Pharmacy

Background: In our previous study regarding infection prevention after COVID-19, many Japanese citizen respondents had not received education/training on infection prevention. However, a total of 47.7% (n = 143) of these respondents wanted to receive education from healthcare professionals regarding the methods and effects of infection prevention. Therefore, changes in recognition of the roles of Japanese pharmacists before and after COVID-19 were investigated. Methods: We conducted a survey to determine whether recognition of Japanese pharmacists’ roles, especially their role in public health in the community, changed after COVID-19. Results: A total of 93.9% (n = 307) of the pharmacist respondents showed an increased awareness of infection prevention. Before COVID-19, the hospital pharmacists (67.2%; n = 80) were more aware of infection prevention than were pharmacy pharmacists (51.7%; n = 74) and drugstore pharmacists (47.7%; n = 31). The number of pharmacists who felt that the role of pharmacists in the community had changed after the pandemic increased, but the numbers of community pharmacy pharmacists (51.8%; n = 74) and drugstore pharmacists (55.4%; n = 36) were found to be slightly higher than those of hospital pharmacists (47.9%; n = 57). Conclusions: In a society in which swift responses and changes are required, for individuals to work as medical personnel their ability to respond while always being aware of the needs of society is required now more than ever. Full article

We describe the first two years of a multifaceted, five-year program to support sustainable pharmacist-provided health services in Alaska. In 2018, the Alaska Pharmacists Association funded the Sustainable Education and Training Model under Pharmacist as Providers (SETMuPP) to train and support pharmacists to navigate the insurance medical billing process for nondispensing healthcare services. The SETMuPP employed a three-pillar implementation approach: (1) training and practice support infrastructure, (2) PharmD curriculum augmentation, and (3) advocacy and legislative support. The first two years have demonstrated the effectiveness of triad partnerships between professional associations, state policy makers, and academic centers to catalyze meaningful practice transformation. Full article

To enable application-oriented training of Swiss pharmacists on pharmacogenetic (PGx) testing, an advanced, digital training program was conceptualized based on the Miller’s Pyramid framework, using a blended learning approach. The PGx advanced training program included an asynchronous self-study online module, synchronous virtual classroom sessions with lectures and workshops, and a follow-up case study for in-depth applied learning including the analysis of the participants’ PGx profile. The evaluation of the training program consisted of (a) an assessment of the participants’ development of knowledge, competencies and attitudes towards PGx testing in the pharmacy setting; (b) a satisfaction survey including; (c) questions about their future plans for implementing a PGx service. Twenty-one pharmacists participated in this pilot program. The evaluation showed: (a) a significant improvement of their PGx knowledge (mean score in the knowledge test 75.3% before to 90.3% after training completion) and a significant increase of their self-perceived competencies in applying PGx counselling; (b) a high level of satisfaction with the training program content and the format (at least 79% expressed high/very high agreement with the statements in the questionnaire); (c) a mixed view on whether participants will implement PGx testing as a pharmacy service (indecisive 8; agreed/completely agreed to implement 7/1; disagreed 3 (n = 19)). We consider ongoing education as an important driver for the implementation of PGx in pharmacy practice. Full article

Background: Successful pharmacy curricula expose students to a variety of teaching and assessment methods to prepare students for clinical practice. However, development of clinical decision-making skills is often challenging for learners. To meet this need, the Choose Your Own Adventure (CYOA) Patient Case Format was developed to enhance traditional paper patient cases by integrating problem-based and case-based learning to improve pharmacy student learning. The objectives of this evaluation were to qualitatively evaluate the CYOA case format. The qualitative assessment of the student pharmacist’s learning experience utilizing this novel patient case format was used to formulate a template for extrapolation to other disease states. Methods: Focus groups were conducted with second year Pharm.D. students enrolled at the University of Tennessee Health Science Center (UTHSC) College of Pharmacy. The focus groups were conducted in Fall 2020, beginning the week after they were exposed to the CYOA case format. The corpus of data was analyzed thematically to identify themes using inductive coding. To establish the validity of this evaluation, the team met to assess the consistency of the data reduction methods and guard against methodological issues that could influence and affect coding decisions. Results: Participants were recruited until thematic saturation was achieved. Out of 25 participants, 23 participants provided demographic information, with 74% identifying as female. Thematic analysis identified three themes: (1) “It was just fun!” (2) Empowering Pharmacy Students through Groupwork: “Collaboration [is] going to be vital” and (3) Meeting the Need for Real-Life Scenarios: “This is a real person.” Conclusions: The data highlight that there are numerous advantages of adopting the CYOA format for delivering applied pharmacotherapy content. The CYOA format presents students with a realistic scenario that is fun and engaging and challenges students to justify their decisions regarding patient care in a structured group environment. Full article

