The knowledge and attitude of the Turkish community pharmacists toward pharmacovigilance in the Kadikoy district of Istanbul

Objective We investigated the knowledge and attitudes of community pharmacists towards pharmacovigilance and adverse drug reactions (ADRs) in Kadık?y district of Istanbul (Turkey). Setting The community pharmacies in Kadikoy. Kadikoy is one of the biggest districts of Istanbul and has the largest number of pharmacies. Kadikoy district was divided into two regions, the central and the peripheral. Method Between December 2005 and June 2006 we conducted a survey about the knowledge and attitude of community pharmacists (n = 219) using a face-to-face questionnaire. The questionnaire consisted of questions about the sociodemographic characteristics of the pharmacists, their knowledge of pharmacovigilance and their attitudes towards ADR reporting. Main outcomes measured The knowledge of pharmacovigilance practice, ADR reporting compliance rates, reasons for not reporting ADR and perceptions of the Turkish community pharmacists on pharmacovigilance practice were evaluated. Results Although all 411 pharmacies in the Kadikoy district were visited, only 53% of the community pharmacists (n = 219) consented to participate in the study. Of those that did respond, only 17.2% of the pharmacists had any knowledge about ‘pharmacovigilance’. Sixty-five percent of the pharmacists stated that patients reported an ADR to them during the previous 12 months, and 21% of pharmacists reported to the concerned organizations. Our survey showed that only 7% actually reported an ADR to the national pharmacovigilance center. On the other hand, 89% of the pharmacists believed that the role of the pharmacist in ADR reporting was essential. Conclusion The results show that Turkish community pharmacists have poor knowledge about pharmacovigilance. There is an urgent need for educational programs to train them about pharmacovigilance and ADR reporting.     

区域中心医院与社区医院临床药师协同管理门诊糖尿病病人效果分析

目的 通过区域中心医院临床药师与社区卫生服务中心临床药师协同管理的模式,提高门诊糖尿病病人的用药依从性、血糖达标率以及解决病人的药物相关问题。方法 收集前来中心医院及社区就诊的符合纳入和排除标准的糖尿病病人信息,录入慢病管理系统(小程序),对应的社区药师和(或)中心医院药师进入慢病管理系统,每两个月对病人进行随访、干预,全程共6个月,评估病人干预前后用药依从性(Morisky评分)、血糖达标率以及药物相关问题(欧洲药学监护联盟分类系统)。结果共入组糖尿病病人132人,失访4人。随访期间,病人的平均依从性评分依次提高0.34、0.09和0.20;第2个月随访时的血糖达标率较入组时,第4个月较第2个月都有显著提高(P<0.05);共解发现药物相关问题145例次,提出干预方案220条,最终解决或部分解决药物相关问题115例次。结论 采用中心医院药师和社区药师的协同管理模式对糖尿病病人进行慢病管理,可以高效提高病人依从性、提高病人血糖达标率以及解决病人的药物相关问题,体现临床药师价值,该经验值得推广。     

Independent prescribing by pharmacists: a study of the awareness, views and attitudes of Scottish community pharmacists

Aims To investigate community pharmacists’ awareness, views and attitudes relating to independent prescribing by community pharmacists and their perceptions of competence and training needs for the management of some common conditions.Setting Community pharmacies in Scotland.Method A pre-piloted postal questionnaire was mailed to 500 randomly selected community pharmacies in Scotland for completion by the ‘main pharmacist’.Main outcome measures Scottish community pharmacists’ awareness, views and attitudes towards independent prescribing by community pharmacists; perceived competence and training needs in relation to diagnosis and treatment of conditions in four therapeutic areas; perceptions about patient accessibility to medicines and safety of independent prescribing by community pharmacists; and attitudes towards becoming an independent prescriber. The items regarding perceptions and attitudes were subjected to Principal Components Analysis (PCA) to identify the domains. Univariate analysis was performed on individual items in the questionnaire against total scores on the identified domains; significant variables in univariate analysis were further analysed in linear regression models.Results A response rate of 43.4% (217/500) was achieved. Despite expressing confidence in their abilities to become independent prescribers and feeling competent in diagnosing and treating those conditions listed in the questionnaire, clinical training prior to implementation of independent prescribing was regarded important by 211 (97.7%) respondents, while 191 (88.4%) regarded clinical training in drugs used for treating the conditions to be important. Gaining improved patient consultation skills and ability to communicate prescribing actions to GP practices were regarded to be important by 125 (57.9%) and 172 (80.0%), respectively. In PCA, three domains—confidence in independent prescribing, satisfaction with the␣current methods of supply, and requirements for the process of independent prescribing were identified. Practising more hours per week as a pharmacist (p = 0.01), supplementary prescribing training (p = 0.02), and involvement in Scottish Executive pharmaceutical care model schemes (p = 0.02), were found to be associated with greater ‘confidence in independent prescribing’.Conclusion High awareness of independent prescribing and perceived competence in diagnosing and selecting appropriate drugs for treating many common conditions were identified. Prescribing training with emphasis on evidence-based medicine, generic issues of prescribing and diagnostic and consultation skills is warranted before independent prescribing is undertaken by community pharmacists.     

