A Scoping Review on the Expected Role of Community Pharmacists in the Era of COVID-19 Pandemic Crisis Across OECD Countries

Objective@#Community pharmacists are frontline health care providers, but have been considered as underutilized professionals on a daily basis. The purpose of this scoping review was to identify information about the impact of the COVID-19 pandemic on community pharmacy services and to evaluate new services that could be applicable. @*Methods@#We searched MEDLINE and EMBASE for studies published up to January 10, 2020. Search terms consisted of keywords relevant to this review, including “COVID-19”, “community pharmacy”, and “community pharmacist”. This review targeted studies of pharmacist services provided by community pharmacies in OECD member countries during the COVID-19 pandemic period. @*Results@#Twenty-seven studies were included in this review. Changes in community pharmacist services due to the COVID-19 pandemic were broadly classified into four categories. First, as the face-to-face services became challenging, various non-face-to-face services were being tried. Second, community pharmacists directly participated in the services to prevent the spread of COVID-19. Third, community pharmacists made efforts to support continuity of care for patients who experienced difficulties due to the reduced professional care as health and medical resources are concentrated in response to COVID-19. Fourth, community pharmacist services were emerging, targeting patients suffering from greater health inequality during the pandemic. Patients expressed high demand and satisfaction for the service of the community pharmacist, and pharmacists reported self-efficacy and professional pride. @*Conclusion@#This study demonstrated that in the era of the COVID-19 pandemic, various community pharmacist services have been tried and received positive evaluations from patients in several OECD countries.

Perception on necessity to introduce public out-of-hours pharmacies and operation plan: A Gyeongsangbuk-do case

Objectives@#This study aimed to identify the opinions of Gyeongsangbuk-do residents on out-of-hours (OOH) pharmacies and to examine the operating experiences of pharmacists who are operating OOH pharmacies in other areas. @*Methods@#Cross-sectional survey was carried out for 1,000 Gyeongbuk residents employing a questionnaire via online or face-to-face, and 82 pharmacists who currently operate OOH pharmacies employing a postal questionnaire. Out of eighty-two, 46 pharmacists replied (response rate 56.1%). @*Results@#As for the necessity of introducing OOH pharmacies in Gyeongsangbuk-do, 84.9% answered more than necessary.86.1% favored the local government support for OOH pharmacies. The necessity of OOH pharmacies was highly evaluated among participants who experienced to be unable to use medicines or services in out of service hours, regardless of their characteristics or health condition. County residents consistently put a positive opinion for the necessity of OOH pharmacies if they have elderly family member(s), while city residents had significant differences across subgroups depending on their conditions (family members, household economics, health status, etc.). Almost all (95.7%) pharmacist participants highly evaluated the necessity of OOH pharmacies and the majority of them (63.0%) felt satisfied. However, 60.9% of participants have ever considered closing their OOH pharmacy business due to private, business management and professional reasons. @*Conclusion@#This study made suggestions to address anticipated issues for the Gyeongbuk-style OOH pharmacy model.

Comparison of National Database of Health Inequality between Korea and the UK:Focusing on Substance Misuse Related Mental Health and Respiratory Diseases

Objective@#Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. @*Methods@#Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. @*Results@#The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. @*Conclusion@#The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.

Comparison of National Database of Health Inequality between Korea and the UK:Focusing on Substance Misuse Related Mental Health and Respiratory Diseases

Objective@#Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. @*Methods@#Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. @*Results@#The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. @*Conclusion@#The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.

