Evaluation of a training and communication-network nephrology program for community pharmacists

Objectives To assess the feasibility and impact of implementing ProFiL program to optimize community-pharmacist management of drug-related problems among chronic kidney disease patients followed in a predialysis clinic. The program comprises a training workshop, communication-network program and consultation service. Setting Forty-two community pharmacies, 101 pharmacists, and 90 chronic kidney disease patients attending a predialysis clinic in Laval (Canada). Patients were followed-up for 6 months. Method In a six-month, pilot, open, cluster-randomized controlled trial, community pharmacies were assigned to ProFiL or the usual care. Chronic kidney disease patients of these pharmacies attending a predialysis clinic were recruited. ProFiL pharmacists attended a workshop, received patient information (diagnoses, medications, and laboratory-test results) and had access to a consultation service. Their knowledge and satisfaction were measured before and after the workshop. The mean numbers of pharmacists’ written recommendations to physicians (pharmaceutical opinions) and refusals to dispense a medication were computed. Results Of the ProFiL pharmacists, 84% attended the workshop; their knowledge increased from 52% to 88% (95% CI: 29–40%). Most ProFiL pharmacists rated workshop (95%), communication program (82%) and consultation service (59%) as “excellent” or “very good”; 82% said the program improved the quality of their follow-up. The consultation service received 21 requests. ProFiL and usual care pharmacists issued a mean of 0.50 and 0.02 opinion/patient, respectively, (95% CI of the adjusted difference: 0.28–1.01 opinion/patient). Conclusion The results of this pilot study suggest that ProFiL can be implemented and may help community pharmacists intervene more frequently to manage drug-related problems. However, a larger-scale study with longer follow-up is necessary to evaluate the impact of the program on management of drug-related problems and its clinical relevance. Institution where the study was conducted: Centre ambulatoire, Centre de santé et de services sociaux de Laval. Information about presentation of the work as an abstract or poster: Abstracts of this study have been published in the proceedings of the 3rd Canadian Joint Therapeutics Congress of the Canadian Society for Clinical Pharmacology—Canadian Association for Population Therapeutics—Canadian College of Clinical Pharmacy (Toronto, Canada, May 2006), the Colloque 2006 of the Réseau québécois de recherche sur l’usage des médicaments (Quebec, Canada, June 2006), the 22nd International Conference of the International Society of Pharmacoepidemiology (Lisbon, Portugal, August 2006), and the North American Primary Care Research Group (NAPCRG) annual meeting (Vancouver, Canada, October 2007).     

Continuing education and community pharmacists in Galicia: a study of opinions

AIM OF THE STUDY: To determine the opinions of a volunteer group of community pharmacists concerning general and specific issues related to continuing education. METHODS: Participants were required to complete questionnaires before and after attendance at a refresher course, and score the relevant options provided on a scale from 0 to 10. The responses of the survey were analyzed to identify preferences and to detect any possible changes in opinion. MAIN OUTCOME MEASURE: Arithmetic means of pharmacists' opinions. RESULTS: The teaching methods preferred by the community pharmacists were workshops for resolution of practical cases (9 +/- 0.25 and 8.88 +/- 0.13) and the distance-learning computer programmes (6.74 +/- 0.25 and 8.18 +/- 0.20). In selecting which topics that should be taught, the participants gave the highest ratings to healthcare needs (8.75 +/- 0.14 and 8.57 +/- 0.15) and the demands of the pharmacists (8.15 +/- 0.16 and 8.40 +/- 0.16), with pharmaceutical care being the most requested topic (29 points). Participants preferred courses lasting 20 to 50 hours (6.94 +/- 0.26 and 7.89 +/- 0.16), without preference for schedule. CONCLUSION: Community pharmacists in Galicia show a great interest in the provision and organization of continuing education activities that meet their needs and expectations.     

