Research in social & administrative pharmacy.
- New York : Elsevier, c2020.
- 267-435 pages : 28 cm.
- Research in social & administrative pharmacy, Volume 16, Issue 3, March 2020 .
Includes bibliographical references.
Pharmacy practice in the domain of assisted dying: A mapping review of the literature -- A review of measures used to examine medication adherence in people with ADHD at initiation, implementation and discontinuation of pharmacotherapy -- Implementing a sustainable medication reconciliation process in Australian hospitals: The World Health Organization High 5s project -- Medication taking in a national sample of dependent older people -- Prevalence of drug-related problems using STOPP/START and medication reviews in elderly patients with dementia -- The Tennessee medication therapy management program: A hybrid type 2 effectiveness-implementation trial study protocol -- Moral distress among community pharmacists: causes and achievable remedies -- Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression -- Improving HPV vaccination using implementation strategies in community pharmacies: Pilot study protocol -- CAPABLE: Calgary zone usage of Additional Prescribing Authorization By pharmacists in an inpatient setting: review of the prescribing Landscape and Environment -- Community pharmacy staff interactions with patients who have risk factors or warning signs of suicide -- Development of a process-oriented quality improvement strategy for the medicines pathway in nursing homes using the SEIPS model -- Arabic-speaking pregnant women with a migration background: A vulnerable target group for prenatal counseling on medicines -- The effectiveness of written communication for decision support in clinical practice -- Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol -- The development of a foundation-level pharmacy competency framework: An analysis of country-level applicability of the Global Competency Framework -- Key stakeholders’ views on the potential implementation of pharmacist prescribing: A qualitative investigation -- Cost-related nonadherence to medicines in people with multiple chronic conditions -- Environmental and individual predictors of medication adherence among elderly patients with hypertension and chronic kidney disease: A geospatial approach -- Medication rebates and health disparities: Mind the gap -- Response letter to the editor “Development and validation of key performance indicators for medication management services provided for outpatients” [Res Social Adm Pharm 15 (9) (2019) 1080-7].
[Article Title: Pharmacy practice in the domain of assisted dying: A mapping review of the literature/ Phillip Woods, Theresa J. Schindel, Michelle A. King and Amary Mey, p. 267-276]
Abstract:
Background The scope and roles of pharmacists worldwide are undergoing dramatic change. Patient-focused care aimed at caring for people that seek medical assistance in dying is among the newest roles. While pharmacists have been involved in medically assisted dying in some international jurisdictions for over two decades, little is known about their actual lived experiences.
Objective To map the literature concerning pharmacy practice in the assisted dying domain to clarify apparent research gaps.
Methods A mapping review was preformed following a systematic search of Medline, CINAHL and IPA to locate academic papers and reports relating to pharmacists’ involvement in assisted dying published between 1990 and 2019. Searches included articles in English, French, and Dutch. References and citations of articles were searched to identify additional articles.
Results A total of 43 articles were selected, including commentaries (n = 26), reports (n = 2), a scoping literature review (n = 1), and empirical studies (n = 14). Most commentaries centered on pharmacists' roles, ethico-legal and moral challenges, and educational concerns in relation to participation. Of the 14 empirical studies, 12 studies were designed around surveys that focused on pharmacists' attitudes, and opinions concerning assisted dying. Other methodologies included thematic analysis of moral dilemmas, experimental design identifying attitudes to sedation at end of life, and analysis of documents such as guidelines, position statements, and standards of practice. Two studies utilized a qualitative research approach. A significant gap was found with respect to research exploring the actual experience of pharmacists’ practice in medically assisted dying.
Conclusion There is an absence of studies exploring pharmacists’ actual experiences in assisted dying practice. Research involving pharmacists that participate in legally sanctioned assisted dying will facilitate a meaningful understanding of the lived experience of pharmacy practice in this domain. https://doi.org/10.1016/j.sapharm.2019.05.012 [Article Title: A review of measures used to examine medication adherence in people with ADHD at initiation, implementation and discontinuation of pharmacotherapy/ Muhammad Umair Khan and Parisa Aslani, p. 277-289]
Abstract:
Background Adherence to prescribed medication is a dynamic process that changes over time. Whilst several measures have been used to examine adherence in patients with ADHD, it is not clear how these measures have been used to measure adherence in the context of its three phases (initiation, implementation, discontinuation).
Objective To examine measures used to assess medication adherence at its three phases in people with ADHD.
