https://www.pharmacypractice.org/journal/index.php/pp/issue/feed Pharmacy Practice 2020-10-30T17:31:18+00:00 Fernando Fernandez-Llimos journal@pharmacypractice.org Open Journal Systems <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge and will never charge any publication fee or article processing charge (APC) to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> https://www.pharmacypractice.org/journal/index.php/pp/article/view/1976 For which patient subgroups are there positive outcomes from a medication review? A systematic review 2020-10-27T11:42:26+00:00 Bjarke Abrahamsen bja@pharmakon.dk Rikke N. Hansen rnh@pharmakon.dk Charlotte Rossing cr@pharmakon.dk <p><strong>Background</strong>: A medication review is a possibility to assess and optimise a patient’s medicine. A model that includes a medication review and a follow-up seem to provide the best results. However, it is not known whether specific subgroups of patients benefit more from a medication review than others.</p> <p><strong>Objective</strong>: This literature review summarises the evidence that is available on which patient subgroups exist positive outcomes from a medication review carried out in a primary care setting.</p> <p><strong>Methods</strong>: We performed a PICO analysis to identify keywords for setting, medication review and effect. We then conducted a search using the PubMed database (2004 to 2019) to identify studies relevant for our investigation. A screening process was carried out based on either title or abstract, and any study that matched the aim and inclusion criteria was included. All matching studies were obtained and read, and were included if they met predefined criteria such as study design, medication review and primary care. The studies were divided into subgroups. First, each subgroup was divided according to the studies’ own definition. Secondly, each subgroup was allocated as either risk patients if the subgroup described a specific patient subgroup or risk medication, if the subgroup was defined as using a specific type of medication. This was done after discussion in the author group.</p> <p><strong>Results</strong>: 28 studies from a total of 935 studies were included. Identified studies were divided into either risk patients; frail, recently discharged or multimorbid patients, or risk medication; heart medication, antithrombotic medication, blood pressure lowering medication, antidiabetic medication, anti-Parkinson medication or medication increasing the risk of falls. The subgroups identified from a medication review in primary care were defined as being frail, recently discharged from hospital or multimorbid (risk patients), or defined as patients using anticoagulant or blood pressure lowering medication (risk medication). Most of the medication reviews in the studies that showed an economic effect included at least one follow-up and were delivered by a pharmacist.</p> <p><strong>Conclusions</strong>: The literature review demonstrates that medication reviews delivered by pharmacists to specific subgroups of patients are a way of optimising the economic effect of medication reviews in primary care. This is obtained by reducing health-related costs or the number of contacts with primary or secondary health care services.</p> 2020-10-27T11:31:47+00:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/1865 Evaluation of simulated drug dispensing and patient counseling in the course of pharmaceutical improvement: 2009 to 2015 2020-10-16T10:19:19+01:00 Priscila B. Packeiser pri_packeiser@hotmail.com Mauro S. Castro mauro.silveira@ufrgs.br <p><strong>Background</strong>: Aiming to facilitate the drug dispensing process and patient counseling, specific professional skills are required. The knowledge, skills and attitudes involved in this process can be improved. From 2012 to 2015, a nationwide course was held, in partnership with the Ministry of Health and the Federal University of Rio Grande do Sul (UFRGS) – Brazil, to train pharmacists working in primary health care through the development of their clinical and communication skills. One of the steps in this process involved the simulation of the drug dispensing process and patient counseling.</p> <p><strong>Objective</strong>: To evaluate the performance of pharmacists in drug dispensing and counseling through patient simulation role-playing held in a face-to-face meeting at the end of a training course.</p> <p><strong>Methods</strong>: A cross-sectional and retrospective study with analysis of patient simulation recordings and data collection using an assessment instrument with scores ranging from 0 to 10 points to assess pharmacist's behavior, skills, and technical knowledge.