The role of community pharmacy in wound care: a scoping review.

OBJECTIVE: To scope the literature describing the role of pharmacy in wound care in the community setting. METHOD: A systematic scoping review was conducted including peer-reviewed and grey literature. A search was undertaken using CINAHL, Embase, Informit, International Pharmaceutical Abstracts and MEDLINE, and a Google search of the top 200 results via three virtual private networks were used to identify relevant grey literature. Keywords relating to pharmacy, pharmacist, wound, wound management and wound care were used. Descriptions of wound care activities were extracted, grouped by similarity, and mapped to the International Pharmaceutical Federation's (FIP) Global Competency Framework Version 2 (GbCFv2). RESULTS: Of 2928 potentially relevant articles and 600 web search results, 55 articles from the database search and 11 results from the Google search met the eligibility criteria. After mapping 14 identified roles to the FIP GbCFv2, it was apparent that the scope of practice for wound care spanned across all four competency domains: pharmaceutical public health; pharmaceutical care; professional/personal; and organisational and management. CONCLUSION: The role of community pharmacy in wound care is multifaceted and within the scope of entry-level competency for pharmacists. These roles comprise wound related and non-wound-specific, clinical and non-clinical activities.

Ensuring the quality of clinical supervision: Stakeholder perceptions of pharmacy preceptor competence.

INTRODUCTION: Experiential education helps to integrate knowledge into practice, develops professionalism and understanding of a pharmacist's role in practice, and is a major component of pharmacy education. The role of the preceptor in experiential education is to model professional behaviours and provide feedback on student preceptee performance and competence. Little is known about how preceptors feel about their competency being assessed or the most appropriate way to assess competency. METHODS: A qualitative study using focus groups was designed, and a purposive convenience sampling strategy was used to target pharmacy students, current pharmacy interns, and registered pharmacists. A semi-structured interview guide was used to probe participants' views of what makes for a good preceptorship experience, opinions about assessment of preceptor competency, and barriers to training and assessment of preceptors. RESULTS: Thirteen focus groups and three interviews were conducted with 56 participants from rural, regional, and urban areas in New South Wales, Australia. Six main themes were generated: the purpose of preceptorship, becoming a preceptor, developing shared expectations, experiences, competing demands, and assessment of preceptor competence. CONCLUSIONS: Preceptorship plays a vital role in the career development of pharmacy students and graduates. Preceptees expect the experience they attain will be the same as their peers regardless of site. Assessing preceptor competency has been identified as a way of standardising performance. This study highlights the need to better support preceptors with the aim of better standardising the preceptorship experience.

Measuring and assessing the competencies of preceptors in health professions: a systematic scoping review.

BACKGROUND: In healthcare, preceptors act as a role model and supervisor, thereby facilitating the socialisation and development of the preceptee into a professional fit to practice. To ensure a consistent approach to every preceptorship experience, preceptor competencies should be measured or assessed to ensure that the desired outcomes are achieved. Defining these would ensure quality management and could inform development of an preceptor competency framework. This review aimed to evaluate the evidence for preceptor competencies and assessment in health professions. METHODS: This study followed the PRISMA ScR scoping review guidelines. A database search was conducted in Embase, Medline, CINAHL and IPA in 2019. Articles were included if they defined criteria for competency, measured or assessed competency, or described performance indicators of preceptors. A modified GRADE CERQual approach and CASP quality assessment were used to appraise identified competencies, performance indicators and confidence in evidence. RESULTS: Forty one studies identified 17 evidence-based competencies, of which 11 had an associated performance indicator. The competency of preceptors was most commonly measured using a preceptee completed survey (moderate to high confidence as per CERQual), followed by preceptor self-assessment, and peer-assessment. Preceptee outcomes as a measure of preceptor performance had good but limited evidence. CONCLUSIONS: Competencies with defined performance indicators allow for effective measurement and may be modifiable with training. To measure preceptor competency, the preceptor perspective, as well as peer and preceptee assessment is recommended. These findings can provide the basis for a common preceptor competency framework in health professions.