Methods The PRISMA guidelines were followed for this review. Six databases (Medline, PubMed, IPA, CINAHL, Embase, and PsycINFO) were systematically searched in October 2018, without any limitations on the start dates. Keywords reflecting three broad concepts (adherence, ADHD and measures) were used as part of the search strategy. Studies that assessed medication adherence in people with ADHD and described methods used to assess adherence were selected for this review.
Results Forty-nine studies were included. Most (69.3%) examined adherence at the implementation phase. Claims databases, self-reported questionnaires, and prescription-refill records were used to measure adherence at the initiation, implementation, and discontinuation phase, respectively. Overall, self-reported questionnaires were the most frequently used measure at the implementation phase, but the psychometric properties were not reported in almost half of the studies that used these measures.
Conclusions Initiation and discontinuation phases of adherence have been relatively less examined in people with ADHD. Although self-reported questionnaires were the commonly used measures, the validity and reliability of these measures are of concern in guiding evidence-based practice. Measures with improved psychometric properties are needed that can examine adherence across its three phases. https://doi.org/10.1016/j.sapharm.2019.06.001 [Article Title: Implementing a sustainable medication reconciliation process in Australian hospitals: The World Health Organization High 5s project/ Helen E. Stark, Linda V. Graudins, Treasure M. McGuire, Cathy Yuen Yi Lee and Margaret J. Duguid, p. 290-298]
Abstract:
Background Medication reconciliation (medrec) is a mandated patient safety strategy by national, including Australian, accreditation bodies. Yet there are no validated performance measures.
Objective To determine the feasibility of implementing the World Health Organization (WHO) Medrec Standard Operating Protocol (SOP) in a range of Australian acute care facilities to achieve measurable and sustainable reductions in medication discrepancies occurring at admission.
Methods A multicentre, prospective national study was conducted in ten academic, urban and regional hospitals to implement the SOP using WHO High 5s project and quality improvement methodology. Sites collected data on the rate of medrec performed within 24 h of admission in a random selection of 50 patients aged ≥65 years admitted via the emergency department, monthly for four years. Medrec quality was reviewed in a subset of 30 patients using three performance measures. Barriers, enablers and benefits of SOP implementation were collected using qualitative surveys.
Results Ten health services reviewed 42,003 patient records. Of these, 20,162 (49.5%) had medicines reconciled within 24 h of admission. Four services increased, two decreased, and in four, medrec completion rates remained static. Mean number of unintentional and undocumented intentional medication discrepancies per patient decreased: 0.21 to 0.16 (p = 0.001) and 0.34 to 0.08 (p = 0.003), respectively. Unintentional discrepancies decreased from 15.2% to 11.1% (p = 0.001). Barriers to full implementation included: medrec not seen as a priority, limited resources and lack of electronic systems integration. Enablers included: use of medrec measures for feedback, educational resources, and 7-day week clinical pharmacy services. Benefits included improvements in medication safety culture and multidisciplinary teamwork.
Conclusions The WHO SOP was feasible, although challenging, to implement in a range of acute health services, and produced measureable and sustainable improvements in medicines information accuracy on admission. Sustaining the quantum of quality and timely medrec requires investment in pharmacist resources and electronic systems integration. https://doi.org/10.1016/j.sapharm.2019.05.011 [Article Title: Medication taking in a national sample of dependent older people/ C.A. Ferguson, W.M. Thomson, M.B. Smith, N. Kerse, K. Peri and B. Gribben, p. 299-307]
Abstract:
Background Polypharmacy is associated with inappropriate medication use, and subsequently increasing older persons’ risk of drug-related harm and health-related costs to individuals and society.
Objective To examine and describe, using a national sample of patient-level medication data, the prevalence of older people's polypharmacy and medication use across dependency levels. To examine oral and general pain prevalence and associated analgesic usage.
Methods Medication data from the 2012 New Zealand Older People's Oral Health Survey, a nationally-representative, cross-sectional study of dependent older people's oral health, were analysed descriptively, comparing classes and sub-classes of drugs and nutrient supplements taken across four categories of dependency: very low (own homes receiving in-home support), low, high and psychogeriatric (all receiving aged residential care). Self-reported current general pain and frequency of orofacial pain data were cross-tabulated by sub-classes of analgesics taken.
