The role of community pharmacists in delivering interventions for osteoporosis: A systematic review

BackgroundOsteoporosis is a major public health concern, given that disease prevalence is expected to substantially increase due to the aging population. Community pharmacists can play a key role in the identification and management of chronic diseases.ObjectivesThe purpose of this systematic review was to present an overview of the literature on the role of community pharmacists in providing osteoporosis interventions to patients. The secondary objective was to assess the impact of these interventions on patient outcomes.MethodsA literature search was conducted in Embase, CINAHL, Scopus, MEDLINE, and Web of Science from database inception to March 2021. The search was limited to human studies in the English language. Primary studies were included if they described or assessed a patient-directed osteoporosis intervention conducted by community pharmacists. The following data were extracted and tabulated: citation, study location, study design, subject, number of participants, nature of intervention, classification of intervention, outcome measures, measurement methods, findings, and effect. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies (ROBINS-I).ResultsTwenty-one studies were included in this review. The main interventions were education, screening, and medication management. Nineteen of these studies reported patient outcomes, all yielding positive outcomes. Outcomes included increased physician follow-up, risk factor reduction, increased osteoporosis knowledge, increased medication adherence, identification of medication-related problems, and positive patient-reported experience measures (PREMs). Three studies were considered to have a moderate risk of bias, whereas the remaining 18 studies had a high risk of bias.ConclusionThere is some evidence that pharmacist-led osteoporosis interventions have a positive impact on patient outcomes. More high-quality studies using objective outcome measures are needed to determine whether this translates into clinical outcomes such as decreased hospitalization and fractures.     

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis

ObjectivesTo evaluate the impact of community pharmacist involvement on transitions of care, specifically on 30-day hospital readmissions.Data SourcesWe searched the following databases from inception to August 2018: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, ProQuest Health and Medical Collection, ProQuest Nursing and Allied Health Database, and Web of Science. We also searched clinical trials registries and personal files to identify additional studies.Study SelectionStudies were eligible if the intervention included community pharmacists and patients were being discharged from the hospital to home. We included reports of randomized controlled trials, nonrandomized controlled trials, controlled before-and-after studies, and interrupted time series published in English.Data ExtractionWe extracted intervention characteristics from each study and 30-day readmissions when present.ResultsFrom 744 abstracts that met our inclusion criteria, we included 39 articles describing 36 unique studies, 10 which contributed to the primary outcome of 30-day readmissions. Overall, community pharmacist involvement in transitions of care was associated with a non–statistically significant 28% reduction in 30-day readmissions (relative risk [RR], 0.72; 95% CI 0.50-1.02; I² = 82%). When using per protocol data, community pharmacist involvement in transitions of care was associated with a statistically significant 40% reduction in 30-day readmissions (RR, 0.60; 95% CI 0.41-0.88; I² = 77%). Studies with more active involvement of community pharmacists had a greater effect on 30-day readmissions (RR, 0.55; 95% CI 0.32-0.95; I² = 88%) than those with less active involvement did (RR, 1.02; 95% CI 0.80-1.31; I² = 0%).ConclusionOur review shows that community pharmacists can have a beneficial effect on patients’ transitions of care; however, the body of evidence is limited by the heterogeneity and imprecision. Future studies should test interventions in which community pharmacists play an integral part and ensure that interventions are completed with fidelity.     

The impact of the pharmacist on continuity of care during transitions of care: A systematic review

ObjectivesTo evaluate programs that provide pharmacy-led continuity of care services and to assess their effectiveness in improving patient outcomes.Data sourcesThree databases were used to conduct the article search and assess relevant articles: PubMed (Medline), Cinahl, and Web of Science.Study selectionArticles that included prospective measurement with defined clinical outcomes of the impact of including a pharmacist in discharge planning and continuity of care after a hospitalization were included in the review. Articles were limited to those available in English, conducted within the United States, and including humans.Data extractionRelevant articles from the full database collections through April 2017.ResultsReadmission rates were the most common primary outcome evaluated. Other primary outcomes included medication adherence, medication error identification and reduction, and patient satisfaction. Although the data has shown that pharmacists play a crucial role by promoting medication adherence and providing effective medication reconciliation, this systematic review did not result in identifying any one pharmacist intervention to be the most effective in improving continuity of care.ConclusionThere is both a need and an opportunity for research that supports best practices in providing continuity of care during transitions of care.     

