ABSTRACT
During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Frontline health care professionals have experienced rapid changes to workloads and work-related pressures during the COVID-19 pandemic, resulting in anxiety, depression, and mental health stressors. For working professionals engaged in postgraduate pharmacy distance learning, access to educators was seen as a means to relay some of these stories and offload the stress caused by these unprecedented circumstances. The postgraduate pharmacy education team at De Montfort University felt a moral responsibility to provide extra support and extended their roles toward offering greater well-being support. In this commentary, we detail the emergence of this new role and offer insights into how this was fashioned and its significance for catering to the mental health needs of pharmacists. This role has largely gone undetected, and research is needed to investigate the acceptability and feasibility of such a model and its plausibility and sustainability in the long-term.
ABSTRACT
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
ABSTRACT
Pharmacists in the community and ambulatory settings are primed for collaboration that can optimize care. Now is the time to capitalize on the momentum and positive disruption of the COVID-19 pandemic that propelled pharmacists and their organizations to respond with agility to deliver care in new ways, pivot to develop new partnerships, and leverage technology. The growth of collaborative practice agreements within ambulatory care settings, the enhancement of clinically integrated networks, and the growth in professional organization support create an environment ripe for implementation of pharmacist-to-pharmacist collaborations. The American College of Clinical Pharmacy 2022 Clinical Practice Affairs B Committee sought out literature, as well as prepublication contemporary examples, demonstrating models of intraprofessional collaboration among pharmacists in community and ambulatory settings. The committee formulated six key recommendations to optimize pharmacist collaborations in the community and ambulatory settings and formed a framework for practical implementation strategies at the levels of individual pharmacists, organizations, and educational institutions and for legislative advocacy.Copyright © 2023 Pharmacotherapy Publications, Inc.
ABSTRACT
Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
ABSTRACT
OBJECTIVES: Deprescribing is a novel strategy whereby medical professionals aim to optimize a patient's prescription program by removing redundant medications. Few studies have looked at the viewpoints of community pharmacists and other healthcare professionals on deprescribing in daily practice. This study's objectives included evaluating community pharmacists' deprescribing knowledge, attitudes and practices, as well as identifying the obstacles to and enablers of deprescribing in daily practice. METHODS: Five pharmacy students in the last year of their studies polled employees of neighbourhood pharmacies in Abu Dhabi, Dubai, and the Northern Emirates from April 2022 to July 2022. The study's questionnaire was divided into two sections: questions that inquired about the respondents' demographic data and questions that evaluated the respondents' understanding and usage of the deprescribing of potentially harmful medications for patients. The original Bloom's cutoff points were revised and modified to assess the general knowledge and deprescribing practices of United Arab Emirates (UAE) community pharmacists. Multivariate logistic regression identified the variables influencing respondents' deprescribing knowledge and practice. KEY FINDINGS: The average age of the participants was 30.8 ± 6.4 SD. Of the total, 255 (37.7%) were male and 422 (62.3%) were female. Pharmacists from independent pharmacies constituted 52.9% of the study sample and 47.1% were from Chain pharmacies. Among the participants, 58.8% (n = 398) had 1-5 years of experience and 41.2% (n = 279) had more than 5 years. Nearly three-quarters of the pharmacists (72.1%, 488) graduated from local universities and 27.9% (n = 189) graduated from regional/international universities. The vast majority of the study sample (84.8%, 574) were bachelor's degree holders and 88.3% (n = 598) were pharmacists in charge. Of the total, 69.3% (n = 469) received deprescribing training to treat patients with multimorbid diseases. The knowledge and practice score was 71.3% with a 95% confidence interval [70.2%, 72.4%]. Of the total participants, 113 (16.7%) had poor knowledge and practice about deprescribing, 393 (58.1%) had moderate knowledge and practice and 171 (25.3%) had good knowledge and practice. CONCLUSION: This study highlights the level of understanding of community pharmacists about deprescribing in the UAE. Although most of the respondents in this study received training on deprescribing, less than half of the community pharmacists were unaware of certain classes (long-acting sulfonylureas, anti-diabetic, antihyperlipidemic and psychotropic drugs) of drugs that are candidates for potential deprescribing. This finding indicates that their knowledge about deprescribing was insufficient. Several barriers community pharmacists face in deprescribing were also identified, with patients' resistance and insufficience being the most prevalent. Therefore, there is a need for improved deprescribing practices to ensure drug safety.
