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Pharmacy, Volume 11, Issue 6 (December 2023) – 20 articles

Cover Story (view full-size image): Learning activities for student pharmacists to achieve professional identity formation (PIF) are essential to the pharmacy curriculum. This study explores the impact upon students’ PIF after viewing and reflecting upon a simulated pharmacist–patient encounter (PPE) video. The principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were featured in the counseling session, with some aspects intentionally performed well by the pharmacist, and the others needing improvement. The main themes of the impact upon students’ PIF included an increased awareness of counseling techniques, patient-friendly medical jargon, patients’ perspectives/empathy, positive and negative pharmacist role-modeling, and the value of observers. View this paper
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26 pages, 321 KiB  
Article
A Qualitative Evaluation of the Australian Community Pharmacy Agreement
Pharmacy 2023, 11(6), 188; https://doi.org/10.3390/pharmacy11060188 - 18 Dec 2023
Viewed by 1212
Abstract
The Australian Federal Government’s Community Pharmacy Agreement (Agreement), initiated in 1990 and renegotiated every five years with a pharmacy owners’ organisation, is the dominant policy directing community pharmacy. We studied the experience with the Agreements of 38 purposively selected individual pharmacists and others [...] Read more.
The Australian Federal Government’s Community Pharmacy Agreement (Agreement), initiated in 1990 and renegotiated every five years with a pharmacy owners’ organisation, is the dominant policy directing community pharmacy. We studied the experience with the Agreements of 38 purposively selected individual pharmacists and others of diverse backgrounds, using in-depth, semi-structured interviews. Although perceived to lack transparency in negotiation and operation, as well as paucity of outcome measures, the Agreements have generally supported the viability of community pharmacies and on balance, contributed positively to the public’s access to medicines. There were, however, contradictory opinions regarding the impact of the policy’s regulation of pharmacy locations, including the suggestion that they provide existing owners with an undue commercial advantage. A reported shortcoming of the Agreements was their impact on pharmacists’ abilities to expand their scopes of practice and assist patients to make better use of medicines, in part due to the funding being almost totally focused on supply-related functions. The support for programs such as medication management services was perceived to be limited, and opportunities for diversification in pharmacy practice appeared constrained. Future pharmacy policy developed by the government could be more inclusive of a diverse range of stakeholders, seek to better utilise pharmacists’ expertise, and have a greater focus on health outcomes. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
32 pages, 1047 KiB  
Review
Stakeholder Perspectives of the Inflation Reduction Act’s (2022) Impact on Prescription Drugs: A Narrative Review
Pharmacy 2023, 11(6), 187; https://doi.org/10.3390/pharmacy11060187 - 17 Dec 2023
Viewed by 1427
Abstract
In this review, we examine the impact of the Inflation Reduction Act (IRA) of 2022 on pharmaceutical drugs in the United States, drawing on a diverse range of sources to understand the perceptions of multiple stakeholders and professionals. Findings suggest that the Act, [...] Read more.
In this review, we examine the impact of the Inflation Reduction Act (IRA) of 2022 on pharmaceutical drugs in the United States, drawing on a diverse range of sources to understand the perceptions of multiple stakeholders and professionals. Findings suggest that the Act, while aiming to control price inflation, has had a multifaceted impact on the pharmaceutical sector. Stakeholders, including pharmaceutical companies, healthcare providers, patient advocacy groups, and policymakers, offered varied perspectives: while some laud the Act for its potential in controlling runaway drug prices and making healthcare more accessible, others raise concerns about possible reductions in drug innovation, disruptions to supply chains, and the sustainability of smaller pharmaceutical companies. The review identified four underlying constructs (themes) in the literature surrounding healthcare stakeholders’ perceptions of the IRA’s impact upon prescription drugs: pricing and/or dictation pricing issues, topics related to patent law and pharmaceuticals, processes surrounding the IRA’s (2022) rules and regulations, and potential threats to the pharmaceutical industry concerning the research and development of future medications. The complex interplay of the Act’s implications underscores the importance of ongoing assessment and potential iterative policy refinements as implementation endures. Full article
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14 pages, 994 KiB  
Review
The Intersection between Pharmacogenomics and Health Equity: A Case Example
Pharmacy 2023, 11(6), 186; https://doi.org/10.3390/pharmacy11060186 - 05 Dec 2023
Viewed by 1395
Abstract
Pharmacogenomics (PGx) and the study of precision medicine has substantial power to either uplift health equity efforts or further widen the gap of our already existing health disparities. In either occurrence, the medication experience plays an integral role within this intersection on an [...] Read more.
