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Kevin C. Readdean Albert J. Heuer J. Scott Parrott 《Research in social & administrative pharmacy》2018,14(4):321-331
Background
Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients.Purpose
The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders.Methods
A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control.Results
The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms.Conclusions
The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes.Article synopsis
Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. 相似文献4.
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Ellie Rosenfeld Sharon Kinney Carlye Weiner Fiona Newall Allison Williams Noel Cranswick Ian Wong Narelle Borrott Elizabeth Manias 《Research in social & administrative pharmacy》2018,14(3):269-278
Objective
Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings.Design
An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically.Setting
The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings.Participants
Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions.Results
Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies.Conclusions
Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making. 相似文献6.
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Milena M. McLaughlin Kevin T. Marx Colleen Terriff 《Journal of the American Pharmacists Association》2018,58(1):109-112.e1
Objectives
To discuss the current barriers to hepatitis C virus (HCV) treatment; to provide information and resources to assist health care providers with the prior authorization process; to provide resources for potential access to medications if a patient's third-party payer may not be an option; and to discuss the pharmacist's vital role as a patient advocate and considerations once medications are approved.Summary
Access to HCV medications is often restricted by third-party payers. Pharmacists are poised to fill an immediate need and assist with providing the necessary clinical evidence to gain access to HCV medications and advocate on the patient's behalf. Once approval for HCV treatment has been obtained, considerations must be given to procurement of therapy, refills, monitoring, and avoid interruptions in therapy.Conclusion
The assistance of a pharmacist should be sought to overcome barriers related to medication access. Once therapy has been obtained, the pharmacist can assist the entire patient care team to ensure timely refills, appropriate monitoring, tolerability of therapy, and continued medication access. 相似文献10.
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Lorah Hickman Susan G. Poole Ria E. Hopkins Diane Walters Michael J. Dooley 《Research in social & administrative pharmacy》2018,14(10):931-935
Background
Medication errors have the potential to cause significant harm and the final verification of dispensed medications is essential to patient safety. There is international evidence to demonstrate that trained pharmacy technicians can safely and accurately undertake the verification of medication orders in ward-based unit dose containers. There is a need for evaluation of pharmacy technician verification of medication orders in broader contexts including the hospital inpatient dispensary.Aim
To compare the accuracy of Accuracy Checking Pharmacy Assistants (ACPTs) to pharmacists when verifying inpatient medication orders within the hospital pharmacy setting.Method
This ‘real world’ single-blinded study was conducted in the inpatient dispensary of a major tertiary hospital in Melbourne, Australia. Inpatient medication orders were randomly allocated to an ACPT or pharmacist for final verification, before being reviewed for accuracy by an independent research pharmacist blinded to study allocation. Errors identified by the reviewing pharmacist were documented and severity was assessed by an independent Medication Safety pharmacist.Results
Between February and August 2014, three ACPTs verified 4718 items with 75 errors missed (1.59%), and twelve pharmacists verified 4194 items with 158 errors missed (3.77%). There was a statistically significant difference between both total and minor error rates, with pharmacists missing significantly more errors (total errors: p < 0.0001; minor errors: 1.42 vs 3.53%; p < 0.0001). There was no statistically significant difference in the rate of major errors missed by the two groups (0.17 vs 0.24%; p = 0.48).Conclusion
This study is the first of its kind in the hospital dispensary setting, demonstrating that the overall accuracy of ACPTs was greater than pharmacists for verifying dispensed medication orders. ACPTs missed fewer minor and overall errors than pharmacists, indicating that trained pharmacy technicians can verify medication orders safely and accurately. This study provides support for the tech-check-tech model in the hospital setting. 相似文献17.
Suhaj Abdulsalim Mazhuvancherry Kesavan Unnikrishnan Mohan K. Manu Alian A. Alrasheedy Brian Godman Donald E. Morisky 《Research in social & administrative pharmacy》2018,14(10):909-914
Background
COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence.Objective
This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital.Methods
In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0.Results
Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P < 0.001). It increased from 49% at the baseline to 80% after 24 months (P < 0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPD patients, but was effectively reduced by the intervention.Conclusions
This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling. 相似文献18.
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