</p> <p><strong>Results</strong>: Participants presented poor-to-regular performance, with median scores equal to or lower than six. The median time of the drug dispensing simulation was five minutes and the patient counseling was eight minutes. Pharmacists had better scores in the simulation of asthma cases. In drug dispensing, 99.5% of pharmacists had difficulty checking the patient's time availability, 98.5% did not know how to use the devices, and 94.7% did not advise the patient on what to do if they forgot to take a dose. In patient counseling simulation, 1.18% of pharmacists remembered to advise on what do with medication leftovers, and 50.6% asked questions that induced the patient's responses.</p> <p><strong>Conclusions</strong>: The low-to-regular performance showed that pharmacists had difficulties at improving their skills in the performance of complete and effective drug dispensing and patient counseling.</p> 2020-10-16T10:17:27+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2038 Training and standardization of simulated patients for multicentre studies in clinical pharmacy education 2020-10-30T17:31:18+00:00 Karina A. Resende karinaresendeufsj@gmail.com Afonso M. Cavaco acavaco@ff.ulisboa.pt Márcia A. Luna-Leite marcia.angeles@gmail.com Bianca R. Acacio bianca.r.acacio@gmail.com Núbia N. Pinto nubiia.naiiara@outlook.com Maria D. Neta mrdeusa@gmail.com Angelita C. Melo angelitamelo@ufsj.edu.br <p><strong>Objective</strong>: To evaluate the training and standardization methods of multiple simulated patients (SPs) performing a single scenario in a multicenter study.</p> <p><strong>Methods</strong>: A prospective quasi-experimental study, using a multicenter approach, evaluated the performance of five different individuals with the same biotype during a simulation session in a high-fidelity environment. The SPs training and standardization process consisted of four steps and six web or face-to-face mediated: Step 1: simulation scenario design and pilot test. Step 2: SPs selection, recruitment and beginning training (Session 1: performance instructions and memorization request.) Session 2: check the SPs’ performances and adjustments). Step 3 and session 3: training role-play and performance’s evaluation. Step 4: SPs' standardization and performances’ evaluation (Sessions 4 and 5: first and second rounds of SPs' standardization assessment. Session 6: Global training and standardization evaluation. SPs performance consistency was estimated using Cronbach's alpha and ICC.</p> <p><strong>Results</strong>: In the evaluation of training results, the Maastricht Simulated Patient Assessment dimensions of SPs performances "It seems authentic", "Can be a real patient" and "Answered questions naturally", presented “moderate or complete agreement” of all evaluators. The dimensions "Seems to retain information unnecessarily", "Remains in his/her role all the time", "Challenges/tests the student", and "Simulates physical complaints in an unrealistic way" presented “moderate or complete disagreement” in all evaluations. The SPs "Appearance fits the role" showed “moderate or complete agreement” in most evaluations. In the second round of evaluations, the SPs had better performance than the first ones. This could indicate the training process’s had good influence on SPs performances. The Cronbach's alpha in the second assessment was better than the first (varied from 0.699 to 0.978). The same improvement occurred in the second round of intraclass correlation coefficient that was between 0.424 and 0.978. The SPs were satisfied with the training method and standardization process. They could perceive improvement on their role-play authenticity.</p> <p><strong>Conclusions</strong>: The SPs training and standardization process revealed good SPs reliability and simulation reproducibility, demonstrating to be a feasible method for SPs standardization in multicenter studies. The Maastricht Simulated Patient Assessment was regarded as missing the assessment of the information consistency between the simulation script and the SPs provision.</p> 2020-10-30T17:21:33+00:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2080 Assessment of occupational violence towards pharmacists at practice settings in Nigeria 2020-10-19T19:57:06+01:00 Garba M. Khalid khalidgmk@gmail.com Umar I. Idris rxumar@gmail.com Abubakar I. Jatau pharmjt@gmail.com Yusuf H. Wada hasawa2011@gmail.com Ya'u Adamu yabal2004@gmail.com Marzuq A. Ungogo myzooq@gmail.com <p><strong>Background</strong>: Occupational Violence is prevalent among healthcare workers, including pharmacists, and poses a big threat to their job satisfaction, safety, and social wellbeing.</p> <p><strong>Objective</strong>: This study seeks to assess the incidents and factors associated with occupational violence towards pharmacists in Nigeria.