Use of privacy-preserving record linkage to examine the dispensing of pharmaceutical benefits scheme medicines to pregnant women in Western Australia.

PURPOSE: Medications are commonly used during pregnancy to manage pre-existing conditions and conditions that arise during pregnancy. However, not all medications are safe to use in pregnancy. This study utilized privacy-preserving record linkage (PPRL) to examine medications dispensed under the national Pharmaceutical Benefits Scheme (PBS) to pregnant women in Western Australia (WA) overall and by medication safety category. METHODS: In this retrospective, cross-sectional, population-based study, state perinatal records (Midwives Notification Scheme) were linked with national PBS dispensing data using PPRL. Live and stillborn neonates born between 2012 and 2019 in WA were included. The proportion of pregnancies during which the mother was dispensed a PBS medication was calculated, overall and by medication safety category. Factors associated with PBS medication dispensing were examined using logistic regression. RESULTS: PPRL linkage identified matching records for 97.4% of women with perinatal records. A total of 271 739 pregnancies were identified, with 158 585 (58.4%) pregnancies involving the dispensing of at least one PBS medication. Category A medications (those considered safe in pregnancy) were the most commonly dispensed (n = 119 126, 43.8%) followed by B3 (n = 51 135, 18.8%) and B1 (n = 42 388, 15.6%) medication (those with unknown safety). Over the study period, the dispensing of PBS medications in pregnancy increased (OR: 1.06, 95%CI: 1.06, 1.07). The strongest predictor of medication dispensing in pregnancy was pre-pregnancy dispensing (OR: 3.61, 95%CI: 3.54, 3.68). Other factors associated with medication use in pregnancy were smoking, older maternal age, obesity, and prior pregnancies. CONCLUSION: Privacy preserving record linkage provides a way to link cross-jurisdictional data while preserving patient confidentiality and data security. The dispensing of PBS medication in pregnancy was common and increased over time, with approximately 60% of women dispensed at least one medication during pregnancy.

Immediate and long-term effects of COVID-19 on antibiotic dispensing: increasing use of Watch antibiotics.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic affected antibiotic usage worldwide. However, there is limited data from Serbia. Dispensing of oral antibiotics in Serbian pharmacies was analyzed to calculate monthly and yearly changes between 2018-2021, and to explore immediate and long-term effects of COVID-19 on antibiotic dispensing during this period. METHODOLOGY: The number of antibiotic packages dispensed from pharmacies during the study period was analyzed with a Chi-square test to assess the average change in annual dispensing, and an interrupted time-series analysis was used to evaluate the impact of the pandemic on antibiotic dispensing. The data from 2018-2021 were retrieved from the database of a large community pharmacy chain in Serbia. RESULTS: The average number of antibiotic packages dispensed per day and per pharmacy was higher in 2021 compared to 2018 by one package. However, the dispensing of macrolides increased significantly; 17.7% (2018) vs. 22.5% (2021) (p < 0.05). In general, an increase in antibiotic dispensing was detected during COVID-19 for total antibiotics (16.4%), Watch antibiotics (44.8%), third-generation cephalosporins (80.4%), macrolides (45.5%) and azithromycin (83.7%). However, the immediate effect of COVID-19 was a decrease in the dispensing of Watch antibiotics, penicillin, and third-generation cephalosporins (p < 0.05); and a notable long-term COVID-19 effect was an increase in the dispensing of azithromycin (p < 0.05). CONCLUSIONS: In spite of a relatively stable trend of total antibiotic dispensing before and during COVID-19 pandemic, the use of Watch antibiotics, third-generation cephalosporins, and macrolides (particularly azithromycin) showed an increasing trend in dispensing that should be optimized.

Feasibility and reliability of a quality indicator system for an ambulatory dispensing service.