Results All participants were taking at least one medication overall, 53.2% (95% CI: 50.4, 56.0) took between five and nine (polypharmacy), and 13.9% (95% CI: 17.4, 22.5) took 10 or more (hyperpolypharmacy). Antihypertensives, analgesics, antiulcer drugs, aspirin, laxatives, statins and antidepressants were the most common drug classes taken, the proportions differing between psychogeriatric level care and all other dependency groups. Overall, simple analgesics were taken (34.5%; 95%CI: 30.8, 38.4) more commonly than other analgesics; the use of nonsteroidal anti-inflammatory drugs was low (3.6%; 95% CI: 2.7, 4.7). Of those reporting experiencing extreme general bodily pain, 63.3% (95% CI: 56.6, 69.4) took an analgesic, more than those experiencing mouth pain occasionally or often. Fat-soluble vitamins were the most common vitamin supplement taken (32.0%; 95%CI: 27.0, 37.4).
Conclusions Polypharmacy and hyperpolypharmacy are common among older people, regardless of dependency level, and pain may be undertreated. https://doi.org/10.1016/j.sapharm.2019.05.010 [Article Title: Prevalence of drug-related problems using STOPP/START and medication reviews in elderly patients with dementia/ Linnea Abramsson and Maria Gustafsson, p. 308-314]
Abstract:
Background Drug-related problems (DRPs) are common among elderly patients with dementia. STOPP/START is an explicit tool that has been used to detect DRPs among elderly patients.
Objectives The objective of this study was to compare prevalence and type of DRPs identified by STOPP/START with DRPs identified by clinical pharmacists among the same population. Secondary objectives were to investigate factors associated with the use of DRPs using the two methods.
Method Extracts from medical records were used to identify DRPs in 212 patients by using STOPP/START. The patients were ≥65 years of age with dementia or cognitive impairment. An earlier study was performed in the same study population in 2012–2014, where DRPs were identified by clinical pharmacists in order to decrease the number of rehospitalizations.
Results STOPP/START identified DRPs in 72.2% of the patients compared with 66.0% identified by the clinical pharmacists. The numbers of DRPs identified by the different methods were 326 and 310, respectively. Different types of DRPs were identified with the different tools. STOPP/START mainly identified DRPs in the categories “ineffective/inappropriate drug” and “needs additional drug therapy”, whereas the clinical pharmacists identified DRPs in several categories.
Conclusion Even though STOPP/START was able to identify a similar number of DRPs compared with DRPs identified by clinical pharmacists, STOPP/START failed to identify DRPs in several important categories. To cover all DRPs, STOPP/START might be used as a complement to implicit criteria. https://doi.org/10.1016/j.sapharm.2019.05.016 [Article Title: The Tennessee medication therapy management program: A hybrid type 2 effectiveness-implementation trial study protocol/ Jacqueline Woeppel, Renee Clark, Lora Underwood, Justin Gatwood, Kea Turner, Chelsea Renfro and Kenneth C. Hohmeier, p. 315-320]
Abstract:
Background Pharmacist-led medication therapy management (MTM) programs are considered evidence-based and have clearly defined core components. Despite this, MTM programs are often implemented without fidelity due to notable implementation barriers, such as physician-pharmacist relationships and pharmacist access to patient medical records. To improve MTM implementation, the Tennessee Medicaid program developed a MTM intervention that incorporates implementation strategies to address some of the known barriers to implementation (e.g., formalizing pharmacist-physician relationships through collaborative practice agreements, ensuring pharmacists’ access to medical records).
Objectives The purpose of this hybrid type 2 effectiveness-implementation study is to (1) assess the effectiveness of the MTM pilot program in Tennessee (e.g., medication adherence, healthcare utilization, quality and cost of care) and (2) assess the implementation of the MTM pilot program (e.g., feasibility, appropriateness, acceptability, penetration).
Methods The Tennessee MTM pilot program is being assessed as a hybrid type 2 effectiveness-implementation study with a quasi-experimental design. A mixed methods approach (QUAN + QUAL) for the purpose of complementarity (e.g., answering related research questions). Data will include surveys, interviews, MTM platform encounter information, and medical and pharmacy claims. Initial analyses will include data between January 2018 and December 2019.
Conclusion The study will further add to the evidence base of MTM interventions by testing an intervention that addresses known barriers to implementation and simultaneously collecting data on effectiveness and implementation to speed up MTM translation. The Tennessee MTM program is expected to serve as a guide to other states seeking to expand pharmacist-delivered clinical services to their Medicaid members, particularly those intending to incorporate MTM into programs seeking to improve primary care delivery. Further, by improving the implementation of MTM, the pilot program is expected to improve the reliability of MTM program benefits including healthcare quality and cost and patient outcomes. https://doi.org/10.1016/j.sapharm.2019.05.018 [Article Title: Moral distress among community pharmacists: causes and achievable remedies/ Jayne L. Astbury and Cathal T. Gallagher, p. 321-328]
Abstract:
Objectives This study aims to explore the incidence of moral distress experienced by UK community pharmacists through the deployment of a previously developed and validated survey instrument to a national sample.
