Self-medication in Poland: the pharmacist’s advisory role in Warsaw

Background

Easy access favours the informative role that pharmacists play in Poland with regard to the proper use of medicinal products as well as preventing illness and promoting health.

Objective

The aim of the present study was to define situations in which patients ask a pharmacist for advice and to identify the most important factors that affect the patients’ decisions in seeking advice from a pharmacist.

Method

n all, 101 patients (69 women, 32 men) aged 19–67 years participated in the study. The study was conducted using a structured interview research method. Patients were asked to answer a set of closed-ended questions related to their habits regarding the purchase of medicines and the factors that affected their decision to seek the advice of a pharmacist.

Main outcome measure

Factors determining the choice to contact a pharmacy.

Results

Patients seldom asked pharmacists for advice: 77 of the patients “rarely” or “never” went to a pharmacy to consult the pharmacist. When patients did ask the pharmacist for advice, it was mainly concerning the choice of over-the-counter medicines. The most important reason for patients visiting a pharmacy for advice was the large number of pharmacies in Poland and their ease of access; the long queues of people in busy pharmacies and the lack of confidentiality in the pharmacy were considered negative factors.

Conclusion

The current advisory role of pharmacists in Poland seems of minimal importance to the public.     

Thai community pharmacist involvement in weight management in primary care to improve patient’s outcomes

Background The community pharmacist has significant potential to assist in providing health advice aimed at the improvement outcomes pertaining to weight management, however, up to now, evidence regarding its effectiveness has been inconclusive. In Thailand, community pharmacy involvement in weight management is a novel idea and therefore needs an evaluation of its effectiveness. Objective To examine essential outcomes, comparing the pharmacist’s interventions with a routine weight management service provided at a primary care unit (PCU). Setting Maha Sarakham province, Thailand. Methods A randomized controlled trial was designed involving sixty-six obese patients randomly assigned to either the control group or the experimental group. Participants in the control group received group counselling from the PCU staff as usual, while those participants in the experimental group received one-on-one advice from a community pharmacist along with the weight loss handbook for self-study. Both groups were followed up and clinical outcomes were monitored four times at weeks 0, 4, 8, and 16. Eating behaviours and knowledge about overweight and obesity were measured twice, at weeks 0 and 16. Main outcome measure Clinical outcomes included weight, waist circumference, body mass index, measured by standard medical devices. Eating behaviours were measured by the theory of planned behaviour (TPB) questionnaire. Knowledge was measured by a questionnaire focusing on the subjects’ level of understanding regarding overweight and obesity issues. Results Neither group showed improvement in clinical outcomes. The TPB average sum score significantly increased from baseline in the experimental group in terms of intention to perform healthy dieting behaviour, subjective norm, behavioural beliefs, normative beliefs, and control beliefs. (P < 0.05) In the control group, scores increased significantly from the baseline only for behavioural beliefs. (P < 0.05) Moreover, the knowledge score in experimental group increased significantly from 6.42 ± 1.94 to 8.75 ± 0.68 (P < 0.05). Conclusion Thai community pharmacists can help to improve both eating behaviour and knowledge about weight and obesity among obese patients. However, since the effect on clinical outcomes is unclear, a long-term study is still needed.     

The pharmacist’s role in advocating for the health care of immigrants in detention centers

ObjectivesThe primary objectives of this commentary are to (1) summarize the role of pharmacists as an advocate for the health care and appropriate use of medications of migrants in immigration detention centers and (2) describe methods to advocate for this vulnerable population.SummaryThere is a current humanitarian crisis occurring within the United States that violates the responsibilities and values held by members of the profession of pharmacy. Reports by reputable news organizations and members of U.S. Congress have shared that there have been inappropriate distribution and use of medications in migrant detention centers along the southern border. Specific instances have been described, including lack of access to vaccinations and vital medications to control chronic conditions and treat acute conditions. The role of the pharmacist is to ensure safe and effective use of medications. This role is not being fulfilled at migrant detention centers in the United States. By advocating to elected leaders, the Department of Homeland Security, and Customs Border and Protection for legislation that ensures the appropriate use and access of medications for migrants in immigration detention centers, pharmacists can push for the appropriate care for this vulnerable patient population.ConclusionThe professional values of a pharmacist should not be hindered by a border or the citizenship of a patient. As is stated in the Oath of a Pharmacist, pharmacists must “consider the welfare of humanity and relief of suffering [their] primary concern.” Through advocacy, pharmacists and student pharmacists can uphold their professional ethics and roles on the health care team by advocating for the care of a patient population that needs the profession’s help.     

