Background:Effective pharmacist-patient communication is essential for modern pharmaceutical services, relying heavily on optimized communication strategies that are essential for ensuring treatment adherence and overcoming the unique challenges of patient care in multilingual regions. Purpose:This study investigates the perceptions, experiences, and strategies used by community pharmacists in Romania to overcome common communication barriers. Methods:The research employed an observational, descriptive, cross-sectional study design, utilizing a self-administered online questionnaire. The data was collected through an anonymous online questionnaire (N=150) administered to patients in eastern Romania. Explicit digital informed consent was obtained. Data analysis involved descriptive statistics, t-tests for independent samples, and Spearman correlation coefficient. Results:Results indicate the perception of significant barriers, notably differences in educational levels, the use of medical terminology, and time constraints. A negative and significant Spearman correlation (ρ = -0.207, p < 0.001) was found between the perceived effectiveness of communication and the need for service improvement, confirming the detrimental impact of these difficulties on the quality of pharmaceutical services. Furthermore, the average self-assessment score of 2.59 for communication training suggests a predominantly negative perception of both university and continuing education in this area. Conclusion:The conclusions highlight an urgent need to integrate culturally and linguistically adapted communication training into the education of community pharmacists. Future research should focus on developing and evaluating pilot educational programs and interventions specifically tailored for bilingual communities.
Background:This study seeks to identify and assess the severity of drug-related problems (DRPs), analyze risk factors and evaluate the impact of DRPs on the health-related quality of life (HRQoL) among elderly multimorbid inpatients with stroke in the Comprehensive Stroke Center (CSC) in China. Methods:A two-year retrospective study was conducted at a tertiary hospital among elderly multimorbid inpatients with stroke. Medication review, HRQoL assessment and stroke-associated clinical scales assessment by clinical pharmacists or the medical team. Results:An analysis of 592 patients revealed 576 DRPs. The mean age of patients was 73.64 ± 7.96 years old. 583 (55.6%) cases had at least one DRP, with an average of 1.53 ± 0.94 DRPs per patient. The most common multimorbidity pattern was co-existing hypertension and stroke (17.4%). "Drug selection, C1" emerged as the predominant cause of DRPs (54.0%; 311/576), followed by "Patient related, C7" (18.2%; 105/576). Most DRPs (79.3%, 457/576) were low severity (B-D); the remaining 20.7% (119/576) were high severity (E-H). Increased hospital length of stays (LOS) and coexisting atrial fibrillation were identified as significant factors influencing the occurrence of DRPs (p < 0.05). The quantity of DRPs showed a weak negative correlation with HRQoL scores (r = -0.291, p < 0.001), as well as moderate positive correlations with both the mRS scores (r = 0.304, p < 0.001) and the NIHSS scores (r = 0.306, p < 0.001). Conclusion:DRPs are prevalent among elderly multimorbid inpatients with stroke in CSC and are mainly caused by drug selection and patient-related problems. Prolonged hospitalization days and the presence of atrial fibrillation were identified as significant risk factors for occurrence of DRPs in elderly multimorbid inpatients with stroke. Pharmaceutical services of medication review could assist in the identification of DRPs at the CSC.
Background:The first online pharmacy (soma.com), started in the United States in 1999, a decade later, e-pharmacy industry has transformed owing to the rise of online shopping, electronic health solutions and direct-to-consumer healthcare. With over 35,000 online pharmacies worldwide, developing countries like Uganda are seeing the emergence of online pharmacy services yet there is limited data on their readiness to provide these services. We evaluated readiness to offer online pharmaceutical services in Kampala Metropolitan Area (KMA). Methods:A cross-sectional study was conducted in 272 retail pharmacies selected by proportionate stratified random sampling from Kampala, Wakiso, Mukono, and Mpigi districts of KMA. Data to assess human resource and technological readiness was collected quantitatively using a questionnaire while assessment of legal and regulatory readiness was done qualitatively using key informants (regional managers of National Drug Authority). Descriptive statistics was conducted for quantitative data and thematic analysis was done for qualitative data. Results:Majority, 222 (95%) of the pharmacies engaged in online pharmacy services offering; tele-pharmacy 189 (85%), home drug delivery 141 (64%), e-prescriptions 97 (44%), home delivery with follow-up 94 (42%), prescription reminder services 79 (36%), and online consultations 75 (34%). Only 23 (10.4%) of online pharmacies had good human resource readiness, 124 (55.9%) had good technological infrastructure readiness and only 20 (9%) had good readiness for both Technological infrastructure and Human resources. Findings also showed a lack of specific regulations and legal frameworks for online pharmacies, minimal enforcement on the quality and authenticity of products sold online, and minimal public awareness and education on online pharmacy services. Conclusion:The majority of the pharmacies in KMA practiced some online pharmacy with over half of the pharmacies having the necessary infrastructure and the majority lacking the human resource requirements for online pharmacy services.