The overall goal of this study was to employ direct-to-consumer advertisements (DTCAs) as a teaching tool in a Doctor of Pharmacy (PharmD) curriculum. The objectives of this pilot study were to investigate the following questions: 1. Do DTCAs generate student curiosity about the advertised drug and associated disease? 2. Can DTCAs help students understand and reinforce various pharmacological aspects of the drug? 3. How do students perceive DTCAs? A DTCA-based teaching tool was employed in a pharmacology course taken by P2 (second professional year) PharmD and final year (U4) Bachelor of Science (BS) in Pharmacology–Toxicology students. A voluntary online survey was administered to students to determine the effectiveness of this tool. Survey data were analyzed quantitatively and qualitatively. 70–85% of responding students indicated that this teaching tool was an effective visual aid for learning pharmacology and correlating the drug to disease state, mechanism of action, and adverse effects. Moreover, themes identified from the qualitative analysis suggest that this teaching tool may be useful to enhance patient counseling skills in students. The initial implementation of this DTCA-based teaching tool proved to be successful, and a similar approach can be easily implemented in other pharmacotherapy and laboratory courses. Further studies are needed to determine if this approach can improve patient counseling skills. Full article

Ensuring adequate engagement and preparation of all stakeholders in an accreditation self-study can be challenging for many reasons, including lack of motivation and inadequate understanding of expectations and procedures. The goal of this exploratory study was to determine whether using team-based learning (TBL) pedagogy to deliver an accreditation preparation workshop could effectively prepare and engage participants. A Likert-scale questionnaire was administered to workshop attendees (n = 52) to determine whether they found TBL-based training helpful and whether it promoted engagement. Twenty-four attendees completed the survey (46%). More than 80% of participants strongly agreed or agreed with 12 statements relating to perceptions of self and participant engagement within team activities and the usefulness of team activities. More than 65% of participants strongly agreed or agreed with statements relating to the helpfulness of the TBL approach in preparing for the self-study (five questions). Subgroup analysis showed no significant difference in responses based on whether on not participants had previously been involved in an accreditation self study. Our data indicate that a TBL approach can be an effective way to engage and prepare stakeholders for an accreditation self-study, and that TBL pedagogy has utility outside of the classroom setting. Full article

The literature indicates that the limited pharmacovigilance knowledge demonstrated by healthcare professionals is the main reason for the underreporting of adverse drug reactions. Therefore, the main objective of this study was to investigate pharmacy, dental and medical students’ knowledge and attitudes to pharmacovigilance and pharmacovigilance education. The cross-sectional questionnaire study was conducted at the University of Split School of Medicine in November 2020. In total, 350 students participated in the study. The results have shown that pharmacy students showed a significantly higher knowledge score compared to dental and medical students (P < 0.001). In total 92.2% of pharmacy, 21.8% of dental and 70.8% of medical students had knowledge of patients’ involvement in adverse drug reactions, reporting (P < 0.001). Interestingly, only 44.3% of all students knew that adverse drug reactions could be reported using a mobile application. Moreover, significantly more pharmacy students (74.4%) were aware of the adverse drug reactions monitoring center in Croatia, with 47.5% of dental and 39.2% of medical students correctly identifying it (P < 0.001). The results showed that most students felt that pharmacovigilance was not adequately covered in curricula; therefore, there is a great need to increase the knowledge and awareness of pharmacovigilance among students aspiring to become future healthcare professionals, and improve their reporting practice in clinical future. Full article

Although clinical pharmacy is a discipline that emerged in the 1960s, the question of precisely how pharmacists can play a role in therapeutic optimization remains unanswered. In the field of mental health, psychiatric pharmacists are increasingly involved in medication reconciliation and therapeutic patient education (or psychoeducation) to improve medication management and enhance medication adherence, respectively. However, psychiatric pharmacists must now assume a growing role in team-based models of care and engage in shared expertise in psychopharmacology in order to truly invest in therapeutic optimization of psychotropics. The increased skills in psychopharmacology and expertise in psychotherapeutic drug monitoring can contribute to future strengthening of the partnership between psychiatrists and psychiatric pharmacists. We propose a narrative review of the literature in order to show the relevance of a clinical pharmacist specializing in psychiatry. With this in mind, herein we will address: (i) briefly, the areas considered the basis of the deployment of clinical pharmacy in mental health, with medication reconciliation, therapeutic education of the patient, as well as the growing involvement of clinical pharmacists in the multidisciplinary reflection on pharmacotherapeutic decisions; (ii) in more depth, we present data concerning the use of therapeutic drug monitoring and shared expertise in psychopharmacology between psychiatric pharmacists and psychiatrists. These last two points are currently in full development in France through the deployment of Resource and Expertise Centers in PsychoPharmacology (CREPP in French). Full article