Methods An e-mail inviting pharmacists to complete an on-line questionnaire developed to measure moral distress was successfully delivered via the mailing list of a nationwide support organisation for the pharmacy profession. Completed questionnaires were subjected to statistical analysis to determine to what extent common practice scenarios generated moral distress in community pharmacists.
Key findings Time constraints represent the greatest source of moral distress for United Kingdom (UK) community pharmacists, scoring highest for both frequency and intensity of distress. The supply of emergency hormonal contraception (EHC) in opposition to religious beliefs scored lowest. Possible underlying causes of moral distress are discussed in the light of our results, and potential mechanisms for reducing the incidence of moral distress for this professional group are considered.
The reduction in the frequency and occurrence of moral distress is best achieved by the creation of morally habitable workplaces, where possible triggers can be identified and avoided. Structured undergraduate ethics education and accessible postgraduate training and resources could provide a meaningful opportunity to support pharmacists in exercising their moral competency or moral agency.
Conclusions Moral distress provides a reliable indicator of constraints in the form of policies, legislation and regulations, and the structural and relational aspects of the working environment in which pharmacists practise. This provides invaluable information in the search for strategies to reduce the recurrence of this phenomenon. https://doi.org/10.1016/j.sapharm.2019.05.019 [Article Title: Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression/ Satabdi Chatterjee, Vishal Bali, Ryan M. Carnahan, Hua Chen, Michael L. Johnson and Rajender R. Aparasu, p. 329-335]
Abstract:
Background Although the adverse cognitive effects of anticholinergic medications in the elderly are well-documented, little is known regarding the cognitive impact of anticholinergics among nursing home residents with depression.
Objective This study examined the risk of mild-to-moderate cognitive impairment due to anticholinergic burden among elderly nursing home residents with depression.
Methods A population-based nested case-control study was conducted using Minimum Data Set (MDS)-linked Medicare data where the base cohort included patients ≥ 65 years with depression who had intact cognition (MDS Cognition score of 0 or 1) and no dementia. Cases were identified as those who had mild-to-moderate cognition (MDS Cognition score of 2–4). Each case was matched on age and sex to one control using incidence density sampling. The study evaluated cumulative anticholinergic burden (defined as score of 3 or more) within 30, 60 and 90 days preceding the event date based on the Anticholinergic Drug Scale (ADS). Conditional logistic regression model stratified on matched case-control sets was performed to evalaute cognitive impairment due to cumulative anticholinergic burden after controlling for other risk factors.
Results The study sample included 3707 cases with mild-to-moderate cognition and 3707 matched controls with intact cognition. Bivariate analysis showed significant association between cumulative anticholinergic exposure and cognitive impairment (Odds Ratio [OR], 1.15; 95% Confidence Interval [CI],1.04–1.30); after controlling for potential risk factors, cumulative anticholinergic exposure 30 days preceding the event was no longer associated with cognitive impairment, (aOR, 1.07; 95% CI, 0.95–1.21). However, the odds of cognitive impairment increased with cumulative anticholinergic exposure 60 days (aOR 1.16; 1.04–1.30) and 90 days (aOR 1.28; 1.14–1.44) before the event date.
Conclusion Cumulative anticholinergic use for prolonged exposure periods was associated with modestly increased risk of cognitive impairment in elderly residents with depression who had intact cognition. The findings suggest the need to be cautious when prescribing multiple anticholinergic drugs in residents, including those with intact cognition. https://doi.org/10.1016/j.sapharm.2019.05.020 [Article Title: Improving HPV vaccination using implementation strategies in community pharmacies: Pilot study protocol/ Benjamin S. Teeter, Cynthia Mosley, Jeremy L. Thomas, Bradley Martin, Duane Jones, Jose R. Romero and Geoffrey M. Curran, p. 336-341]
Abstract:
Background Nearly 80 million people in the United States have contracted the Human Papillomavirus (HPV), and it is currently the most common sexually transmitted disease. Each year approximately 14 million people are newly infected.
Objective(s) This study will address increasing the HPV vaccination rates by initiating a research agenda focusing on how best to utilize community pharmacies as Vaccines For Children (VFC) vaccination sites. Community pharmacies are highly accessible when compared to traditional vaccination sites due to extended evening and weekend business hours, no copays for visits, and no appointment required to speak with a pharmacist.