Prescription Drug Use Behavior and Influence Factors in Veteran Patients from the Perspective of Veterans

Objective@#This study aimed to explore a veteran patients’ behavior of prescribing drug use and of which influencing factors from the veteran patients’ perspective through qualitative interviews. @*Methods@#We recruited veteran patients through purposive sampling and interviewed 30 veteran patients aged 20 and over who had been taking prescription drugs. We developed and utilized an interview guide consisting of three themes for data collection. We made verbatim transcripts and analyzed data using the framework analysis. @*Results@#Participants were aware that they had large amounts of prescribing medicines and discarded the medicines. They often used improperly by the person himself or his family or acquaintances. The factors that influenced these inefficient prescription drug usage were grouped into ‘factors procuring more drugs than necessary’ and ‘factors being prescribed more drugs than necessary’. Anxiety about downgrading from the upper class to the lower among reward classes for veterans, and suspicion or dissatisfaction with the veteran policy caused the participants to procure more drugs than necessary. Additionally, they received too many medicines due to long-term prescriptions and lack of communication with their doctors, and poor quality of veteran health services. @*Conclusion@#To improve the medication use behavior of veteran patients, providing information or introducing interventions for the proper medication use is not enough. Efforts should be made to improve their negative recognition over relevant policies and health care services.

Prescription Drug Use Behavior and Influence Factors in Veteran Patients from the Perspective of Veterans

Objective@#This study aimed to explore a veteran patients’ behavior of prescribing drug use and of which influencing factors from the veteran patients’ perspective through qualitative interviews. @*Methods@#We recruited veteran patients through purposive sampling and interviewed 30 veteran patients aged 20 and over who had been taking prescription drugs. We developed and utilized an interview guide consisting of three themes for data collection. We made verbatim transcripts and analyzed data using the framework analysis. @*Results@#Participants were aware that they had large amounts of prescribing medicines and discarded the medicines. They often used improperly by the person himself or his family or acquaintances. The factors that influenced these inefficient prescription drug usage were grouped into ‘factors procuring more drugs than necessary’ and ‘factors being prescribed more drugs than necessary’. Anxiety about downgrading from the upper class to the lower among reward classes for veterans, and suspicion or dissatisfaction with the veteran policy caused the participants to procure more drugs than necessary. Additionally, they received too many medicines due to long-term prescriptions and lack of communication with their doctors, and poor quality of veteran health services. @*Conclusion@#To improve the medication use behavior of veteran patients, providing information or introducing interventions for the proper medication use is not enough. Efforts should be made to improve their negative recognition over relevant policies and health care services.

Improvement of Waste Drug Management System by Comparing Domestic and Overseas Programs

BACKGROUND@#At the end of the‘Waste Drug Disposal Project’, collection and disposal of waste drugs remain a social issue.@*OBJECTIVE@#This study aimed to provide suggestions to improve the drug waste management system in Korea by comparing domestic and overseas relevant programs. Methods: This is a comparative study between South Korea, Australia, Canada, France, and the US. These overseas countries were selected because they have been operating waste drug management programs continuously to date. Comparison was conducted by a pre-determined analysis frame including legal regulation, enforcement program and its performance.@*RESULTS@#All selected countries except Australia had legal regulations on drug wastes. The US had the largest variety of drug waste disposal methods. Canada had recommended that pharmacies actively participate in drug waste withdrawal programs. France had the largest variety of methods to promote relevant programs, including window sticker, SNS, and app, as well as the highest level of awareness and participation. Australia had the lowest level of awareness and participation in pharmaceutical waste management programs. Pharmaceutical companies took responsibility of paying for these programs in the selected overseas countries.@*CONCLUSION@#Further efforts should be made to establish a clear guideline including the role of pharmaceutical companies, and to develop various methods for the public to be aware of appropriate ways of disposing drug wastes in Korea.

