Applications for pharmacogenomics in pharmacy practice: A scoping review

BackgroundPharmacogenomics (PGx) can provide valuable pharmacokinetic and pharmacodynamic information for the pharmacist's assessment of drug therapy, especially within medication therapy management (MTM) services. However, no review has comprehensively mapped the pharmacists' use of PGx in practice-based research. Doing so would allow future researchers, practitioners, and policy-makers to identify the ideal populations and settings for PGx implementation within the pharmacy.ObjectiveThe purpose of this review is to identify the evidence to date of PGx use in pharmacy practice.MethodsA scoping review was conducted to find all studied non-oncologic pharmacy practices incorporating PGx testing. Search terms were applied to 5 databases and relevant journals. Characteristics of patients, pharmacy settings, genetic tests, and outcomes were summarized to determine models most likely to benefit patients.ResultsThe search identified 43 studies on the use of PGx by pharmacists published between 2007 and 2020. CYP2C19 testing with antiplatelets was the most studied model, found in both community and institutional settings. It also was the most actionable test: approximately 30% of patients have polymorphisms indicating a need for alternative antiplatelets, and identifying these patients can reduce morbidity and mortality by more than 50%. As technology shifts, broader studies using multi-gene panel tests within MTM demonstrate an approximate 50% decrease in emergency visits and hospitalizations in elderly polypharmacy patients. Clinical benefit or drug-gene interactions are also found in other cardiovascular, psychiatric, analgesic, and gastrointestinal indications. No evaluations of actual costs or of pharmacist prescribing within pharmacy-based PGx have been performed. Facilitators towards successful PGx implementation included pharmacist education, collaboration with other healthcare providers, and the use of clinical decision software.ConclusionsPharmacogenomic testing has demonstrated feasibility and improved medication outcomes in pharmacy practice, including in the community pharmacy. Further PGx research should be directed towards pharmacist prescribing, pharmacist education, and pharmacoeconomics.     

A quality improvement course review of advanced pharmacy practice experiences

Objectives. To determine strengths of and quality improvements needed in advanced pharmacy practice experiences (APPE) through a systematic course review process.Design. Following the “developing a curriculum” (DACUM) format, course materials and assessments were reviewed by the curricular subcommittee responsible for experiential education and by key stakeholders. Course sequence overview and data were presented and discussed. A course review worksheet was completed, outlining strengths and areas for improvement.Assessment. Student feedback was positive. Strengths and areas for improvement were identified. The committee found reviewing the sequence of 8 APPE courses to be challenging.Conclusions. Course reviews are a necessary process in curricular quality improvement but can be difficult to accomplish. We found overall feedback about APPEs was positive and student performance was high. Areas identified as needing improvement will be the focus of continuous quality improvement of the APPE sequence.     

Biotechnology: an overview of the tools, therapeutic agents, and applications to pharmacy practice

The promise of pharmaceutical biotechnology and its applications to health care is now being realized. Over 30 therapeutic agents produced by the tools of biotechnology are now available and nearly 300 more are in various stages of development. Recombinant proteins, monoclonal antibodies, gene therapy, and vaccines can provide effective treatments and cures for diseases we could only mitigate in the past. The availability of these drugs presents several interesting challenges and opportunities to pharmacists. The expense, complexity, and unique properties of biotechnology agents will continue to alter not only the knowledge base of pharmacy but also the way pharmacists perform their professional responsibilities.     

A systematic review of the use of simulated patients and pharmacy practice research