Background: For a medication dispensing service to function with quality, continuous evaluation is required, which is why it is necessary to have reliable measurement tools that make it possible. Quality indicators can serve as tools for managing quality, as they are variables that directly or indirectly measure changes in a situation and help evaluate the progress made in addressing it. This article aims to determine the feasibility and reliability of a quality indicator system for a drug dispensing service for paediatric outpatients in two Mexican hospitals. Methods: A study of the development type of health systems and services at a microlevel was conducted from October 2020 to October 2021 in the pharmaceutical service of two Mexican hospitals. To determine the feasibility of the quality indicators, a retrospective evaluation was performed, which considered the indicators that could be calculated with the available information to be feasible. To determine reliability, an inter-observer agreement study (Kappa (κ)) was performed. Results: The feasibility analysis revealed that all five reference indicators related to the structure were feasible in both hospitals. In the Infantil of the Californias hospital, all six process indicators evaluated were feasible, whilst only one was found feasible in H+ Querétaro. As for outcome indicators, only one was feasible in the Infantil of the Californias hospital. The causes of non-feasibility in both hospitals were the non-documentation of the primary data related to the stages of the process and the lack of instruments to measure patient satisfaction. The reliability of the indicators showed little variability. Conclusion: Although not all indicators were feasible, solutions were proposed so that the 15 reference indicators could be used if an organization decided to do so. The reliability of the indicators was demonstrated, evidencing the importance of the data sheet as a tool to generate valid reliable measures.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.

Nanosphere pharmacodynamics improves safety of immunostimulatory cytokine therapy.

Systemic administration of interleukin (IL)-12 induces potent anti-tumor immune responses in preclinical cancer models through the systemic activation of effector immune cells and release of proinflammatory cytokines. IL-12-loaded PLGA nanospheres (IL12ns) are hypothesized to improve therapeutic efficacy and thwart unwanted side effects observed in previous human clinical trials. Through the investigation of peripheral blood and local tissue immune responses in healthy BALB/c mice, the immune-protective pharmacodynamics of IL12ns were suggested. Nanospheres increased pro-inflammatory plasma cytokines/chemokines (IFN-γ, IL-6, TNF-α, and CXCL10) without inducing maladaptive transcriptomic signatures in circulating peripheral immune cells. Gene expression profiling revealed activation of pro-inflammatory signaling pathways in systemic tissues, the likely source of these effector cytokines. These data support that nanosphere pharmacodynamics, including shielding IL-12 from circulating immune cells, depositing peripherally in systemic immune tissues, and then slowly eluting bioactive cytokine, thereafter, are essential to safe immunostimulatory therapy.

Knowledge and Practices toward Tuberculosis Case Identification among Accredited Drug Dispensing Outlets Dispensers in Magu District, Northwestern Tanzania.

Accredited Drug Dispensing Outlets dispensers (ADDO dispensers) have a crucial role in detecting and referring TB suspects. However, several studies highlight low knowledge of TB among ADDO dispensers. To facilitate this, the National TB and Leprosy Control Program trained ADDO dispensers on case identification and referral. Hence, this was a community-based cross-sectional study to determine the knowledge and practice of ADDO dispensers in the detection of active tuberculosis suspects in Magu Districts, Mwanza, Tanzania. This was a cross-sectional study that included 133 systematically selected ADDO dispensers. Out of 133 ADDO dispensers, 88 (66.9%) had attended TB training. About 108 (81%) participants had good knowledge of TB. The majority of ADDO dispensers 104 (78.4%) had poor practice toward the identification of TB cases. Attending training (AOR 4.49, CI 1.03-19.47), longer working experience (AOR 4.64, CI 1.99-10.81), and the presence of national TB guidelines (AOR 3.85, CI 1.11-13.34) was significantly associated with good self-reported TB case identification practices. Therefore, the study revealed adequate knowledge but with poor practice. Provisions to train ADDO dispensers in tuberculosis case detection and referral could yield great results.

[Drug dispensation at both community and hospital pharmacy, the highly active antiretrovirals example]. / Le double circuit de dispensation, exemple des traitements antirétroviraux : quelle pertinence ?