Visual Analysis of Regional Variations in Antidepressant Use and Suicide Rate

BACKGROUND: Some mental illnesses such as depression are known to be one of the risk factors of suicide and proper antidepressant therapy can reduce suicidal behavior. OBJECTIVES: This study aimed to analyze regional variations in antidepressant consumption and adherence, suicide rate, prevalence of suicide related mental disorders, and access to relevant healthcare services. METHODS: Cross-sectional analyses were conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service between 2014 and 2016. We included patients who had a diagnosis record of suicide related mental disorders during the study period. Cause of death statistics and National health and medical statistics were used to identify suicide rate and distribution of healthcare service. We conducted visual analyses, chi-squared tests, independent t-tests and correlation analyses to demonstrate regional variations. RESULTS: Between 2014 and 2016, the average prevalence of suicide related mental disorders was 5.4 per cent. Suicide rate and prevalence of suicide related mental disorders were higher in Gangwon, Chungcheong, and Jeolla (p < 0.001), and lower in Seoul (p < 0.001) than the national average. Unexpectedly, regional variations in antidepressant consumption were seen in the limited area including Daejeon, Chungnam and Gyeongnam (p < 0.05). The number of mild patient-centered clinics was associated positively with antidepressant consumption (p < 0.01) and associated negatively with suicide rate (p < 0.01). CONCLUSION: There were some regional variations in prevalence of suicide related mental disorders, antidepressant adherence and suicide rate. The higher level of antidepressant therapy and the lower level of suicide rates were seen in regions with easy access to mild patient-centered clinics.

Trends and Appropriateness of Outpatient Prescription Drug Use in Veterans

OBJECTIVE: This study analyzed the national claims data of veterans to generate scientific evidence of the trends and appropriateness of their drug utilization in an outpatient setting. METHODS: The claims data were provided by the Health Insurance Review & Assessment (HIRA). Through sampling and matching data, we selected two comparable groups; Veterans vs. National Health Insurance (NHI) patients and Veterans vs. Medical Aid (MAID) patients. Drug use and costs were compared between groups by using multivariate gamma regression models to account for the skewed distribution, and therapeutic duplication was analyzed by using multivariate logistic regression models. RESULTS: In equivalent conditions, veteran patients made fewer visits to medical institutions (0.88 vs. 1), had 1.86 times more drug use, and paid 1.4 times more drug costs than NHI patients (p < 0.05); similarly, veteran patients made fewer visits to medical institutions (0.96 vs. 1), had 1.11 times more drug use, and paid 0.95 times less drug costs than MAID patients (p < 0.05). The risk of therapeutic duplication was 1.7 times higher (OR=1.657) in veteran patients than in NHI patients and 1.3 times higher (OR=1.311) than in MAID patients (p < 0.0001). CONCLUSION: Similar patterns of drug use were found in veteran patients and MAID patients. There were greater concerns about the drug use behavior in veteran patients, with longer prescribing days and a higher rate of therapeutic duplication, than in MAID patients. Efforts should be made to measure if any inefficiency exists in veterans' drug use behavior.

Developing and Evaluating a Drug Information Leaflet of Antidiabetics for Senior Citizens; Employing Performance-based User-testing

OBJECTIVE: The study purpose was to develop a drug information leaflet for the elderly and to evaluate it with performance-based user-testing. METHODS: We performed a stratified randomized controlled trial. We recruited 62 elderly patients with age of 65 or above who were taking antidiabetic medications at the point of participating and excluded those who suffered illiteracy. We randomly allocated them into the intervention group with a leaflet for the elderly and the control group with a leaflet for the general public. Main outcome measures were to ‘be able to find information’ and to ‘be able to understand information.’ We measured outcome variables by employing performance-based user-testing and analyzed data to find any differences between two groups with t-tests, chi-squared tests or Fisher's exact tests accordingly. RESULTS: More participants in the intervention group understood how to store their medications than those in the control group (intervention group 93% vs. control group 70%; p=0.02). There were no significant differences in other information items between two groups. Mostly ‘being able to understand information’ was lower than ‘being able to find information.’ The gaps between two outcome variables were about 10% in the intervention group and about 18% in the control group. The lowest understanding was observed in information relating to drug names and their potential adverse events. CONCLUSION: Without providing personalized drug information, it might be hard for the elderly to improve their drug knowledge even with leaflets that were developed specifically for the elderly.

