-and-after study across a large UK city utilizing local prescribing data taken from patients receiving end-of-life care. Intervention: An electronic prescribing template with decision support. Main outcome measures: The following were assessed: (1) the rate of prescription errors; (2) the proportion of prescriptions specifying a dose range and if the specified range complied with local recommendations; and (3) the proportion of prescriptions specifying legal mixing directions. Results: The intervention was associated with a significant reduction in errors of omission, with all prescriptions clearly stating drug indication, route of administration, drug dose, and infusion duration. The numbers of continuous subcutaneous infusion prescriptions that specified dose ranges were similar at baseline and post-intervention, at 71% (n = 122) and 72% (n = 179), respectively. At baseline, 69% (n = 84) of CSCI prescriptions specifying a dose range were deemed safe, and post-intervention, 97% (n = 173) were determined to be safe. At baseline, mixing directions were not specified correctly on any continuous subcutaneous infusion prescriptions, while post-intervention, such directions were correct on 75% (n = 157; p < 0.05) of the prescriptions. Conclusions: The intervention eliminated errors of omission, ensured the safety of prescribed dose ranges, and improved compliance with legislation surrounding the mixing of multicomponent infusions. Overall, the intervention has the potential to improve patient safety at the end of life and to increase the efficiency of community services. Full article

Pharmacists identify, resolve, and document medication-related problems (MRPs) in community pharmacies. Enhanced medication therapy management (eMTM) targets specific situations, such as high-risk medications, while continuous medication monitoring (CoMM) occurs for every patient and is integrated into the dispensing process. This study describes types and frequencies of MRPs and interventions for health plan-directed eMTM and pharmacist-identified CoMM for a cohort of Medicare Part D patients. Pharmacy dispensing and clinical records from one independent community pharmacy in the Midwest were reviewed for patients eligible for eMTM in 2019. Data were coded for medication-related problems and interventions; descriptive statistics were calculated. Forty-seven patients were included in the study, resulting in 439 health plan-directed and 775 pharmacist-identified MRPs and corresponding interventions for a total of 1214 over 12 months. The average age of the patients was 77; they received an average of about 14 medications dispensed over 25 dates. Nonadherence was the most common MRP overall, as well as for the two categories separately. Patient Counseling and Lab Values Needed MRPs were found more often by pharmacists. Continue to Monitor was the most common intervention flagged overall. Medication Discontinued was found more often in health plan-directed interventions; Patient Counseling occurred more frequently in pharmacist-identified interventions. Using pharmacists to identify MRPs can complement health plan-driven eMTM, which can provide more complete medication management. Future work is needed to determine if this approach is reproducible in other pharmacies. Full article

Due to the heavy focus on development of communication skills, compounding laboratories and many practical workshops, undertaking a registerable pharmacist qualification in an online format is typically not an option for students. COVID-19 presented on-campus pharmacy students with the opportunity to experience online learning. The aim of this study was to explore the experiences of on-campus pharmacy students who were required to move their studies to online learning during the COVID-19 pandemic. An interpretive phenomenological methodology was adopted, and semi-structured interviews were conducted with pharmacy students who were originally enrolled in on-campus learning and had to transition to online learning. Data were analyzed using a hermeneutic phenomenological approach whereby themes were identified to aid in the development of the phenomena guided by ‘lived experience’. Seven interviews were conducted with pharmacy students. Four emergent themes resulted from the interviews: (1) life as an on-campus pharmacy student, (2) preconceived ideas of online learning, (3) learning differences as an online pharmacy student and (4) the future of online pharmacy programs. Students were initially hesitant to transition to online learning due to preconceived ideas and expectations that may have tainted their overall experience. Pharmacy students preferred face-to-face learning due to their sociable personality and heavy dependence on peer and teacher support. All participants reported that they preferred face-to-face learning and acknowledged that fully online programs were not suited to their learning style or to the discipline of pharmacy. After their experience of online learning, participants believed that there was a place for online learning components in pharmacy courses. Lectures and some discussion workshops could be delivered online, but some aspects, such as compounding; dispensing; counselling; and demonstration of medication delivery devices, such as asthma inhalers and injectable diabetes products, should be delivered on campus. Full article

Suicide is a global public health problem and is among the leading causes of death worldwide. Over 700,000 people die by suicide globally each year, affecting all ages, genders, and regions. Community pharmacists are easily accessible and trusted frontline healthcare professionals. They provide pharmaceutical care to the community, yet their role is still yet to be fully optimised. With the expanding role of community pharmacists and their constant accessibility to the local population, they could have a potential role in suicide prevention and awareness in Nigeria through restriction of means, signposting to services, and conversations with patients built on trusting relationships. In this commentary, we review the literature on the involvement of community pharmacists in suicide prevention. In addition, we discuss the potential role of community pharmacists in Nigeria through establishing trusting relationships with patients, clinical counselling, and medication gatekeeping, given the existing gaps in knowledge and awareness of suicide prevention within community settings. This commentary also outlines potential barriers and solutions, making suggestions for future research. Full article

(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis. Full article