Along with the positive development in health services and facilities, hospital pharmacy practice in Nepal has also evolved. The minimum service standards (MSS) developed by the Ministry of Health and Population of Nepal act as a structured framework to assess hospitals' readiness and capacity to deliver quality health services and consist of three significant domains: governance and management standards, clinical service management standards, and support service standards. The clinical service management standards also consist of the hospital pharmacy service standards of practice checklist. This study presents a perspective review of MSS checklists and their implications for pharmacy services, where we discuss how the MSS checklist acts as a viable tool for strengthening the hospital pharmacy practice in Nepal's primary, secondary, and tertiary hospitals. Following the MSS checklist, hospital administration, hospital leaders, hospital management committee, and the hospital pharmacy and therapeutic committee can help to develop further action plans to mitigate issues, thus resulting in 100% compliance with the checklist and quality improvement. This paper can also serve as evidence or a start-up for conducting MSS-based research at the provincial and federal levels to inform hospital pharmacy-based practices among the policy-related institutions in the coming days.
Purpose:Pharmacists ensure prescription accuracy to safeguard patient safety. Clinical decision support systems (CDSS), integrated with computerized physician order entry (CPOE), help detect medication errors and enhance care quality. Traditional homegrown CDSS (HG systems) require manual updates, while commercial CDSS offer real-time, curated drug data but come with licensing costs. To evaluate the impact and benefits of integrating a commercial CDSS with a CPOE system on clinical decision-making and pharmaceutical care in a Taiwanese medical center. Patients and Methods:This retrospective study was conducted in a 1,354-bed teaching hospital in southern Taiwan in 2022. Alerts generated by a homegrown (HG) CDSS and a commercial CDSS, both integrated with CPOE, were compared. Fifty-six trained inpatient pharmacists reviewed prescription alerts. Effective alerts were defined as those initially missed by physicians but corrected after pharmacist intervention. Alerts were categorized by clinical issue type and severity. A model incorporating the probability of adverse drug events (ADEs), extended hospital stays, and daily costs was used to estimate cost savings. A benefit-cost ratio was calculated to assess the added value of the commercial CDSS. Results:The commercial CDSS generated 357 effective alerts, and the HG system generated 251. Over 95% of pharmacist interventions were accepted by physicians. The commercial CDSS helped avoid inappropriate prescriptions, which resulted in estimated cost savings from USD 78,540 to USD 103,530 and reduced hospital stays by 470-620 days. Conclusion:Using a commercial CDSS to assist pharmacists in prescription verification provides the most real-time information and efficiently identifies inappropriate prescriptions. This reduces medical costs and avoids prolonged hospitalization owing to ADEs.
Background:Pharmaceutical care is currently being implemented in Polish community pharmacies, but remains unsupported by state funding, limiting its widespread adoption. In Spain pharmacists there provide a wide range of pharmaceutical care services. Objective:The aim of the work is to understand how other countries, such as Spain, have approached pharmaceutical care, which may offer potential strategies. Given this constant evolution and the challenges they face, a comprehensive review of current pharmaceutical care practices is necessary. Methods:The study design was guided by Newman TV et al. Chosen review type was an umbrella review, which includes systematic reviews, narrative reviews, and meta-analyses concerning pharmacist-led interventions in the field of pharmaceutical care. Utilized PRISMA framework. Used the PubMed database, which includes MEDLINE-indexed articles. Search strategy initially identified 18,076 articles and abstracts. Articles were limited to English-language, free full-text systematic reviews or meta-analyses published between January 2019 and October 2024. The dataset was reduced to 3,016 articles. Ultimately, 13 articles were selected for final analysis. Results:Given the identified lack of funding and training gaps, Poland must address workforce shortages, strengthen interdisciplinary trust, and ensure proper remuneration for pharmacists. Drawing on Spain's experience, investing in pharmacist-led education and preventive services may significantly enhance care outcomes in community settings. Conclusion:This review highlights key pharmaceutical services currently implemented in community pharmacies and identifies critical barriers that hinder their widespread adoption in Poland. The main tasks of pharmaceutical care are to reduce morbidity and mortality related to medications. These services are most often not provided due to the lack of additional remuneration for the pharmacist for their provision, which would serve as reimbursement for the cost of delivering these services. The results of this review will serve as a basis for developing future in-depth studies focused on the implementation and delivery of pharmaceutical care.