Systematic Review on Clinical Equivalence of Generic and Brand-name Drugs in Statin Therapy

BACKGROUND: Generic medications are approved on the basis of bioequivalence with brand medications in healthy volunteers rather than the target population, there remains a substantial uncertainty regarding their clinical effectiveness and safety. The object of this paper is to compare the clinical equivalence of generic statin drugs in patients. METHODS: Literature published before September 2016, which is indexed in PubMed, EMBASE, RISS, comparing generic to brand products in statins. Outcomes included blood lipid level, proportion of days covered (adherence), hospitalization and mortality. RESULTS: 511 citations were screened, of which 11 studies met eligibility criteria (6 randomized clinical trials, 5 observational studies). Generic atorvastatin was clinical equivalent with brand drugs in blood lipid level (3 RCTs) and generic simvastatin was also clinical equivalent with brand drugs (2 RCTs). 2 of 3 studies reported no significant difference in proportion of days covered except 1 study which reported generic statin significantly enhance proportion of days covered (p0.05). 1 study reported that all cause of mortality was significantly low in generic drugs (p<0.0001). CONCLUSION: Published data on comparing clinical efficacy of generic and brand statins were insufficient in both quantity and quality. This systematic review suggests that additional studies on clinical equivalence and safety of generic medications in patients would be needed.

Performance-based User Testing of a Patient Drug Leaflet in the Elderly

OBJECTIVE: This study aimed to explore the readability and comprehensibility of the drug information on a patient leaflet for the senior by employing performance-based user-testing. METHODS: We included 36 elderly (65 years old or older) as the senior group (intervention group) and 36 adults (40~59 years old) as the adult group (control). We developed a questionnaire to test if participants could access to drug information. After completing a questionnaire, the participant was interviewed about their understanding over the patient leaflet. We performed t-test, χ2-test or Fisher's exact test to examine differences between two groups in primary outcomes. RESULTS: The senior were less likely able to find information (78%) than the adult (91%); they were much less likely able to understand information (42%) than the adult (69%). While we found differences between the ability of finding and understanding drug information in both groups, the senior group had greater difficulties in understanding all kinds of drug information. They had significant difficulties to remember information after reading the patient leaflet and frequently failed to find proper information even though they were allowed to access freely to the leaflet during interviewing. CONCLUSION: To secure safe and effective use of drugs for the senior, it is necessary to develop drug leaflets for the senior.

Readability of Patient Information Leaflets in Clinical Trials

BACKGROUND: Elements of informed consent including capacity, disclosure, understanding, voluntariness, and permission of the participant, are all crucial for clinical trials to be legally and ethically valid. During the informed consent process, the patient information leaflet is an important information source which prospective research subjects can utilize in their decision-making. In the adequate provision of information, KGCP guideline necessitate 20 specific items, as well as the use language that individuals can understand. This study measures the vocabulary level of patient information leaflets in an effort to provide an objective evaluation on the readability of such material. METHODS: The word difficulty of 13 leaflets was quantitatively evaluated using Kim kwang Hae's vocabulary grading framework, which was compared to the difficulty level of words found in the 6th grade Korean textbook. The quantitative outcomes were statistically analyzed using chi-squared tests and linear by linear association for ordinal data. RESULTS: There was a statistically significant difference between the vocabulary level and frequency of words in leaflets and the 6th Korean textbook. The leaflets were on average 260 sentences and about roughly 15 pages long, including lay language (easier or equal to language used in primary school) of around 12% less; technical language of around 4.5% more. As the vocabulary grades increase, there was a distinct difference in vocabulary level between Korean textbook and each information leaflet (p < 0.001). CONCLUSION: Patient information leaflets may fail to provide appropriate information for self-determination by clinical trial subject through the difficulty level of its wording. Improvements in the degree of patients' understanding and appropriate use of information leaflets are collaboratively equipped to strengthen patient's autonomy and therefore guaranteeing participant's rights.