Subject(s)
Community Pharmacy Services , Deprescriptions , Pharmacies , Humans , Male , Female , Pharmacists , Surveys and Questionnaires , Health Knowledge, Attitudes, Practice , Treatment OutcomeABSTRACT
Background: Pharmacists are integral members of the multidisciplinary healthcare team who, with their skills, knowledge, and training, are well positioned to prevent, identify, and manage medication-related issues. Many published articles related to COVID-19 management have highlighted the important role of the pharmacists in assuring the safe, effective, and cost-effective use of medications. During such challenging times of COVID-19 pandemic that resulted in a high demand on medical resources and healthcare providers, pharmacists are well positioned to contribute and add more efforts to the healthcare system to achieve best use of the available resources including medications and providing high quality pharmaceutical care to help the patients and support the healthcare providers. Methods: This is a retrospective chart review included all admitted adult patients with confirmed COVID-19 diagnosis from 1 March 2020 till 30 June 2020. The documented clinical pharmacist interventions were extracted from the EMR and reviewed by multiple clinical pharmacists to identify type, number, frequency, outcome, and physician's acceptance rate of documented interventions. Results: A total of 484 pharmacist interventions included in the final analysis. Antimicrobial stewardship interventions were the most reported (149, 30.8%) and antibiotics were the most reported class of medication, constituting 31.1% of the total interventions. "Optimized therapy" was the most commonly reported outcome (58.8%). Overall, 50.8% (246) of the interventions were rated as having "moderate" clinical significance using the clinical significance scoring tool. The physicians' acceptance rate was 94.7%.Conclusion: Pharmacist interventions are associated with improved communication and medication use in admitted adult patients with COVID-19. Clinical pharmacists can play a crucial role in optimizing medication use in patients with COVID-19 through prevention, identification, and resolving existing or potential drug-related problems.
ABSTRACT
BackgroundAlcohol is often overlooked in primary care even though it has wide-ranging impacts. The Structured Medication Review (SMR) in England is a new 'holistic' service designed to tackle problematic polypharmacy, delivered by clinical pharmacists in a general practice setting. Implementation has been protracted owing to the COVID-19 pandemic. This study explores early patient experiences of the SMR and views on the acceptability of integrating clinical attention to alcohol as another drug linked to their conditions and medicines, rather than as a standalone 'healthy living' or 'lifestyle' question.MethodSemi-structured interviews with a sample of 10 patients who drank alcohol twice or more each week, recruited to the study by five clinical pharmacists during routine SMR delivery.ResultsSMRs received were remote, brief, and paid scant attention to alcohol. Interviewees were interested in the possibility of receiving integrated attention to alcohol within a SMR that was similar to the service specification. They saw alcohol inclusion as congruent with the aims of a holistic medicines review linked to their medical history. For some, considering alcohol as a drug impacting on their medications and the conditions for which they were prescribed, introduced a new frame for thinking about their own drinking.ConclusionsIncluding alcohol in SMRs and changing the framing of alcohol away from a brief check with little meaningful scope for discussion, toward being fully integrated within the consultation, was welcomed as a concept by participants in this study. This was not their current medication review experience.
ABSTRACT
Objectives To display virtual pharmaceutical care programs implemented by pharmacists across the world. Accordingly, a search in PubMed, Scopus and Embase with keywords such as ''Pharmacist', 'Pharmaceutical care', 'Virtual platform' and its associated medical subject headings retrieved appropriate articles. The quality of each filtered article were assessed with the Critical Appraisal Skills Program checklist. Key findings A total of 2 14 841 articles were identified through database screening and 16 articles were extracted and finalized. Twelve papers presented different forms of electronic medical record-based virtual pharmacy systems that had significantly contributed to patient care;minimizing medication errors, rectifying adverse events, modifying drug administration patterns to reduce the fatality of drug-drug interaction and further promoting medication counselling. Nevertheless, few studies had social media platforms for providing clinical pharmacy services that depicted good patient satisfaction. Additionally, we were also able to portray community pharmacies that transformed themselves to provide better and easily accessible pharmaceutical care to their society. There are limited numbers of peer-reviewed articles on pharmacist-operated virtual systems. However, owing to the benefits imparted to patient safety and care by the virtual pharmacy in the era of pandemic, it is highly recommended that more pharmacy professionals contribute and implement such programs in their settings. Prospero Registration ID CRD42022307175.
ABSTRACT
OBJECTIVES: In the context of the SARS-CoV-2 pandemic, hospital pharmacists supported the implementation of recommendations and ensured the safety of patient medication management. The aim of this study is to establish the interest of the involvement of the hospital pharmacist in this context by describing and comparing the activities carried out with patients with COVID-19 and those without. METHODS: During the study period, data on clinical pharmacy activities with hospitalized patients were collected and analyzed: pharmaceutical analysis of prescriptions, participation in multi-professional consultation meetings (RCP) dedicated to COVID-19, and monitoring of adverse events. RESULTS: The activities concerned 1483 patients, including 444 with COVID-19, resulting in 575 pharmaceutical interventions (PI). The main problems identified were overdoses, untreated indications, and drug-drug interactions (DDI). AMIs were significantly more common in patients with COVID-19, with 73.3% involving disease-specific therapies. Eleven PIs had a life-threatening impact, 189 a major impact. During the PCRs, 36 PIs were performed for 59% of the patients presented. A pharmacovigilance report was performed for a quarter of patients treated with hydroxychloroquine and 33% of patients treated with lopinavir/ritonavir. CONCLUSIONS: This study demonstrates the value of involving hospital pharmacists in the drug management of patients with COVID-19, particularly with the evolution of available therapies and the implementation of vaccination, in order to reduce the spread of SARS-COV2 and limit the appearance of resistance.
