Includes bibliographical references.

Patient access to medicines in two countries with similar health systems and differing medicines policies: Implications from a comprehensive literature review -- A systematic review of pharmacy health coaching and an evaluation of patient outcomes -- Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients -- Stakeholder roles in facilitating access to essential medicines -- Collaboration between hospital and community pharmacists to address drug-related problems: The HomeCoMe-program -- Barriers and facilitators to diabetes self-management in a primary care setting – Patient perspectives -- Impact of clinical pharmacist engagement in ward teams on the number of drug-related readmissions among older patients with dementia or cognitive impairment: An economic evaluation -- Community pharmacy minor ailment services: Pharmacy stakeholder perspectives on the factors affecting sustainability -- Immediate or deferred adjustment of drug regimens in multidose drug dispensing systems -- The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis -- The need for a paradigm shift in adherence research: The case of ADHD -- Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector: A case study.

[Article Title: Patient access to medicines in two countries with similar health systems and differing medicines policies: Implications from a comprehensive literature review/ Zaheer- Ud-Din Babar, Todd Gammie, Ali Seyfoddin, Syed Shahzad Hasan and Louise E. Curley, p. 231-243]

Abstract:

Background
Countries with similar health systems but different medicines policies might result in substantial medicines usage differences and resultant outcomes. The literature is sparse in this area.

Objective
To review pharmaceutical policy research in New Zealand and Australia and discuss differences between the two countries and the impact these differences may have on subsequent medicine access.

Methods
A review of the literature (2008–2016) was performed to identify relevant, peer-reviewed articles. Systematic searches were conducted across the six databases MEDLINE, PubMed, Science Direct, Springer Links, Scopus and Google Scholar. A further search of journals of high relevance was also conducted. Using content analysis, a narrative synthesis of pharmaceutical policy research influencing access to medicines in Australia and New Zealand was conducted. The results were critically assessed in the context of policy material available via grey literature from the respective countries.

Results
Key elements regarding pharmaceutical policy were identified from the 35 research papers identified for this review. Through a content analysis, three broad categories of pharmaceutical policy were found, which potentially could influence patient access to medicines in each country; the national health system, pricing and reimbursement. Within these three categories, 9 subcategories were identified: national health policy, pharmacy system, marketing authorization and regulation, prescription to non-prescription medicine switch, orphan drug policies, generic medicine substitution, national pharmaceutical schedule and health technology assessment, patient co-payment and managed entry agreements.

Conclusions
This review systematically evaluated the current literature and identified key areas of difference in policy between Australia and NZ. Australia appears to cover and reimburse a greater number of medicines, while New Zealand achieves much lower prices for medicines than their Australian counterparts and has been more successful in controlling national pharmaceutical expenditure. Delays in patient access to new therapies in New Zealand have considerable implications for overall patient access to medicines; however, higher patient co-payments and relative pharmaceutical expenditure in Australia and its effect upon patient access to medicines must also be considered.

https://doi.org/10.1016/j.sapharm.2018.04.006

[Article Title: A systematic review of pharmacy health coaching and an evaluation of patient outcomes/ Harjit K. Singh, Gerard A. Kennedy and Ieva Stupans, p. 244-251]

Abstract:

Background
Pharmacy health coaching is a nascent topic offering promise on several fronts. There is considerable benefit to discerning the contributions thus far and future directions of pharmacy health coaching and research of the topic.

Objective
The objective of this review was to synthesize the available empirical evidence regarding pharmacy health coaching and to define it.

Methods
This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS) were searched (2000–2017) to identify sources related to pharmacy health coaching. Included articles were reviewed for their definition and outcomes of health coaching as well as recurring terms/themes pertaining to health coaching.

Results
Ten papers met the eligibility criteria. The results of each empirical study as well as the definitions were used to identify the key outcomes associated with pharmacy health coaching and were then cross tabulated. The most commonly occurring outcome of health coaching was an improvement in a health outcome of a target population. An improvement in medication management/adherence and the relationship between health professionals was equally evident. Lastly, an improved attitude towards drug therapy was referred to more often than the cost-effectiveness of health coaching.

Conclusions
The evaluations enabled the formulation of a grounded definition of health coaching.

https://doi.org/10.1016/j.sapharm.2018.04.012

[Article Title: Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients/ Monica Zolezzi, Oraib Abdallah, Nadir Kheir and Abdelsalam Gomaa Abdelsalam, p. 252-259]

Abstract:

Background
Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD.

Objectives
To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services.

Methods
A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation.

Results
The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p < 0.01).

Conclusion
The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services.

https://doi.org/10.1016/j.sapharm.2018.04.032

[Article Title: Stakeholder roles in facilitating access to essential medicines/ Mai H. Duong, Rebekah J. Moles, Betty Chaar and Timothy F. Chen, p. 260-266]

Abstract:

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.

