An electronic prompt in dispensing software to promote clinical interventions by community pharmacists: a randomized controlled trial

Aim

To evaluate the effect of an electronic prompt in dispensing software on the frequency of clinical interventions recorded by community pharmacists.

Method

An electronic decision-support prompt identifying patients for a targeted proactive clinical intervention was developed and implemented. Each time an oral antidiabetic agent was dispensed, a prompt was displayed reminding pharmacists to discuss the suitability of aspirin therapy in eligible patients with diabetes. The prompt was randomly assigned to 31 of 52 metropolitan pharmacies in Melbourne (Australia) for 6 weeks, with the remaining pharmacies as controls.

Results

One hundred and fifty pharmacists in 52 pharmacies recorded a total of 2396 clinical interventions at an intervention rate of 0.92 interventions per 100 patients [95% confidence interval (CI) 0.58, 1.23]. Pharmacists recorded a total of 201 target interventions related to aspirin therapy in diabetes at an intervention rate of 2.55 interventions per 100 diabetic patients (95% CI 0.85, 4.24). All of the targeted clinical interventions were recorded in the prompt arm; no targeted interventions were recorded in the control group. The effect of the prompt decreased over the study period and was not maintained after prompt deactivation.

Conclusion

An electronic prompt significantly increased pharmacists'' recording of the targeted clinical intervention in diabetic patients. An electronic decision-support prompt has significant potential to promote community pharmacists'' contribution to the quality use of medicines.

What is already known about this subject

• Computerized prompts and reminders have been shown to be effective in changing the behaviour of health professionals in a variety of settings.
• There is little literature describing or evaluating electronic decision-support for pharmacists.

What this study adds

• An electronic prompt in dispensing software for a targeted clinical intervention has a significant effect on pharmacists'' behaviour. A markedly increased rate of recording and performing the targeted clinical intervention was found.
• The effect of the prompt reduces markedly once the prompt is deactivated.

     

Practice characteristics of bachelor of science and doctor of pharmacy degreed pharmacists based on the 2009 National Workforce Survey

Objective

To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees.

Methods

Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care.

Results

The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care.

Conclusion

Time spent in dispensing and patient care were influenced more by practice setting than by educational degree and residency training.     

Medicine prices, availability and affordability in Sri Lanka

Background:

No pricing formula has been implemented from November 2002 to date in Sri Lanka. Therefore, we initiated a study in 2003 to determine the prices, availability and affordability of medicines in the private sector of Sri Lanka in the absence of a price control.

Materials and Methods:

The World Health Organization/Health Action International methodology was used. The study was conducted in retail pharmacies (Rajya Osu Sala) of State Pharmaceuticals Corporation (semigovernment) and privately owned retail pharmacies (n = 15) in 2003, 2006 and 2009 in a geographical area. Essential medicines (n = 28) were studied and, for each medicine, innovator, most sold generic and cheapest generic were monitored. The medicine’s median price was compared with the international reference prices (IRP) to obtain the median price ratio. The daily wage of the lowest-paid government worker was used to calculate affordability.

Results:

Innovators were five to six-times the IRP at privately owned pharmacies and four to seven-times at the Rajya Osu Sala. The prices of generics were ≤1 the IRP during 6 years in privately owned and Rajya Osu Sala pharmacies. Cheapest generics were high in availability (>80%) throughout the study period. Innovators cost more than a day’s wage of the lowest-paid government worker; in contrast, generics were always less than one day’s wage. There seems to be no difference in affordability between privately owned or semigovernment pharmacies.

Conclusion:

In Sri Lanka, generic medicines have effective pricing and are available and affordable. No drastic changes in prices of medicine in the private sector were observed over the 6 years despite removal of price control.     

Attitude and perception of patients and health care practitioners toward oral sustained release dosage forms in Palestine

Aim

To evaluate the knowledge of health professionals in Palestine regarding the advantages of sustained release dosage forms (SRDFs) over conventional therapy.

Methods

Data were gathered from a questionnaire that was handed out to community pharmacists, physicians and patients. Pharmaceutical industry decision makers were enrolled in this study. Data were analyzed using the SPSS.

Results

Pharmacists (92.9%) and 89.2% of physicians thought that SRDFs improve patient compliance. 81.5% of pharmacists and 77% of physicians were in agreement regarding the capacity of SRDFs to maintain therapeutic activity during night. In this study, 81.5% of pharmacists and 81% of physicians believed that SRDFs provide further advantage with psychiatric patients who forget to take their medications. Pharmacists (63.1%) and only 63.5% of physicians believed that SRDFs yield a time saving for nurses who use SRDFs in hospital. Only 45.3% of physicians and 43.4% of pharmacists thought that SRDFs result in cost saving due to better disease management. Pharmacists (95.2%) and 95.9% of physicians agreed that SRDFs could be the right choice for faith patient’s who must take their medication during the month of Ramadan. Pharmacists (66.7%) and 50.7% of physicians recognize that SRDFs may be unsafe if they are improperly formulated. Bad swallowing was also recognized as inconveniences of SRDFs by 67.9% of pharmacists and 57.3% of physicians. Given the above advantages, 75% of patients showed economical problems regarding the cost of the single course therapy of SRDFs and 100% of interviewed patients were enthusiastic about the advantage of SRDFs during Ramadan.

