University Pharmacy: from the foundation to the Pandemic times of Covid-19

Abstract The University Pharmacy Program (FU), from the Federal University of Rio de Janeiro (UFRJ), was created based on the need to offer a curricular internship to students of the Undergraduate Course at the Faculty of Pharmacy. Currently, it is responsible for the care of about 200 patients/day, offering vacancies for curricular internships for students in the Pharmacy course, it has become a reference in the manipulation of many drugs neglected by the pharmaceutical industry and provides access to medicines for low-income users playing an important social function. Research is one of the pillars of FU-UFRJ and several master and doctoral students use the FU research laboratory in the development of dissertations and theses. As of 2002, the Pharmaceutical Care extension projects started to guarantee a rational and safe pharmacotherapy for the medicine users. From its beginning in 1982 until the current quarantine due to the COVID-19 pandemic, FU-UFRJ has been adapting to the new reality and continued to provide patient care services, maintaining its teaching, research, and extension activities. The FU plays a relevant social role in guaranteeing the low-income population access to special and neglected medicines, and to pharmaceutical and education services in health promotion.

Amazon Pharmacy: distraction or disruption?

After years of anticipation about Amazon's rumored entry into pharmacy, Amazon Pharmacy launched in November 2020. What is yet to be understood is whether this new Amazon offering is a true market disruption capable of upending the pharmacy industry. This commentary describes the epic rise of Amazon from bookseller to retail giant, leading to its entry into the retail pharmacy space. Amazon Pharmacy's business model is described and its potential for industry disruption discussed.

Application of "Internet +" pharmaceutical consultation services in psychiatric hospital during the epidemic.

This study explored the application value of "Internet +" pharmacy service on psychiatric hospital during the COVID-19 epidemic. During the epidemic, as of December 31, 2020, the number of online pharmacist consultations increased to 149 cases (82.78 %). At the same time, patients had various types of consultation questions, mainly involving adverse drug reactions, drug selection, usage and dosage, persistence of long-term medication, drug distribution, etc. Due to the particularity of psychiatric hospital, pharmaceutical consultation services mainly focus on nervous system drugs. The results indicated that the demand for "Internet +" pharmaceutical consultation services has increased significantly during the COVID-19 epidemic.

Attention Deficit Hyperactivity Disorder: What Are Pharmacists' Roles and Associated Outcomes?

Globally, the prevalence of attention deficit hyperactivity disorder (ADHD) is increasing. The treatment for ADHD is multifaceted and requires long-term care and support. Pharmacists are capable of assisting patients and their caretakers in achieving desired outcomes. This work discusses and summarizes pharmacists' roles in ADHD care and their associated outcomes. Overall, pharmacists are positioned to educate on ADHD, optimize medications in a collaborative practice model, manage and monitor side effects, and provide remote and virtual pharmaceutical care. Pharmacists could directly contribute to ensuring medication safety and increasing awareness regarding the optimal use of ADHD medications. Patients with ADHD can benefit from pharmacist involvement in a variety of ways, including, but not limited to, initial screening and referral, the provision of clinical consultation and feedback, and the improvement of self-management and self-awareness of the illness. Pharmacists also play a significant role in therapeutic decision making regarding the initiation, intensification, and monitoring of ADHD treatment to ensure its effectiveness and quality of life improvement. Lastly, pharmacists could help identify more cost-effective treatment approaches for ADHD patients based on the clinical scenario that is encountered.

HIV Patients' Satisfaction with Pharmaceutical Care at a Nigerian Tertiary Healthcare Facility During the Covid-19 Pandemic.

Background: Patients' satisfaction is an important indicator of determining the quality of pharmaceutical care (PC). This study investigated Human Immunodeficiency Virus (HIV) patients' satisfaction with PC at Federal Medical Centre, Keffi-Nigeria and determined the statistical correlation between the respondents' socio-demographic variables and their satisfaction with PC. Methods: This cross-sectional survey study involved 351 randomly selected HIV-positive patients receiving PC in the facility. A Likert-type questionnaire was used for the data collection. Results: The Cronbach's alpha of the questionnaire was .916. The "overall perception of pharmacists' care or service" had a mean satisfaction score of 4.24 ± 0.749 and "the amount of time spent with the pharmacists" had a mean score of 3.94 ± 0.791. No significant association was found between socio-demographic variables and overall patients' satisfaction with PC. Conclusion: The reliability of the questionnaire was high and the HIV patients had a good satisfaction with the PC they received in the facility.