The pharmacist’s active role in combating COVID-19 medication misinformation

Pharmacists listen to and dispel medication misinformation daily. Because of their accessibility, pharmacists have the opportunity during pharmacist-patient interactions to begin a dialogue with their patients and provide critical education to improve patient safety and public health. Current examples of pharmacists intervening with medication misinformation include addressing the antivaccination community, educating on the safety of generic drugs, and using evidence-based medicine for antimicrobial stewardship. However, combating medication misinformation in pharmacy practice with patients takes on many forms and can pose a number of challenges. Most recently during the coronavirus disease 2019 (COVID-19) pandemic, a concurrent infodemic has led to claims of pharmacotherapeutic superiority and efficacy unsubstantiated by scientific evidence. Misinformation and partisan politics have also created a distrust in COVID-19 vaccine development. In addition, rogue Internet pharmacies and companies have marketed new and unverified COVID-19 treatments and tests. Pharmacists must actively combat these instances of medication misinformation and educate their patients on how not to fall victim to convincing marketing and misinformation schemes. Pharmacists can help patients recognize misinformation by vetting sources of information and communicating how negative emotional information circulates. In addition, pharmacists combat misinformation with patients by providing accurate alternative explanations in patient-friendly language. Although it is easier to stay silent and let misinformation circulate, pharmacists must work with their health care team members to actively reject misinformation pertaining to medications, COVID-19 pharmacotherapy and vaccinations, and in any future public health crisis.     

An evaluation of Australian pharmacist’s attitudes on expanding their prescribing role

Objectives To evaluate the views of Australian pharmacists on expanded pharmacist prescribing roles and identify important drivers and barriers to its implementation. Setting Pharmacists in Australia. Method Data were collected using a self-administered questionnaire distributed nationally to a random sample of pharmacists either directly, or in the case of one state, via community pharmacies. One-way ANOVA and ?² testing were used to identify significant associations. Factor analysis was conducted to pool variables and the derived factors were subjected to regression analysis. Main outcome measures Perceptions of Australian pharmacists on expanded prescribing and the relationships between variables derived. Results A total of 2592 questionnaires were distributed and a response rate of 40.4% was achieved (n = 1049). Of the respondents 83.9% strongly agreed/agreed to an expanded prescribing role for pharmacists and 97.1% reported they would need further training. Of the respondents 896 agreed that pharmacists should engage in supplementary, independent prescribing or both. Of these 69.1% preferred only supplementary prescribing, 3.3% independent prescribing and 27.4% both models. Both models were found to be positive predictors of expanding pharmaceutical services through prescribing (P < 0.001) with supplementary prescribing showing a stronger association (β = 0.52 vs. β = 0.18). Pharmacists’ opinion based on their current perceptions of their clients was an important predictor in expanding pharmaceutical services through prescribing (P = 0.005). Inadequate training in patient assessment, diagnosis and monitoring were the strongest barriers to expanded pharmacist prescribing (P < 0.001). Conclusions The majority of Australian pharmacists supported an expanded pharmacist prescribing role. Support for supplementary was stronger than independent prescribing. Pharmacists acknowledged that they would need further training to perform such roles.     