Purpose:To evaluate the local anesthetic drugs commonly used after hip arthroplasty and knee arthroplasty, and to provide a reference for clinical drug use and drug selection in medical institutions. Methods:Based on the "Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions (Second Edition)", the included drugs were evaluated from five dimensions of pharmaceutical properties, effectiveness, safety, economy, and other attributes using a 100-point scoring method. Results:The quantitative scoring results were ranked from high to low as Dishili-Ropivacaine injection (75 points), Naropin-Ropivacaine injection (68.97 points), liposomal bupivacaine (65.06 points), bupivacaine injection (61.05 points), and levobupivacaine injection (60.35 points). Conclusion:The Dishili-Ropivacaine injection of the collectible variety is a strongly recommended variety, which is recommended to be introduced or retained in the drug catalog of medical institutions, and the Naropin-Ropivacaine injection and liposomal bupivacaine can be adjusted according to the actual situation and clinical needs of medical institutions.
This systematic review aimed to evaluate the association between pharmacists' interventions and health outcomes of patients with type 2 Diabetes Mellitus (DM) in the Middle East. A comprehensive database search was conducted in July 2024 using the electronic databases of PubMed, MEDLINE, Embase, Cochrane Library, Web of Science and Scopus. The search strategy involved the following keywords: "Impact", "Effect", "Pharmacist", "Pharmacy services", "Pharmaceutical Care", "Intervention", "Type 2 diabetes mellitus", "diabetes", and "Middle East". Articles published in the English language between January 2010 and July 2024 related to the research question were included. The data extracted from the included papers were summarized using narrative data synthesis. Twelve articles were selected from 536 retrieved articles, with most studies conducted in hospitals (n = 10) and randomized clinical trials (n = 8). The quality of studies was evaluated using the Cochrane risk of bias tool for RCTs and the Newcastle-Ottawa Scale for non-randomized studies to ensure transparent evaluation of the study quality. Narrative synthesis was employed to address variations in study design, outcomes, and biases. Pharmacist interventions reported included patient education (n = 11), counseling (n = 5), drug therapy initiation (n = 5), and dosage adjustment (n = 5). Studies reported significant reductions in glycosylated (HbA1c) (range: 1.4-1.78%) and fasting blood glucose levels (FBG) (range: 2.3-53 mg/dL), decreased systolic and diastolic blood pressure (range: 4.65-14.9 mmHg), body mass index (BMI) (range: 1-2.44 kg/m2), cholesterol, triglycerides, and total cholesterol, and improved medication adherence, self-care activities, and knowledge of diabetes management. In this review, pharmacist interventions reported were associated with improved clinical and humanistic outcomes among type 2 DM patients in the Middle-East. Therefore, collaborative care models involving pharmacists and other healthcare practitioners in the management of type 2 DM should be considered by health policymakers in the region.
Purpose:Telepharmacy must be monitored within a quality management system in order to guarantee the efficiency, safety and quality of the activities it encompasses. The Spanish Society of Hospital Pharmacy has proposed the first scorecard of quality and activity indicators for Telepharmacy (TIS). The objective of this project is to validate this TIS for its implementation in hospital pharmacy services. Material and Methods:The project was developed in 4 phases: elaboration of the validation questionnaire/validation criteria; selection of hospitals where the study will be carried out; completion of the validation questionnaire by the selected hospitals; analysis of the results, a proposal of conclusions, and preparation of the final document. The validation criteria were performed using the RAND/UCLA methodology for each of the 5 TIS characteristics: holistic, practical, quantitative, usability, and continuous improvement. Characteristics were considered validated when the median was found to be within the score range 5-9 and at least 2/3 (66.66%) of the respondents scored in the range containing the median. Results:Forty-four hospitals were included and the responses related to TIS characteristics were: holistic=8.2 and 98.5% of responses >5; practical=7.9 and 98.9% of responses >5; quantitative=7.9 and 98.6% of responses >5; usability=6.9 and 87.37% of responses >5; continuous improvement= 7.9 and 100% of responses >5. Discussion:TIS has been validated for use in hospital pharmacy services and its tools and supporting documents are very useful and comprehensive. Hospital informatics systems are needed to allow efficient extraction of the data necessary to obtain the TIS indices.