Conclusion

The advantages of SRDFs are not completely understood by Palestinian health professionals. Pharmaceutical industries should pay more attention to the development and advertising of SRDFs due to the valuable advantages of these dosage forms.     

Care providers' satisfaction with restructured clinical pharmacy services in a tertiary care teaching hospital

Background:

At the time this study was undertaken, clinical pharmacy services at the authors’ institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage.

Objective:

To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services.

Methods:

The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients’ health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring.

Results:

Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about “cutting back” services where they had previously been provided.

Conclusions:

Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists’ satisfaction and created demand from other stakeholders to provide this level of service for all patients.     

Biosimilars Are Here: A Hospital Pharmacist’s Guide to Educating Health Care Professionals on Biosimilars

Background:

Pharmacists are the recognized experts in pharmacotherapy. With the recent introduction of biosimilar agents into the US market, pharmacists are poised to play a pivotal role in evaluating their risks versus benefits within the framework of cost containment.

Purpose:

This article provides hospital pharmacists with the necessary information on the principles surrounding the development, approval process, and use of biosimilars.

Methods:

Information contained in this article enables hospital pharmacists to identify concerns relating to biosimilars, implement educational components, and successfully evaluate biosimilars for the addition to the formulary. Additionally, this article reviews the European experience with biosimilars, the US Food and Drug Administration approval process, and postauthorization safety and pharmacovigilance programs.

Conclusion:

It is important to educate health care providers about the differences between biosimilars and their reference biologics. The adoption of biosimilars is necessary to control long-term costs of biologics, increase patient access to care, and encourage innovation.     

Community pharmacists’ attitudes toward dispensing errors at community pharmacy setting in Central Saudi Arabia

Purpose

The main objective of this study was to survey pharmacists’ attitudes toward dispensing errors in community pharmacy settings in Saudi Arabia.

Methods

A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from March through September 2012. A stratified random sample of eight hundred registered pharmacy practitioners was collected all over Riyadh region. Statistical analysis was done using SPSS version19.0 for windows (SPSS Inc., Chicago, Illinois).

Results

The response rate was almost 82%. The majority of the respondents are young adults (90.2%). The median for years of registration of respondent pharmacists was 9 years (range 1–37 years). About 62% (407) of the respondents have a positive response while only 37.8% (n = 248) have a negative response in this respect. The major factors identified were pharmacist assistant (82.2%) and high workload (72.5%). The most appreciated factors that help reducing dispensing errors are improving doctors’ hand writing and reducing work load of the pharmacist (82.9% and 82.8% respectively), having drug names that are distinctive (76.1%) and having more than one pharmacist in duty (75.5%).

Conclusion

In conclusion, majority of community pharmacists indicated that the risk of dispensing errors was increasing and most of them were aware of dispensing errors. It is obvious from the study results that dispensing errors is a big concern for community pharmacy practice in Saudi Arabia. Therefore, there is an urgent need for the professional organizations and Pharmacy Boards in Saudi Arabia to determine standards for the profession.     

An Inservice Program on Pharmacogenetics to Individualize Drug Therapy

Objectives

To provide an understanding of the principles and applications of pharmacogenetics in drug therapy optimization.

Design

An online learning session accessed using the hospital intranet and a live case-based session were offered to hospital pharmacists, residents, students, and interns.

Assessment

Knowledge was assessed with “check your knowledge” questions, case discussions, and a follow-up questionnaire. Pharmacists evaluated the instructor and the course using an anonymous survey tool.

Conclusion

This education provided pharmacists with a basic understanding of pharmacogenetics and the ability to apply pharmacogenetics to clinical practice.     

Personality Traits of Hospital Pharmacists: Toward a Better Understanding of Factors Influencing Pharmacy Practice Change

Background

The profession of pharmacy has adopted a mandate to become more patient-centred; however, significant change in this direction has not been achieved.

Objective:

To characterize the personality traits of hospital pharmacists in one Canadian province, to provide insights into potential barriers to practice change.

Methods:

A cross-sectional survey of hospital pharmacists was conducted in Alberta, Canada. An invitation to participate was sent to all 766 hospital pharmacists practising in the province’s 2 health service organizations. The survey was based on the Big Five Inventory, a validated, reliable instrument that uses a 5-point Likert scale to measure the traits of extraversion, agreeableness, conscientiousness, neuroticism, and openness.

Results:

Of the 347 pharmacists who completed the survey (45% response rate), the majority (297 [86%]) were staff pharmacists working full time in an urban setting. The average age of respondents was 41 years (standard deviation [SD] 11 years), and the average period in practice was 17 years (SD 11 years). Respondents’ mean scores were 3.2 (SD 0.7) on extraversion, 3.8 (SD 0.4) on agreeableness, 4.0 (SD 0.4) on conscientiousness, 2.5 (SD 0.7) on neuroticism, and 3.5 (SD 0.6) on openness. Total frequency counts revealed that respondents tended toward stronger expression of extraversion, agreeableness, conscientiousness, and openness and low levels of neuroticism (with the latter indicating stability).

