Detection of adverse drug reactions among ordinary users of liraglutide on the occasion of drug dispensing in the community pharmacy setting.

OBJECTIVES: Postmarketing studies of drugs forms an essential part of safety surveillance. In particular, this concerns new drugs as safety information of these by large rests on randomized clinical studies conducted on a limited number of subjects before licensing. Pharmacists in community pharmacies are in a unique position for detection of user experienced adverse drug reactions (ADRs) in relation to drug dispensing. The study reports from a research initiative exploring prompt and proactive ADR detection of liraglutide and reporting facilitated by pharmacy students undertaking internship in a community pharmacy in Denmark. METHODS: Nineteen pharmacy students undertaking regular 6 months' internship--eighth semester--in a Danish community pharmacy participated in the data collection. Before the data collection, students attended an interactive training seminar addressing ADRs in general, organ symptoms, diagnostic classification, and pharmacovigilance systems. Pharmacy students approached recurrent drug users purchasing liraglutide. Participating users were asked about experienced ADRs linked to liraglutide use. Reported ADRs were collected and analyzed. RESULTS: Sixty-two liraglutide users participated in the study, of whom, 38 reported 84 ADRs possibly linked to liraglutide usage. Nausea was by far the most reported ADR followed by decreased appetite, diarrhea, fatigue, and abdominal pain (upper). The reported ADRs are in accordance with previously reported ADRs. CONCLUSIONS: The study has demonstrated the feasibility of community pharmacy driven pharmacovigilance. The study supports the thesis that community pharmacists in the future may play a proactive and prominent role in patient-centered pharmacovigilance.

Patients' preferences for patient-centered communication: a survey from an outpatient department in rural Sierra Leone.

OBJECTIVES: To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone. METHODS: A survey was conducted using an adapted version of the Patient-Practitioner Orientation Scale (PPOS) as a structured interview guide. The study population was drawn from the population of all adults attending for treatment or treatment for their children. RESULTS: 144 patients were included in the analysis. Factors, such as doctor's friendly approach, the interpersonal relationship and information-sharing were all scored high (patient-centered) on the PPOS. Factors associated with shared-decision making had a lower (doctor-centered) score. A high educational level was associated with a more patient-centered scoring, an association that was most pronounced in the female population. CONCLUSION: The results provide an insight into the patients' preferences for PCC. Patients expressed a patient-centered attitude toward certain areas of PCC, while other areas were less expressed. More research is needed in order to fully qualify the applicability of PCC in resource-poor settings. PRACTICE IMPLICATIONS: Stakeholders and healthcare professionals should aim to strengthen healthcare practice by focusing on PCC in the medical encounter while taking into considerations the patients' awareness and preferences for PCC.

Exploring long term implementation of cognitive services in community pharmacies - a qualitative study / Explorando la implantación a largo plazo de servicios cognitivos en farmacias comunitarias: un estudio cualitativo

Implementing cognitive services in community pharmacies faces certain obstacles. One approach aimed at improving long-term implementation is to consider the implementation process as consisting of different stages, all of which require tailored initiatives. Taking this approach into account, there is a marked need for increased knowledge regarding the initiatives necessary to support especially the later phases of the implementation process. Objective: The aim of this project was to develop insight into factors pertaining to the later phases of implementing cognitive services in community pharmacies. Methods: A qualitative study was conducted, consisting of semi-structured interviews with 12 Danish pharmacy staff members, who were all in charge of improving the implementation of the Inhaler Technique Assessment Service (ITAS) in the 5 years following its introduction. The interviews were used to explore which implementation barriers had been identified by the staff and how they had sought to overcome them. The interviews were analyzed by combining content and critical common sense analysis with theoretical interpretations based on Rogers «Diffusion of innovation» theory. Results: The most predominant long-term barrier was the staff members' adoption of the ITAS at very different rates. The problem of laggards was not lack of competencies, but a lack of self-efficacy in believing that their actual competencies were sufficient to provide the service. Lack of time and attention to the service and obtaining support from the more senior members of the pharmacy were also problematic. Both individual and group activities were launched to overcome the identified challenges belonging to different phases of the implementation process. Conclusion: Those in charge of ensuring long term implementation of cognitive services in community pharmacies should consider the necessity to handle several simultaneous actions of both an individual and collective kind at the same time. Hence, the implementation process should be perceived as a series of interrelated stages rather than a linear process where one stage succeeds the other (AU)