Background:The global increase in type 2 diabetes mellitus (DM2) and obesity presents a significant public health challenge, as these interconnected conditions contribute to severe complications, including cardiovascular disease, stroke, and certain cancers. The incretin system, particularly glucagon-like peptide-1 (GLP-1), has emerged as a promising therapeutic target due to its role in glycemic control and weight management. Objective:This review explores the molecular pharmacology of GLP-1 and its receptor agonists, evaluating their therapeutic efficacy in managing DM2 and obesity. Methods:A comprehensive literature review was conducted, analyzing recent advancements in GLP-1-based therapies, their mechanisms of action, and their clinical applications. The review also highlights the pharmacokinetic modifications developed to enhance the stability and efficacy of GLP-1 receptor agonists. Results:GLP-1 receptor agonists have demonstrated significant benefits in improving glycemic control, reducing body weight, and addressing metabolic complications. Novel therapeutic approaches, including dual and triple incretin receptor agonists, are showing enhanced efficacy in both diabetes and obesity management. However, challenges remain in optimizing treatment outcomes, addressing patient variability, and improving long-term adherence. Conclusion:GLP-1-based therapies have revolutionized the management of DM2 and obesity. Continued research is essential to refine these treatments, overcome existing limitations, and develop personalized approaches to maximize patient outcomes.
Purpose:Artificial Intelligence (AI), especially ChatGPT, is rapidly assimilating into healthcare, providing significant advantages in pharmacy practice, such as improved clinical decision-making, patient counselling, and drug information management. The adoption of AI tools is heavily contingent upon pharmacy practitioners' knowledge, attitudes, and practices (KAP). This study sought to evaluate the knowledge and practices of pharmacists in Saudi Arabia concerning the utilization of ChatGPT in their daily activities. Patients and Methods:A cross-sectional study was performed from May 2023 to July 2024 including pharmacists in Riyadh, Saudi Arabia. An online pre-validated KAP questionnaire was disseminated, collecting data on demographics, knowledge, attitudes, and practices about ChatGPT. Descriptive statistics and regression analyses were conducted using SPSS. Results:Of 1022 respondents, 78.7% were familiar with AI in pharmacy, while 90.1% correctly identified ChatGPT as an advanced AI chatbot. Positive attitudes towards ChatGPT were reported by 64.1% of pharmacists, although only 24.3% used AI tools regularly. Significant predictors of positive attitudes and practices included academic/research roles (β=0.7, p=0.005) and 6-10 years of experience (β=0.9, p=0.05). Ethical concerns were raised by 64% of respondents, and 92% reported a lack of formal training. Conclusion:While the majority of pharmacists held positive attitudes toward ChatGPT, practical implementation remains limited due to ethical concerns and inadequate training. Addressing these barriers is essential for successful AI integration in pharmacy, supporting Saudi Arabia's Vision 2030 initiative.
Background:"The World Health Organization aims for universal HIV control by 2030, requiring robust healthcare infrastructure and efficient supply chain management". In Uganda, a functional real-time ARV Stock Status (RASS) monitoring system and dashboard was developed to provide real-time intelligent data and reliable and accurate information on antiretroviral drugs and other HIV commodities. This integrates data from different information systems for timely decision-making and supports evidence-based ARV commodities supply chain management solutions. This study aimed to identify the factors influencing the quality and reporting rate for Real-Time ARV Stock Status (RASS) weekly reporting in public health facilities in the West Acholi sub-region of Uganda. Methods:A mixed-methods cross-sectional study was conducted in six public health facilities of the West Acholi sub-region. Quantitative data involved a review of 312 reports for the reporting rate. The available 180 RASS reports were reviewed for data quality; supplemental qualitative data was gathered through key informant interviews with 11 healthcare workers and stakeholders. Quantitative data was then cleaned using EPI data, and all the variables were coded and analyzed using SPSS version 21. The tables were then computed using the analyzed data from the software, and the pie charts were constructed using the Excel 2019 version. Thematic analysis was done for the key informant qualitative interviews. Results:Analysis of RASS reports revealed a mixed level of quality, with only 40 reports (22%) categorized as good quality. The overall reporting rate was slightly more than half, with only 180 reports (57.7%) of the expected reports. Key factors influencing data quality were infrastructural limitations, such as unreliable internet, lack of proper equipment, and staff transfers. Lack of training on RASS and limited leadership support were documented to influence the data quality and RASS reporting rate. Conclusion:The quality of RASS reports could have been better than the national set targets. The reporting rate was slightly above average but far below the national set targets. Several factors affecting both the reporting rate and quality of reports were cited. These include staff attitude, knowledge gap, Staff transfers, poor internet connectivity, and lack of internet data bundles.