Development of constructs to measure client satisfaction with pharmacy services in resource-limited settings. A multicenter cross-sectional study.

BACKGROUND: Satisfaction with pharmacy services has many implications, including the degree of interaction with health care providers, the type and quality of service provided, and the extent to which needs and desires are met. This study aimed to identify the dimensions of pharmacy services and quantify client satisfaction with them. METHODS: A quantitative cross-sectional study was employed to guide this study. Data were entered into Epi Data, exported to SPSS 26.0, and analyzed using exploratory factor analysis to identify the underlying dimensions of pharmacy service. The study was conducted between 14th August 2020 and 28th December 2020. For standardization and comparison purposes, items loaded onto each dimension were computed and rescaled, and descriptive statistics were used to summarize the results. Stepwise linear regression was performed to quantify the contribution of each dimension to overall satisfaction and to identify determinant variables for overall satisfaction. A 95% CI, and a P-value of < 0.05 were used for the declaration of statistical significance. RESULTS: The mean overall satisfaction with pharmacy service was found to be (21.62±6.74)/30. There were eight dimensions of pharmacy service identified, and poor customer satisfaction was recorded for the premises and supply dimensions, with mean satisfaction of (12.08±8.49)/30 and (13.66±10.06)/30, respectively. The highest mean satisfaction was recorded with waiting time (24.24±6.54). Of the emergent dimensions, only four (supply, compassion and care, privacy, and premises) were predictors of overall satisfaction (P<0.05). The supply component was the strongest predictor of overall satisfaction, accounting for 20% of the variance in overall satisfaction. The number of prescribed and dispensed pharmaceuticals, marital status, and gender of participants also predicted overall satisfaction (P<0.05). CONCLUSION: The survey uncovered eight underlying aspects of pharmacy services that influence client satisfaction. A significant gap was recorded with premises and supply chain-related components. These dimensions' contributions to total satisfaction were substantial in terms of practical relevance. As a result, improving the availability of pharmaceuticals and the infrastructure surrounding pharmacy services may enhance consumer satisfaction considerably. Stakeholders must work on addressing supply related and premises difficulties to increase client satisfaction.

Evaluating the effects of a global pandemic on the operation of an investigational drug service.

PURPOSE: This study is an analysis of the changes to workload and operations of UNC Health's investigational drug service (IDS) brought about by the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Workload statistics were collected and analyzed for trend changes to illustrate operational changes necessitated by the COVID-19 pandemic within the IDS pharmacy at UNC Health. RESULTS: Multiple workload metrics declined at the beginning of the COVID-19 pandemic, followed by an increase in the metrics for many categories as the pandemic continued. Notably, monthly inventory added initially decreased by 37.5%, later leveling off but showing increased variability. Fills dispensed and monitoring visits both decreased by 34.5% from the first quarter (Q1) to Q2 of 2020. Both metrics returned to or slightly exceeded prepandemic levels by the end of the study period in March 2021. Patient enrollment decreased 76% from February to May 2020 before dramatically increasing in Q3 of 2020 and Q1 of 2021 with the initiation of COVID-19 vaccine studies. The average time to study startup increased for trials not related to COVID-19 and decreased for COVID-19-related trials. There has been no major impact on the number of open protocols throughout the course of the pandemic. CONCLUSION: Despite initial decreases in workload following the start of the COVID-19 pandemic, IDS operations returned to and, in some cases, exceeded prepandemic levels.

Patient and family perceptions of the provision of medicines as part of virtual outpatient consultations for children during COVID-19 pandemic.

