A Medical Mission to Guatemala as an Advanced Pharmacy Practice Experience

Objective. To describe the development and outcomes of an advanced pharmacy practice experience (APPE) for a medical mission trip to Guatemala.Design. Pre-mission preparation and post-mission reflection activities were combined with in-country activities to create a 5-week APPE. During the 10-day medical mission trip, pharmacy students dispensed medications, counseled patients, conducted quality improvement assessments, and presented their findings and experiences as part of an interdisciplinary health care team.Assessment. The students who completed the mission trip met the objectives of the APPE and reported substantial learning in the areas of interdisciplinary teamwork and cultural competency. All students’ scores on the Inventory for Assessing the Process of Cultural Competence—Student Version (IAPCC-SV) increased. The majority (81%) of student-generated quality improvement recommendations were implemented by the mission team.Conclusions. The medical mission APPE provided a rich learning environment for pharmacy students and resulted in modifications to the medical mission operation. This type of APPE could be implemented in other colleges of pharmacy via formation of partnerships with established medical mission teams as this one was.     

The experiences of the community pharmacy team in supporting people with dementia and family carers with medication management during the COVID-19 pandemic

BackgroundThe novel coronavirus COVID-19 pandemic has changed the lives of people across the globe in significant and long-lasting ways. People with dementia were significantly and disproportionally affected at the height of the pandemic in England. Community pharmacies in England continued to operate during the pandemic but had to adjust the way they provided key healthcare services. The impact of these changes on the provision of medication services to people with dementia is underexplored.ObjectiveTo explore the experiences of the community pharmacy team in supporting people with dementia and their family carers with the management of medications during the COVID-19 pandemic.MethodsAn interpretivist/constructivist research paradigm was used; semi-structured one-to-one telephone interviews were conducted with any member of the community pharmacy team who had been involved in providing medication services to people with dementia in England before and during the COVID-19 pandemic. Recruitment took place between July and August 2020. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFourteen participants were interviewed with equal numbers of qualified pharmacists and non-pharmacist staff. Participants were in their role for an average of 4.5 years. The analysis of interviews generated three themes: 1) key interactions curtailed due to COVID-19 restrictions, 2) utilising resources within and outside of the pharmacy to provide tailored services for people with dementia, and 3) the interplay between professional duty and personal values underpinned decisions to provide medication services.ConclusionsThe study provided a unique and important first insights to our understanding of how the community pharmacy team in England supported people with dementia and their family carers during the COVID-19 pandemic. These insights provide opportunities for reflection by individuals, healthcare teams, healthcare organisations, policy makers and the public, in an international context, to enable long-term planning, investment and implementation of strategies beyond the current pandemic.     

Fighting against COVID-19: Innovative strategies for clinical pharmacists

BackgroundClinical pharmacists’ routine task is carrying out pharmaceutical care to ensure patients' safe and reasonable medication use. However, under public health emergencies, such as the outbreak of COVID-19, the work strategies of clinical pharmacists need to be modified according to the rapid spread of the disease, where information and resources are usually lack to guide them.ObjectiveTo retrieve and investigate the prevention and control measures of clinical pharmacists during the outbreak of novel coronavirus, summarize the roles and responsibilities of clinical pharmacists, and to propose innovative strategies for developing pharmacy services under the epidemic.MethodsThe Chinese and English databases, self-media network, website of professional society or medical institution, and clinical trial center platforms were searched, and clinical pharmacists involved in the work against COVID-19 were surveyed and interviewed. Investigate the challenges and needs of frontline medical staffs for treating patients, and formulate strategies based on the actual medical environment.ResultsClinical pharmacists play a vital role in leading the industry to formulate work instructions, provide frontline medical staff with drug information, and develop innovative pharmacy services to promote the rational use of medicines with collaborative teamwork and close communication according to the epidemic situation of COVID-19. Anti-epidemic work indeed has driven the development of remote pharmacy services.ConclusionFacing public health emergencies, clinical pharmacists can give full play to their professional expertise, analyze the current situation rationally, formulate telehealth strategies swiftly, and work in a united and efficient manner to provide innovative pharmacy services to ensure medication safety and rational use of medicine.     

Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective

BackgroundThe novel coronavirus pneumonia (COVID-19), which was first detected in Wuhan City, has now became a pandemic that affecting patients around the world. Particularly, the community patient population are at high risk of infection and are facing potential failure of proper medication use during the pandemic.ObjectiveTo discuss community pharmacists’ role and the content of pharmaceutical care (PC) during the novel coronavirus pandemic to promote effective prevention and control and safe drug use of the community patient population.MethodCollect and summarize the experience Chinese community pharmacies gained from providing pharmacy services during the COVID-19 outbreak, and taking patients' PC needs into consideration, analyze and discuss the methods and strategies that community pharmacies and pharmacists shall use to provide PC during the pandemic.ResultsCommunity pharmacy management teams shall support PC services by providing adequate supply of COVID-19 related medications and preventative products, following environment regulations, and providing sufficient staff trainings. Pharmacists shall use various approaches to provide PC services in drug dispensing, consulting and referrals, chronic disease management, safe use of infusions, patient education, home care guidance and psychological support to promote the COVID-19 pandemic control and ensure safe medication use of community patients during the pandemic.ConclusionPC services in communities during the COVID-19 shall possess different properties due to disease characteristics and related change in patients' need. Community pharmacies shall work as a strong supporter of patient's medication and protective equipment supply. Community pharmacists shall be prepared to provide skilled and effective PC services for community patient population to ensure medication safety and promote the overall COVID-19 pandemic control.     

Pharmacy service accreditation: Raising the bar of practice standards

PurposeTo summarize the journey of a tertiary and quaternary care hospital outside the United States in receiving American Society of Health-System Pharmacists (ASHP) accreditation for its pharmacy services.SummaryTertiary and quaternary care hospitals have gained their reputation owing to the high quality and advanced services that they provide. Our organization, King Faisal Hospital & Research Center (KFSH&RC), Riyadh, Saudi Arabia, is a 1300-bed capacity hospital that serves as a center of excellence in solid organ transplant, genetic and metabolic diseases, hematology and oncology, and cardiology, in addition to a diversity of medical services. Accreditation of the pharmacy services by ASHP represents an important recognition of the quality and breadth of the services performed at KFSH&RC. The process of accreditation and the accreditation standards have also continued to serve as a guide for the hospital to maintain pharmacy service standards as they evolve.ConclusionAs the first internationally accredited pharmacy services, KFSH&RC now demonstrates the path forward for other international hospitals seeking to reach the same standards of practice defined by ASHP.     

Afghanistan: An assessment of the status of health care and pharmacy mentoring efforts in an Afghan National Army Hospital

BackgroundThe United States and Coalition countries initiated mentoring in Afghanistan as a means of training the Afghan people for independence, to include democratic self-governance and national defense. Several medical Embedded Training Teams are executing the medical component of the mentoring mission at Afghan Army hospitals around the country.ObjectivesTo provide a brief synopsis of Afghanistan history, review the status of Afghanistan health care, and provide an overview of pharmacy mentoring efforts by an Air Force pharmacist and pharmacy technician at Kandahar Regional Military Hospital.SummaryAfghanistan health care has suffered from neglect, and improving health care in the country is an important part of bolstering their military and the country as a whole. Afghanistan is rebounding from decades of civil war and occupation from a number of oppressive regimes, and the Afghan military faces considerable challenges. Challenges specific to military pharmacy include lack of established policies and procedures, medication shortages, medication quality issues, and lack of basic equipment, supplies, and training.ConclusionThrough ingenuity and determination, Afghan and Coalition pharmacists are working together to make progress in advancing the practice of pharmacy in Afghanistan.     