Background:University students typically use prescribed or non-prescribed medications, often resulting in the accumulation of leftover medications. Hence, understanding their disposal practices is crucial, as improper disposal contribute to significant public health and environmental risks. Objective:This study intended to assess the disposal practices of leftover medications among undergraduate students at the University of Rwanda, as well as the factors influencing these practices. Methods:The participants were randomly selected for this cross-sectional study. Data were collected using a self-administered questionnaire, and responses were entered into Microsoft Excel for cleaning. The cleaned data were imported into the Statistical Package for Social Sciences (SPSS) version 25.0 for analysis. Using SPSS, Inferential statistics, notably Pearson's chi-square test, was used to determine variables associated with the disposal practices, with a p-value <0.05 considered significant. Results:Out of 378 students, 66.1% had leftover medications, with 21.2% keeping them for future use. Just 7.1% returned them to pharmacies, while 92.9% resorted to improper disposal practices, with the main methods being discarding them in the toilet (36.3%) and household rubbish (24.6%). Key reasons cited by 81.2% were that neither a drug take-back system was introduced on campus nor were disposal procedures communicated. Gender (x 2=9.735, p-value=0.046), level of study (x 2=8.331, p-value˂001), and college (x 2=9.735, p-value=0.046),and lack of training (x 2=35.66, p-value˂001), and lack of understanding about a drug take-back system (x 2=36.72, p-value˂001) were significantly associated with improper disposal practices. Conclusion:Leftover medications and improper disposal practices were prevalent, mostly caused by lack of awareness about proper disposal practices. This underscores the need to raise public awareness.
Background: In the realm of Evidence-Based Medicine, introduced by Gordon Guyatt in the early 1990s, the integration of machine learning technologies marks a significant advancement towards more objective, evidence-driven healthcare. Evidence-Based Medicine principles focus on using the best available scientific evidence for clinical decision-making, enhancing healthcare quality and consistency by integrating this evidence with clinician expertise and patient values. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) have become essential in evaluating the broader impacts of treatments, especially for chronic conditions like HIV, reflecting patient health and well-being comprehensively. Purpose: The study aims to leverage Machine Learning (ML) technologies to predict health outcomes from PROMs/PREMs data, focusing on people living with HIV. Patients and Methods: Our research utilizes a ML Random Forest Regression to analyze PROMs/PREMs data collected from over 1200 people living with HIV through the NAVETA telemedicine system. Results: The findings demonstrate the potential of ML algorithms to provide precise and consistent predictions of health outcomes, indicating high reliability and effectiveness in clinical settings. Notably, our ALGOPROMIA ML model achieved the highest predictive accuracy for questionnaires such as MOS30 VIH (Adj. R2 = 0.984), ESTAR (Adj. R2 = 0.963), and BERGER (Adj. R2 = 0.936). Moderate performance was observed for the P3CEQ (Adj. R2 = 0.753) and TSQM (Adj. R2 = 0.698), reflecting variability in model accuracy across instruments. Additionally, the model demonstrated strong reliability in maintaining standardized prediction errors below 0.2 for most instruments, with probabilities of achieving this threshold being 96.43% for WHOQoL HIV Bref and 88.44% for ESTAR, while lower probabilities were observed for TSQM (44%) and WRFQ (51%). Conclusion: The results from our machine learning algorithms are promising for predicting PROMs and PREMs in AIDS settings. This work highlights how integrating ML technologies can enhance clinical pharmaceutical decision-making and support personalized treatment strategies within a multidisciplinary integration framework. Furthermore, leveraging platforms like NAVETA for deploying these models presents a scalable approach to implementation, fostering patient-centered, value-based care.