Conclusion:

The Big Five Inventory represents a novel approach to examining pharmacists’ change-related behaviours. Improving understanding of hospital pharmacists’ personality traits will provide insights for the development of training and support programs tailored specifically to this group.     

Comparative evaluation of metered-dose inhaler technique demonstration among community pharmacists in Al Qassim and Al-Ahsa region,Saudi-Arabia

Title

Comparative evaluation of metered-dose inhaler technique demonstration among community pharmacists in Al Qassim and Al Ahsa regions, Saudi Arabia.

Background

Patients rely on the information about use of proper inhaler technique when dispensed by community pharmacists however; several studies have shown that patients are unable to show correct inhalation technique. The aim of this study is to assess the ability of community pharmacists in Al Qassim region to demonstrate proper inhalation technique of metered dose inhaler and compare the baseline outcomes with a similar study at Al-Ahsa region.

Method

We approach 96 pharmacies in Al Qassim region as mock patient (Investigator). The investigator asks the Pharmacist to guide him about proper inhalation technique of metered dose inhaler. Investigator completes a standardized and validated checklist of 8 steps of inhaler device use immediately after leaving the pharmacy. Baseline data were compared between the two study groups et al. Ahsa and Al-Qassim for variables for effectiveness of pharmacist handling of patient queries.

Result

A total number of 96 community pharmacies were approached in five cities of the Al Qassim province in Saudi Arabia This study has found that majority (93.7%) of community pharmacists failed to demonstrate proper inhalation technique of pMDI inhaler.

Conclusion

The pharmacists demonstrated particularly poor skills involving steps for coordination of the actuation process with the mechanics of inhalation with MDI. The errors detected in this simple assessment session, if translated to patient self-medication errors, are potentially significant.     

Lack of pharmacokinetic bioequivalence between generic and branded amoxicillin formulations. A post-marketing clinical study on healthy volunteers

AIMS

There are concerns about the quality of generic drugs in the postmarketing setting. The aim was to establish whether two generic formulations of amoxicillin, available on the Italian market, fulfil the criteria for clinical pharmacokinetic bioequivalence vs. the branded drug.

METHODS

Two generic amoxicillin products (generic A and B) were selected among four fast-release tablet formulations available on the Italian market. Twenty-four healthy adult volunteers of either sex participated to a single-dose, randomized, three-treatment, crossover, single-blind bioequivalence study designed to compare generic A and B with branded amoxicillin. Plasma samples were collected at preset times for 24 h after dosing, and assayed for amoxicillin levels by high-performance liquid chromatography.

RESULTS

Ninety percent confidence intervals of AUC ratios were 0.8238, 1.0502 (ratio 0.9302) and 0.8116, 1.1007 (ratio 0.9452) for generic A and B vs. branded amoxicillin, respectively. Ninety percent confidence intervals of C_max ratios were 0.7921, 1.0134 (ratio 0.8960) and 0.8246, 1.1199 (ratio 0.9610) for generic A and B vs. branded amoxicillin, respectively. The mean pharmacokinetic profiles showed that the AUC value of branded amoxicillin was 8.5 and 5.4% greater than that estimated for generic A and B, respectively. Few adverse events were recorded; these were not serious and occurred without apparent relationship to any specific amoxicillin formulation.

CONCLUSIONS

These results indicate that one of the two marketed amoxicillin generics analysed in the present study is not bioequivalent to the brand leader product for C_max on the basis of single-dose pharmacokinetic assessment.     

What Patients Want: Preferences Regarding Hospital Pharmacy Services

Background

The role of hospital pharmacists has evolved over the past couple of decades from preparation and distribution of medications to active involvement in health care teams, through identification and resolution of patients’ medication-related issues in an effort to improve patient outcomes. However, patients’ preferences about pharmacy services are not well known.

Objective:

To use content analysis of open-ended survey responses from recently discharged patients to determine desired pharmacy services.

Methods:

Former inpatients were randomly selected for participation in a telephone survey following discharge from acute care hospitals in the Horizon Health Network in New Brunswick. The survey included the question, “What service or information would you like a pharmacist to provide in the hospital that would most help you in managing your medications?” For responses to this question, 2 raters established response categories, obtained acceptable inter-rater agreement, and independently scored the responses.

Results:

Four global categories of responses were obtained, each having multiple subcategories. Of the 703 responses (from 325 respondents), 445 (63.3%) were related to the category “information about medications”, including purpose, adherence, and side effects. The second most common response category was “self-disclosure” (167 [23.8%]), including experiences with pharmacies, medications, or hospitals. Less frequently, responses pertained to “pharmacy services” (54 [7.7%]), such as medication costs and continuity of care, and to “information source for medications” (37 [5.3%]).

Conclusions:

Most respondents to this survey wanted hospital pharmacists to provide a general medication overview, including information about side effects and interactions, during their admission. The results suggest that many patients are unaware of other potential clinical services that pharmacists can provide. A future study could assess patients’ willingness to select from a guiding list of potential clinical services.