Methods We will conduct a Developmental Formative Evaluation using semi-structured interviews with key informants (pharmacists, pharmacy managers, technicians) from 5 Harps pharmacies to identify barriers and facilitators to community pharmacies’ provision of HPV vaccine through a mixed methods design with pharmacy staff members and local physicians. We will follow that by selecting a pharmacist-physician collaborative model and identify implementation strategies through an Evidence Based Quality Improvement (EBQI) process with key stakeholders. This will be followed by piloting the selected pharmacist-physician collaborative model and implementation strategies in two Harps pharmacies (1 rural, 1 urban) on relevant implementation outcomes.
Project impact This study will examine the current model of HPV vaccinations and how to improve HPV vaccination rates among adolescents by utilizing community pharmacy services. https://doi.org/10.1016/j.sapharm.2019.05.022 [Article Title: CAPABLE: Calgary zone usage of Additional Prescribing Authorization By pharmacists in an inpatient setting: review of the prescribing Landscape and Environment/ Sydney Saunders, Deonne Dersch-Mills, Tania Mysak, Lori Romonko-Slack, Art Chernick, Gerald Lazarenko and Dalyce Zuk, p. 342-348]
Abstract:
Background In Alberta, Canada, pharmacists have been granted the ability to prescribe most medications independently after completing an additional authorization process. While there are data to support the use of pharmacists’ prescribing in the community setting, little is known about its use in the inpatient hospital setting.
Objectives To describe the prescribing patterns of pharmacists in an inpatient setting including the percentage of pharmacists using their prescribing authority, the care areas where prescribing occurred, and the frequency of prescribing. Secondary objectives included describing the medications prescribed, and to determine if pharmacists are documenting their prescribing interventions.
Methods A descriptive, retrospective, cross-sectional study of medications ordered by pharmacists through the electronic order entry system in Calgary, Alberta, Canada. Prescriptions were examined in the context of how often each pharmacist prescribed, the medications prescribed, and an audit of documentation practices was performed using patient charts.
Results A total of 64,293 orders from 172 pharmacists were included in the analysis, of which 51% (n = 32,681) were discontinuation orders. It was found that 90% of pharmacists used their prescribing authority, ordering a median of 11.3 prescriptions monthly (interquartile range 4.3–32.8). Clinical areas with the most overall prescribing included critical care (854.8), oncology and palliative care (463.0), and surgery (409.3) prescriptions per pharmacist Full-Time Equivalent per year.
Conclusions This study demonstrates a broad range of prescribing from pharmacists within acute care practice and a wide variety of medication prescribed. Future areas for research include barriers and enablers to pharmacist prescribing and examination of where prescribing pharmacists have the greatest value.
https://doi.org/10.1016/j.sapharm.2019.05.021 [Article Title: Community pharmacy staff interactions with patients who have risk factors or warning signs of suicide/ Delesha M. Carpenter, Jill E. Lavigne, Evan W. Colmenares, Kristin Falbo and Sherita L. Mosley, p. 349-359]
Abstract:
Background Little is known about community pharmacy staff members’ interactions with patients at risk of suicide.
Objectives To: 1) develop a measure to assess the frequency with which pharmacy staff encounter patients with suicide risk factors and warning signs; 2) to assess the measure's validity and reliability; and 3) describe pharmacy staff members' interactions with at-risk patients and their suicide prevention training preferences.
Methods A convenience sample of 501 community pharmacy staff members who worked in North Carolina completed an anonymous online survey. A 10-item measure (the Pharmacy Suicide Interaction Scale (PSIS)) assessed how often respondents encountered patients with suicide risk factors or warning signs, and one open-ended question elicited barriers to interacting with these patients. Psychometric analyses, including an exploratory factor analysis, were performed to examine the validity and reliability of the PSIS. Descriptive statistics were calculated, and responses to open-ended questions were analyzed thematically.
Results The PSIS possessed two factors (or subscales): a non-verbal suicide warning signs and risk factors subscale (Cronbach's alpha = 0.79) and a verbal warning signs subscale (Cronbach's alpha = 0.67). Respondents who knew a patient who had died by suicide had higher mean scores on the non-verbal and verbal subscales, indicating that the PSIS had construct validity. Many respondents (22.4%) knew a patient who died by suicide, and 21.6% of respondents had patients request a lethal dose of medication. Interactions occurred both face-to-face and over the phone, and respondents most commonly reacted to patients by contacting others or offering emotional support. Few respondents (8.8%) had suicide prevention training or resources, but most (89.6%) desired additional training.