OBJECTIVES: Highly active antiretroviral therapies against the human immunodeficiency virus are available for patients in France in community pharmacy or in hospital pharmacy. More than 20 years after the implementation of the dual delivery system, it seems necessary to question the relevance of the dual dispensing circuit both in terms of service provided to patients and expenditure for health insurance. METHODS: The health insurance files were used to quantify the delivery of antiretrovirals therapies in the community pharmacy and in the hospital pharmacy. A survey was performed involving patients to find out their point of view on dispensing in hospital pharmacy and were the patients came from. The differential cost from the health insurance point of view between the two delivery system was calculated on the basis of the quantities delivered and the purchase prices at the hospital center in 2018. RESULTS: More than 80% of the quantities of antiretrovirals therapies are now delivered by community pharmacies. The arguments in favor of the antiretrovirals therapies dispensation by hospital pharmacy forwarded by patients are the anonymity and constant medicines availability. Health insurance is required to refund a drug at different prices depending on the delivery place, for about 37€ per box in favour of hospital dispensing. CONCLUSION: This study presents a complete inventory of the dual delivery system for antiretroviral therapies. Hospital and community therefore remain complementary to welcome outptients who will seek different delivery methods there. Little known to patients and professionals, this dual delivery system generates complexities at the stages of prescription, dispensing and reimbursement. It only concerns a minority of patients and its benefit for health insurance seems uncertain.

Implementing six multi-month dispensing of antiretroviral therapy in Ethiopia: perspectives of clients and healthcare workers.

BACKGROUND: Multi-month dispensing (MMD) of antiretroviral therapy (ART) is an integral component of differentiated HIV service delivery for people living with HIV (PLHIV). Although many countries have scaled up ART dispensing to 3-month intervals, Ethiopia was the first African country to implement six-month dispensing (6-MMD) at scale, introducing its Appointment Spacing Model (ASM) for people doing well on ART in 2017. As of June 2021, 51.4% (n = 215,101) of PLHIV on ART aged ≥ 15 years had enrolled in ASM. Since little is known about the benefits and challenges of ASM perceived by Ethiopian clients and their healthcare workers (HCWs), we explored how the ASM was being implemented in Ethiopia's Oromia region in September 2019. METHODS: Using a parallel convergent mixed-methods study design, we conducted 6 focus groups with ASM-eligible enrolled clients, 6 with ASM-eligible non-enrolled clients, and 22 in-depth interviews with HCWs. Data were audio-recorded, transcribed and translated into English. We used thematic analysis, initially coding deductively, followed by inductive coding of themes that emerged from the data, and compared the perspectives of ASM-enrolled and non-enrolled clients and their HCWs. RESULTS: Participants enrolled in ASM and HCWs perceived client-level ASM benefits to include time and cost-savings, fewer work disruptions, reduced stigma due to fewer clinic visits, better medication adherence and improved overall health. Perceived health system-level benefits included improved quality of care, decongested facilities, reduced provider workloads, and improved record-keeping. Although non-enrolled participants anticipated many of the same benefits, their reasons for non-enrollment included medication storage challenges, concerns over less frequent health monitoring, and increased stress due to the large quantities of medicines dispensed. Enrolled participants and HCWs identified similar challenges, including client misunderstandings about ASM and initial ART stock-outs. CONCLUSIONS: ASM with 6-MMD was perceived to have marked benefits for clients and health systems. Clients enrolled in the ASM and their HCWs had positive experiences with the model, including perceived improvements in efficiency, quality and convenience of HIV treatment services. The concerns of non-ASM enrolled participants suggest the need for enhanced client education about the model and more discreet and efficiently packaged ART and highlight that ASM is not ideal for all clients.

Dispensing patterns of mental health medications before and during the COVID-19 pandemic in Alberta, Canada: An interrupted time series analysis.

