Background Surgical antimicrobial prophylaxis (SAP) guidelines specify the most appropriate prescribing of antimicrobials. Despite evidence justifying the value of SAP guidelines, clinical practice continues to differ.Aim To determine SAP guideline compliance at a regional Australian hospital and identify any barriers influencing guideline adherence in this setting.Method This was a mixed method study. Part 1 was conducted in March 2023 and consisted of a retrospective audit of all surgeries at a regional, secondary hospital, located in New South Wales, Australia. De-identified data collected included patient demographics, operation details, and perioperative antimicrobial dosing. Appropriateness of prescribing was assessed using definitions from the Surgical National Antimicrobial Prescribing Survey and Therapeutic Guidelines. Part 2 was a validated survey of all prescribers at the study site during March 2023 about perceived barriers and enablers to SAP guideline adherence, which were measured on 5-point Likert Scales. Ethical approval was granted by the Greater Western Human Research Ethics Committee Low and Negligible Risk Research Review Committee (Reference no: 2023/ETH01971; Site authorisation no: 2023/STE03143) and the study conforms with the Australian National statement on ethical conduct in human research. Informed consent was obtained from all participants via distribution of project information and the completion of electronic consent forms.Results Overall, 352 surgical cases were reviewed, 248 antimicrobial prescriptions were included, and 34.5% of these were inappropriate. Eight causes of inappropriate prescribing were identified, with 'antimicrobial prescribed when not indicated' being the most common cause. Twenty-seven prescribers responded to the survey, a response rate of 40.9%. Work demands and lack of training were reported as barriers, while Point of Care guidelines and greater education were identified as compliance enablers.Conclusion Compliance to SAP guidelines was low and prescribing was often inappropriate. A range of causes and factors for poor prescribing and suboptimal guideline adherence in a regional Australian context were identified. Understanding these factors is important to drive the development and delivery of targeted interventions, specific to regional settings, to improve guideline adherence.
Older adults are at high risk of drug-related problems during hospitalisation for surgery. Pharmacists play a key role in the multidisciplinary health care team to improve the safety and quality use of medicines in hospitals. The aims of this prospective study were to examine the frequency, type, associated factors, and acceptance rates of pharmacist consultations in a cohort of 302 consecutive patients aged ≥65 years admitted to a tertiary vascular surgery unit. Data collected included frequency and type of pharmacist consultations, patient and clinical characteristics, and the rate of acceptance of pharmacist recommendations. There was a total of 299 pharmacist consultations, with 159 (52.6%) patients being reviewed at least once by a pharmacist. Of the 299 pharmacist consultations, the most common reason for consultation was a medication order review (38.8%). Pharmacist consultation was more likely if the patient had an emergency admission (p = 0.045), had admission to intensive care unit during the hospitalisation (p < 0.001), or had a long-stay admission defined as >14 days (p < 0.001). Older age, frailty status, cognitive impairment, polypharmacy, and operative management were not associated with having a pharmacist review. Of these pharmacist consultations, 190 (63.5%) included recommendations for the care team to implement, and 166 (87.4%) of the 190 recommendations were addressed. These findings provide insight into the roles played by hospital pharmacists and suggest an unmet need for proactive pharmacist consultation for older surgical patients with polypharmacy, frailty, and cognitive impairment. Ethical approval was granted by the Sydney Local Health District Human Research Ethics Committee — Concord Hospital (Reference no: CH62/6/2018–170) and the study conforms to the Australian National statement on ethical conduct in human research .
People with end-stage kidney disease receiving dialysis in any form commonly experience symptoms associated with their reduced renal function and dialysis treatment, often requiring complex medication therapy to manage. Pharmacists are ideally placed as medicines experts to contribute alongside the multidisciplinary team in optimising patient care. However, specialty dialysis clinical pharmacist roles are beginning to emerge, and few studies have been conducted evaluating the impact of clinical pharmacists in dialysis services. This scoping review aimed to identify and evaluate clinical pharmacy services implemented, and outcomes measured, for patients receiving haemodialysis or peritoneal dialysis in the hospital or home setting. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies published in English, with participants aged over 18 years receiving any chronic dialysis and involving clinical pharmacist services were included. Studies were excluded if they included only medication supply services or only included patients receiving continuous renal replacement therapy. Thirty-five studies, published 1997–2024, detailing 17 unique pharmacist interventions for patients receiving dialysis were identified and measured using 17 different outcomes. In the 25 studies, the most common pharmacist interventions included specialist pharmacist medication review ( n = 29), pharmacist inclusion in the multidisciplinary team ( n = 22), extended pharmacist consultation ( n = 20), and targeted adherence counselling ( n = 18). The outcomes measured were categorised into three broad themes: therapy-effectiveness, patient-centred, and health-system measures. The interventions detailed in the included studies highlight an opportunity to extend the scope of pharmacist activities in providing dialysis services in Australia. This expansion would be in line with the ongoing reviews of scope of practice for health professionals and the broader trend of expanding the clinical pharmacist's role. The variability of detail provided in the studies limits transparency and transferability to different dialysis contexts and may impact the achievement of the outcomes described, but further inquiry is warranted.
Type 2 diabetes mellitus (T2DM) is a global health concern, and medication non-adherence contributes to poor glycaemic control and complications. Mobile applications are a potential strategy to improve adherence, but their effectiveness remains uncertain. This systematic review evaluates the effectiveness of mobile applications interventions in improving medication adherence in patients with T2DM. A comprehensive search of PubMed, Cochrane Library, and Scopus was conducted. Studies included were English-language studies published in from 2013–2023. Study quality was assessed using the Mixed Method Appraisal Tool. Seven clinical studies with 717 participants (median age 54.7 years) were included. All studies showed improvements in adherence, but only four reported statistically significant changes. Among these, three studies also showed significant reductions in haemoglobin A1c (HbA1c) levels, suggesting a positive clinical impact. The studies were generally of high quality. Mobile applications appear to improve medication adherence in T2DM patients compared to traditional care. However, the specific application features that enhance adherence are unclear due to variations in study designs and small sample sizes. Future research should focus on identifying key applications characteristics, improving usability, and ensuring cost-effectiveness to optimize patient outcomes.
Geographical maldistribution of pharmacists to regional and rural areas in Australia is well documented in a similar fashion to other health professions. This narrative review aimed to identify the enablers and barriers to staff recruitment and retention and ascertain the extent of evidence in the literature from the perspective of prospective employers. A comprehensive literature search was undertaken for peer reviewed, English language articles published from 2002–2022 using non-Medical Subject Headings (MeSH) terms including ‘rural’, ‘remote’, ‘pharmacy’, ‘pharmacist’, ‘employer’, ‘manager’, ‘workforce’ and ‘practice’, with pharmacy-specific filters applied using databases MEDLINE/EBSCOhost, PudMed, Scopus, ScienceDirect, and DOAJ (Directory of Open Access Journals). The themes identified were tabulated and analysed. A large number of themes were identified, and much of the literature focused on the perspectives of employees. The most commonly identified themes in the 12 studies included ‘rural origin or background/initial training’, ‘professional relationship with other health professionals’, and ‘lifestyle/lifestyle enabled by cost of housing and living’. Some previously highly regarded predictors such as ‘rural origin’ were less common. Recent studies suggest that positive experiences during rural clinical placements and initial employment after undergraduate study are likely to be statistically impactful. Only few themes were shared between employees and employers. The existing literature is heavily skewed towards the views of prospective employees, while relatively little regarding the views of employers. Further, original research from an employer's point of view, especially with regards to the challenges they face and any incentives they offer in attracting a pharmacist workforce to rural and regional areas, is needed.