Conclusion Many community pharmacy staff members have interacted with patients who exhibited suicide warning signs or died by suicide. Suicide prevention training may help prepare pharmacy staff to recognize, communicate with, and refer at-risk patients. https://doi.org/10.1016/j.sapharm.2019.05.024 [Article Title: Development of a process-oriented quality improvement strategy for the medicines pathway in nursing homes using the SEIPS model/ Goedele Strauven, Kris Vanhaecht, Pauline Anrys, Jan De Lepeleire, Anne Spinewine and Veerle Foulon, p. 360-376]
Abstract:
Background and objective Medication errors in nursing homes are highly prevalent and occur in different stages of the medicines pathway. The application of the SEIPS (System Engineering Initiative for Patient Safety) model facilitates the identification of work system factors that contribute to errors. Therefore, the aim of our research was to investigate in-depth the medicines pathway in nursing homes by using the SEIPS model and to develop a set of key activities and aggregated key interventions to be used as a basis for quality-improvement strategies.
Methods A variety of qualitative methods, including observations, semi-structured interviews, the development of a flowchart, an expert meeting and a working symposium, were used to identify processes and work system components. Key interventions and activities were developed in three rounds (one development and two validation rounds) across the different research methods to fine-tune the defined key interventions and activities.
Results Our analysis revealed a large variety of tasks as well as persons elements, aspects related to technology and tools, organisational factors and environmental elements that all interact and influence the medicines pathway. The large number of tasks could be linked to eight overarching processes: prescribing, purchase and ordering, delivery, storage, preparation, administration, monitoring and (re-)admission. After three rounds (one development and two validation rounds), a final set of 137 key activities and 27 aggregated key interventions, concretising the eight processes, was obtained.
Conclusion The in-depth analysis of processes within the medicines pathway in nursing homes resulted in a set of key activities and aggregated key interventions which may serve as a basis for the nursing home sector and policy makers to enhance a safe and efficient medicines pathway. https://doi.org/10.1016/j.sapharm.2019.06.003 [Article Title: Arabic-speaking pregnant women with a migration background: A vulnerable target group for prenatal counseling on medicines/ Michael Ceulemans, Raneem Chaar, Kristel Van Calsteren, Karel Allegaert and Veerle Foulon, p. 377-382]
Abstract:
Background The diversity of the European population increased over the last decades due to migration influences. It is obvious that pregnant women with a migration background also need access to the healthcare system of their host country. Nevertheless, pregnancies among women with a migration background may be even more challenging due to a higher prevalence of adverse pregnancy outcomes, higher risk of vitamin deficiencies or lower intake of folic acid. These issues reinforce the need for effective counseling by healthcare professionals (HCPs).
Objectives To explore the experiences of Arabic-speaking pregnant women with a migration background living in Belgium regarding their communication with HCPs, as well as their perceptions towards HCPs and the use of healthcare products during pregnancy.
Methods Semi-structured interviews with Arabic-speaking pregnant women were conducted between February–July 2017 using purposive and snowball sampling. An empirically based conceptual framework, grounded in the interview data, was developed prior to content analysis and coding with Nvivo 11.
Results In total, 17 interviews were conducted. Most women reported that they were suffering from the language barrier, which hindered their communication with HCPs and had undesirable consequences on their treatment and medication use. Communication was largely affected by the presence of interpreters. During pregnancy, a high threshold to use medicines and a preference for natural remedies was observed.
Conclusion Arabic-speaking pregnant women with a migration background living in Belgium are a vulnerable target group for prenatal counseling on medicines. Besides early dectection and willingness to help these women, HCPs should refer them to appropriate and understandable online sources and provide evidence-based information about the use of healthcare products during pregnancy. To facilitate the patient-HCP communication, strategies are further needed to stimulate these women to learn a national language and to increase their social integration. https://doi.org/10.1016/j.sapharm.2019.06.004 [Article Title: The effectiveness of written communication for decision support in clinical practice/ Shane P. Desselle, Patricia Shane, Helen Berhane, Yewande Samuel and Trang Tran, p. 383-389]
Abstract:
Background The application of various tools suggests limitations in the usage of drug information provided to medical professionals. Concurrent views of utility and suggested improvements for written information by health care practitioners are lacking.