Objectives
This study aimed to examine how different key stakeholders’ roles facilitate access to essential medicines.

Methods
In depth interviews were conducted with 47 participants across seven stakeholder groups globally. Stakeholders included government, academics, consumer groups, non-profit organizations, hospital healthcare providers, manufacturers, and wholesaler/distributors. An inductive approach to data analysis was undertaken. A pragmatic Grounded Theory “approach” was adopted, using tools such as open, axial, and selective coding. Thematic content analysis was applied to the comprehensive theory of collaboration to provide a contextual management framework to interpret themes. Results were displayed in Ishikawa fishbone diagrams for decision making and the logistics process.

Results
Findings showed that logistics management and therapeutic decision making were managed separately by stakeholders. Interestingly, hospital pharmacists had overlapping roles in patient care decisions and supply chain logistics, highlighting their importance as supply chain managers. Furthermore, despite the significant role that wholesalers/distributors had in managing supply disruptions and shortages, they were not involved in the decision-making process and did not participate in therapeutic selection committees. Additionally, sometimes stakeholders’ intended control mechanisms contributed to increasing the complexity of the supply chain.

Conclusion
There is a need for improved and innovative stakeholder engagement. Expanding the role of pharmacy to include hospital formulary pharmacists and including wholesaler/distributors in therapeutic selection committee decisions could improve these collaborations, may help to align the selection and procurement of medicines processes.

https://doi.org/10.1016/j.sapharm.2018.04.034

[Article Title: Collaboration between hospital and community pharmacists to address drug-related problems: The HomeCoMe-program/ Hendrik T. Ensing, Ellen S. Koster Dasha J. Dubero, Ad A. van Dooren and Marcel L. Bouvy, p. 267-278]

Abstract:

Background
Hospital discharge poses a significant threat to the continuity of medication therapy and frequently results in drug-related problems post-discharge. Therefore, establishing continuity of care by realizing optimal collaboration between hospital and community pharmacists is of utmost importance.

Objective
To evaluate the collaboration between hospital and community pharmacists on addressing drug-related problems after hospital discharge.

Methods
A prospective follow-up study was conducted between November 2013–December 2014 in a general hospital and all affiliated community pharmacies. Adult patients, admitted for ≥48 h to the neurology or pulmonology ward were eligible if they used ≥3 chronic prescription drugs and lived in the community pharmacies' service area. The HomeCoMe intervention program was comprised of medication verification and counseling at admission, medication screening by the hospital pharmacist during admission, outpatient pharmacy discharge consultation and support, and a community pharmacist home visit within one week post-discharge.

Results
The mean age of the 152 included patients was 67.0 ± 12.6 years and 56.6% were female. A total of 745 DRPs (4.9 ± 2.2 DRPs per patient, range: 0–11) were identified with the need for additional “Education or information” (36.1%) and “Compliance” (16.4%) issues as most common DRP-types. This led to a total of 928 recommendations (6.1 ± 3.0 per patient, range: 1–19) to solve the DRP. The majority of DRPs were identified (83.6%, n = 623) and solved (91.6%, n = 682) by the community pharmacist during the home visit. Furthermore, 52.5% (n = 64) of the DRPs identified during hospitalization were solved during the post-discharge home visit.

Conclusions
Collaboration between hospital and community pharmacists from hospital admission to readmission to primary care is crucial to establish continuity of care. A post-discharge community pharmacist home visit is a valuable addition to in-hospital transitional care to identify and solve drug-related problems.

https://doi.org/10.1016/j.sapharm.2018.05.001

[Article Title: Barriers and facilitators to diabetes self-management in a primary care setting – Patient perspectives/ Rahul Khairnar, Khalid M. Kamal, Vincent Giannetti, Nilanjana Dwibedi and Jamie McConaha, p. 279-286]

Abstract:

Background
Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population.

Objective
To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting.

Methods
This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7–9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted.

Results
A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and ‘less than graduate level’ education were significant predictors of glycemic stability.

Conclusions
Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.

https://doi.org/10.1016/j.sapharm.2018.05.003

[Article Title: Impact of clinical pharmacist engagement in ward teams on the number of drug-related readmissions among older patients with dementia or cognitive impairment: An economic evaluation/ Maria Sjölander, Lars Lindholm, Bettina Pfister, Jeanette Jonsson, Jörn Schneede, Hugo Lövheim and Maria Gustafsson, p. 287-291]

Abstract:

Background
Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far.

Objectives
To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments.

Methods
Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated.

Results
The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person.

Conclusions
Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments.

https://doi.org/10.1016/j.sapharm.2018.05.006

[Article Title: Community pharmacy minor ailment services: Pharmacy stakeholder perspectives on the factors affecting sustainability/ Hamde Nazar and Zachariah Nazar, p. 292-302]

Abstract:

Background
Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning.

Objective
To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England.

Methods
A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis.

Results
Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain ‘Partnerships’ demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services.