Community pharmacy and the extended community pharmacist practice roles: The UAE experiences

Background: The pharmaceutical care and ‘extended’ roles are still not practiced optimally by community pharmacists. Several studies have discussed the practice of community pharmacy in the UAE and have shown that most community pharmacists only counsel patients. However, UAE, has taken initiatives to allow and prepare community pharmacists to practice ‘extended’ roles. Aim of the review: The aim was to review the current roles of community pharmacists in Abu Dhabi Emirate, United Arab Emirates (UAE). Objective: The objective was to encourage community pharmacists toward extending their practice roles. Methods: In 2010, Health Authority Abu Dhabi (HAAD) surveyed community pharmacists, using an online questionnaire, on their preferences toward extending their counseling roles and their opinion of the greatest challenge facing the extension of their counseling roles. Results: Following this survey, several programs have been developed to prepare community pharmacists to undertake these extended counseling roles. In addition to that, HAAD redefined the scope of pharmacist roles to include some extended/enhanced roles. Abu Dhabi Health Services (SEHA) mission is to ensure reliable excellence in healthcare. It has put clear plans to achieve this; these include increasing focus on public health matters, developing and monitoring evidence-based clinical policies, training health professionals to comply with international standards to deliver world-class quality care, among others. Prior to making further plans to extend community pharmacists’ roles, and to ensure the success of these plans, it is imperative to establish the views of community pharmacists in Abu Dhabi on practicing extended roles and to gain understanding and information on what pharmacists see as preferred change strategies or facilitators to change. Conclusions: In an attempt to adapt to the changes occurring and to the growing needs of patients and to maximize the utilization of community pharmacists’ unique structured strategies are needed to be introduced to the community pharmacy profession.     

Involvement and practice of community pharmacists in maternal and child health services: A systematic review

IntroductionCommunity pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.ObjectiveThe objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.MethodsSeven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.ResultA total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.ConclusionCommunity pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.     

药师在抗生素合理应用中的作用

《抗菌药物临床应用指导原则》要求在医疗服务中合理应用抗生素,但在具体医疗实践中存在着无指征的预防用药,抗菌药物品种、剂量的选择错误等不合理应用的情况。这就要求医院药师要深入临床,收集抗生素使用信息,认真分析总结,采取有效的干预措施,指导临床合理应用抗生素,规范医疗用药行为,提升药物治疗水平。     

A national approach to pharmacovigilance: The case of India as a growing hub of global clinical trials

Pharmacovigilance is the pharmacological science associated with the detection, understanding and prevention of adverse effects, especially long-term and short-term adverse effects of medicines. In the present day pharmaceutical scenario, where the development and marketing of an ever-growing array of medicines has rendered their safety and therapeutic efficacy key to determining the success of a drug, pharmacovigilance has come about to play a critical and significant part. While pharmacovigilance, as a system, has witnessed considerable progress and evolution in the West, not as much has been accomplished in India. With India now being recognised as a hub of global clinical trials and with an increasing number of clinical trials and clinical research studies being conducted actively, the need for a dynamic pharmacovigilance network with an efficient and prudent operation methodology is felt, now more than ever. This article observes the evolution of the pharmacovigilance system in India, with a fundamental overview of the present system in place and also various schemes and proposals to establish and sustain the same. It also examines the challenges faced in the execution of an effective pharmacovigilance network as well as the future prospects with regards to the Indian market.     

Adverse drug reactions in hospitalized pediatric patients of Saudi Arabian University Hospital and impact of pharmacovigilance in reporting ADR

ObjectivesChildren are more vulnerable to ADRs, and this susceptibility is compounded due to hospitalization. There is a lack of local data regarding the potential risk of ADRs in hospitalized pediatric patients. Therefore, this study is designed to identify the frequent nature, severity of adverse drug reactions, drugs implicated and factors influencing ADRs.MethodsIntensive monitoring study of ADRs was done in hospitalized pediatric patients of King Abdulaziz University Hospital, Jeddah from January to December 2011, with an analogous retrospective study for the preceding year to determine incidence rate, demographic aspects, causality appraisal, polypharmacy, body organs/systems involved and drugs implicated in ADR. Comparison of the two data was done to determine the impact of pharmacovigilance.ResultsIncidence rate of ADRs in retrospective study was (4.50%) and (8.2%) in prospective study. ADR was more in patients who received 5–6 drugs, which was (15.5%) in retrospective study and (22.1%) in prospective study. Regarding age, it was the highest in patients of 0–1 year of age which was (40.7%) in retrospective study and (38.8%) in prospective study. Anti-infective agents were the most frequently involved in ADR (40.8%) in prospective study and (48.2%) and retrospective study. This study also demonstrated that, there was high susceptibility of the skin to the ADR which was (37%) in retrospective study and (42.9%) in prospective study. None of the ADRs proved to be fatal.ConclusionWell premeditated intensive monitoring approach in pharmacovigilance amplifies the ADR detection, which can persuade healthcare providers into more drug safety.     

临床药师在不良反应监测中的实践与体会

目的浅析临床药师在临床实践中开展不良反应监测的工作模式及体会。方法通过对4例典型患者进行药学监护,从正确认识药品不良反应、特殊剂型药物的规范服用、重症患者的用药调整及输液管理等诸方面,阐述临床药师在不良反应监测工作中的切入点。结果临床药师判断出与突发不良反应相关的药物,并采取积极抢救措施,减少了药源性损害。结论临床药师应重点着眼于不良反应报告与监测工作,收集安全性信息,提出相应的药物警戒建议,保障公众用药安全。     

肿瘤专科医院PIVAS合理用药及临床药师的作用

目的分析医院静脉药物配置中心(PIVAS)药物的使用情况与临床药师在安全用药中的作用。方法对医院2010年度PIVAS全年用药及各季度用药进行分析,并对562 915组输液医嘱进行审核。结果植物类抗肿瘤药物销售金额占55.50%,紫杉醇类药物各季度均占销售首位,鸦胆子油销售数量持续增加,其中679组医嘱存在溶媒选择、用量和给药剂量不当等不合理用药现象。结论药师可凭借PIVAS平台,积极开展临床药学工作,确保静脉用药安全。