Objective This study's objectives were to: (1) assess practice-based perspectives on the relative efficacy and utility of different medication-related written materials for health care practitioners, (2) discern aspects of written communications that are valued for actionable information and merit health care practitioners' attention, (3) determine common or unique themes of clinicians practicing as physicians, pharmacists, physician assistants, and nurses regarding medication-related written information; and (4) organize constructs and themes as a cogent array of current deficiencies in written communications to guide improvements.
Methods Two focus group panels (physicians, physician assistants, pharmacists, nurses) were convened to address clinical decisional balance and the utility of written information about medicines in assisting them with those decisions. A facilitated dialogue followed a semi-structured interview guide including overarching questions and tap-root probes derived from the literature. Comparative analyses were used to interpret data. An a priori coding framework informed the interview guide and served as a basis for initial identification of themes.
Results Panelists from diverse practices and settings voiced convergent agreement on the limited utility of written materials, attributed primarily to current structure, formatting, content, and design. Recommendations thematically supported the need for greater accuracy, recency, adaptability, sequencing, and accessibility of information in formats more frequently digitalized.
Conclusions Focus group panels of practitioners provided rich information on how current written information such as Dear Doctor letters and package inserts could be improved to facilitate real-time decision-making. Overall, improvements could contribute to an improved capacity for efficient, effective, and sustained evidence-based practice behavior. https://doi.org/10.1016/j.sapharm.2019.06.005 [Article Title: Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol/ Laney K. Jones, Samuel S. Gidding, Terry L. Seaton, Anne Goldberg, Christina Gregor, Amy C. Sturm, Ross C. Brownson, Alanna Kulchak Rahm and Marc S. Williams, p. 390-395]
Abstract:
Background Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia. This study seeks to address a significant gap in the care of individuals with FH by systematically developing an effective approach to increase the adoption of guideline-recommended treatments for FH.
Methods This developmental study will consist of three aims: 1) determine the barriers to and facilitators of treatment of FH; 2) develop a list of potential implementation strategies to promote the adoption of guideline-recommended treatment of individuals with FH, and 3) pilot one implementation strategy from Aim 2 in one health care system to evaluate implementation outcomes of the strategy. The Practical, Robust Implementation and Sustainability Model will guide this project, including the development of interview questions, implementation strategies, and evaluation of the implementation strategy. The implementation outcomes include: of individuals targeted by the implementation strategy, how many are impacted by it (reach), measure the change in knowledge, attitude, and behavior that is impacted by the implementation strategy (effectiveness), in settings targeted by the implementation strategy, how many adopt it (adoption), and fidelity and cost of the implementation strategy (implementation). Data sources will include electronic health records, administrative databases, surveys, and semi-structured interviews.
Discussion The inclusion of patient and organizational stakeholder experiences is a critically important step in developing efficient and effective implementation strategies. Additionally, perspectives from a variety of geographic areas and cultural perspectives should increase feasibility and fidelity of the interventional approach to improve adoption of guideline-recommended practices for FH care. https://doi.org/10.1016/j.sapharm.2019.06.006 [Article Title: The development of a foundation-level pharmacy competency framework: An analysis of country-level applicability of the Global Competency Framework/ Naoko Arakawa, Shigeo Yamamura, Catherine Duggan and Ian Bates, p. 396-404]
Abstract:
Background The importance and usefulness of competency frameworks (CFs) in pharmacy professional development is recognised globally. However, there is no national CF for pharmacists in Japan yet.
Objective This study was conducted to measure the level of relevance of behavioural statements of the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) to Japanese foundation-level pharmacy practice, aiming for developing a national framework for foundation-level pharmacists in Japan.
Methods A cross-sectional, anonymous, online self-completed survey was conducted during June and July 2018 in Japan. The questionnaire was adopted from the GbCF, translated into Japanese. A snowballing sampling approach was used. The relevance levels of the GbCF items were assessed by using 4-point Likert scales, and analysed by descriptive and inferential methods.
Results A total 604 useable responses were included in analyses. High levels of relevance levels were found in two clusters (‘pharmaceutical public health’ and ‘pharmaceutical care’), while the other two clusters (‘organisation and management’ and ‘professional/personal’) showed significantly low relevance (relevance = 89.6%, 82.5%, 59.6%, and 67.9%, respectively). The study found little engagement of the academic sector with framework, while the industry sector showed relevance to all clusters evenly. Regarding years working in sectors, there was no progression of relevance in ‘organisation and management’ and ‘professional/personal’ competencies during foundation years as well as very little professional/personal development.
