Stakeholder roles in facilitating access to essential medicines

Background

Persistent medicine shortages have highlighted that global access to essential medicines remain problematic. Existing supply chain vulnerabilities impact health systems and risk consumer safety.

Measurement of the reliability of pharmacy staff and simulated patient reports of non-prescription medicine requests in community pharmacies

BackgroundThe use of simulated patients (SPs) in pharmacy practice research has become an established method to observe practice. The reliability of data reported using this method in comparison to pharmacy staff self-reported behaviour has yet to be ascertained.ObjectiveTo compare the inter-rater agreement of pharmacy staff and SP-reported data to researcher-reported data from audio recordings of SP encounters.MethodsA dataset of 352 audio-recorded SP encounters was generated in March–October 2015 by 61 undergraduate pharmacy students completing SP visits to 36 community pharmacies in Sydney, Australia. Post-visit scores were recorded on data collection forms by SPs. Staff completed self-assessments on identical forms immediately after the encounter. Two-hundred-and-seventy visits were randomly selected as the sample for this study, where the researcher independently scored encounters via audio recordings. Inter-rater agreement was calculated through intra-class correlation (ICC) and weighted kappa analyses.ResultsAnalysis of staff scores returned ICC values of 0.48 (95% CI:0.38–0.56; p < 0.001) for information gathering and 0.63 (95% CI:0.55–0.70; p < 0.001) for total score. Weighted kappa for information rating was 0.30 (95% CI:0.21–0.38; p < 0.001) and 0.43 (95% CI:0.34–0.51; p < 0.001) for overall outcome. ICC values for SPs were 0.91 (95% CI:0.88–0.93; p < 0.001) and 0.90 (95% CI:0.87–0.92; p < 0.001) for information gathering and total scores respectively. Weighted kappa values were 0.44 (95% CI:0.37–0.52; p < 0.001) for information rating and 0.63 (95% CI:0.55–0.70; p < 0.001) for overall outcome.ConclusionPharmacy staff self-reported their behaviour with a poor degree of reliability. Conversely, SPs had a high level of agreement with the researcher scoring from audio recordings. Disagreement for both groups of raters was most apparent in rating the information provided and overall appropriateness of outcome. Future research should investigate this discrepancy between staff-reported behaviour and actual behaviour and consider the implications of this discrepancy in the interpretation of self-reported data.     

Pharmacists and patients sharing decisions about medicines: Development and feasibility of a conversation guide

BackgroundIn Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understanding, decision-making and information preferences, health priorities related to medicines, patient goals and fears, views on important activities and trade-offs.ObjectiveThis study describes the development and feasibility testing of a Medicines Conversation Guide in HMRs with pharmacists and older patients.MethodsThe Guide was developed using a systematic and iterative process, followed by testing in clinical practice with 11 pharmacists, 17 patients (aged 65+) and their companions. A researcher observed HMRs, surveyed and qualitatively interviewed patients and pharmacists to discuss feasibility. Transcribed recordings of the interviews were thematically coded and a Framework Analysis method used.ResultsPharmacists found the Guide to be an acceptable and useful component to the HMR, especially among patients with limited knowledge of their medicines. The Guide seemed most effective when integrated with the HMR and tailored to suit the individual patient. Some questions were difficult for patients to grasp (e.g. trade-offs) or sounded formal. Most patients found the Guide focused the HMR on their perspective and encouraged a more holistic approach to the HMR. From the quantitative survey, pharmacists found the Guide easy to implement, balanced and understandable.ConclusionsPharmacists and patients reported the Guide fits with the HMR encounter relatively easily and promoted communication about goals and preferences in relation to medications. This study highlighted some key challenges for communication about medicines and how the Guide may help support the process of involving patients more in the HMR.     

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.

Improving medication information transfer between hospitals,skilled-nursing facilities,and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework

Introduction

Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff.

A review of DTCA techniques: Appraising their success and potential impact on medication users

Background

Direct-to-consumer advertising (DTCA) has been present in some countries for nearly two decades. Its success and ramifications have been examined but not yet cataloged recently in a comprehensive manner.

Perspectives on privacy in the pharmacy: The views of opioid substitution treatment clients

BackgroundMany pharmacists practise in settings in which protecting privacy can be difficult. To address this, some community pharmacies are rearranging their retail space to provide private areas for clinical consultations. Such facilities are deemed particularly important when dealing with clients who have sensitive medical conditions, such as opioid dependence.ObjectiveTo explore Opioid Substitution Treatment (OST) patients’ perceptions of privacy in a community pharmacy setting, with a particular focus on the layout of the community pharmacy.MethodsWe conducted semi-structured interviews with OST clients. Recruitment and the interviews were conducted at state government drug and alcohol clinic. The interviews were audio recorded and transcribed verbatim. The data were analysed in NVivo using the framework approach.ResultsWe interviewed fourteen OST clients. Most participants were concerned about privacy and considered that the pharmacy layout could enhance or hinder privacy. However, they disagreed about exactly which pharmacy layout was most privacy-protecting. In addition, a small group of clients interviewed who had a very positive relationship with pharmacists believed that the relationship contributed to their confidence that their privacy was protected.ConclusionsThere is little consensus amongst consumers about how to protect privacy in the community pharmacy. The range of views expressed by clients in this study may reflect the lack of consensus about the nature of privacy in health ethics. Attention to the meaning of and rationales for privacy protections may be helpful when designing pharmacy layouts to meet the needs of a broad range of consumers. An enclosed or screened private area which can be used as a consultation area for all private pharmacy discussions, including for OST dosing, could be a solution to addressing these varying views on privacy in the pharmacy. Further attention to enhancing the pharmacist and client relationship may assist in reducing sensitivity about privacy.     