Objective The use of simulated patients to assess current practice, or to derive outcome measures for pharmacy practice research, has received much attention in recent years. A simulated patient is an individual who is trained to visit a pharmacy to enact a scenario testing specific behaviour of the pharmacist or pharmacy staff. The aim of this study was to provide a definitive review of the use of simulated patients as a methodological tool for pharmacy practice research. Method A systematic review was undertaken to identify all pharmacy practice studies that had used simulated patient methodology. The electronic databases searched to identify relevant studies were MEDLINE, EMBASE and CINAHL. Articles fulfilling all the following criteria were considered for inclusion in the review: primary reports of trials conducted in community pharmacy and drug store settings which used simulated patients to derive outcome measures. The review was not restricted by language or by country. The review was restricted to publications from 1976 to May 2005. Key findings In total, 56 full publications were retrieved for further examination, of which 46 studies were included in the review, including: nine randomised controlled trials, three controlled trials, 30 cross‐sectional, two time‐series and two ‘other’ studies. Ten publications were excluded: seven reviews, one laboratory‐based study, one telephone survey and one study presented only as an abstract. Conclusions There has been steady growth in the use of simulated patient methodology over the past 30 years. Although simulated patients have received negative attention in the pharmaceutical media, they can be a rigorous and robust method of measuring practice if used appropriately. This review demonstrates the range of activities for which this method can be used, including the assessment of counselling and advice provision, the treatment of minor and major illness, and the assessment of the public health activities of pharmacy and drug store staff. Simulated patient methodology has been used in developing countries to a similar, if not greater extent, than the developed world, demonstrating its versatility and applicability to pharmacy practice research globally.     

A comprehensive systematic review of pharmacy perspectives on interprofessional education and collaborative practice

Introduction

Pharmacists are key professionals in the collaborative working process and are integral members of the healthcare team. However, there is paucity of information regarding their perspectives towards interprofessional education (IPE) and collaborative practice.

药师在老年科临床药学实践的系统评价

目的:探索与评价药师基于老年科病房的临床药学实践的特征、内容及效果。方法:计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CHINAL、Clinical Trials、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,检索时间均从建库至2014年10月31日。由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价并交叉核对后,进行系统评价,必要时采用STATA 12.0进行Meta分析。结果:共纳入15篇文献,其中2篇为随机对照研究,7篇为队列研究,6篇为病例系列研究,共涉及2 796名患者。研究结果表明,药师在老年科进行临床实践实施地点、团队合作、实践时间、使用工具、实践目的均较为多样化,实践内容以医嘱审核(9/15)、药物重整(5/15)为主。在药师实践的效果方面,药师提出了药物重整、药物相关问题等多方面建议,药师建议被接受比例的范围为45.0%~90.0%;进行单臂的Meta分析后,整体而言,药师建议被接受的比例为63.7%[95%CI, (0.523, 0.751)]。尽管药师的药学实践对死亡率、再入院率等终点指标效果并不明确,但能够提高患者的用药合理性,降低患者的用药复杂程度,提高患者的依从性,降低患者的额外就诊率[OR 0.44, 95%CI(0.22, 0.88),P=0.021]。结论:药师在老年科的临床药学实践形式和内容多样化,临床实践可对临床产生积极的作用,仍需设计良好的研究进一步明确药师对于终点结局的效果。     

Ethics applied to pharmacy practice

This article tries to develop an ethical reasoning that can be applied to (the practice of) pharmacy. Only general principles, based on accepted values in western society, lead to guidelines for ethical behaviour. Such essential values are personal autonomy, democracy and solidarity.The principle of nonmaleficence can be derived from these. Results of this analysis can be applied to health care and pharmacy practice. Subchapters deal with questions such as budget limitations and the autonomy of the patient versus that of the care provider. It concludes that protocols are important tools for ethical behaviour in every day practice. The ethical problem appears to be the unequal access to the health care system.An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of nonmaleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within our profession. A definition of target groups for pharmaceutical care will facilitate this task.A suggestion for a general code of ethics for pharmacists is proposed and compared with the code of ethics as currently accepted by the International Pharmaceutical Federation (FIP) council.     

A shared assignment to integrate pharmaceutics and pharmacy practice course concepts

Objective

To demonstrate for first-year pharmacy students the relevance of pharmaceutics course content to pharmacy practice by implementing a joint, integrated assignment in both courses and assessing its impact.

Design

Medication errors and patient safety issues relevant to ophthalmic and otic formulations were selected as the assignment topic. A homework assignment based on a mock court case involving a patient who was given an inappropriate formulation because of a pharmacist''s medication error was given to students. The scenario was followed by essay and calculation questions linking physical pharmacy concepts with patient safety recommendations.

Assessment

Students’ average score on the crossover assignment was 88.7%. Minute papers completed before and after the assignment showed improvement in student learning. Students’ scores on examination questions related to the assignment topic were significantly higher than the previous year''s students’ performance on similar questions. In a survey conducted at the end of the semester, 91% of students indicated that the assignment helped them relate the covered topics to future practice, and 98% agreed that the assignment emphasized the importance of the pharmaceutics in professional practice.