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted among pharmacists practicing in Nigeria, using an online survey (Google Form<sup>TM</sup>). Occupational violence was assessed using a validated questionnaire. The survey was conducted and reported based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Participants were recruited by sharing the survey link via social media platforms including WhatsApp, Facebook, LinkedIn, and Twitter.</p> <p><strong>Results</strong>: A total of 263 respondents returned the online questionnaire, with a completion rate of 99.2%. The prevalence of occupational violence was 92.7% (95% CI, 90 to 96). Violent events occurred among 48.7% of pharmacists with at least six years of experience, and 68.4% of hospital pharmacists. The commonly reported factors associated with the violence include long waiting times in the pharmacy (36.5%), refusal to fulfil aggressor’s demands (22.1%), and counseling/poor communication (21.7%). Events related to verbal abuse were reported among 95% of the participants. The prevalence of violence was significantly higher among hospital pharmacists, compared with those practicing in administration/regulatory, and in community pharmacies (chi-square=10.213 (2); p=0.006). Similarly, physical aggression was higher among hospital pharmacists (chi-square=10.646 (2), p = 0.005).</p> <p><strong>Conclusions</strong>: The prevalence of occupational violence towards pharmacists practicing in Nigeria appeared to be high. Major factors associated with the violence were refusal to fulfil aggressors’ demands and frustrations due to long waiting times at pharmacy. Recommended strategies to slowdown the incidences of violence were improved pharmacists’ workforce, interprofessional harmony, and penalties against perpetrators.</p> 2020-10-19T19:47:46+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2111 Dispensing errors in community pharmacies in the United Arab Emirates: investigating incidence, types, severity, and causes 2020-10-20T11:35:13+01:00 Osama Mohamed Ibrahim oibrahim@sharjah.ac.ae Rana M. Ibrahim ribrahim@sharjah.ac.ae Ahmad Z. Al Meslamani amaslamanie1095@gmail.com Nadia Al Mazrouei nalmazrouei@sharjah.ac.ae <p><strong>Background</strong>: Medication dispensing is a fundamental function of community pharmacies, and errors that occur during the dispensing process are a major threat to patient safety. However, to date there has been no national study of medication dispensing errors in the United Arab Emirates (UAE).</p> <p><strong>Objective</strong>: The study aimed to investigate the incidence, types, clinical significance, causes and predictors of medication dispensing errors.</p> <p><strong>Methods</strong>: The study was conducted in randomly selected community pharmacies (n=350) across all regions of UAE over six months using a mixed-method approach, incorporating prospective disguised observation of dispensing errors and interviews with pharmacists regarding the causes of errors. A multidisciplinary committee, which included an otolaryngologist, a general practitioner and a clinical pharmacist, evaluated the severity of errors. SPSS (Version 26) was used for data analysis.</p> <p><strong>Results</strong>: The overall rate of medication dispensing errors was 6.7% (n=30912/ 464222), of which 2.6% (n=12274/464222) were prescription-related errors and 4.1% (n= 18638/464222) pharmacist counselling errors. The most common type of prescription-related errors was wrong quantity (30.0%), whereas the most common pharmacist counselling error was wrong drug (32.1%). The majority of errors were caused by medicine replaced with near expire one (24.7%) followed by look-alike/sound-alike drugs (22.3%). The majority of errors were moderate (46.8%) and minor (44.5%); 8.7% were serious errors. Predictors of medication dispensing errors were: grade A pharmacies (dispensing  60 prescriptions a day (OR 2.1; 95%CI 1.4-3.6; p=0.03) and prescriptions containing ≥4 medication orders (OR 2.5; 95%CI 1.7-4.3; p=0.01).</p> <p><strong>Conclusions</strong>: Medication dispensing errors are common in the UAE and our findings can be generalised and considered as a reference to launch training programmes on safe medication dispensing practice.</p> 2020-10-20T11:18:37+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2133 Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial 2020-10-21T22:02:00+01:00 Raquel Varas-Doval raquelvaras@redfarma.org Miguel A. Gastelurrutia magastelu@farmanorte.org Shalom I. Benrimoj shalom.benrimoj@gmail.com Victoria García-Cárdenas victoria.garciacardenas@uts.edu.au Loreto Sáez-Benito lsaezbenito@usj.es Fernando Martinez-Martínez femartin@ugr.es <p><strong>Background</strong>: Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of ConSIGUE.