Developing a Drug Information Leaflet of Antihypertensives for Senior Citizens; Employing Performance-based User-testing

OBJECTIVE: Written information could be helpful for senior population to adhere to complex medication therapies, but must be well prepared and empirically assessed to achieve such end. We purposed to develop a drug information leaflet for senior citizens by applying 'performance-based user-testing.' METHODS: We employed a user-testing, a mixed method to figure difficulties out with patients' leaflets from the user perspective. The cycle made of test and revision can be repeated as necessary. We recruited senior citizens with age of 65 or above who were taking antihypertensive medications at the point of participating and excluded the elderly who suffered illiteracy. We firstly rectified a drug information leaflet of antihypertensive medications for the general public distributed by the Korean authority based on focus group interviews (9 participants). The revised leaflets were tested four times with 8~12 participants in each round (40 seniors in total). We targeted to develop a leaflet which more than 80% of participants understood 10 key information. Main outcomes measures were to be able to find information and be able to understand information. This study was approved by the Yeungnam University Research Ethics Committee. RESULTS: Focus group interviews identified difficulties with small font of words, professional language, long information, and a poor structure. The leaflet was revised and in the first round questionnaire found problems with 4/10 information points; interviews disclosed all but one (normal blood pressure range) were ill-understood. The second round questionnaire and interview found fewer problems but the comprehensiveness of participants was still poor in several points. For the third and fourth rounds we revised the leaflets in the individual-targeted manner. Finally, the fourth round showed all key information found and understood by at least 80% of participants except one question about drug name. CONCLUSION: The drug leaflets need to be developed in a personalized mode for the seniors. There was a limit for Korean seniors to understand nonproprietary name of their drugs because they used to producers' trade names which the Korean health system predominantly works with.

Assessment of Potentially Inappropriate Medication Use in Korean Elderly Patients with Parkinson's Disease

OBJECTIVES: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. METHOD: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. RESULTS: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. CONCLUSION: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.

Readability of the Product Labelling Information of Over-The-Counter Pharmaceuticals in Convenience Store

BACKGROUND: Since November 2012, some of over-the-counter (OTC) medications have been sold in convenience store without pharmacist' s supervision. We purposed to examine if the product labels of OTCs provide sufficient information that is appropriate for consumers who may have low health literacy. METHODS: We compared the difficulty of words that are utilized in pharmaceutical product labels of interest (intervention) with those in the 6th grade textbook (control). Pharmaceutical products of interest were comprised of 13 OTCs which have been sold currently in convenience stores. We grouped words into the 4 levels of difficulty based on the Korean Vocabulary Classification for Education, and statistically tested words frequency in each level between OTCs and control. RESULTS: The 13 OTC labels included lay language (easier or equal to language used in primary school) about 10% less; professional language about 10% more (p < 0.001 in all). Labels for analgesics had the longest and most difficult information, followed by common cold preparations, muscle pain relievers as plaster or cataplasma and digestives. CONCLUSION: The 13 OTC labels might fail to provide appropriate information for safety use by consumers in terms of the difficulty level of words. The improvement of labels of OTC medications and consumer education strategies are called for safety use of OTC medications sold in convenience stores.

The Development of a Korean Drug Dosing Database / 대한의료정보학회지

OBJECTIVES: This report describes the development process of a drug dosing database for ethical drugs approved by the Korea Food & Drug Administration (KFDA). The goal of this study was to develop a computerized system that supports physicians' prescribing decisions, particularly in regards to medication dosing. METHODS: The advisory committee, comprised of doctors, pharmacists, and nurses from the Seoul National University Bundang Hospital, pharmacists familiar with drug databases, KFDA officials, and software developers from the BIT Computer Co. Ltd. analyzed approved KFDA drug dosing information, defined the fields and properties of the information structure, and designed a management program used to enter dosing information. The management program was developed using a web based system that allows multiple researchers to input drug dosing information in an organized manner. The whole process was improved by adding additional input fields and eliminating the unnecessary existing fields used when the dosing information was entered, resulting in an improved field structure. RESULTS: A total of 16,994 drugs sold in the Korean market in July 2009, excluding the exclusion criteria (e.g., radioactivity drugs, X-ray contrast medium), usage and dosing information were made into a database. CONCLUSIONS: The drug dosing database was successfully developed and the dosing information for new drugs can be continually maintained through the management mode. This database will be used to develop the drug utilization review standards and to provide appropriate dosing information.