Pharmacy — Open Access Journal

Peripheral neuropathy is a neurological disease characterised by pain, numbness, tingling, swelling or muscle weakness due to nerve damage, caused by multiple factors such as trauma, infections and metabolic diseases such as diabetes. In Kuwait 54% of the diabetic population, has peripheral neuropathy. In this exploratory, qualitative study conducted in Kuwait, 25 subjects with peripheral neuropathy took part in one-on-one, semi-structured interviews lasting 45–60 min. Interviews were transcribed, translated into English and coded using NVivo 12. Four individual patient journeys were mapped out in detail, then compared and condensed into a single process map. The remaining 21 interviews were then reviewed to ensure the final map represented all patient journeys. Participants reported similar healthcare pathways for their peripheral neuropathy and faced various difficulties including lack of psychological support, administrative issues (long waiting referral periods, loss of medical documents, shortage of specialists and lack of centralized electronic medical records) and inadequate medical care (shortage of new treatments and deficient follow-ups). Mapping the patient journey in Kuwait showed similar pharmacological treatment to UK guidelines, except that some medicines were unavailable. The map also indicated the need for an integrated referral approach, the use of technology for electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with peripheral neuropathy. Full article

There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is “more drugs than needed”. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy. Full article

Background: To investigate information sources utilized in pharmacists’ assessment of population-based health needs and/or community changes; and the association between information sources utilized and reported completion of continuing professional education topics. Methods: In 2017; licensed pharmacists (n = 1124) in North Dakota; South Dakota; Minnesota; Iowa; and Nebraska completed a questionnaire on continuing professional education and information sources on population-based health needs and community changes. Data were entered; cleaned and imported into Stata 11.1. Census Bureau county-level population density data were used to classify local area characteristics. Descriptive statistics and multivariate logistic regression analyses were performed. Results: Most sources of primary; county-level data on population-based health needs or community changes were minimally utilized. Pharmacists in more rural areas were statistically more likely to use local health professionals; local non-health professionals; and/or the state health department compared to pharmacists in less rural areas. Pharmacists reporting higher use of population-based information sources were more likely to have completed continuing education in the past 12 months for all 21 surveyed topics; 13 significantly so. Conclusions: There is a reliance of pharmacists on information from local health and non-health professionals for information on population-based health needs and/or community changes. Utilization of health departments and other primary information sources was associated with increased rates of completion of an array of continuing professional education topics. Expanding utilization of evidence-driven information sources would improve pharmacists’ ability to better identify and respond to population-based health needs and/or community changes through programs and services offered; and tailor continuing professional education to population-based health needs. Full article

Aminoglycosides are antimicrobial agents that are primarily used for infections caused by Gram-negative pathogens. The purpose of this article is to review the allergic reactions reported in the published literature to aminoglycoside antibiotics. A thorough PubMed search was conducted and excluded non-allergic adverse reactions to aminoglycosides. Allergic reactions to aminoglycosides occur infrequently, but can include cutaneous reactions as well as systemic reactions, including anaphylaxis. Of the evaluated aminoglycosides, gentamicin had the most reported allergic reactions, including the most reports of anaphylaxis, followed by tobramycin, and then amikacin. Most reports of allergic reactions occurred in patients who had a prior exposure to some dosage form of an aminoglycoside. Cross-reactivity among aminoglycosides is common and occurs due to the similarities in their chemical structures. Desensitization protocols to tobramycin have been described in the literature. Full article

Practice-based research networks (PBRNs) rely on a cadre of engaged members to participate in research projects. As pharmacist PBRNs increase in number, it is helpful to understand how members of other professions view their own participation in PBRNs and potential collaborative research endeavors with pharmacists. Due to their longer history of PBRN experience, physician PBRN members may have helpful advice for the establishment of pharmacy networks. The objectives of this study were to describe perceptions among a group of physician PBRN members about: Advice for developing a pharmacist PBRN, practice aspects that might benefit from collaborating with pharmacists who are part of a PBRN, and benefits and challenges of PBRN member participation. This study employed qualitative research methods. Semi-structured interviews were conducted with physician members of the Oklahoma Physicians Resource/Research Network, a primary care PBRN. Advice for establishing a pharmacist PBRN included identifying a champion, recruiting a core group, and conducting a needs assessment. Collaborative areas of interest included medication use management, patient education on chronic disease states, and physician education on new therapies. Participation benefits were categorized as personal satisfaction, improvement in practice quality improvement, advancement of specialty, peer interaction and learning, and real-time information and support. These findings offer insight into strategies for developing and sustaining pharmacist PBRNs and may inform pharmacist PBRN initiatives related to development, member recruitment and retention, and interprofessional project planning with physician PBRNs. Full article

Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions. Full article

This paper describes the design and implementation of elements of an integrated competency-focused pharmacy programme in the School of Pharmacy and Pharmaceutical Sciences (SoPPS), Trinity College Dublin (TCD), Ireland. Following a national review of pharmacy education and training in Ireland in 2010, and subsequent publication of legislation in 2014, the School has implemented a five-year integrated programme of pharmacy education and training, leading to the award of a Master’s degree in Pharmacy (M. Pharm.). Curricular integration has been achieved by underpinning the new programme with a national competency framework for pharmacists and through the utilisation of curricular integration themes. Programme integration also encompasses embedded experiential learning placements in Years 2, 4 and 5 of the five-year programme. The new five-year integrated pharmacy programme, which commenced in 2015, replaced the 4 + 1 model of education and training where a four-year Bachelor’s degree was followed by a one-year internship, which was a distinct and separate element of the students’ training. Full article

The consequences of a documented penicillin allergy in the medical record are especially troublesome in acutely ill, hospitalized patients. A penicillin allergy label may lead to alternative or second line therapies resulting in adverse drug events, negative clinical outcomes and increased costs. Reconciling penicillin allergies is a necessity to facilitate early, optimal therapy and is a shared responsibility among the healthcare team. Penicillin skin testing (PST) has been utilized successfully in hospitalized patients to de-label erroneous penicillin allergies and optimize antibiotic therapy. This targeted review aims to discuss the practical development and implementation of PST in the inpatient setting. This includes a needs assessment checklist with common considerations allowing for customization to one’s institution based on available personnel, time, and technological resources. Full article

There has been an increase in opioid analgesic prescribing in general practice (GP). This is causing some concern around this contributing to dependency. NHS Lanarkshire have attempted to reduce the prescribing from GP surgeries through the development of specialised Pharmacist Independent Prescriber clinics being delivered from the practices. This article looks at the development of these services with pharmacist independent prescribers and the results from developing the services. The article aims to provide advice and recommendations for the development of other services and strategies to minimise the risks associated with Opioid Analgesic Dependence for patients. Full article

Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to develop a practice-based research network (PBRN) in partnership with existing CINs to perform robust outcome evaluations. The objective of this study was to learn pharmacists’ opinions on participating in research to facilitate the formation of a community pharmacy PBRN in Pennsylvania. A 20-item survey gathered information on pharmacists’ research interests, perceived benefits of research participation, and preferences on communication and patient engagement. Descriptive statistics and Chi-square tests were used to analyze quantitative data. Seventy-three participants completed the survey, with 47% representing independent pharmacies. The majority (96%) were interested in research opportunities and 86% believed improving workflow and patient care was the most valuable benefit. Eighty percent of pharmacists reported it is very important to demonstrate that pharmacists care about making patients’ health better. Connecting pharmacists with other health care providers was reported as very important by 75% of respondents. Pharmacists reported face-to-face communication (76%) as their preferred way to approach patients about research and 72% supported using student pharmacists to assist with patient engagement. The results from this study can inform others who are structuring processes and developing communication strategies for community pharmacy PBRNs, particularly in partnership with CINs. Full article

Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal of the current study was to determine whether completion of a pre-pharmacy biochemistry course and/or performance on a biochemistry competency test (administered at the beginning of the pharmacy program) are associated with pharmacy student performance in foundational science courses and overall academic performance. A secondary goal was to determine whether performance in pre-pharmacy courses and/or student demographics are associated with pharmacy student performance. Prospective univariate analyses (n = 75) determined that completion of a pre-pharmacy biochemistry course is not associated with pharmacy student performance. However, performance on a biochemistry competency test was associated with performance in Biochemistry and Cell&Molecular Biology (p = 0.002). Furthermore, post-hoc analyses determined that pre-pharmacy cumulative chemistry GPA correlates with performance in both the Biochemistry and Cell&Molecular Biology and Medicinal Chemistry foundational science courses (p = 0.002 and p = 0.04, respectively) and can predict first year GPA (p = 0.002). The combined data indicate that further assessment of the impact of pre-pharmacy competency in biochemistry and chemistry on pharmacy student success is warranted. Full article

Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized. An evaluation framework to determine the pharmacy school’s effectiveness in strengthening the health system could be applied. A needs-based pharmacy educational approach modeled on population health could: Integrate resources from education, service, and research activities; follow a monitoring and evaluation framework that tracks educational outcomes; and engage with external stakeholders in curricular development and assessment. Full article

MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound patients (MCH), and residents of long-term care homes (MCLTC). The Ontario government introduced an abrupt policy change effective 1 October 2016 that added several components to all MC services, especially those completed in the community. We used an interrupted time series design to examine the impact of the policy change (24 months pre- and post-intervention) on the monthly number of MedsCheck services delivered. Immediate declines in all services were identified, especially in the community (47%–64% drop MC, 71%–83% drop MCD, 55% drop MCH, and 9%–14% drop MCLTC). Gradual increases were seen over 24 months post-policy change, yet remained 21%–76% lower than predicted for MedsCheck services delivered in the community, especially for MCD. In contrast, MCLTC services were similar or exceeded predicted values by September 2018 (from 5.1% decrease to 3.5% increase). A more effective implementation of health policy changes is needed to ensure the feasibility and sustainability of professional community pharmacy services. Full article

Our objective was to explore the implementation of a novel NHS England (NHSE)-funded pilot project aimed at deploying clinical pharmacists in an integrated urgent care (IUC) setting including the NHS 111 service. Eight integrated urgent care clinical pharmacists (IUCCPs) within the participating North East of England Trusts. Individuals participated in semi-structured 1-to-1 interviews by an experienced qualitative researcher, either face-to-face or via the telephone. Each recording was transcribed, and the five stages of framework analysis (familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation) took place to establish emerging themes. All interviews took place between November 2018–February 2019. Four higher-order themes were identified: 1. Personality Traits, 2. Integration, 3. Benefits, 4. Training. The IUCCP programme is an innovative NHSE initiative. It provides an opportunity to extend the role of clinical pharmacists into the hard-pressed clinical environment of urgent and emergency care. Our evaluation has highlighted the potential for this professional group to contribute clinically in this area. Better communications, standard operating procedures and induction will improve how individuals develop in these novel roles. Full article

Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow. Full article

Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit. Full article

Medicine falsification is a global issue. Viagra, an erectile dysfunction therapeutic (EDT) medicine consisting primarily of sildenafil citrate, is the most commonly falsified medicine worldwide. Recently falsified EDTs have been reported multiple times in developing countries. The globalization of falsified EDTs has become a concern. In the present study, we selected sildenafil citrate tablets as an indicator and examined samples from a developing country, Cambodia, to investigate the availability of falsified sildenafil tablets in Cambodia and verify the current globalization status of falsified medicines from the standpoint of a developing country. Six samples of the originator Viagra, and 68 samples of generic sildenafil products were purchased from private drug outlets and wholesalers in Phnom Penh, Svay Rieng, and Battambang. The samples’ manufacturers were contacted to authenticate the samples. The quantities and dissolution rates of active ingredients were measured by a high-performance liquid chromatography system with photodiode array. Five generic samples were strongly suspected to be falsified medicines because of their extremely low quality; however, there was little distribution and no falsified medicine alleged to be produced by the originator of Viagra, which charges high prices. That finding indicates that falsification reflects local economic circumstances. Full article

Understanding antibiotic allergies and the risk of cross-sensitivity between and within antibiotic classes can have a substantial impact on patient care. The purpose of this review article is to provide insight into carbapenem allergies, describing the overall incidence, risk factors, and in-class cross-sensitivity. A PubMed search was conducted using the following search terms: carbapenem, allergy, cross-sensitivity, incidence, imipenem/cilastatin, meropenem, ertapenem, and doripenem. Article bibliographies and relevant drug monographs were also reviewed. The overall reported incidence of carbapenem allergy is 0.3%–3.7%. Risk of cross-sensitivity between penicillins and carbapenems is less than 1% in patients with a positive penicillin skin test. Data on cross-sensitivity between cephalosporins and carbapenems are limited; however, the risk appears to also be low. No clinical studies have described cross-sensitivity between the carbapenem agents thus far. The limited data available from case reports demonstrates a lack of cross-sensitivity between the individual carbapenems, suggesting that an alternative carbapenem may cautiously be used in patients with a reported carbapenem allergy. Full article

Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. Measures of interest included: subject characteristics and preference in a variety job offers. Discrete Choice Experiment methodology of questionnaire design was used and Conditional Logit models were conducted to analyze the data to determine the financial incentive required for pharmacy students to take a post-graduate job with particular traits. Conclusions: A total of 283 students completed questionnaires from Iowa, North Dakota, South Dakota, Saskatchewan, and Manitoba. The majority of subjects were female, P3 students, and from a non-rural hometown. American students would need to be paid an additional $18,738 in salary to practice in a rural area, while Canadian students would require an additional $17,156. Canadian respondents would require an additional $7125 in salary to work in a community pharmacy with a low level of patient interaction compared to a community position with a large amount of patient interaction. Overall, pharmacy student preferences in post-graduation job attributes vary significantly between states and provinces. Full article