Pharmacogenomics (PGx) and the study of precision medicine has substantial power to either uplift health equity efforts or further widen the gap of our already existing health disparities. In either occurrence, the medication experience plays an integral role within this intersection on an individual and population level. Examples of this intertwined web are highlighted through a case discussion. With these perspectives in mind, several recommendations for the research and clinical communities are highlighted to promote equitable healthcare with PGx integrated. Full article
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14 pages, 730 KiB  
Review
Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review
Pharmacy 2023, 11(6), 185; https://doi.org/10.3390/pharmacy11060185 - 30 Nov 2023
Viewed by 2172
Abstract
Background: Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD. Aim: To characterize peer [...] Read more.
Background: Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD. Aim: To characterize peer reviewed literature on the role of pharmacists in supporting medication adherence of patients with chronic kidney disease and highlight the impact they might have in the health outcomes for patients. Method: This review was performed in accordance with the Scoping Review Framework outlined in the Joanna Briggs Institute Reviewer’s Guide. Four electronic databases were searched (Medline (Ovid), Emcare, Scopus and Web of Science) for all relevant literature published up until November 2022. A total of 32 studies were reviewed against an exclusion and inclusion criteria, with findings from each study categorized into barriers, interventions, perceptions, financial implications and outcomes. Results: Eight eligible studies were identified, where pharmacists’ interventions including medication reconciliation, medicine reviews, patient counselling and disease state and medication education, were all reported to have a positive effect on medication adherence. Although pharmacy services in chronic kidney disease were acceptable to patients and pharmacists, these services were under-utilized and limited by logistical constraints, including staffing shortages and time limitations. Patient education supplemented with education tools describing disease states and medications was reported to increase patient adherence to medication regimes. Conclusions: Pharmacist-led interventions play an integral role in improving medication adherence in patients with chronic kidney disease, with their inclusion in renal care settings having the potential to improve outcomes for patients. Full article
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47 pages, 707 KiB  
Review
Uncovering the Hidden Burden of Pharmaceutical Poisoning in High-Income and Low-Middle-Income Countries: A Scoping Review
Pharmacy 2023, 11(6), 184; https://doi.org/10.3390/pharmacy11060184 - 24 Nov 2023
Cited by 1 | Viewed by 1430
Abstract
Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths annually. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed [...] Read more.
Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths annually. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1 January 2011 to 31 December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. Toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes due to poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research. Full article
(This article belongs to the Special Issue Pharmacy Reviews in 2022)
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12 pages, 677 KiB  
Article
Patterns of Drug Utilization and Self-Medication Practices: A Cross Sectional Study
Pharmacy 2023, 11(6), 183; https://doi.org/10.3390/pharmacy11060183 - 22 Nov 2023
Viewed by 1485
Abstract
Background: Self-medication (SM) is a growing phenomenon worldwide that has recently been classified as one of the most serious public health problems. SM can result in an incorrect self-diagnosis, inappropriate treatment, potential adverse reactions, interactions, and the masking of more sinister disease. Objectives: [...] Read more.