Routine opioid outcome monitoring in community pharmacy: Pilot implementation study protocol

BackgroundIncreases in opioid use and related harms such as mortality are occurring in many high income countries. Community pharmacists are often in contact with patients at risk of opioid-related harm and represent an ideal point for intervention. Best practice in monitoring opioid-related outcomes involves assessing analgesia, pain functioning, mood, risks and harms associated with opioid use. Community pharmacists are well-placed to undertake these tasks.ObjectivesOur pilot study will test the implementation of a computer-facilitated screening and brief intervention (SBI). The SBI will support pharmacist identification of opioid-related problems and provide capacity for brief intervention including verbal reinforcement of tailored information sheets, supply of naloxone and referral back to the opioid prescriber. The SBI utilises software that embeds study procedures into dispensing workflow and assesses opioid outcomes with domains aligned with a widely accepted clinical framework.MethodsWe will recruit and train 75 pharmacists from 25 pharmacies to deliver the Routine Opioid Outcome Monitoring (ROOM) SBI. Pharmacists will complete the SBI with up to 500 patients in total (20 per pharmacy). Data will be collected on pharmacists’ knowledge and confidence through pre- and post-intervention online surveys. Data on feasibility, acceptability and implementation outcomes, including naloxone supply, will also be collected.Project impactOur study will examine changes in pharmacists’ knowledge and confidence to deliver the SBI. Through the implementation pilot, we will establish the feasibility and acceptability of a pharmacist SBI that aims to improve monitoring and clinical management of patients who are prescribed opioids.     

Advancing pharmaceuticals and patient safety in Saudi Arabia: A 2030 vision initiative

Low-quality medicines deliver sub-optimal clinical outcomes and waste precious health resources. It is important to ensure that public funds are spent on healthcare technologies that meet national regulatory bodies such as the Saudi Food and Drug Authority (SFDA), quality standards for safety, efficacy, and quality. Medicines quality is a complicated combination of pre-market regulatory specifications, appropriate sourcing of ingredients (active pharmaceutical ingredient (API), excipients, etc.), manufacturing processes, healthcare ecosystem communications, and regular and robust pharmacovigilance practices. A recent conference in Riyadh, sponsored by King Saud University, sought to discuss these issues and develop specific policy recommendations for the Saudi 2030 Vision plan. This and other efforts will require more and more creative educational programs for physicians, pharmacists, hospitals, and patients, and, most importantly evolving regulations on quality standards and oversight by Saudi health authorities.     

Clinical decision-making: An essential skill for 21st century pharmacy practice

Clinical decision-making skills are recognized as a central component of professional competency but are under-developed in pharmacy compared to other health professions. There is an urgent need for a comprehensive understanding of how pharmacists can best develop and use therapeutic decision-making skills in clinical practice. The aims of this commentary are to define clinical decision-making in pharmacy practice, and to present a model for clinical decision-making that aligns with a philosophical framework for pharmacy practice. The model has utility in education programs for pharmacists and provides a framework for understanding patient-facing clinical services in practice.     

Community pharmacist led,employer-based wellness services: A pilot study

The emphasis that United States employers are placing on employee wellness continues to grow; however, most attention has been paid to larger firms to gauge return-on-investment from a larger pool of enrollees. With fewer resources available to fund expansive wellness programs, smaller businesses need a cost-effective mechanism to provide such benefits. As the most accessible healthcare provider, community pharmacists are in an ideal position to support certain wellness programs for smaller businesses. This research piloted a community pharmacist-led, employer-sponsored wellness program for a self-insured financial services company in Tennessee. Employees with diabetes, hypertension, hyperlipidemia, asthma, or COPD were recruited from the partnering firm to receive live, one-on-one counseling from a community pharmacist over a calendar year. Each session was tailored to individual employee's needs and goals but generally focused on medication adherence, diet, exercise, and health maintenance strategies. Fifteen employees participated in the program, and improvements in clinical measures were not realized over the course of a year. Some, albeit not statistically significant, improvements were seen in self-reported medication adherence and quality of life; however, a trend toward some weight gain was observed. Results suggest that, similar to Medicare beneficiaries, working-age adults with certain chronic conditions may benefit from pharmacist-led MTM programs but deeper investigation is needed.