Since 2014, select states have allowed pharmacists to prescribe hormonal contraception (HC). This study describes student pharmacists’ perceptions of a pharmacist’s scope of practice, education, and interest, and identifies differences between students who have completed didactic HC content in their professional curriculum versus those who have not. A voluntary online survey was emailed to all students in three Georgia pharmacy schools. Descriptive statistics were reported. Likert square responses were dichotomized, and Chi square testing identified differences between groups. A total of 1256 students were invited, 35% completed the survey, of those 68% had received HC didactic content in their curriculum. Regardless of HC education, most students “agree” or “strongly agree” that pharmacists are adequately educated to prescribe HC (92% vs. 86%, p = 0.05) and prescribing HC is within the pharmacist’s scope of practice (89% vs. 84%, p = 0.12). Although not currently permitted in Georgia, most are interested in prescribing (97% vs. 96%, p = 0.5). Of the students who have received HC didactic content, 87% felt “moderately”, “well”, or “extremely well-educated” regarding HC prescribing clinical skills. Regardless of didactic training, pharmacy students believe pharmacists are prepared to prescribe HC and support pharmacist-prescribed HC as a part of their future professional scope of practice. Full article

The spread of COVID-19 and social-distancing rules have increased the need for alternative learning environments with a focus on e-learning platforms. The objective of this study was to assess whether and to what extent the transition from traditional learning and assessment environment to the e-setting impacts the knowledge and skills acquired by students and their satisfaction with new e-solutions of taking the OSCE test. The study compared the results of three face-to-face (2018–2019) and one electronically conducted (2021) OSCE tests, as well as students’ feedback on the content and organization of the tests. For data analysis the one-way ANOVA test and post hoc multiple comparisons were used. The results demonstrated the feasibility and effectiveness of and students’ satisfaction with OSCE tests in the Zoom environment. However, more focus on communication techniques is required in a remote communication environment to better cover all patient health-related and drug communication aspects. There were identified differences between undergraduate students and practicing assistant pharmacists in assessing patients’ health problems and providing corresponding counseling. This result points to the need to implement the continuous development of patient-centered counseling techniques in the lifelong learning of pharmacists and the need to use innovative digital solutions, if applicable. Full article

The objectives of this study are to report the contribution of pharmacists to smoking cessation and study the determinants of smoking cessation success in eight pharmacies in Portugal (south) between 2009 and 2019. A real-life study was conducted with a sample of smokers who participated in pharmacist consultations. The sample included 135 smokers (average age of 47.9 ± 1.21 years), 79 (58.5%) of whom were male. In parallel with the motivation and behavioral approach, 116 (85.9%) smokers received pharmacological therapies: 108 (80.0%) were treated with nicotine replacement products and eight (5.9%) with non-nicotine medications. The interventions resulted in 70 (51.9%) smokers complying with the quit day, of whom 59 (43.7%) were smoking-abstinent at the end of the first month. Success rates were reduced to 32.6%, 28.1%, and 20.7% at the end of the 3rd, 6th, and 12th months, respectively. Smoking cessation was more successful for the participants receiving pharmacological therapies (Fisher’s exact test, p < 0.001) and those who participated in more pharmacist consultations (χ² = 59.994, p < 0.001) and more telephone sessions (χ² = 17.845, p < 0.001). Pharmacists can contribute significantly to the promotion of smoking cessation. Smokers who are more thoroughly followed up by pharmacists showed increased success rates when compared with smokers having fewer sessions with pharmacists. Full article

Background: Australians are no strangers to sudden natural disasters, such as bushfires. The effects of a natural disaster can devastate local communities and health care services. Currently, limited research has explored the role of the pharmacist during a natural disaster. This study explores the role of the Australian pharmacist during the 2019/2020 Black Summer Bushfires. Methods: Semi-structured phone interviews were conducted with ten community pharmacists who worked through the Black Summer Bushfires whose daily tasks and work environment were directly affected by the bushfires. Thematic analysis using NVivo^®, a qualitative data analysis software was conducted. Results: Analysis of the transcripts generated six main themes: collaboration; trauma and mental health; power and communication; acute presentations; triaging and emergency prescribing. Pharmacists worked in close collaboration with doctors and members of the local community. They provided triaging services, timely health advice about chronic health problems, and managed acute issues, including wound and burn management and mental health support in traumatic conditions, sometimes without power and communication amenities. The challenges presented to pharmacists during the bushfires warranted creative and flexible approaches at times. Conclusion: This study highlights the need for mental health support and training for pharmacists, provisional prescribing privileges, and a clearer set of contingency regulations and legislation related to emergencies and natural disasters. Further research is warranted to gain greater insight into the roles undertaken by Australian pharmacists during natural disasters and their autonomy in decision making processes during such times. Full article