Pharmacokinetic changes post-bariatric surgery: A scoping review.

Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post-bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre-post studies reporting on pharmacokinetic parameters were included, and the Newcastle-Ottawa Scale was used to assess risk-of-bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk-of-bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long-term monitoring is recommended in patients post-surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.

The future of weight management in pharmacy education - Perspectives of new generation pharmacists.

INTRODUCTION: Over recent years, the profession of pharmacy has transitioned towards providing more individualised patient care services. In this context, community pharmacy has proven to be an excellent facilitator for weight management programs. However, education on weight management in pharmacy undergraduate curricula is often lacking. The perspectives of early career pharmacists on their perceived role in weight management services and their associated educational needs can inform curricula review. METHODS: In-depth, semi-structured interviews were conducted with 20 final year pharmacy students of The University of Sydney and five early career pharmacists from the greater Sydney, Australia area. Interviews were recorded, transcribed, and analysed for themes emerging. RESULTS: Participants were positive about their perceived role in providing weight management services. They regarded a program not based on commercial products as most suitable for pharmacy-delivered weight management services. However, some barriers were identified, such as lack of training and communication skills related to weight management. Participants requested more educational resources to ensure the delivery of high quality weight management services. DISCUSSION: Methods to enhance (future) pharmacists' knowledge of weight management services could include case-based learning, enhancement of communication skills, and the development of suitable guidelines. CONCLUSIONS: Participants perceived a clear role for themselves in providing weight management services in community pharmacies. However, the current educational system does not meet their requirements to prepare them for this role. A hands-on approach in education on weight management and appropriate communication skills should be introduced in pharmacy curricula to ensure future pharmacists are well prepared to deliver weight management services.

Incorporating a Weight Management Skills Workshop in Pharmacy Curricula in Australia.

Objective. To develop, implement, and evaluate a competency-based weight management skills workshop for undergraduate pharmacy students in an Australian university. Design. A 3-hour workshop titled "Weight Management in Pharmacy" was implemented with a cohort of fourth-year undergraduate pharmacy students (n=180). Learning activities used included case-based learning, hands-on experience, role-play, and group discussion. Assessment. A 22-item attitudinal survey instrument and the validated Obesity Risk Knowledge (ORK-10) scale were administered at baseline and postworkshop to evaluate the impact of this educational workshop. There was significant improvement in the students' ORK scores and students' perceived level of self-confidence in performing weight management skills. Conclusion. An educational workshop designed to enhance professional competencies in weight management ensured graduates were "service-ready" and had the appropriate knowledge, skills, and attributes to deliver patient-centered pharmacy-based weight management services.

Developing and testing evidence-based weight management in Australian pharmacies: A Healthier Life Program.

BACKGROUND: Pharmacies represent a valuable opportunity to deliver weight management services, rather than just the routine supply of weight-loss products. In order to provide optimal services and translation of evidence-based weight management in community pharmacy, a best practice model program was designed and pilot tested to facilitate implementation of such services in pharmacies in Australia. OBJECTIVE: To develop and pilot a pharmacist-delivered, evidence-based, non-product-centred weight management service for community pharmacy in Australia. Setting Sydney, New South Wales, Australia. METHOD: A pharmacy-based weight management service called the A Healthier Life Program (AHLP), for overweight and obese individuals, was developed based on current Australian weight management guidelines and recommendations made by key stakeholders. The pharmacist undertook training to acquire specific competencies to deliver the program. The AHLP involved six individual face-to-face sessions with the pharmacist over 3 months. The intervention targeted three areas: diet, physical activity and behavioural change. MAIN OUTCOME MEASURES: Weight, BMI, waist circumference, blood pressure, dietary intake, and physical activity levels at 3 months were compared with values at baseline. Qualitative feedback on participants' satisfaction and willingness to pay were also analysed. RESULTS: Eight pharmacies provided the AHLP between February and December 2013. Thirty-four participants were enrolled in the AHLP; mean age 50.7 years (SD 15.7) and mean BMI 34.3 kg/m(2) (SD 5.3). Of the 22 (65%) participants who completed the program, six had achieved the target weight loss of ≥5%. The mean change in weight was -3.5 kg (95% CI -4.8, -2.2) and waist circumference -2.0 cm (95% CI -2.8, -1.3) for program completers at 3 months. Furthermore, participants reported overall positive experiences of the program, and identified accessibility of the pharmacy and high comfort level with the pharmacist, as the major advantages. CONCLUSION: The AHLP was well received and participants achieved targeted weight loss. This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies.