Background: Self-medication (SM) is a growing phenomenon worldwide that has recently been classified as one of the most serious public health problems. SM can result in an incorrect self-diagnosis, inappropriate treatment, potential adverse reactions, interactions, and the masking of more sinister disease. Objectives: To assess the prevalence of SM practices amongst healthcare professionals and the general population in Saudi Arabia and to identify the sociodemographic contributing factors to this practice. Methods: A total of 540 participants were enrolled in this study. Participants were asked to complete the study questionnaire comprising two sections to gather demographic information and to collect data regarding SM practice. Results: The prevalence of SM practice among the study participants was 78.6%, and it was the highest among the middle age groups of (21–40 years) 82% compared to the younger and older age groups. The observed prevalence was higher in the female participants (53.7%) and those who live alone. Type of education did not affect the attitude of SM (p = 0.374); however, level of education strongly affected the prevalence of the SM, with higher incidence among university graduates (p < 0.001). Analgesics with antipyretics properties were the most self-medicated drugs. Patients considering their illnesses minor was the main reason behind the high prevalence of this practice. Among healthcare professions the highest prevalence of SM was found among pharmacists (95%), followed by physicians, nurses, and other medical practitioners. Conclusion: The general population should be better educated and made conscious about the consequences, risks, and side effects of SM. Awareness campaigns may prove to be useful in this matter, allowing the patient to consider the appropriateness of this practice. Individuals in the age group of 21–40 years, females, and those who live alone should be considered priority target populations in the design and implementation of SM awareness projects. Full article
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16 pages, 979 KiB  
Review
The Association of Serotonin Toxicity with Combination Linezolid–Serotonergic Agent Therapy: A Systematic Review and Meta-Analysis
Pharmacy 2023, 11(6), 182; https://doi.org/10.3390/pharmacy11060182 - 20 Nov 2023
Viewed by 1390
Abstract
Linezolid (LZD) has a longstanding reported association with the onset of serotonin toxicity (ST), secondary to drug–drug interactions with serotoninergic agents. There have been no conclusive data supporting the incidence or contributing risk factors to date. The study evaluated the incidence of ST [...] Read more.
Linezolid (LZD) has a longstanding reported association with the onset of serotonin toxicity (ST), secondary to drug–drug interactions with serotoninergic agents. There have been no conclusive data supporting the incidence or contributing risk factors to date. The study evaluated the incidence of ST in patients treated with LZD and serotonergic agents concomitantly versus LZD alone. The secondary objectives included a comparison of ST incidence in patients treated with one serotonergic agent + LZD versus two or more serotonergic agents + LZD. The studies used for this meta-analysis were retrieved from PubMed, Scopus, and Google Scholar. All studies including a comparison between LZD alone and LZD + a serotonergic agent published between 1 January 2000 and 1 October 2023 and meeting the quality standards were considered for inclusion. Fourteen studies were identified, with five meeting all inclusion and exclusion criteria with no significant heterogeneity. For the analysis of LZD monotherapy vs. SA combination therapy, four studies with 6025 patients total were analyzed and yielded an odds ratio of 1.78 (CI [1.04, 3.02]; I2 = 49%; GRADE certainty: low). Four studies and 2501 patients were included in the analysis of one versus more than one SA with an odds ratio of 5.18 (CI [1.05, 25.49]; I2 = 44.87; GRADE certainty: moderate). The Newcastle–Ottawa score, visual inspection of the funnel plot, and Egger’s statistic were used to evaluate quality and heterogeneity. The Peto method was used to calculate the summary odds ratios. All analyses were performed using Comprehensive Meta-Analysis version 3.0 and R, while GRADE was used to evaluate the quality of the final recommendation. The number of concomitant serotonergic agents may play a role in the development of serotonin toxicity in patients prescribed linezolid. In patients requiring linezolid therapy and serotonergic agents, risk versus benefit analysis should pay attention to the number of interacting drugs. Full article
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10 pages, 247 KiB  
Article
Norwegian Community Pharmacists’ Experiences with COVID-19 Vaccination—A Qualitative Interview Study
Pharmacy 2023, 11(6), 181; https://doi.org/10.3390/pharmacy11060181 - 19 Nov 2023
Viewed by 1513
Abstract
Background: Immunising the population became important during the COVID-19 pandemic. Community pharmacies in Norway collaborated with municipalities to offer a vaccination services to increase the vaccination rate. Only some pharmacies were allowed to offer this service in the pandemic’s early phase. This study [...] Read more.