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.     

The role of pharmacists in opioid stewardship: A scoping review

BackgroundThe opioid epidemic is an international public health concern. Pharmacists are in a strategic position to promote and implement effective opioid stewardship due to both their central role on health care teams and frequent interaction with patients. Despite this integral role, pharmacists do not have harmonized scopes of practice in opioid stewardship.ObjectivesThis scoping review was conducted to identify and critically review the role of pharmacists in opioid stewardship and identify future areas of study.MethodsThe scoping review was conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases were searched for original, peer-reviewed research; PubMed (MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo.ResultsIn 92% of the included studies (n = 77), opioid stewardship interventions led by either a pharmacist or in an interdisciplinary team resulted in improvements in at least one outcome measure, with education and medication therapy adjustments being the most predominant activities. Other areas supported by evidence include community stakeholder education, policy and guideline setting, and risk assessment.ConclusionThis scoping review provides valuable insight into the various roles pharmacists can have in opioid stewardship. The findings from this review identified opioid stewardship activities that can make significant contributions towards reducing the impact of the opioid crisis. This review informs future research and has the potential to influence pharmacy practice on a national and international scale.     

COVID-19 pandemic: The role of community pharmacists in chronic kidney disease management supportive care

The COVID-19 pandemic is putting enormous pressure on healthcare systems worldwide and various countries are struggling to flatten the curve to prevent their healthcare system from becoming overwhelmed. Studies have shown that people with chronic kidney disease (CKD) are at increased risk of COVID-19 infection and mortality. However, the interruption of routine care and support due to the current challenges with healthcare providers, facilities, and essential medicines due to this pandemic is adversely affecting people with CKD. This is because poor management of this disease leads to negative health outcomes. In order to maintain good health, this vulnerable group of patients rely heavily on the extended role of the community pharmacists in chronic disease management. This paper highlights the extended role of the community pharmacists in CKD management supportive care during the COVID-19 pandemic.     

Mental health training programs for community pharmacists,pharmacy staff and students: A systematic review

BackgroundPrimary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students’ outcomes.ObjectivesTo summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.MethodsA systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.ResultsThirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants’ attitudes, knowledge and stigma were frequently identified following participation in training programs.ConclusionsThis systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students’ skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.     

A systematic review of the role of pharmacists in vaccination services in low-and middle-income countries

BackgroundPharmacists' role in vaccination has expanded in some countries with pharmacists having greater authority to perform various immunization activities, from vaccine storage, vaccine adverse event reporting, vaccination education and advocacy, to vaccine administration. However, pharmacists’ present involvement in vaccination services is poorly understood across low- and middle-income countries (LMICs).ObjectiveTo identify and synthesize evidence on pharmacists’ roles in offering vaccination services in LMICs.MethodsWe searched three databases (PubMed, Embase, Scopus) and the gray literature to identify articles which described pharmacist involvement in vaccination services in LMICs. We abstracted data on reported roles of pharmacists in vaccination, as well as relevant country, vaccines, and populations served.ResultsFrom the initial 612 records we identified, twenty-five (n = 25) studies representing 25 LMICs met our inclusion criteria. The most commonly reported role of pharmacists in vaccination across identified LMICs was vaccine advocacy and education (n = 15 countries). Pharmacist administered vaccination and storage of vaccines at pharmacies was reported in 8 countries. An additional 6 countries reported allowing vaccination at community pharmacies by other healthcare professionals. Immunization related training for pharmacists was reported or required in 8 countries. Fewer studies reported that pharmacists have access to patient immunization records in their respective LMICs (n = 6 countries) or had reported pharmacist involvement in vaccine adverse event reporting (n = 4 countries).ConclusionsPharmacists have the potential to play an important role in increasing access to vaccines and improving coverage, yet evidence of their role in vaccinations remains limited across LMICs. Greater documentation of pharmacists’ involvement in vaccination services in LMICs is needed to demonstrate the value of successful integration of pharmacists in immunization programs.     