ABSTRACT
The use of pharmacogenetics to optimize pharmacotherapy is growing rapidly. This study evaluates the feasibility and operability of a collaborative circuit involving hospital and community pharmacists to implement clopidogrel pharmacogenetics in Barcelona, Catalonia, Spain. We aimed to enroll patients with a clopidogrel prescription from cardiologists at the collaborating hospital. Community pharmacists collected patients' pharmacotherapeutic profiles and saliva samples, which were then sent to the hospital for CYP2C19 genotyping. Hospital pharmacists collated the obtained data with patients' clinical records. Data were analyzed jointly with a cardiologist to assess the suitability of clopidogrel. The provincial pharmacists' association coordinated the project and provided IT and logistic support. The study began in January 2020. However, it was suspended in March 2020 due to the COVID-19 pandemic. At that moment, 120 patients had been assessed, 16 of whom met the inclusion criteria and were enrolled in the study. The processing of samples obtained before the pandemic had an average delay of 13.8 ± 5.4 days. A total of 37.5% patients were intermediate metabolizers and 18.8% were ultrarapid metabolizers. No poor metabolizers were detected. Pharmacists rated their experience with a 7.3 ± 2.7 likelihood of recommending that fellow pharmacists participate. The net promoter score among participating pharmacists was +10%. Our results show that the circuit is feasible and operable for further initiatives.
ABSTRACT
BACKGROUND: Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. METHODS: Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. RESULTS: When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. CONCLUSIONS: Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles.
Subject(s)
Pharmacists , Professional Role , Humans , Qualitative Research , Polypharmacy , Primary Health CareABSTRACT
Pre-COVID our dermatology department had slightly fragmented and unreliable methods of storing the details of patients receiving second-line and systemic medications, such as immunosuppressive agents. Often, this information was held within individual Microsoft Excel worksheets on desktop PCs. At the onset of the COVID-19 pandemic in 2020, rapid access to this information was required to allow high-risk patients and shielding groups to be identified. We spent significant time updating and merging these separate files to form a single document. At that stage, multiuser updates and simultaneous working on a single document was not feasible, and there was often duplication and being 'locked out'. A multirow section of our newly combined document was also inadvertently deleted and could not be recovered. Thankfully, at an early stage of the COVID-19 pandemic, Microsoft 365 was rapidly adopted and rolled out in our health board. The aim was to provide a comprehensive, all-in-one digital workspace, including communications, cloud storage, backup and syncing, and productivity apps to aid working remotely and from home. Our department, in a tertiary teaching hospital, migrated to this software and it rapidly helped facilitate increased digital collaboration between clinical team members. It was recognized that its cloud storage capability would be a useful tool to help centralize and store an online, amendable patient database to record details of current and previous second- line treatments, and important information relating to shielding and COVID-19 risk status. One of the revamped application functions within Office 365 is Microsoft Lists. This offers real-time, online, secure functionality, with the ability to colour-code patients by drug, consultant and COVID-19 risk status. All members of our team have access, including administrative and clinical pharmacy staff, allowing each patient record to be easily accessed and updated. There is an additional functionality to allow email notifications of any updates (e.g. when made to specific patient entries) and even direct notification to associated stakeholders (such as government COVID-19 risk and shielding bodies). This set-up has also provided an ideal platform to allow research and clinical audit activities to be performed, which can be backwards formatted into Microsoft Excel, again for any data interpretation. Removed entries for patients no longer on second-line drugs can be automatically transferred to a linked archive list. In summary, this digital project highlights our departmental experience in using Microsoft Lists as an online, secure, cloud-based portal for patients on second-line medications and to record accurately COVID-19 risk status. It is easy to use, pleasing on the eye and its functionality could be transferrable to other clinical areas, such as in skin cancer or diagnosis logs.