Background: Immunising the population became important during the COVID-19 pandemic. Community pharmacies in Norway collaborated with municipalities to offer a vaccination services to increase the vaccination rate. Only some pharmacies were allowed to offer this service in the pandemic’s early phase. This study learns about pharmacists’ experiences during this first period of COVID-19 vaccination services in community pharmacies, which is relevant for informing policy and organisational decision makers about the feasibility and acceptability of pharmacy vaccination. Methods: Individual interviews were conducted with 13 pharmacists in community pharmacies offering a COVID-19 vaccination service. Informants were recruited from the eleven pharmacies that first offered COVID-19 vaccinations. The key themes in the interview were COVID-19 vaccination, what the pharmacists think about the vaccination service, and how it is performed. The data were analysed using systematic text condensation. Results: Three main themes and eight subthemes were identified. The main themes were creative solutions, organising and making resources available, and professionally satisfying and an important mission. The interviewed pharmacists experienced the COVID-19 vaccination service as hectic but something important that they would prioritise. They experienced their efforts to be substantial in the pandemic’s early phase. Conclusions: Pharmacists in community pharmacies were a resource for increasing the vaccination rate during the COVID-19 pandemic. The pharmacies’ easy accessibility and the pharmacists’ ability to adjust their daily workflow for a new service should be considered when an expanded healthcare service is needed. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
5 pages, 542 KiB  
Editorial
The Potential Roles of Pharmacists in the Clinical Implementation of Pharmacogenomics
Pharmacy 2023, 11(6), 180; https://doi.org/10.3390/pharmacy11060180 - 19 Nov 2023
Cited by 1 | Viewed by 2232
Abstract
The field of pharmacogenomics is at the forefront of a healthcare revolution, promising to usher in a new era of precision medicine [...] Full article
(This article belongs to the Special Issue The Emerging Role of Pharmacists in Pharmacogenomics)
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10 pages, 241 KiB  
Article
Patients Are Using Dietary Supplement for the Treatment of Their Diseases without Consultation with Their Physicians and Pharmacists
Pharmacy 2023, 11(6), 179; https://doi.org/10.3390/pharmacy11060179 - 17 Nov 2023
Viewed by 1665
Abstract
Inappropriate use of dietary supplements by patients might exacerbate their diseases. The aim of this study was to clarify the situation of dietary supplement use for disease treatment among patients. A cross-sectional online questionnaire survey was conducted between 18 and 30 November 2022. [...] Read more.
Inappropriate use of dietary supplements by patients might exacerbate their diseases. The aim of this study was to clarify the situation of dietary supplement use for disease treatment among patients. A cross-sectional online questionnaire survey was conducted between 18 and 30 November 2022. A preliminary survey revealed that the proportion of patients who used dietary supplements to treat their disease ranged from 7.7% (cancer) to 28.2% (menopausal disorder). In the actual survey, across all diseases, patients who used dietary supplements for treatment purposes were satisfied with their therapeutic effects. Information obtained via the internet was the most common reason given for starting to use supplements. The proportions of patients who used supplements concurrently with medicine ranged from 25.4% (liver disease) to 72.2% (mental disorder). Most users of supplements did not consult with their physicians or pharmacists about them. However, patients preferred face-to-face consultation with a physician or pharmacist when discussing the concomitant use of medicines. In conclusion, the role of pharmacists is important for the appropriate use of dietary supplements among patients, especially concomitant use with medicines. More awareness about dietary supplements is needed for healthcare professionals to consult with their patients. Full article
9 pages, 415 KiB  
Brief Report
An EMR-Based Approach to Determine Frequency, Prescribing Pattern, and Characteristics of Patients Receiving Drugs with Pharmacogenomic Guidelines
Pharmacy 2023, 11(6), 178; https://doi.org/10.3390/pharmacy11060178 - 17 Nov 2023
Viewed by 1556
Abstract
(1) Background: This retrospective analysis utilizing electronic medical record (EMR) data from a tertiary integrated health system sought to identify patients and prescribers who would benefit from pharmacogenomic (PGx) testing based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: EMR data from [...] Read more.
(1) Background: This retrospective analysis utilizing electronic medical record (EMR) data from a tertiary integrated health system sought to identify patients and prescribers who would benefit from pharmacogenomic (PGx) testing based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: EMR data from a clinical research data warehouse were analyzed from 845,518 patients that had an encounter between 2015 and 2019 at an academic medical center. Data were collected for 42 commercially available drugs with 52 evidence-based PGx guidelines from CPIC. Provider data were obtained through the EMR linked by specialty via national provider identification (NPI) number. (3) Results: A total of 845,518 patients had an encounter in the extraction period with 590,526 medication orders processed. A total of 335,849 (56.9%) patients had medication orders represented by CPIC drugs prescribed by 2803 providers, representing 239 distinct medications. (4) Conclusions: The results from this study show that over half of patients were prescribed a CPIC actionable medication from a variety of prescriber specialties. Understanding the magnitude of patients that may benefit from PGx testing, will enable the development of preemptive testing processes, physician support strategies, and pharmacist workflows to optimize outcomes should a PGx service be implemented. Full article
(This article belongs to the Collection Pharmacy Services)
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15 pages, 297 KiB  
Article
Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists’ Professional Identity Formation Using a Simulated Pharmacist–Patient Encounter
Pharmacy 2023, 11(6), 177; https://doi.org/10.3390/pharmacy11060177 - 16 Nov 2023
Viewed by 1339
Abstract
Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists’ PIF after viewing, analyzing, and reflecting upon a [...] Read more.
Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists’ PIF after viewing, analyzing, and reflecting upon a simulated pharmacist–patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient’s varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students’ self-reflections, which most often referenced effective pharmacist–patient communication and enacting optimal patient care. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
13 pages, 8268 KiB  
Project Report
Descriptive Report of a Pharmacist-Directed Preconception Care Outreach Program in a Rural Maternity Care Desert
Pharmacy 2023, 11(6), 176; https://doi.org/10.3390/pharmacy11060176 - 10 Nov 2023
Viewed by 1284
Abstract
Preconception care is the prevention and management of biomedical, behavioral, and social risk factors to improve pregnancy outcomes and overall health for reproductive-age patients. A community-based pharmacist-directed preconception care outreach program was developed for women ages 18–45 years living in a rural maternity [...] Read more.
Preconception care is the prevention and management of biomedical, behavioral, and social risk factors to improve pregnancy outcomes and overall health for reproductive-age patients. A community-based pharmacist-directed preconception care outreach program was developed for women ages 18–45 years living in a rural maternity care desert to help them identify potential health risks and provide them with the needed education, counseling, or referrals to address these risks. Supervised student pharmacists, pharmacy practice residents, and pharmacy faculty from a local University collaborated to provide this program at four community events in conjunction with a mobile health clinic. A summative evaluation was performed after the events concluded, modeled after the RE-AIM framework. One hundred and forty-one women were served by the outreach program. Nearly 98% reported at least one preconception health risk, and 45% reported a barrier preventing them from being able to have an appointment with a physician in the last year. The outreach program was feasible to implement and can be adapted to different settings. Pharmacist-directed outreach programs in rural communities may benefit patients who are not receiving or do not have access to such care in traditional healthcare settings. Full article
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32 pages, 6333 KiB  
Review
Efficacy and Tolerance of Antipsychotics Used for the Treatment of Patients Newly Diagnosed with Schizophrenia: A Systematic Review and Meta-Analysis
Pharmacy 2023, 11(6), 175; https://doi.org/10.3390/pharmacy11060175 - 10 Nov 2023
Viewed by 1534
Abstract
This systematic review compared the efficacy and tolerance of oral antipsychotics (APDs) used in the treatment of schizophrenia following the PRISMA-P© statement (n = 21). The primary outcomes of interest were clinical response measured with symptoms’ improvement, tolerance to side effects and [...] Read more.
This systematic review compared the efficacy and tolerance of oral antipsychotics (APDs) used in the treatment of schizophrenia following the PRISMA-P© statement (n = 21). The primary outcomes of interest were clinical response measured with symptoms’ improvement, tolerance to side effects and discontinuation reasons. There was better individual patients’ response to aripiprazole vs. ziprasidone and quetiapine ((CDSS p = 0.04), BPRS p = 0.02, YMRS p = 0.001) and ziprasidone vs. quetiapine (CGI p = 0.02, CDSS p = 0.02). Aripiprazole was more tolerated than risperidone, ziprasidone and quetiapine (p < 0.05). Quetiapine was more tolerated than aripiprazole, ziprasidone and risperidone (p < 0.05). Ziprasidone was more tolerated than quetiapine haloperidol and olanzapine (p < 0.05). Risperidone was more tolerated than olanzapine (p = 0.03) and haloperidol was more tolerated than olanzapine and quetiapine (p < 0.05). Olanzapine caused less discontinuation than quetiapine; quetiapine caused less discontinuation than ziprasidone, aripiprazole and haloperidol; ziprasidone caused less discontinuation than quetiapine, aripiprazole and haloperidol; aripiprazole caused less discontinuation than quetiapine, ziprasidone and olanzapine and olanzapine caused less discontinuation than ziprasidone and haloperidol (p < 0.05). It was concluded that individual patient clinical response, tolerance to side effects and life-threatening side effects remain the most reliable basis for selecting and continuing the use of APD. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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17 pages, 529 KiB  
Article
Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications
Pharmacy 2023, 11(6), 174; https://doi.org/10.3390/pharmacy11060174 - 09 Nov 2023
Viewed by 1418
Abstract
Background: Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event [...] Read more.