BACKGROUND: The COVID-19 pandemic has negatively impacted the general population in all aspects of life. Estimates of mental health medication dispensing in Alberta were investigated to elucidate areas of need within mental health and pharmacy practice during the pandemic. METHODS: We employed an interrupted time series analysis using linear regression models to estimate community and outpatient medication dispensing trends of 46 medications used to treat mental health disorders. Three parameters were examined. The first was the medication dispensing slope before COVID-19. The second was the immediate effect of COVID-19 on dispensing (i.e., the difference in dispensing rate between the month before and after the first case of COVID-19) and the third was the medication dispensing slope during COVID-19. RESULTS: Dispensing rates of 61% (n = 34) of the examined medications remained similar before and during the COVID-19 pandemic. However, eight medications (i.e., amitriptyline, escitalopram, fluoxetine, paroxetine, bupropion, desvenlafaxine, venlafaxine, and oxazepam) showed an immediate and significant increase in dispensing rate following the onset of the pandemic that was sustained over the first 13-months of the pandemic. CONCLUSION: Initial increases in dispensing patterns of antidepressants may be attributed to a "stockpiling phenomenon" but the sustained higher levels of dispensing suggest an unfavorable shift in the population's mental health. Monitoring of medication dispensing patterns during COVID-19 may serve as a useful indicator of the population's mental health during the current pandemic and better prepare community pharmacists in future pandemic planning, medication dispensing strategies, and care of chronic medical conditions.

Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study.

RATIONALE, AIMS AND OBJECTIVES: Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. METHOD: This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. RESULTS: We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2) and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. CONCLUSION(S): This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Take action now to prevent medication errors: lessons from a fatal error involving an automated dispensing cabinet.

An error in the administration of an anaesthetic medication related to an automated dispensing cabinet resulted in a patient fatality and a highly publicised criminal prosecution of a healthcare worker, which concluded in 2022. Urgent action is required to re-engineer systems and workflows to prevent such errors. Exhortation, blame, and criminal prosecution are unlikely to advance the cause of patient safety.

Application of similar drug dispensing mode in drug dispensing management / 中国药房

OBJECTIVE To provide reference for improving the dispensing accuracy of similar drugs and reducing dispensing error risk through exploring the dispensing mode of similar drugs. METHODS The effectiveness and feasibility of the similar drug dispensing management mode was explored through adjusting the traditional horizontal or vertical sorting method to a “Z” shaped cargo location sorting， implementing similar drug in different zones dispensed by different people， and combining measures such as adjusting the format of drug dispensing documents and improving inventory methods. The role of similar drug dispensing mode in drug dispensing management was evaluated comprehensively from two aspects： work quality and work efficiency. RESULTS After the implementation of similar drug dispensing mode， total number of monthly dispensing errors （18.42±8.79 vs. 28.50±6.87，P= 0.005） and the proportion of monthly dispensing errors of similar drugs （[ 4.17±5.71）% vs. （10.96±7.05）%，P＝0.017] were significantly lower than before the implementation； the monthly consistency rate between accounts and materials （[ 98.46±0.73）% vs. （97.61±0.57）%， P＝0.004] was significantly higher than before implementation； completion time of dispensing in each batch was not significantly affected， and daily work was carried out smoothly and orderly. CONCLUSIONS The similar drug dispensing mode has a significant effect in improving the accuracy of dispensing similar drugs， reducing the risk of dispensing errors， and does not affect the efficiency of dispensing work.

Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities.

BACKGROUND: In low- and middle-income countries, too, public-private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public-private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs. METHODS: This was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews. RESULTS: Study participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff's working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF). CONCLUSIONS: As the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public-private partnership in health insurance schemes in low- and middle-income countries.

An Assessment of Outpatient Satisfaction with Hospital Pharmacy Quality and Influential Factors in the Context of the COVID-19 Pandemic.

The study aims to evaluate outpatient satisfaction (OS) with health insurance drug dispensing at the central hospital in Vietnam and to explore the influential factors. A cross-sectional survey was conducted on adult outpatients via an adjusted SERVQUAL questionnaire. The questionnaire's internal consistency (Cronbach alpha) and construct validity (exploratory factor analysis) were considered. The difference between groups was solved using a t-test or ANOVA-test. The multiple-regression analysis determined the influence levels of each factor. A p-value less than 0.05 was statistically significant. A total of 210 participants participated, with most being over 55 years old, female, with a high school education, and freelancers. The mean general satisfaction score was 3.42 (SD = 0.79). The reliability obtained the highest satisfaction score, and the guarantee was the lowest. The final questionnaire, including five factors (reliability, responsiveness, assurance, sympathy, and tangible) with 26 observational variables, had an internal consistency reliability and construct validity. These five factors had a statistically significant correlation and influence on the general satisfaction of the outpatients. The reliability factor had the strongest influence, and assurance had the weakest. Training staff about communication, counseling, and consolidating the facilities are the core solutions for increasing OS.