The role and impact of the pharmacist in long-term care settings: A systematic review

ObjectiveOlder adults in long-term care (LTC) are often frail and comorbid and have multiple medications. Although medication review by pharmacists has been integrated into LTC practice in many countries through policy and reimbursement models, the impact is variable in the literature. The purpose of our study was to review the literature regarding the impact of the pharmacist in LTC.Data sourcesFour databases were searched from inception to September 2017, including Ovid MEDLINE, Ovid Embase, Ovid Evidence-Based Medicine Reviews (Cochrane Library), and Ovid International Pharmaceutical Abstracts.Study selectionStudies in any language were included if they met the following criteria: (1) pharmacist involved in care, (2) quasi-experimental or experimental design, and (3) conducted in LTC.Data extractionTwo reviewers independently reviewed the titles, abstracts, and full-text articles to determine if they met inclusion criteria, with a third researcher resolving discrepancies. Data of included studies were independently abstracted by 2 reviewers and confirmed by a third researcher.ResultsTwenty-six studies (total N = 20,228, median study duration = 12 months) met the inclusion criteria. Medication review was the most common intervention, evaluated in 24 studies (92%). Eleven studies (42%) reported on the total number of medications per patient, with 7 studies finding a statistically significant reduction in medication usage. Six studies focused on psychotropic medications, with 4 of those leading to a reduction in medication. Explicit medication appropriateness criteria showed improvement in 5 studies. Medication and health care costs were evaluated in 14 studies (54%), with 4 reporting a statistically significant reduction. Studies reporting hospitalizations (10, 38%) were moderately heterogeneous (I² = 59%) and failed to demonstrate an impact. Studies reporting mortality (8, 31%) were less heterogeneous (I² = 0%), but they also failed to show a change.ConclusionThere is evidence to support pharmacist intervention, primarily through medication review, to improve measures in medication appropriateness.     

Effects of educational interventions on the smoking cessation service provided by community pharmacists: A systematic review

ObjectiveThis systematic review aimed to evaluate the effectiveness of educational interventions on the smoking cessation service provided by community pharmacists.MethodsA systematic literature search was performed in May–July 2021, in electronic databases, which included PubMed (MEDLINE), Embase, and Web of Science. Studies were included in this systematic review if they were original articles published in English language from 2010 to 2021 and evaluated the effect of any types of educational interventions intended to improve the ability of community pharmacists to provide smoking cessation services.ResultsIn total, 12 studies were included for this systematic review. The effectiveness of the educational interventions across the included studies was measured using a range of outcomes, which can be broadly categorized into 3 categories, namely changes in pharmacists' self-efficacy, knowledge, and attitude toward providing smoking cessation service, changes in pharmacists' smoking cessation practices, and changes in the effectiveness of community pharmacy based smoking cessation services. Included studies reported that educational interventions can improve pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists’ smoking cessation practices. Though the evidence is limited, improvement in the effectiveness of community pharmacy based smoking cessation services has also been observed.ConclusionAny form educational interventions can positively impact improve community pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists’ smoking cessation practices, but it is currently uncertain whether these outcomes are able to translate into higher effectiveness of the community pharmacy based smoking cessation services.     