Implantar servicios cognitivos en farmacias comunitarias se enfrenta a ciertos obstáculos. Un abordaje para mejorar la implantación a largo plazo se basa en considerar el proceso de implantación compuesto de diferentes etapas, todas las cuales requieren estrategias personalizadas. Siguiendo esta idea, es altamente necesario aumentar el conocimiento sobre las iniciativas necesarias apara apoyar especialmente las ultimas fases del proceso de implantación. Objetivo: El objetivo de este proyecto fue explorar los factores pertenecientes a las últimas fases de la implantación de servicios cognitivos en farmacias comunitarias. Métodos: Se realizó un estudio cualitativo consistente en entrevistas semi-estructuradas a 12 personas trabajando en farmacias comunitarias danesas que estaban a cargo de mejorar la implantación del Servicio de Evaluación de la Técnica Inhalatoria (ITAS) a los 5 años de su introducción. Se usó las entrevistas que barreras a la implantación habían sido identificadas por el personal y como habían pensado sobrepasarlas. Las entrevistas fueron analizadas combinando análisis de contenido y de sentido común crítico con interpretaciones teóricas basadas en la teoría de Rogers «Difusión de la Innovación». Resultados: La barrera a largo plazo más predominante fue la adopción del ITAS por el personal a velocidades muy diferentes. El problema de los rezagados no fue la falta de competencias, sino la falta de auto-eficacia en creer que sus competencias reales eran suficientes para proporcionar el servicio. La falta de tiempo y atención al servicio y obtener apoyo de los miembros mayores de la farmacia también fue problemática. Se lanzaron actividades tanto individuales como grupales para superar los retos identificados pertenecientes a las diferentes fases del proceso de implantación. Conclusión: Los encargados de garantizar la implantación a largo plazo de servicios cognitivos en farmacias comunitarias deberían considerar la necesidad de gestionar simultáneamente varias acciones de tipo individual y colectivo al mismo tiempo. En adelante, debería percibirse el proceso de implantación como una serie de pasos interrelacionados, más que como un proceso lineal donde un paso sucede a otro (AU)

Exploring long term implementation of cognitive services in community pharmacies - a qualitative study.

UNLABELLED: Implementing cognitive services in community pharmacies faces certain obstacles. One approach aimed at improving long-term implementation is to consider the implementation process as consisting of different stages, all of which require tailored initiatives. Taking this approach into account, there is a marked need for increased knowledge regarding the initiatives necessary to support especially the later phases of the implementation process. OBJECTIVE: The aim of this project was to develop insight into factors pertaining to the later phases of implementing cognitive services in community pharmacies. METHODS: A qualitative study was conducted, consisting of semi-structured interviews with 12 Danish pharmacy staff members, who were all in charge of improving the implementation of the Inhaler Technique Assessment Service (ITAS) in the 5 years following its introduction. The interviews were used to explore which implementation barriers had been identified by the staff and how they had sought to overcome them. The interviews were analyzed by combining content and critical common sense analysis with theoretical interpretations based on Rogers "Diffusion of innovation" theory. RESULTS: The most predominant long-term barrier was the staff members' adoption of the ITAS at very different rates. The problem of laggards was not lack of competencies, but a lack of self-efficacy in believing that their actual competencies were sufficient to provide the service. Lack of time and attention to the service and obtaining support from the more senior members of the pharmacy were also problematic. Both individual and group activities were launched to overcome the identified challenges belonging to different phases of the implementation process. CONCLUSIONS: Those in charge of ensuring long term implementation of cognitive services in community pharmacies should consider the necessity to handle several simultaneous actions of both an individual and collective kind at the same time. Hence, the implementation process should be perceived as a series of interrelated stages rather than a linear process where one stage succeeds the other.

Pharmacy student driven detection of adverse drug reactions in the community pharmacy setting.

PURPOSE: Post-marketing safety studies of adverse drug reactions (ADRs) form an important part of pharmacovigilance. Countries having a formal pharmacovigilance system to a large extent rely on voluntary ADR reporting from health professionals through spontaneous report systems. The contribution of pharmacists in ADR reporting, although varies significantly among countries. Pharmacists in community pharmacies are in a unique position for detection of experienced ADRs by the drug users. The study reports from a study on community pharmacy internship students' proactive role in ADR detection through direct encountering and questioning with drug users. METHOD: Pharmacy students undertaking internship in a community pharmacy were approached. Thirteen students from nine community pharmacies participated in the project as data collectors. Prior to the study students attended an educational seminar focusing on ADR detection and reporting in general. Ibuprofen was chosen as the drug of study. Pharmacy students approached recurrent drug users purchasing the drug. Participating users were asked about experienced ADRs linked to ibuprofen use. Reported ADRs were collected and analysed. RESULTS: Hundred and twenty eight ibuprofen users participated in the study out of who thirty three reported forty five ADRs possibly linked to ibuprofen use. The reported ADRs followed earlier reported patterns of distribution with gastric pain showing up as the most commonly reported symptom followed by heartburn, nausea, diarrhoea and constipation. CONCLUSIONS: Through adequate training community pharmacy internship students get competencies and are capable of detecting and reporting ADRs through direct questions to drug users.