Conclusion
The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment.

https://doi.org/10.1016/j.sapharm.2018.04.036

[Article Title: Immediate or deferred adjustment of drug regimens in multidose drug dispensing systems/ Bram J. Mertens, Henk-Frans Kwint, Rob J. van Marum and Marcel L. Bouvy, p. 303-309]

Abstract:

Background
Multidose drug dispensing (MDD) is used to help patients take their medicines appropriately. Little is known about drug regimen changes within these MDD systems and how they are effectuated by the community pharmacist. Manual immediate adjustments of the MDD system could introduce dispensing errors. MDD guidelines therefore recommend to effectuate drug regimen changes at the start of a new MDD system.

Objective
The aim of this study was to investigate the frequency, type, procedure followed, immediate necessity, and time taken to make MDD adjustments.

Methods
This was a cross-sectional study in eight community pharmacies in the Netherlands. All adjustments to MDD systems were systematically documented for 3 weeks by the community pharmacist.

Results
Overall, 261 MDD adjustments involving 364 drug changes were documented for 250 patients: 127 (35%) drug changes involved the addition of a new drug, 124 (34%) a change in dosage, and 95 (26%) drug discontinuation. Of the MDD adjustments, 135 (52%) were effectuated immediately: 81 (31%) by adjusting the MDD system manually, 49 (19%) by temporarily dispensing the drug separately from the MDD system, and 5 (2%) by ordering a new MDD system. Pharmacists considered that 36 (27%) of the immediate MDD adjustments could have been deferred until the next MDD system was produced. Immediate adjustment took significantly longer than deferred adjustment (p < 0.001).

Conclusions
This study shows that in patients using MDD systems, over half of the drug regimen changes are adjusted immediately. The necessity of these immediate changes should be critically evaluated.

https://doi.org/10.1016/j.sapharm.2018.05.008

[Article Title: The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis/ Mohammed I. Aladul, Raymond W. Fitzpatrick and Stephen R. Chapman, p. 310-317]

Abstract:

Background
The approval of new biosimilars of infliximab, etanercept and adalimumab by the European Medicines Agency is expected to produce further cost savings to the healthcare system budget.

Objectives
This study aimed to estimate the budget impact of the introduction of new biosimilars Flixabi®, Erelzi®, Solymbic®, Amgevita® and Imraldi® in rheumatology and gastroenterology specialities in the UK.

Methods
A published budget impact model was adapted to estimate the expected cost savings following the entry of new biosimilars Flixabi®, Erelzi®, Solymbic®, Amgevita® and Imraldi® in the UK over three-year time horizon. This model was based on retrospective market shares of biologics used in rheumatology and gastroenterology which were derived from DEFINE Software and healthcare professional perspectives.

Results
The model predicted that infliximab and etanercept biosimilars would replace their corresponding reference agents by 2020. Adalimumab biosimilars were predicted to achieve 19% of the rheumatology and gastroenterology market by 2020. Without the introduction of further biosimilars, the model predicted a reduction in expenditure of £44 million on biologics over the next three years. With the entry of Flixabi®, Erelzi®, Solymbic®, Amgevita® and Imraldi® the model estimates cumulative savings of £285 million by 2020.

Conclusions
The introduction of new infliximab, etanercept and adalimumab biosimilars will be associated with considerable cost savings and have a substantial favourable impact on the UK NHS budget. The number of biosimilars and time of entry of is critical to create competition which will result in maximum cost savings.

https://doi.org/10.1016/j.sapharm.2018.05.009

[Article Title: The need for a paradigm shift in adherence research: The case of ADHD/ Muhammad Umair Khan, Michael Kohn and Parisa Aslani, p. 318-320]

Abstract: Nonadherence to long-term medications attenuates optimum health outcomes. There is an abundance of research on measuring and identifying factors affecting medication adherence in a range of chronic medical conditions. However, there is a lack of standardisation in adherence research, namely in the methods and measures used. In the case of attention deficit hyperactivity disorder, this lack of standardisation makes it difficult to compare and combine findings and to draw meaningful conclusions. Standardisation should commence with a universally accepted categorisation or taxonomy of adherence which takes into consideration the dynamic nature of medication-taking. This should then be followed by the use of valid and reliable measures of adherence which can accurately quantify adherence at any of its phases, and provide useful information which can be utilised in planning targeted interventions to improve adherence throughout the patient medication-taking journey.

https://doi.org/10.1016/j.sapharm.2018.04.033

[Article Title: Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector: A case study/ Christian Díaz de León-Castañeda, Jéssica Gutiérrez-Godínez, Juventino III Colado-Velázquez and Cairo Toledano-Jaimes, p. 321-329]

Abstract:

Background
In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services.

Objectives
To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision.

Methods
A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti.

Results
Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision.

Conclusions
The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision.

https://doi.org/10.1016/j.sapharm.2018.04.014