互联网时代增强分级诊疗制度中药学服务的实践

目的 探讨浙江省稳步开展"三位一体"分级诊疗试点改革工作过程中,各级医疗机构药学服务的一系列变化和发展。方法 结合分级诊疗制度中药学服务的现状和需求,实施"双下沉、两提升"药学对口帮扶,依托浙江省转诊服务平台和互联网医院优势创新药学服务。结果 实现了双向转诊过程中药学服务的上下联动以及药学服务的线上、线下联动,保障了患者在分级诊疗过程中享受到同质化的药学服务。结论 互联网+背景下实施连续化、全程化的药学服务,充分体现了药师在分级诊疗中的价值。     

Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies – An implementation method

IntroductionCommunity pharmacists’ optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties.Project aimsTo build community pharmacies’ capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting.MethodsCommunity pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process.Intended outcomesTo assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.     

临床药师绩效考核制度的构建

目的 建立新医改背景下医院临床药师的绩效考核制度,激励和挖掘临床药师潜能,强化竞争与责任意识,提高临床药学工作成绩。方法 以工作量为核心,创新性、效益性、推广性工作为导向,工作质量、时效性和成果并重的原则,制定考核制度与明细。结果 结合临床药学实际情况,制定了覆盖日常工作、牵头工作、科研服务、工作态度、对外交流与学术辐射、教学工作、临床问题挖掘与创新性工作、科研成果、学术任职与个人荣誉、医德医风的临床药师工作量化方案,并建立了科学可行的考核方法、分值细则和计算方法。结论 本研究建立的临床药师考核制度客观可行,达到了临床药师的绩效考核目的,对提高临床药学管理水平和药学服务质量均具有重大意义。     

Patient outcomes from implementing an enhanced services pharmacy network

ObjectiveTo evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending.DesignQuasi-experimental difference-in-difference analysis with a nonequivalent control group.Setting and participantsEligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016. A control group was propensity score-matched. Interventions consisted of enhanced services and a more intensive, comprehensive initial pharmacy assessment (CIPA).Outcome measuresOutcomes included hospitalizations; emergency department (ED) visits; health care spending for total medical, inpatient, outpatient, and ED services; and adherence to renin-angiotensin system antagonists (RASA), statins, noninsulin diabetes medications (NIDM), and multiple medications for chronic conditions (MMCC).ResultsThere were 31,509 patients who met eligibility criteria and were attributed to a participating pharmacy. Of these, 3897 received a CIPA. Before matching, patients attributed to participating pharmacies had greater Medicaid enrollment through aged, blind, or disabled status (49.2% vs. 31.5%, P < 0.001); greater case management (10.3% vs. 7%, P < 0.001); and worse rates of chronic disease (P < 0.001). Successful matching removed these differences. Adherence to RASA medications and MMCC increased by 9.5% and 10.3% (P < 0.05), respectively. Adherence did not change for statins and NIDM. The analysis also revealed a slower decline in average total medical spending of 5.7% (P < 0.01) relative to the control group over the same period, owed to a 9.6% (P < 0.001) slower decline in outpatient spending. ED utilization also decreased more slowly relative to controls by 4.8% (P < 0.05) following the intervention.ConclusionThe pharmacy intervention resulted in a statistically significant improvement in medication adherence to RASA and multiple chronic medications, but did not change or may have worsened utilization and spending outcomes. More research is needed to explore patient selection and variation in implementation and heterogeneity of treatment effects when evaluating pharmacy interventions.     