Conclusions The study revealed specific competencies and behaviours which require modifications to adapt the GbCF into the Japanese pharmacy practice environment. This is a key step towards the development of a national framework, illustrating current Japanese foundation-level pharmacy practice compared with global standards. The findings will be used as a base for developing a framework for foundation-level pharmacists in Japan and address concerns such as pharmacist preparedness to advance in management roles and limited personal and professional development.
https://doi.org/10.1016/j.sapharm.2019.06.007 [Article Title: Key stakeholders’ views on the potential implementation of pharmacist prescribing: A qualitative investigation/ Tesnime Jebara, Scott Cunningham, Katie MacLure, Abdulrouf Pallivalapila, Ahmed Awaisu, Moza Al Hail and Derek Stewart, p. 405-414]
Abstract:
Background An accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown.
Objective To explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing.
Methods Qualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework.
Results Thirty-seven interviews were conducted with directors of medicine (n = 5), pharmacy (n = 6) and nursing (n = 5), healthcare policy developers (n = 6), healthcare academics (n = 9), and patient safety advocates (n = 6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists’ prescribing competence, and extensive engagement of stakeholders were considered crucial.
Conclusion There is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation. https://doi.org/10.1016/j.sapharm.2019.06.009 [Article Title: Cost-related nonadherence to medicines in people with multiple chronic conditions/ Tracey-Lea Laba, Lucy Cheng, Ashra Kolhatkar and Michael R. Law, p. 415-421]
Abstract:
Background Multimorbidity is common and frequently associated with medicine nonadherence. Although cost is a common reason for nonadherence, very little research has quantified cost-related nonadherence (CRNA) to medicines specifically in people with multimorbidity, the prevalence of CRNA for different conditions nor the impact of cost when prioritising treatment between conditions.
Objective To determine the extent of CRNA in people with multimorbidity and the patient characteristics associated with these behaviours.
Design and setting People reporting two or more chronic conditions responding to a rapid response module regarding prescription drug affordability fielded between January 1 and June 30 2016 in the Canadian Community Health Survey, a cross-sectional household survey.
Methods Ordinal logistic regression, adjusted for key sociodemographic, clinical and treatment related variables, of weighted population estimates of self-reported CRNA within one group of conditions, across multiple groups of conditions, or no CRNA.
Results 10.2% of 8420 Canadians with multimorbidity reported CRNA. The majority (61%) reported CRNA within one group of conditions, especially respiratory (16%) and mental health disorders (17%). CRNA was more common in younger adults, people without employer or association drug insurance plans, poorer health status, more chronic conditions, and increased out-of-pocket prescription costs. Having no prescription insurance was associated with a higher probability of CRNA across multiple groups of conditions.
Conclusions People with multimorbidity primarily forego medicines because of cost within one group of conditions. However, those without drug insurance extended these behaviours to multiple condition groups. Further work is needed to determine how people prioritise the conditions and treatments that are foregone because of cost, and how to best incorporate this information into treatment plans. https://doi.org/10.1016/j.sapharm.2019.06.008 [Article Title: Environmental and individual predictors of medication adherence among elderly patients with hypertension and chronic kidney disease: A geospatial approach/ Yun Han, Rajiv Saran, Steven R. Erickson, Richard A. Hirth, Kevin He and Rajesh Balkrishnan, p. 422-430]
Abstract: Background Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals’ medication-taking behaviors in patients.
Objective To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States.
Methods The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence.
Results A total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence.
Conclusions Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective. https://doi.org/10.1016/j.sapharm.2019.06.011 [Article Title: Medication rebates and health disparities: Mind the gap/ Leah L. Zullig, Bradi B. Granger, Helene Vilme, Megan M. Oakes and Hayden B. Bosworth, p. 431-433]
Abstract: Compared to white patients in the United States, people of racial and ethnic minority groups face higher rates of chronic disease including diabetes, obesity, stroke, cardiovascular disease and cancer. Minority groups are also less likely to receive medication therapy to manage complications of chronic disease as well as be adherent to these therapies. A recently announced proposed rule by the Department of Health and Human Services Office of the Inspector General (HHS OIG), which would discourage rebates between manufacturers and payers in favor of discounts directly provided to patients, has received significant attention for its anticipated impact on prescription drug pricing and reimbursement in Medicare. This commentary describes the proposed rule and how it may impact adherence among patients of racial minority groups through an illustrative case study and discussion. https://doi.org/10.1016/j.sapharm.2019.04.053