美国药师培养体系的启示

以美国匹兹堡大学药学院Pharm D学位教育为例,评述美国药学服务型人才的学位设置、培养目标、课程设计、教学方法以及师资队伍建设等药师的培养体系及模式。审视我国当前药学教育的现状与执业药师转型发展,提出借鉴国外药学教育的成功模式和经验,推进我国高等药学职业教育,从人才培养源头提高我国执业药师的素质与能力。     

The importance that community pharmacists in Malta place on the introduction of pharmaceutical care

The results from a study to assess the importance Maltese pharmacists placed on various aspects of pharmaceutical care and their willingness to provide such care are reported. A modified version of the Behavioural Pharmaceutical Care Scale (BPCS) questionnaire (consisting of three dimensions and 14 domains( was mailed to the 198 privately owned community pharmacies in Malta. A total of 99 questionnaires were returned following two reminder telephone calls. Pharmacists were asked to score the importance of each pharmaceutical care activity contained in the modified BPCS on a 6 point Likert scale ranging from 0 to 5. The overall score for the questionnaire, which illustrated the importance pharmacists attributed to various aspects of pharmaceutical care, ranged from 90 to 170 with a mean score of 134.8. There was little difference recorded between the scores for the three dimensions. The Referral and Consultation domain recorded a slightly higher score than the other two domains. Younger pharmacists obtained significantly higher scores (p>0.05; KruskalWallis test) in the Verification of Patient Understanding domain. Approximately 72% of respondents indicated that they were willing to provide pharmaceutical care, but remarked that a number of issues e.g. reimbursement, qualified support staff, GPpharmacist cooperation, had to be addressed. A series of strategic steps are needed to help pharmacists resolve these issues before pharmaceutical care programmes could be offered by Maltese community pharmacists.     

A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders

Background

Many community pharmacists are uncomfortable educating patients about naloxone, an opioid reversal agent.

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.     

药学学生参与社会药房药学服务工作的探索与实践

目的呼吁药学实习生积极参与社会药房的药学服务工作,提高药学人员技术服务能力,为实习企业赢得社会信誉。方法通过对部分社区居民的问卷调查,结合淄博市社会药房药学服务的现状,制订实习基地药学服务计划,引导本专业实习生进行多种形式的药学服务活动。结果与结论初步为实习基地确立了有效的药学服务模式,强化了学生的沟通技巧及药学服务知识,培养了药学服务专业人才队伍。为我院开展药学服务活动提供建议和参考依据。     

Losing the uphill battle? Emergent harm reduction interventions and barriers during the opioid overdose crisis in Canada

Canada continues to experience an escalating opioid overdose crisis that has claimed more than 8000 lives in the country since 2016. The presence of the synthetic opioid fentanyl and its analogues is a central contributor to the increases in preventable opioid-related deaths. However, a number of converging social-structural factors (e.g., the continued criminalisation of drug use, political changes) and political barriers are also complicating and contributing to the current crisis. We briefly outline four harm reduction interventions (i.e., injectable opioid agonist treatment, naloxone distribution programs, overdose prevention sites, and drug checking services) as emerging and rapidly expanding responses to this crisis in Canada. These examples of innovation and expansion are encouraging but also occurring at the same time that the opioid overdose crisis shows few signs of abating. To truly address the crisis, Canada needs political environments at all government levels that are responsive and foster harm reduction innovation and drug policy experimentation.     

Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States

BackgroundThe U.S. is facing an unprecedented number of opioid-related overdose deaths, and an array of other countries have experienced increases in opioid-related fatalities. In the U.S., naloxone is increasingly distributed to first responders to improve early administration to overdose victims, but its cost-effectiveness has not been studied. Lay distribution, in contrast, has been found to be cost-effective, but rising naloxone prices and increased mortality due to synthetic opioids may reduce cost-effectiveness. We evaluate the cost-effectiveness of increased naloxone distribution to (a) people likely to witness or experience overdose (“laypeople”); (b) police and firefighters; (c) emergency medical services (EMS) personnel; and (d) combinations of these groups.MethodsWe use a decision-analytic model to analyze the cost-effectiveness of eight naloxone distribution strategies. We use a lifetime horizon and conduct both a societal analysis (accounting for productivity and criminal justice system costs) and a health sector analysis. We calculate: the ranking of strategies by net monetary benefit; incremental cost-effectiveness ratios; and number of fatal overdoses.ResultsHigh distribution to all three groups maximized net monetary benefit and minimized fatal overdoses; it averted 21% of overdose deaths compared to minimum distribution. High distribution to laypeople and one of the other groups comprised the second and third best strategies. The majority of health gains resulted from increased lay distribution. In the societal analysis, every strategy was cost-saving compared to its next-best alternative; cost savings were greatest in the maximum distribution strategy. In the health sector analysis, all undominated strategies were cost-effective. Results were highly robust to deterministic and probabilistic sensitivity analysis.ConclusionsIncreasing naloxone distribution to laypeople and first responder groups would maximize health gains and be cost-effective. If feasible, communities should distribute naloxone to all groups; otherwise, distribution to laypeople and one of the first responder groups should be emphasized.     