Workplace violence against pharmacists: A systematic review and meta-analysis

BackgroundThe rate of violence against health care workers is increasing worldwide. Pharmacists are the most accessible and frequently visited health care team members and are potentially more susceptible to violence than other health care workers.Objective(s)This systematic review and meta-analysis aimed to estimate the magnitude of workplace violence toward pharmacists.MethodsWe comprehensively searched PubMed, Scopus, and Embase from their inception till December 2021 for pertinent studies that reported workplace violence incidents against pharmacists. Rates of workplace violence against pharmacists were calculated in a meta-analysis using a random-effects model.ResultsOverall, 624 articles were found, and 6 studies comprising 1896 pharmacists met the criteria for meta-analysis. The pooled estimate of workplace violence was 45% (95% confidence interval [CI]: 30-60%), and 39% (95% CI: 24-55%) experienced violent events over preceding 12 months. Considerable proportion of pharmacists experienced some form of violence (65%, 95% CI: 41-88%), verbal abuse (50%, 95% CI: 36-65%), threats (42%, 95% CI: 26-59%) or assaults (27%, 95% CI: 9-46%). Moreover, 56% (95% CI: 23-89%) of pharmacists reported experiencing physical and/or verbal violence over the previous 12 months.ConclusionThe analysis reveals the high rate of workplace violence in the pharmacy environment, with nearly half of pharmacists affected. While more studies are required, the limited evidence suggests the need to ensure safe workspaces in pharmacy environments through implementation of appropriate policies and legislation.     

The role of hospital and community pharmacists in pharmacovigilance

In this paper, we give an overview of the role pharmacists actually have and could have in collecting reports of adverse drug reactions (ADRs) and more widely in pharmacovigilance.In the literature, several ways are mentioned in which the pharmacist, both the community pharmacist and the hospital pharmacist, can contribute to the safe use of drugs. In addition to their responsibilities regarding drug dispensing and compliance, they can have a substantial role in ADR reporting.Especially, hospital pharmacists can play a significant role in ADR reporting because the most serious adverse drug events occur in hospitals, and ADRs account for a substantial proportion of hospital admissions.Community pharmacists, however, can also play an important role in ADR reporting. This is, for example, the case in the Netherlands where community pharmacists contribute substantially, both in numbers and in quality of ADR reports.The contribution of the pharmacist to pharmacovigilance should, however, not be limited to ADR reporting. The various pharmaceutical disciplines could also greatly enhance our understanding of the nature of ADRs. If those involved in pharmaceutical disciplines can rise to this challenge, they will significantly help deepen our insights into ADRs.     

A systematic review of the role of community pharmacies in improving the transition from secondary to primary care

Aim

We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings.

Method

We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes.

Results

We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered.

Conclusions

There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.     

Instruments measuring community pharmacist role stress and strain measures: A systematic review

BackgroundWhile macro and meso approaches to implementing public health initiatives in community pharmacies have been studied, the micro perspective of their pharmacist providers requires more inspection. Community pharmacists report increasing stress, overload, and limited control over facets of their work.1, 2, 3, 4, 5, 6, 7 Social exchange principles, e.g. role price, may help to typify pharmacist work decisions so problematic situations can be modified, thus protecting workforce health. To do so, the underlying pressures of the pharmacist role (i.e. role stresses) and indicators of systemically-caused strain (i.e. role strains) should be measurable.ObjectivesTo summarise validated and reliable instruments used to measure role stress and strain among community pharmacists and evaluate compatibility in testing a theoretically-derived framework.MethodsIn April 2020, journal articles describing reliable and validated instruments measuring role stress and strain responses among community pharmacists were identified from an online search via Scopus, Web of Science and PubMed. English-language articles after 1990 were selected; duplicates were deleted. Inclusion and exclusion criteria were used to screen title/abstracts and full texts. Reference lists were manually searched. Resultant instruments were analysed for theoretical compatibility.ResultsAfter review, 26 separate instruments were found: seven psychological strain instruments, 14 social strain response instruments, and five role stress instruments. Role stresses were often present as facet-specific dimensions in psychological and social strain instruments. Strain instruments measuring individual evaluation of work were compatible with a social exchange approach.ConclusionsTwenty-six reliable and validated instruments measuring role stress and role strain were found to measure negative role outcomes from the micro community pharmacist perspective. Structural measurement of role stress and resultant negative responses enable detailed examination into pharmacist roles and insights into pharmacist behaviour. Further research is required to develop additional role stress and strain instruments, and to discover pharmacist role benefits and their influence.     

The role of community pharmacists in immunisation: a national cross-sectional study

International Journal of Clinical Pharmacy - Background Austrian pharmacists are not authorised to administer immunisations, and evidence about their willingness to immunise is lacking. Aim The aim...