Background: The World Health Organization (WHO) recommends HIV self-testing (HIVST) to complement the existing HIV testing services. Pursuant to this, Rwanda approved the over-the-counter sale of Oral Quick HIV self-tests in community pharmacies, facilitating home testing and addressing accessibility issues. However, the availability and affordability of HIVSTs in these settings remains unexplored. Hence, this study determined the availability and affordability of HIVST kits in Community Pharmacies across Rwanda. Methods: This cross-sectional study was conducted among 220 licensed community pharmacists between February and May 2023. Tools standardized by WHO and Health Action International (HAI) were used to evaluate the affordability of HIVST kits. An ANOVA followed by a post-hoc test examined significant price differences across regions. Bivariate and multivariate logistic regression analyses were used to identify the factors associated with the availability of HIVST kits. Results: The availability was 76%, with 53% being finger-stick tests. Pharmacies owned by pharmacists were almost twice as likely to have HIVST available (AOR=1.858; 95%: 1.280-2.629, p=0.007) than their counterparts. Pharmacies in Kigali were more likely to stock HIVST (AOR=3.549; 95%: 1.283-9.814, p=0.015) than in other regions. Pharmacies experiencing frequent requests for HIVST were more likely to have HIVST available (AOR=0.22; 95%: 0.07-0.66, p<0.001) than those with fewer requests. Both oral quick and finger-stick HIVST were priced beyond the affordability of low-income earners. Moreover, significant price differences for Oral Quick HIVST (F=11.349; p<0.001) were observed across regions, with Kigali's prices significantly differing from those in the southern (p<0.001) and western Provinces (p=0.004). Conclusion: HIVSTs are not economically priced for the lowest-paid workers, with variations in availability and prices across the country. Policymakers should apply subsidies or price regulation strategies to make HIVST more affordable, ensuring equitable access to all regions and income levels.
Introduction:Antimicrobial resistance (AMR) is largely driven by the inappropriate use of antibiotics. This has been attributed to the non-prescription sale of antibiotics in retail drug outlets. Despite the rising number of retail drug outlets in Malawi, the practice of drug dispensing in private pharmacies has not been evaluated. This study therefore assessed the prevalence of non-prescription sales of antibiotics in retail drug outlets in Lilongwe, Malawi. Methods:A community-based simulated client cross-sectional study was conducted in Lilongwe, Malawi from December 2023 to February 2024 using mystery shopping. Data were analyzed using IBM SPSS software version 29 using both descriptive and Analytical statistics. We computed simple proportions and conducted a hypotheses test using Chi-Square to test for Significance. Results:Antibiotic dispensing practices were surveyed in 51 retail drug outlets comprising 36 retail pharmacies and 15 drugstores. 35.3% (n=18) of the drug outlets had drug dispensing done by pharmacists, 13.7% (n=7) by pharmacy technicians, 21.5% (n=11) by pharmacy assistants and 25.5% (n=15) by drug dispensers who had no pharmacy-related training. The rate of non-prescription sales of antibiotics ranged between 53% for acute diarrhoea and 92% for upper respiratory tract infections. Amoxicillin was the most dispensed antibiotic across all case scenarios. Over 50% of dispensed antibiotics were done upon recommendation of the drug dispensers in the absence of a doctor's prescription. Furthermore, for all the dispensed antibiotics across all case scenarios, no advice was given for finishing a full course of the antibiotics. Conclusion:This study found high rates of over-the-counter dispensing of antibiotics, which call for urgent and comprehensive regulatory measures to control antibiotic consumption in an urban part of Malawi that risks increased AMR. These could range from enacting stringent antibiotic dispensing policies to deploying digital systems to monitor prescription practices and community education on rational antibiotic use.
Background:The use of unlicensed medicines has been associated with safety concerns, availability and accessibility issues, and lack of integrated care across care settings. Objective:To understand the interaction between the views and experiences of those who prescribe, those who supply and those who receive unlicensed "special" medicines, so that factors affecting the patient journey and successful treatment can be identified and used to inform areas for change. Methods:A qualitative, phenomenological approach was adopted, with semi-structured interviews with prescribers, community pharmacy staff and patients. A combination of stratified, purposive, snowball and convenience sampling was used to identify participants. Interviews were analysed using reflexive thematic analysis and the findings were integrated using an adapted model of the Pillar Integration Process. Results:Three pillars were constructed after synthesising results from interviews with patients (n=4), prescribers (n=5) and pharmacy staff (n=6): the awareness of licensing status; perceptions of patient care and acceptability of unlicensed medicine use; and challenges associated with the accessibility of unlicensed medicines. The varying levels of awareness when unlicensed medicines are prescribed and the varying perceptions of responsibility and acceptability of the use of unlicensed medicines help to explain the challenges faced by participants across the patient journey, Challenges identified included understanding what unlicensed medicines are, awareness of the licensing status when unlicensed medicines are prescribed, managing care across care settings to ensure the patient is effectively treated and ensuring continuity of care for patients in the community. Conclusion:The results highlight a clear need for more integrated care and support for prescribers to reduce the chances of delays between care settings, and more patient-centred care to ensure that any delays when accessing medicines do not lead to treatment disruption for the patient. The new national guidelines informed by findings of this study can support policy-makers across the globe.