住院药房药师分层培训计划的构建

目的： 基于住院药房各类药师岗位胜任力的要求,为确保工作间所有新员工的带教工作全面、统一、有序执行,探索药师分层培训的具体培训计划的构建。方法： 积累并记录各类药师工作实际内容和教学要点,通过住院药房教学小组共同讨论,形成住院药房药师分层培训计划。结果： 形成住院药房培训计划共68条目,将培训内容和时长分为三层。规范化培训药师培训内容最多、时间最长,药品调配、药品管理和用药合理性并重;药师（包括合同制药师）注重药品调配和药品管理;药工注重药品调配相关工作技能。结论： 构建覆盖全部新职工、统一而分层的培训计划,有助于提升住院药房培训质量、促进分工合作、提升药师胜任力。     

英格兰社区药房服务及其对中国社会药房发展的启示

目的:探讨英格兰社区药房服务对中国社会药房发展的启示。方法:回顾和探讨2000-2008年英国社区药房各种制度和政策对社区药房服务内容的影响,提出对中国社会药房未来发展的建议。结果与结论:英格兰社区药房的基本服务内容包括配药、重复配药、回收药物、公共健康、提供转诊指导、自我保健以及临床管理。此外,英国皇家药学会也不断推出各项社区药房的额外服务以提高其效能,如抗凝血剂监测服务、特定疾病专用药物管理服务等。这些举措对中国社会药房的发展具有较大启示,也有实际可行性。     

以药学服务为主线开展执业药师继续教育

目的:为"十二五"执业药师继续教育大纲的制定提供参考。方法:分析执业药师队伍的现状及发展趋势。结果与结论:"十二五"期间,大部分执业药师基本具备药学或中药学本科毕业生水平,主要在药品使用一线从事药学服务工作;继续教育的目标在于提高执业药师的药学服务水平和能力。以药学服务为主线构建执业药师继续教育内容,对于完善执业药师的知识结构,促进执业药师资格制度的健康发展具有重要意义。     

国内、外药店药学服务研究比较

目的:比较国内、外药店药学服务研究在内容和形式上的差别。方法:检索相关文献,采用回顾法和比较法进行归纳、概括及对比分析。结果与结论:相对于国内来说,国外开展药店药学服务研究理论丰富、方法科学、对象明确、内容充实,可为国内研究药店药学服务提供重要借鉴。     

Social pharmacy strengthening clinical pharmacy: why pharmaceutical policy research is needed in Pakistan?

Pakistan has a population of more than 160 million and is the sixth most populous country in the world. Drugs are the most common form of treatment modality; however, inappropriate use of medicines is a crucial issue in the country. In Pakistan, recently there is a surge of number of pharmacy schools, the pharmacy degree (B. Pharm) has been changed to Pharm D and there is a lot of rhetoric about “clinical pharmacy”. However, whether this change has brought any significant improvement in drug use situation; it is still a moot question for academics and policy makers. Authors feel that before embarking upon on clinical pharmacy at an institutional level, it is important that basic pharmacy system should be in place. Thus, a strong culture in social pharmacy or pharmaceutical policy research will not only be helpful to establish clinical pharmacy practice, but it would also be supportive enough to provide manpower to the country’s proposed drug regulatory authority.     

Implementing a pediatric pharmacy educational program for health-system pharmacists

Objective. To implement an educational program to improve pediatric content knowledge and confidence in providing pediatric care among health-system pharmacists.Design. Pharmacists were asked to voluntarily participate in this prospective, observational education program. A demographic assessment, pre- and post-intervention confidence assessments, and pre- and post-lecture competency assessments were conducted to evaluate the program.Assessment. Five of the 6 confidence scores improved from the preintervention to the postintervention stage. Test scores for 2 of the 8 postlecture tests improved significantly, and the average test scores for all postlecture tests combined were significantly higher than those for the prelecture tests.Conclusion. This study demonstrated significant improvements in both confidence and competence in pediatric pharmacotherapy among health-system pharmacists following implementation of a pediatric pharmacy education program.