OBJECTIVES: To evaluate (1) views and perceptions of patients/parents/carers and healthcare professionals on the medicines optimisation (MO) process following virtual outpatient clinic (VOC) during the COVID-19 pandemic and (2) the processes introduced at this time, identifying areas for improvements and suggest potential solutions. DESIGN: A mixed-methods service evaluation using qualitative and quantitative methods of the MO pathway in children aged 0-18 years following VOC across three specialist children's units.Semi-structured interviews were conducted over the telephone with the participants exploring their experiences and categorised into themes.Process mapping sessions with the multidisciplinary team identified areas for improvement and an ease impact framework developed for potential solutions.Outcome measures included: (1) themes from interviews, (2) patients satisfaction rates, (3) process maps and (4) development of a simplified future process. RESULTS: One hundred and twenty-five patients' families were contacted: 71 families consented to participate and their views were categorised into four main themes: (1) patient experience, (2) communication, (3) need for virtual video consultations for patient education by hospital pharmacists and (4) need for electronic processes to send prescriptions to local pharmacies.Median patient satisfaction rate was 96% (range 67%-100%). The convenience of receiving medications directly to patient's homes; access to medicines information helplines and education provided by pharmacists were regarded as valuable. Communication between care providers, development of virtual video consultations by hospital pharmacists and electronic transfer of some prescriptions directly to community pharmacies were identified as areas of improvement. CONCLUSIONS: Participants appreciated the pharmacy processes adopted during the pandemic, however, challenges and recommendations for improvement in delivering MO VOC were identified. As digital innovations evolve within the NHS, future research should focus on integrated care and improved communication between care providers with selected medications prescribed directly to community pharmacies using electronic prescription service, with clinical screening and education provided by hospital pharmacists.

Telepharmacy and pharmaceutical care: A narrative review by International Pharmaceutical Federation.

Digital transformation impacts health care through technology. Telepharmacy is set to become one of the most important aspects of Telemedicine in the years  to come with its ability to provide patients with increased and more timely  access to pharmaceutical care, reduced costs for individuals and health  systems, improved patient satisfaction, experience and convenience, and  better health outcomes. Telepharmacy has gained increasing importance in the delivery of pharmaceutical care, largely due to the COVID-19 pandemic which  has placed enormous pressures on healthcare systems globally. There is a  significant amount of published literature from different countries around the  world that provide examples of Telepharmacy. There are some innovative  models of Telepharmacy services aimed at optimizing and improving access to  pharmaceutical care, resulting in improved patient safety and outcomes. The  benefits of Telepharmacy include increased value for pharmacies and  pharmacists and adapting to patients´ needs, enhanced interprofessional care  and increased efficiency of health systems and increased provision of patient- centred services, among others. However, despite these benefits, major  barriers for implementation of Telepharmacy remain such as patient  confidentiality and privacy of health information. These barriers to the  implementation of Telepharmacy have been identified and can be divided into  four different environments: technological, organizational, human and  economic. Delivering pharmaceutical care and services through digital media is identified as a key priority for the International Pharmaceutical Federation. Digital health is one of the 21 Development Goals launched by International Pharmaceutical Federation in 2020. The International Pharmaceutical Federation Digital Health in Pharmacy Education report in 2021, describes the  readiness, adaptability and responsiveness of pharmacy education and  knowledge and skill needs of pharmaceutical workforce on digital health.  Amongst other digital health tools, telehealth/Telepharmacy has been reported  as one of the most preferred tools to teach and learn about by respondents.