Introduction:Improper disposal of unused antibiotics poses a significant global challenge, drawing attention from various stakeholders. This discharge of antibiotics into the environment can occur through various means such as industrial production, consumption, and excretion by humans and animals, as well as improper disposal of unused or expired antibiotics. The aim of our study is to investigate the availability of proper disposal of antibiotics in community pharmacies and to explore obstacles and opportunities from pharmacist's point of view. Methods:This study used a mixed-methods approach that consisted of two study arms: quantitative and qualitative. The quantitative arm used a mystery-shopper method for assessing the disposal of antibiotics in community pharmacies. The qualitative study arm consisted of several in-depth semi-structured focus groups with a sample of pharmacists working in community pharmacies in Riyadh. Results:The mystery shopper arm showed that 85% (n=88) refused to take the return of antibiotics. Interviews with pharmacists have indicated a lack of knowledge on safe disposal methods for antibiotics and medications. Additionally, pharmacists have cited several factors contributed to accumulation of the antibiotics such as nonadherence or policies mandating the sale of whole medication packs instead of the required amounts as a contributing factor to this issue. Furthermore, there is a lack of dedicated facilities for the population to safely dispose of their medications and/antibiotics. Conclusion:By acknowledging the factors contributing to improper disposal practices, recognizing the importance of proper antibiotic disposal, and advocating for multi-faceted initiatives, we can work towards mitigating this critical issue. Through collaborative efforts involving education, policy interventions, and community engagement, we can foster a culture of responsible medication disposal, ultimately safeguarding public health and environmental well-being.
Background:Finnish authorities have published specific instructions for prescribing, handling, and dispensing unlicensed medicines and for the associated communication with patients. However, there is a clear research gap concerning the quality of medication counselling given by doctors and especially pharmacists to patients who are prescribed unlicensed medicines. The success of such counselling was studied with a survey for both pharmacy staff and patients. Methods:The survey was conducted in 2022 with two electronic semi-structured questionnaires, one for patients (or caregivers of underaged patients) purchasing medicines with special or fixed-term special permits from community pharmacies in Finland and one for the pharmacy staff dispensing such medication. Results:In all, 49% of the 389 pharmacists did not know if the prescribing doctor had given any counselling to the patient, and 52% of the pharmacists had not given any counselling to the patient themselves. Still, 51% of the pharmacists considered that the patient had received sufficient medication counselling. Almost every one of the 36 patients expressed that they had received medication counselling, 61% of them from the prescribing doctor and 53% from a pharmacist. Conclusion:Medication counselling on unlicensed medicines should be improved to ensure their safe and effective use. This survey revealed that many patients did not receive any such medication counselling as required by the Finnish Medicines Decree.
Purpose:Providing medical, nursing, and welfare services in each community is becoming increasingly important as population ages in Japan, and the demand for aseptic preparation in community pharmacies is expected to increase. In this study, the disparity in the distribution of community pharmacies providing aseptic preparation services were examined to explore how the unequal distribution of the pharmacies can be improved in the future. Methods:The regional inequality of community pharmacies providing aseptic preparation services was evaluated using Gini coefficients. The regional distribution was evaluated using a geographic information system application. Results:Only 8.0% of all insurance community pharmacies in Japan provided aseptic preparation services. The Gini coefficient of pharmacies providing aseptic preparation services for the total population of each municipality was 0.410. The population coverage, within 16 km of pharmacies providing aseptic preparation services, was 96.5% of the total population. The residential grid coverage, within 16 km of the pharmacies, was 75.2% of the total network, approximately one quarter not covered. It is estimated that the coverage ratios will improve by some percentage by 2050, although the projected population in 2050 is expected to decrease by approximately 20%. Conclusion:The current number and distribution of pharmacies providing aseptic preparation services are inadequate, and measures need to be taken to avoid future problems.