Impact of automated drug dispensing system on patient safety

Objectives: Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods: A selfdesigned questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results: The developed questionnaire had an excellent internal consistency (both Cronbach’s α and McDonald’s ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions: ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists’ freed-time towards patient care. (AU)

Automation of a tertiary hospital pharmacy drug dispensing system in a lower-middle-income country: A case study and preliminary results.

Background: An increase in the use of automated systems has optimised the drug dispensing process in hospitals. Methods: This case study describes the implementation of automated drug dispensing system and presents the preliminary results of automated pharmaceutical dispensing with robots (PillPick® and BoxPicker®, ©Swisslog Healthcare) at Hospital Sírio-Libanês, a private tertiary hospital in Brazil. Results: During the study period, between 2013 (pre-automation) and 2017 (post-automation) the number total of medication errors has not changed post-automation, but there was significant reduction in error in the dispensing phase with a relative risk of 0.84 (95% confidence interval: 0.70-0.99) withal a reduction in the numbers of returned items, breakages, and loss of medications, although that delivery times have increased.. Conclusion: The study results suggest that the use of robotic systems in the central pharmacy may improve hospital pharmacy management and generate only a few errors in dispensing pharmaceuticals.

Evaluation of pharmacy value-added services in public health facilities: Staff perception and cost analysis.

Background: Pharmacy Value Added Services (VAS) were introduced in Malaysian public health facilities to facilitate the process of medicine collection. Examples include Drive-through pharmacy, Medicine by Post, SMS Take&Go, Appointment Card and medicine locker, commonly referred to as Medibox. Objectives: To assess the perception of VAS among pharmacy staff, and to compare the time and cost needed to prepare medications for VAS and conventional counter service. Methods: A cross-sectional study was conducted in 17 public health facilities across Kuala Lumpur and Putrajaya from May until September 2020. There were two parts of this study: 1) a survey on the perception of VAS among pharmacy staff, which assessed respondents' experience of handling VAS and their perception towards the services; and 2) a cost analysis to compare the direct cost of preparing refill medications for VAS and conventional counter service, estimated from average salary and direct non-medical cost. Results: 290 respondents answered the survey. Most respondents had a positive opinion about VAS. Lack of storage and insufficient manpower were the top two barriers in VAS utilisation and implementation as perceived by pharmacy staff. The average time (in minutes) needed to prepare one prescription was highest for Medicine by Post service (10.31), followed by Medibox (10.25), Appointment Systems (6.24) and conventional counter service (3.99). Medibox had the highest average cost per prescription (RM5.49), followed by Medicine by Post (RM5.05), Appointment Systems (RM2.89) and conventional counter service (RM1.75). Conclusions: The majority of the respondents involved in this study acknowledged the benefits of VAS to patients, but there were aspects of the services that could be improved. Preparation of patient medication for VAS requires significantly more time and cost than conventional counter service, indicating the need to review and streamline implementation of the services.

Perception of community pharmacists about the work process of drug dispensing: a cross-sectional survey study.

BACKGROUND: Drug dispensing aims to promote rational medicine use. However, in many countries, the work processes are still not well defined. In this sense, the perception of pharmacists about dispensing practices presents an overview of how the service is being performed in the country and its main challenges. Thus, the purpose of this study was to determine the self-reported work process of Brazilian community pharmacists in relation to drug dispensing, challenges, and strategies for carrying out the service. METHOD: A cross-sectional survey was conducted between May and July 2021, with community pharmacists from all regions of Brazil. Pharmacists were invited to answer a validated, self-administered questionnaire, implemented through Google Forms, containing 33 questions related to the steps of drug dispensing (questions and counseling) and the main challenges and strategies to perform the service. The data were exported to Microsoft Office Excel and SPSS®. Multiple linear regression analysis was used to assess the association between responses and demographic information, with a significance level of less than 5% (p < 0.05). This study was approved by the Research Ethics Committee (number: 4.295.171). RESULTS: A total of 625 community pharmacists responded to the survey. Most pharmacists reported always or frequently performing 17 (54%) of the 31 steps described in the instrument. The steps that pharmacists reported performing more frequently were forming the medication name (n = 569, 91.04%), verifying the completeness and adequacy of the prescription according to current legislation (n = 567, 90.72%) and providing counseling on dosage (n = 549, 87.84%). Documentation was the main step in which pharmacists reported never or rarely performing (n = 424, 67.84%). The results showed that there was a significant influence of the variables of public education institution, age, and postgraduate education on the frequency of dispensing steps (F(3, 621) = 14.884, p < 0.001; R2ajdusted = 0,063). CONCLUSION: This study showed that most pharmacists reported always or frequently asking most of the questions and performing counseling contained in the instrument during drug dispensing. These results can contribute to an understanding of current dispensing practices and generate insights for developing strategies to qualify the service.