La tecnología surgida de la transformación digital ha traído consigo cambios en la asistencia sanitaria. En los próximos años, la Telefarmacia previsiblemente  se convertirá en uno de los aspectos más importantes de la Telemedicina, ya  que ofrece a los pacientes un acceso más inmediato a la atención  farmacéutica, supone una reducción de costes tanto para los pacientes como  para los sistemas sanitarios, y deriva en una mayor satisfacción, experiencia y  comodidad de los pacientes, mejorando así los resultados clínicos. Debido en  gran medida a la pandemia de COVID­19, la Telefarmacia ha adquirido gran  importancia en el ámbito de la atención farmacéutica, ya que esta crisis ha  provocado una enorme presión sobre los sistemas sanitarios de todo el mundo. Se pueden encontrar multitud de experiencias publicadas en la literatura  científica sobre modelos de Telefarmacia en diferentes países del mundo.  Existen algunos modelos innovadores de servicios de Telefarmacia orientados a  optimizar y mejorar el acceso a la atención farmacéutica, lo que se traduce  en una mejora de la seguridad y los resultados de los pacientes. Entre las  ventajas de la Telefarmacia se incluye el aumento del valor para las farmacias  y los farmacéuticos y la adaptación a las necesidades de los pacientes, la mejora de la atención interprofesional, el aumento de la eficiencia de los  sistemas sanitarios y la mayor prestación de servicios centrados en el paciente, entre otras. Sin embargo, a pesar de presentar múltiples ventajas, siguen  existiendo importantes barreras para la implantación de la Telefarmacia, como  la confidencialidad del paciente y la privacidad de la información clínica. Estas  barreras para la implantación de la Telefarmacia pueden dividirse en cuatro  ámbitos: tecnológico, organizativo, humano y económico. La prestación de  atención y servicios farmacéuticos a través de medios digitales es una  prioridad clave de la Federación Internacional Farmacéutica. La salud digital es  uno de los 21 Objetivos de Desarrollo lanzados por la Federación Internacional  Farmacéutica en 2020. El informe de la Federación Internacional Farmacéutica  sobre salud digital en la formación farmacéutica en 2021 describe la  preparación, adaptabilidad y capacidad de respuesta de la formación  farmacéutica y las necesidades de conocimientos y habilidades de los  farmacéuticos sobre la salud digital. Entre otras herramientas de salud digital,  la Telemedicina/Telefarmacia ha sido señalada como una de las herramientas  preferidas por los encuestados para formar y aprender.

Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services.

OBJECTIVES: The study aimed to determine how eHealth was adopted in pharmaceutical care (PC), the outcome reported and the contextual factors. DESIGN: Systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Literature was searched in six databases including PubMed, Scopus, Medline, Web of Science, Science Direct and China National Knowledge Infrastructure. ELIGIBILITY CRITERIA: Studies which reported the usage experiences of eHealth in any aspects of PC by pharmacists during the COVID-19 pandemic, written in English or Chinese, and published in peer-reviewed journals between December 2019 and March 2022 were included. Opinion articles, conference abstracts, correspondence, letters and editorials were excluded. DATA EXTRACTION AND SYNTHESIS: The literature search was completed on 15 April 2022. Two researchers independently conducted the literature search and extracted the data into an Excel table informed by the logic model with the key components of goals, input, activities, output and contextual factors. RESULTS: Forty-three studies were included in this review. During the COVID-19 pandemic, hospital pharmacists, community pharmacists and specialist pharmacists in 17 countries continued to educate, consult, monitor and manage the patients and the general public via phone calls, videoconferences, mobile applications, social media, websites and/or enhanced interoperability of electronic medical records. Assuring the continuity of pharmacy care, reduced need for hospital visits, and improved work accuracy and efficiency were the benefits of eHealth mostly reported. Contextual factors affecting the adoption of eHealth were multifaceted, prompting supporting actions at the levels of government, hospital/pharmacy, pharmacists and patients. CONCLUSION: This study revealed the wide adoption of eHealth in PC during the pandemic and the emerging evidence for its importance. Proper adoption of eHealth will help reshape the mode of pharmacy services to ensure continuity, quality and efficiency of care amid the challenges of the pandemic. PROSPERO REGISTRATION NUMBER: CRD42022299812.

Developing pharmacy services in a home hospital program: The Mayo Clinic experience.

PURPOSE: Home hospital programs are rapidly becoming a more common patient care model in the market. The impact on hospital pharmacy practices is not well defined. This article describes the development of pharmacy services in a home hospital program in an attempt to help other organizations create their own home hospital pharmacy programs. SUMMARY: Caring for acutely ill patients in their home was a novel idea when Mayo Clinic began considering this in January 2020. Since then, the coronavirus disease 2019 (COVID-19) pandemic has rapidly escalated interest in and pursuit of these programs. One question we asked ourselves, and many colleagues are asking us today, is "How does pharmacy fit in?" Through 2 years of active engagement, innovation, and persistence, our team has developed a robust pharmacy presence in the home hospital care team and a well-articulated approach to medication management for our patients. We have tightly aligned and blended our clinical efforts to mirror our typical inpatient and ambulatory care clinical activities. We have also developed and modified our dispensing functions to serve the unique needs of the care model. CONCLUSION: Home hospital medication management is both complex and ripe with opportunities for pharmacy engagement.