Fluoroquinolones are associated with an increased risk of Clostridioides difficile infection (CDI). Probiotic supplementation has been shown to reduce the risk of antibiotic-associated diarrhea with variable effects on CDI. The objective of this study was to evaluate receipt of probiotics on development of primary CDI among hospitalized patients receiving fluoroquinolones. A retrospective cohort was evaluated that consisted of two groups of 100 patients each, admitted August 2018 through August 2020 that received ≥3 days of definitive monotherapy with levofloxacin or ciprofloxacin within 72 h of admission. Primary outcome was incidence of CDI. Secondary outcomes included rates of C. difficile diagnostic stool testing, additional infectious diagnostic testing, and non-CDI related gastrointestinal side effects. Patients on fluoroquinolones who received probiotics had a non-statistically significantly lower incidence in overall cases of CDI compared to those who did not receive probiotics (0% vs. 3%, p = 0.246). Patients who received probiotics had statistically significantly fewer C. difficile diagnostic stool tests performed (4% vs. 16%, p = 0.005) and fewer additional infectious diagnostic testing performed (4% vs. 10%, p = 0.096), respectively. Further research is warranted to optimize and standardize probiotic prescribing in high-risk patients. Full article

Nearly half of all patients prescribed a chronic medication do not adhere to their regimen. Conversion from a 30- to 90-day medication refill is associated with improved adherence. The objective of the study was to assess the change in proportion of days covered (PDC) in those who converted to a 90-day fill and those who did not after a telehealth pharmacist-delivered, medication adherence intervention. This retrospective review involved data collected between May and December 2018. Patients with ≤85% baseline PDC rates were targeted. One group included patients who converted to a 90-day fill after the pharmacist intervention. The comparator group did not convert to a 90-day fill. Differences in median end-of-year (EOY) PDC rates for each medication class were compared between groups. An alpha level of 0.05 was set a priori. Overall, 237 patients converted to a 90-day fill and 501 did not. There was no significant difference in age, sex, and total number of drugs per patient. A Mann–Whitney U test revealed statistically significant improvements in median EOY PDC in the group that converted to a 90-day fill (+9% vs. −3%, p < 0.001). Pharmacist-delivered telehealth interventions were associated with improved PDC rates in those who converted to a 90-day fill. Full article

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB. Full article

Background: A 2016 meta-analysis of pharmaceutical care for patients with diabetes mellitus showed that the following four components were most effective: (a) individual goal setting, (b) sending feedback to the physician, (c) reviewing the medication, and (d) reviewing blood glucose measurements. Methods: To formulate a hypothesis regarding the effect of these four pharmaceutical care components on glycemic control in patients with diabetes mellitus and the feasibility of these components in practice. Ten patients with type 2 diabetes were included in the case series and received medication therapy management over four months. Results: The four care components were feasible in everyday practice and could be implemented within one patient visit. The average visits were 49 and 28 min at the beginning and end of the study, respectively. The glycated hemoglobin values did not change over the study period, though the fasting blood glucose decreased from 142 to 120 mg/dl, and the number of unsolved drug-related problems decreased from 6.9 to 1.9 per patient by the study end. Conclusions: This case series supports the hypothesis that community pharmacists can implement structured pharmaceutical care in everyday pharmacy practice for patients with type 2 diabetes mellitus. Full article

In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interventions after this PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). The secondary outcome was antibiotic days of therapy (DOT), with a subgroup analysis examining antibiotic use and the length of stay (LOS) in patients with a pharmacist intervention. From 1/2019 to 11/2019, there were 165 alerts in 116 unique patients on antibiotics for LRTI. Pharmacists attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral being the most common interventions. Pharmacist interventions prevented 125 DOT in the hospital. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to a 27.4% discontinuation in patients without documented intervention (p = 0.0156). The LOS was similar in both groups (median 6.4 days vs. 7 days, p = 0.81). In conclusion, interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with a normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation. Full article