Consumer perspectives about weight management services in a community pharmacy setting in NSW, Australia.

BACKGROUND: Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia's obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers' needs is vital to the development of any new services or the evaluation of existing services. OBJECTIVE: To explore Australian consumers' perspectives regarding weight management services in the community pharmacy setting, including their past experiences and willingness to pay for a specific pharmacy-based service. DESIGN: An online cross-sectional consumer survey was distributed through a marketing research company. The survey instrument comprised open-ended and closed questions exploring consumers' experiences of and preferences for weight management services in pharmacy. It also included an attitudinal measure, the Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale. SETTING AND PARTICIPANTS: A total of 403 consumers from New South Wales, Australia, completed the survey. RESULTS: The majority of respondents had previously not sought a pharmacist's advice regarding weight management. Those who had previously consulted a pharmacist were more willing to pay for and support pharmacy-based services in the future. Most consumers considered pharmacists' motivations to provide advice related to gaining profit from selling a product and expressed concerns about the perceived conflicts of interest. Participants also perceived pharmacists as lacking expertise and time. CONCLUSION: Although Australian consumers were willing to seek pharmacists' advice about weight management, they perceived several barriers to the provision of weight management services in community pharmacy. If barriers are addressed, community pharmacies could be a viable and accessible setting to manage obesity.

Weight management in community pharmacy: what do the experts think?

BACKGROUND: The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts' and key stakeholders' opinions on this matter. OBJECTIVES: (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. SETTING: Australian primary care sector. METHOD: Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. MAIN OUTCOME MEASURE: Recommended components of pharmacy-based weight management services and training requirements. RESULTS: Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists' knowledge, attributes and skills to acquire competencies necessary for delivery of this service. Some physical and financial barriers in providing these services were also identified including infrastructure, pharmacists' time and cost-effectiveness. CONCLUSION: Pharmacists are well-positioned to promote healthy weight and/or implement weight management interventions. Furthering pharmacists' role would involve training and up-skilling; and addressing key practice change facilitators such as pharmacy layout and remuneration. This study provides some insight into the design and implementation of a best practice model for pharmacy-based weight management services in Australia.

55-week treatment of mice with the unani and ayurvedic medicine pomegranate flower ameliorates ageing-associated insulin resistance and skin abnormalities.

PPARs play a pivotal role in regulating lipid and glucose homeostasis and are involved in diverse biological activities in skin. Pomegranate flower (PGF, an antidiabetic therapy in Unani and Ayurvedic medicines) has been previously demonstrated to activate both PPARalpha/gamma. Here, we found that treatment of mice with the diet containing PGF powder over 55 weeks attenuated ageing-induced abnormal increases in the homeostasis model assessment of insulin resistance, glucose concentrations during oral glucose tolerance test, and adipose insulin resistance index. The diet tended to decrease the excessive peri-ovary fat mass. It, however, increased the thinned subcutaneous fat thickness. In addition, the diet restored decreases in skin water content, epidermis thickness, and collagen density in corium. Thus, our results demonstrate that long-term treatment with the Unani and Ayurvedic therapy ameliorates ageing-induced insulin resistance, which is associated with reversal of ageing-induced fat redistribution. Further, PGF attenuates ageing-mediated undesirable skin abnormalities.

Managing obesity in pharmacy: the Australian experience.

OBJECTIVE: To explore pharmacists' opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. SETTING: Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. METHOD: In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. MAIN OUTCOME MEASURE: The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists' willingness to undertake training and accreditation. RESULTS: Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. CONCLUSION: Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.