</p> <p><strong>Objective</strong>: The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective or unsafe medications and the pharmacists’ interventions implemented during MRF provision.</p> <p><strong>Methods</strong>: An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG received usual care.</p> <p><strong>Results</strong>: 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95%CI: -0.10, 0.04). Main DRPs identified as potential causes of failures of uncontrolled health problems’ treatment were undertreated condition (559 DRPs; 35.81%), lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369 interventions; 22.01%).</p> <p><strong>Conclusions</strong>: This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests that the provision of an MRF in collaboration with general medical practitioners and patients contributes to the improvement of aged polypharmacy patients’ health status and reduces their problems related with the use of medicines.</p> 2020-10-21T18:53:40+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2171 Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system 2020-10-18T16:12:04+01:00 Taylor Raiche taylor.raiche@usask.ca Robert Pammett Robert.Pammett@northernhealth.ca Shelita Dattani SDattani@pharmacists.ca Lisa Dolovich lisa.dolovich@utoronto.ca Kevin Hamilton hamilt23@myumanitoba.ca Natalie Kennie-Kaulbach nkennie@dal.ca Lisa McCarthy lisa.mccarthy@utoronto.ca Derek Jorgenson derek.jorgenson@usask.ca <p>Canada’s universal public health care system provides physician, diagnostic, and hospital services at no cost to all Canadians, accounting for approximately 70% of the 264 billion CAD spent in health expenditure yearly. Pharmacy-related services, including prescription drugs, however, are not universally publicly insured. Although this system underpins the Canadian identity, primary health care reform has long been desired by Canadians wanting better access to high quality, effective, patient-centred, and safe primary care services. A nationally coordinated approach to remodel the primary health care system was incited at the turn of the 21<sup>st</sup> century yet, twenty years later, evidence of widespread meaningful improvement remains underwhelming. As a provincial/territorial responsibility, the organization and provision of primary care remains discordant across the country. Canadian pharmacists are, now more than ever, poised and primed to provide care integrated with the rest of the primary health care system. However, the self-regulation of the profession of pharmacy is also a provincial/territorial mandate, making progress toward integration of pharmacists into the primary care system incongruent across jurisdictions. Among 11,000 pharmacies, Canada’s 28,000 community pharmacists possess varying authority to prescribe, administer, and monitor drug therapies as an extension to their traditional dispensing role. Expanded professional services offered at most community pharmacies include medication reviews, minor/common ailment management, pharmacist prescribing for existing prescriptions, smoking cessation counselling, and administration of injectable drugs and vaccinations. Barriers to widely offering these services include uncertainties around remuneration, perceived skepticism from other providers about pharmacists’ skills, and slow digital modernization including limited access by pharmacists to patient health records held by other professionals. Each province/territory enables pharmacists to offer these services under specific legislation, practice standards, and remuneration models unique to their jurisdiction. There is also a small, but growing, number of pharmacists across the country working within interdisciplinary primary care teams. To achieve meaningful, consistent, and seamless integration into the interdisciplinary model of Canadian primary health care reform, pharmacy advocacy groups across the country must coordinate and collaborate on a harmonized vision for innovation in primary care integration, and move toward implementing that vision with ongoing collaboration on primary health care initiatives, strategic plans, and policies. Canadians deserve to receive timely, equitable, and safe interdisciplinary care within a coordinated primary health care system, including from their pharmacy team.</p> 2020-10-18T16:11:04+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors https://www.pharmacypractice.org/journal/index.php/pp/article/view/2173 Integration of Community pharmacy and pharmacists in primary health care policies in Argentina 2020-10-22T20:35:32+01:00 Pedro D. Armando pdarmando@yahoo.es Sonia A. Uema suema@fcq.unc.edu.ar Elena M. Vega emvega@ciq.uchile.cl <p>Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.</p> 2020-10-22T20:20:13+01:00 Copyright (c) 2020 Pharmacy Practice and the Authors