Impact of community pharmaceutical care on patient health and quality of drug treatment in Parkinson’s disease

Background The well-being of patients with Parkinson's disease may be improved by pharmaceutical care in community pharmacies. Objective To investigate the effects of standardised pharmaceutical care on health outcomes and quality of drug treatment in patients with Parkinson's disease. Setting Community pharmacies in Germany. Method An open-label, multicentre, longitudinal, parallel-group study was conducted in outpatients with idiopathic Parkinson's disease who were receiving anti-parkinsonian medication. Patients were recruited by 32 community pharmacists (pharmacy group) and local offices of the German Parkinson's disease patients' association (comparison group). All patients were assessed at baseline and at 8 months' follow-up. In the intervening period, the pharmacists provided patients in the pharmacy group with standardised pharmaceutical care. Main outcome measure Mean change in symptom-related impairment of health status, assessed using the 23-item Parkinson's Scale Total Score. Results In total 235 patients were enrolled into the study (113 pharmacy group; 122 comparison group). Between-group analysis showed that the mean changes in the primary and secondary endpoints, all 23-item Parkinson's Scale sub-scores and the EuroQol 5-Dimension Questionnaire Index Score were significantly in favour of the pharmacy group after 8 months (p?相似文献   

Enacting ‘more-than-human’ care: Clients’ and counsellors’ views on the multiple affordances of chatbots in alcohol and other drug counselling

Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for ‘narrow AI’ tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological ‘affordances’ and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a ‘human’ element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as ‘more-than-human’ care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential ‘addiction futures’ and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare.     

Impact of ‘Chief-Pharmacist System’ on drug expenditures and rational drug use

International Journal of Clinical Pharmacy - Background Over the last few years, pharmacists in China have been searching for effective strategies to expand their roles in pharmaceutical care. In...     

‘Trapping’ in drug use and sex work careers

This paper examines the reinforcement of sex work and drug use. Data from 92 survey and in-depth interviews were analysed to examine associations between vulnerabilities and ‘trapping’: mutually reinforcing sex work and problematic drug use. Three-quarters of participants had used drugs and half had sold sex before 18. Half had been in care and half had been homeless. One in 5 (21%) had run away or left home before 16 and 80% had been convicted for acquisitive offences. Nevertheless, these experiences did not explain trapping.

There were strong associations between being trapped and convictions (81%); and being trapped and outdoor/drift sex work (92%). After adjustment for the other vulnerabilities in the logistic regression only outdoor/drift sex work remained significant: with sex workers involved in outdoor/drift sex-work having an adjusted odds ratio of over 7 (95% c.i. 1.7–28.3) of being trapped. Moreover, since the sample over-represents the extent of problematic drug use amongst indoor sex workers the study underestimates differences in trapping potential between sex markets. We conclude that outdoor/drift sex markets may reinforce vulnerability, sex work and problematic drug use. Interventions are recommended to disentangle sex and drugs markets, and reduce the sex industry's potential for exploitation and abuse.     

Key stakeholders’ views on the potential implementation of pharmacist prescribing: A qualitative investigation

BackgroundAn accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown.ObjectiveTo explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing.MethodsQualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework.ResultsThirty-seven interviews were conducted with directors of medicine (n = 5), pharmacy (n = 6) and nursing (n = 5), healthcare policy developers (n = 6), healthcare academics (n = 9), and patient safety advocates (n = 6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists’ prescribing competence, and extensive engagement of stakeholders were considered crucial.ConclusionThere is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation.     

What’s the role of topiramate in the management of patients with hyperkinetic movement disorders?

Topiramate (TPM) is an O-alkyl sulfamate derivative of the naturally occurring monosaccharide D-fructose with an epileptic activity. However, it has been suggested that, in addition to its use in epilepsy, TPM could also be used in the treatment of neurological disorders, psychiatric conditions and hyperkinetic movement disorders. The clinical applications of TPM in hyperkinetic movement disorders is consistent with the multiple pharmacodynamic mechanisms e.g., the modulation of both γ-aminobutyric acidergic or glutamatergic neurotransmission and the modulation of voltage-gated ion channels or intracellular signalling pathways. The purpose of the present review is to describe the mechanisms of action of TPM and its clinical efficacy in patients with hyperkinetic movement disorders.