Conclusion

A crossover assignment was an effective means of demonstrating the connection between specific pharmaceutics concepts and practice applications to pharmacy students.     

Decision analysis applied to pharmacy practice

The use of decision analysis is discussed as it relates to pharmacy practice. Decision analysis is a valuable approach to selecting a choice from among several uncertain alternatives. It encourages the practitioner to define his views explicitly and weigh the merits of each alternative. The decision maker lists the choices or options to be considered. These choices are incorporated into a decision tree with their probability of occurrence and the relative worth of each potential outcome (utility) to the concerned party. A limitation of the method is that utility values and probabilities are often estimated on the basis of the decision makers' biases. Examples of applying decision analysis to clinical and administrative choices in pharmacy practice are presented.     

Advancing learning to advance pharmacy practice

Objectives

The objectives of this commentary are to: 1) describe advancements in the continuing professional development (CPD) model over the past decade; 2) detail an updated CPD cycle; and 3) describe how practitioners' adoption of the CPD approach may facilitate the advancement of pharmacy practice.

Clinical career ladders: application to hospital pharmacy practice

The reasons for job dissatisfaction among hospital pharmacists are reviewed, and an option for ameliorating the problem by offering clinical career ladders is advanced. Not enough new pharmacists are being trained to replace those leaving the profession, and hospital pharmacy managers seeking to recruit and retain quality pharmacists are facing stiff competition from retail outlets, academia, and the pharmaceutical industry. Hospital staff pharmacists report less of a sense of accomplishment than other workers and are more likely to change jobs. Although inadequate pay and benefits are frequently cited, one investigator found that the greatest source of dissatisfaction was the lack of opportunity for advancement. Other professions facing similar problems have experimented with a system of parallel career ladders in which alternatives to the traditional managerial advancement track are offered. Staff nurses on a clinical ladder remain in a direct patient-care role while ascending a hierarchy of clinical practice levels; each level brings greater responsibility and rewards. Outcomes have included improved recruitment, decreased turnover, and increased interest in educational programs. In pharmacy, each level of a clinical career ladder would be defined by explicit criteria for knowledge and skill in patient care and drug therapy. As in nursing, such a ladder would create advancement opportunities and reward the acquisition of knowledge and skills. Several hospital pharmacy departments now offer clinical career ladders. Implementation of clinical career ladders has the potential to enhance the job satisfaction of hospital pharmacists and improve their recruitment and retention.     

Physician and pharmacy student expectations of pharmacy practice

This study was initiated to examine the attitudes of some of the future health care providers, family practice residents, toward various ambulatory pharmacy services. Pharmacy students were then asked to predict what the resident attitudes would be and the results were compared. This project addressed the following questions: (i) What are the expectations of family practice residents of what today's pharmacists should be doing? and (ii) How accurately can pharmacy students judge what the responses of the residents will be? The survey results indicated that the family practice residents' perceptions of certain pharmacist behaviors rated significantly higher than how the pharmacy students thought they would respond. Such behaviors included: (i) maintain and review patient profiles; (ii) counsel patients; (iii) take medication/allergy histories; (iv) provide therapeutic information to physicians; and (v) stock a wide variety of generic drugs. Most of these behaviors reflect direct involvement of the pharmacist in disseminating information to the patient and/or physician. Other expanded roles of the pharmacist such as triage, refill determination, reimbursement for consultation services, and chronic care management were given low priority.     

Realist research to inform pharmacy practice and policy

Theory-driven implementation and evaluation of pharmacy services can enhance their contribution to overall healthcare. As complex interventions most pharmacy practice programmes and services will be adopted and modified during their implementation into various healthcare contexts and systems. Realist approaches to theory-driven evaluation consider these variations in programmes, interventions and the contexts of their implementation and establish theories on how they work best, for whom and why. This paper illustrates the practical application of the realist philosophy of science to pharmacy practice relevant areas of healthcare using two case studies, a realist synthesis of existing literature on medication reviews and a realist review and evaluation related to medicines management. Applying realist logic establishes causative explanations of what could be essential factors in the success of programmes, enabling policy makers in their decision-making and pharmacy practice researchers as well as practitioners in optimising service design.