Satisfaction with community pharmacies services in Jordan: A cross-sectional study

BackgroundPharmacists are responsible for giving patients basic information about their medications, as well as informing them about drug administration, safety, efficacy, medication storage, and promoting patient adherence to their medications. Patient satisfaction will undoubtedly improve if patient-centered care is used and the patient is encouraged to participate in the decision-making process. The aim of this study is to explore patients' satisfaction with the pharmacy, its location, medication handling, dispensing and counselling procedures, or other non-paid services.MethodThis was a cross-sectional study that was conducted in Jordan using online questionnaire tool. Data was collected for the period between November 2021 and January 2022. A previously developed and validated questionnaire tool was used in this study. Binary logistic regression analysis was used to determine factors affecting satisfaction with community pharmacy services.ResultsA total of 1,611 patients participated in this study. More than half of the patients (55.5%) were males. Around 50.0% of the patients were aged 30 years and below. Patients were moderately satisfied with community pharmacy services (the mean satisfaction score was 148.6 (SD: 19.4) out of 205 (maximum obtainable score), which is equal to 72.5%). Patients' satisfaction was relatively consistent across the four sub-scales, ranging from 68.0% (satisfaction with additional non-paid services) to 74.7% (for satisfaction with the store, location, and staff). Patients' satisfaction with the store, location, and staff, as well as satisfaction with dispensing and counselling methods, differed significantly by age, marital status, work status, and the existence of chronic disease history. Patients' satisfaction with drug handling varies significantly depending on the patients' age, marital status, education level, employment position, and the presence of a history of chronic conditions. Patients' satisfaction with additional non-paid services differed significantly depending on the patients' educational level alone. Patients aged between 24 and 30 years old, as well as university students, were more likely to be satisfied with community pharmacy services.ConclusionIn Jordan, patients were satisfied with community pharmacy services to a moderate degree. Future research should look on patient satisfaction with pharmaceutical services in hospitals. Furthermore, strategies to promote satisfaction with pharmaceutical services should be investigated.     

Older adults’ understanding of hypothetical community pharmacy quality report cards

BackgroundQuality ratings for health plans and health services have become increasingly available to patients.ObjectiveWe sought to explore older adults’ understanding of hypothetical community pharmacy report cards and the information they valued on the report card.MethodsWe recruited participants aged 50 years or older to complete a 59-question telephone survey. The participants reviewed 3 different pairs of report cards, which represented a hypothetical pharmacy, and each pair contained different quality metrics. The participants identified which pharmacy of the pair they preferred, and this served as the primary outcome. We asked the participants to rate the level of importance (4-point unidirectional scale, not at all to very important) of the star ratings, source of information, and quality metrics. We also gathered information about the participants personal experiences with medications and pharmacy services, their self-reported health, health literacy, health numeracy, and demographics. The frequency that the pharmacy with higher quality metrics was selected was reported. We used logistic regression to examine factors associated with correctly identifying the highest quality pharmacy for all 3 sets of report cards.ResultsMost participants (n = 152) correctly identified all 3 (n = 120, 79.0%) report cards for pharmacies with higher quality metrics. The source of the information, individual quality metrics, and star ratings were all perceived as moderately or very important by most participants. Ratings of importance were strongly correlated (r, 0.70–1.00).ConclusionMore than 75% were able to correctly identify all 3 report cards with higher quality ratings. Most participants believed that the source of the information, the individual quality metrics, and the star rating were all important. Research is needed to explore to what extent patients would use these types of quality metric report cards to make decisions about where to obtain their medications.     

全流程信息化药房管理与药学服务实践

目的 探讨在药房管理和药学服务中采用信息化手段,保障患者用药安全,提高药事管理水平。方法 总结中南大学湘雅二医院五官科药房在药品调剂、药学服务和团队建设各方面的信息化建设进展及经验,分析对比实施效果,提出改进方案。结果 笔者所在医院五官科药房信息化建设程度较高,尤其是建立了用于药品养护的温湿度监控管理系统、用于住院药房调剂的数字化智能药房系统以及促进合理用药的审方平台。各病区医嘱领药组车效率均>65%,眼科医嘱单调配时间均<2 min。结论 医院药房全流程信息化建设有助于提高工作效率,降低调剂差错,保障患者安全用药。