ABSTRACT
Telehealth allows patients to receive healthcare with the aid of technology by overcoming physical barriers. The Coronavirus Disease 2019 (COVID-19) pandemic created challenges with regards to in person patient care. The use of video visits and telehealth increased in a rapid manner due to the COVID-19 pandemic. The objective of this paper is to describe telehealth services utilized by pharmacists at a large, academic medical center. Pharmacists teaching and clinical services conducted via telehealth and remote methods in the inpatient and outpatient settings are discussed. The tools and platforms utilized for patient care, staff communications, and education are described. Telehealth is likely to remain in many clinical practices even after restrictions due to COVID-19 are removed; however, as we transition, a more sustainable model that includes faculty and staff development is needed. Additionally, clinical outcomes and patient and provider satisfaction for the varying visit types should continue to be examined. Although the switch to telehealth was rapid and unprecedented, it allowed a large academic medical center to continue providing patient care and learning experiences for most clinical pharmacy services.
ABSTRACT
BACKGROUND: The recent SARS-CoV-2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy's experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose. METHODOLOGY: We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020. RESULTS: We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges. CONCLUSIONS: This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced.
ABSTRACT
INTRODUCTION: The study objective was to explore the impact of the complete virtual transition of in-hospital clinical training on students' academic performance and to assess students' perceptions of the overall experience. METHODS: In-hospital clinical training was delivered via distance learning using daily synchronous videoconferences for two successive weeks to 350 final-year pharmacy students. The Virtual Faculty of Pharmacy Cairo University (VFOPCU) platform allowed trainees to virtually browse patient files interactively with their clinical instructors to simulate a typical rounding experience. Academic performance was evaluated through identical 20-question tests before and after training. Perceptions were assessed through an online survey. RESULTS: Response rates were 79% pretest and 64% posttest. The median score was significantly higher after receiving the virtual training (7/20 [6-9] out of 20 pretest vs. 18/20 [11-20] posttest, P < .001]. Training evaluations revealed high levels of satisfaction (average rating > 3.5/5). Around 27% of respondents were completely satisfied with the overall experience, providing no suggestions for improvement. However, inappropriate timing of the training (27.4%) and describing training as being condensed and tiring (16.2%) were the main disadvantages reported. CONCLUSIONS: Implementing a distance learning method with the aid of the VFOPCU platform to deliver clinical experiences instead of physical presence in hospitals appeared to be feasible and helpful during the COVID-19 crisis. Consideration of student suggestions and better utilization of available resources will open the door for new and better ideas to deliver clinical skills virtually even after resolution of the pandemic.
Subject(s)
COVID-19 , Education, Distance , Pharmacy Service, Hospital , Pharmacy , Humans , StudentsABSTRACT
Background: On March 16, 2020, because of the COVID-19 pandemic, the Swiss Federal Council declared an 'extraordinary situation' in terms of the Epidemics Act. Purpose(s): To assess the roles of an inter-hospital pharmacy in the fight against SARS-CoV-2. Method(s): All missions performed by our pharmacy were systematically collected and evaluated. They were also compared to its official duties. Result(s): Specific missions, which have been mainly managed by the crisis unit and the four departments of the pharmacy (Pharmaceutical Logistics, Drug Manufacturing, Clinical Pharmacy and Nursing Homes Supply), were: 1) human resources continuity;2) specific drug supply (for both hospitals and nursing homes;e.g. anaesthetics, sedatives, antiviral drugs, incl. for clinical trials);3) clinical assistance (especially in the ICU of the main acute hospital);4) individual drug manufacturing (e.g. hydroxychloroquine oral solution);5) on-site pharmacies management;6) own infrastructure securing (especially in term of hygiene);7) hand disinfectant production;and 8) hygienic masks supply for healthcare professionals in the area. The two last missions were out of the traditional duties of our pharmacy and have been achieved with the support of staff from the Swiss civil protection. A particular challenge was the management of the shortage of various products and the identification of alternative therapeutic options. Conclusion(s): Our pharmacy has faced various challenges during the acute pandemic situation. Some missions performed were even beyond our traditional ones. The disaster plan of our pharmacy has to be further developed, as well as the associated training of the staff, based on the lessons learned from this pandemic.
ABSTRACT
The 5th European Conference on Oncology Pharmacy took place as a face-to-face exchange between colleagues in Hamburg 2022.
ABSTRACT
Prior-to the COVID-19 outbreak, undergraduate PharmCare II Clerkship activities consisted of two phases. The first phase requires pharmacy students to clerk infectious disease and endocrine-related cases of patients admitted into wards at a teaching hospital, whilst in the second phase, the students are required to present the clerked cases in front of their group members with a thorough assessment by lecturers at Universiti Sains Malaysia. Due to sudden outbreak of COVID-19, presentations at hospitals and face-to-face learning were no longer feasible;therefore an online methodology was executed. Each student was assigned a real completed case clerked by a previous Master's in Clinical Pharmacy graduate. The students then critically evaluated any pharmaceutical care issues (PCIs) in each of the cases, recorded a video presentation for assessment by the lecturers and discussed each case with other group members in a synchronous online session via web-conferencing software. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.