Medicine Storage and Dispensing Facilities in Public Healthcare Pharmacies of Puducherry, India.

Background Large amounts of medicines are wasted during procurement, storage, distribution, and utilization. Proper procurement, storage, dispensing, and documentation of medicines are important aspects of pharmacy management. The World Health Organization (WHO) and the Indian Pharmaceutical Association (IPA) have developed guidelines for the storage and dispensing of medicines by pharmacists. This study was conducted to assess the storage and dispensing facilities of medicines in public healthcare pharmacies of Puducherry province in south India. Methodology A one-time survey was conducted in 10 public healthcare pharmacies by filling the checklist which was prepared based on the WHO and IPA guidelines. Results Facilities such as adequate surface area, storage area, reception area, and availability of water supply in dispensing area were available in 90% of surveyed pharmacies. The most common system used for the arrangement of medicines was alphabetical order (70%). In 80% of pharmacies, a sufficient number of shelves was available for storage of medicine, and in 90% of pharmacies, shelves were properly labeled. None of the pharmacies had separate storage facilities for expired medicines and narcotic drugs. Conclusions In Puducherry, pharmacy services are provided by qualified and experienced pharmacists. Although most of the surveyed pharmacies had all the required infrastructure and equipment facilities, few pharmacies need to improve their facilities to promote good drug-dispensing practices.

Implementation of E-prescription for Multidose Dispensed Drugs: Qualitative Study of General Practitioners' Experiences.

BACKGROUND: Increased use of pharmaceuticals challenges both capacity and safety related to medication management for patients and changes in how general practitioners (GPs) and other health personnel interact with and follow up with patients. E-prescribing of multidose drug dispensing (eMDD) is 1 of the national measures being tested in Norway. OBJECTIVE: The objective of this study is to explore GPs' experiences with the challenges and benefits of implementing eMDD in Norway. METHODS: Qualitative in-depth and group interviews were conducted with a total of 25 GPs between 2018 and 2020. Transcribed files were saved in NVivo to conduct a step-by-step content analysis. NVivo is a software tool for organizing, managing, and analyzing qualitative data. RESULTS: The study revealed that eMDD offers many benefits. At the same time, there are several challenges related to information, training, and initiation, as well as to the responsibility for the medication, interactions, and the risk of incorrect medication. An important activity in the start-up phase was an information meeting with pharmacies and technology suppliers, as well as exchanging information and instructions with pharmacies on how to get started. Four analytic themes emerged through the extraction of data: (1) start-up with eMDD ("Be patient"); (2) the need for training; (3) interaction, safety, and efficiency; and (4) the working day with eMDD. CONCLUSIONS: There is a variation in different GPs' needs regarding training and information, and considerable variation in competence and motivation related to the use of digital tools. There are also different degrees of understanding the everyday work of the other actors in the medication chain. In particular, the harmonization of medication lists related to the use of time, expenditures, and challenges with technological solutions in the introduction phase was emphasized as a challenge. Overall, GPs who have started using the system report great benefits; these are largely related to an increased overview of patients' total medication lists, less time spent on prescribing prescriptions, and increased collaboration with pharmacies and nurses, both in service from providers in homes and in nursing homes.

Impact of automated drug dispensing system on patient safety.

Objectives: Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods: A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results: The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions: ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.