Microcredentials training in pharmacy practice and education: an exploratory study of its viability and pharmacists' professional needs.

BACKGROUND: Microcredentials (MCs) are short courses that certify/recognise an individual's achievement of specific skills or knowledge. Schools of pharmacy could be well-placed to contribute to the continuing professional development (CPD) of pharmacists through the inclusion of MCs training in their programs. This study aimed to explore pharmacy professionals' views on the need and viability of MC courses globally. METHODS: Eleven semi-structured telephone interviews were conducted with pharmacy practitioners, policymakers, and academics across seven countries. The participants were selected using purposive sampling to explore information from varying pharmacy disciplines. Interviews were audio-recorded, transcribed verbatim, and analysed using a general inductive approach. RESULTS: Participants regarded MCs in pharmacy as an innovative idea, well-suited to the increasingly technology-driven world. They believe MCs provide easily accessible means of skills and knowledge acquisition that fulfils the needs of the pharmacy profession. MCs were also perceived as an alternative pathway of meeting the requirements of traditional CPD programmes. Many participants believe universities are well-suited to provide MCs; however, numerous challenges such as recognition, time and resources have been identified as potential barriers to enrolment and implementation. CONCLUSIONS: This study provides an insight into the views of pharmacy practitioners and academics on MCs, and their potential utility in pharmacy education and practice. The findings should help in the development of MCs that could be utilised by pharmacy practitioners around the world for CPD purposes. This study comes at a time when alternative models of teaching and learning are being explored as a direct result of the COVID-19 pandemic.

A new perspective: Practice-enhancing publications about the medication-use process in ambulatory care in 2020.

PURPOSE: This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2020 that can impact ambulatory pharmacy practice. SUMMARY: The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search covering calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 9,433 articles. A thorough review identified 65 potentially practice-enhancing articles: 14 for transitions of care, 19 for prescribing and collaborative practice, 10 for adherence, 6 for accessing care, and 16 for monitoring and quality. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article is the first to define and evaluate the currently published literature pertinent to the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Impact of a pharmaceutical care service for patients with rheumatoid arthritis using a customised mobile device (the PROUD trial): study protocol for a randomised controlled trial.

INTRODUCTION: Rheumatoid arthritis (RA) generally requires lifelong treatment; however, its medication complexity might affect non-adherence. Pharmacist-led telehealth services were as effective as face-to-face services and reduced potential side effects in outpatients with chronic diseases. This study aims to analyse the effect of a telepharmacy service with a customised mobile device in comparison with the usual pharmacist service on the humanistic and clinical outcomes in patients with RA. METHODS AND ANALYSIS: The study is designed as a prospective, randomised, open-label, and controlled trial to compare the humanistic and clinical outcomes of the pharmaceutical care service with monthly telecommunications and a customised mobile application (telepharmacy care group) against the usual service by community pharmacists (usual care group) in 256 patients with RA and prescribed at least one of the disease-modifying antirheumatic drugs. Participants will be recruited from a tertiary hospital in Republic of Korea with written informed consent. The primary outcome will be the changes in health-related quality of life as measured by the Korean version of the EuroQoL's five-dimensional questionnaire at 6 months compared with baseline. The secondary outcomes will be the changes in the following: scores of the Korean version of the Compliance Questionnaire-Rheumatology and medication knowledge at 3 and 6 months compared with baseline; scores of the Korean version of the Pharmacy Service Questionnaire at 6 months compared with baseline; clinical parameters such as erythrocyte sedimentation rate, C reactive protein level, and pain score at 3 and 6 months compared with baseline; frequency of acute care utilisation over 6 months. Analysis will be carried out with intent-to-treat and per-protocol principles. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Daegu Catholic University Medical Center (IRB no. CR-21-082-L, 14 July 2021). The study findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: KCT0006508.