Background: Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. Methods: This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0–2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. Results: From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0–2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). Conclusion: The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines. Full article
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16 pages, 686 KiB  
Article
Factors Influencing the Implementation of a New Pharmacist Prescribing Service in Community Pharmacies
Pharmacy 2023, 11(6), 173; https://doi.org/10.3390/pharmacy11060173 - 06 Nov 2023
Viewed by 1380
Abstract
The pharmacist prescribing service was legally permitted in 2019 in Switzerland to face challenges in the health system; however, there has been a lack of implementation. The aims of this study were to identify implementation factors and to evaluate pharmacy association interventions that [...] Read more.
The pharmacist prescribing service was legally permitted in 2019 in Switzerland to face challenges in the health system; however, there has been a lack of implementation. The aims of this study were to identify implementation factors and to evaluate pharmacy association interventions that aim to support implementation. A qualitative study with two methods was carried out: (1) twelve semi-structured interviews with community pharmacists were recorded, transcribed, and a thematic analysis was carried out using the Consolidated Framework of Implementation Research (CFIR); (2) questionnaires were submitted to the six pharmacy associations of French-speaking Switzerland. The main barriers found were non-reimbursement by health insurance companies, medications’ lack of clinical relevance, a negative perception of GPs, and a lack of time. The main facilitators were the availability of service information, pharmacies belonging to chains/groups, a reduction in the medical consultation burden, and the accessibility of pharmacies. Five associations answered, revealing different initiatives supporting implementation, but none of them had strategies at the political level nor communication strategies aimed at patients or GPs. Based on the CFIR, the most frequent implementation factors were highlighted, and this classification facilitates the transposition of the results to other contexts. The results will allow the development of targeted strategies and add the role of the pharmacy associations, which should be considered in future studies. Full article
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19 pages, 588 KiB  
Review
A Scoping Review of Educator Proficiency Interventions in Pharmacy Education Illustrated by an Interdisciplinary Model Integrating Pedagogical Theories into Practice
Pharmacy 2023, 11(6), 172; https://doi.org/10.3390/pharmacy11060172 - 30 Oct 2023
Viewed by 1426
Abstract
Pharmacy schools recognize the need for flexibility and comprehensive curricular transformation with a competency-based focus to effectively prepare for the evolving practitioner competencies and challenges of the pharmacy profession. The curricular implementation of evidence-based teaching and learning theories and practices demands educator proficiency [...] Read more.
Pharmacy schools recognize the need for flexibility and comprehensive curricular transformation with a competency-based focus to effectively prepare for the evolving practitioner competencies and challenges of the pharmacy profession. The curricular implementation of evidence-based teaching and learning theories and practices demands educator proficiency through skills development with indispensable faculty leadership support. Our scoping review of online databases and pharmacy education-related journals aims to identify faculty development interventions or teaching proficiency programs that integrate educational and pedagogical theories. Original studies and reviews published between 2010 and 2022 were screened based on four inclusion criteria. Thirty-four manuscripts were eligible for full-text analysis, of which seven results referenced target faculty pedagogy knowledge development. Nine key messages, as Results Statements, synthesize and provide a framework for our results analysis. An ongoing Hungarian intervention model of comprehensive faculty development with strong interdisciplinary cooperation is discussed in our study to illustrate the applicability of the Results Statements through each stage of the process. Educator motivation and relatedness to students or awareness of the educator roles are intrinsic factors, which may not be easily detectable yet significantly impact teaching proficiency and student learning outcomes. The integration of evidence-based pedagogical knowledge and training in educator proficiency development contributes to the sustainability and cost-effectiveness of faculty interventions. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
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22 pages, 606 KiB  
Review
Insomnia Medication Use by University Students: A Systematic Review
Pharmacy 2023, 11(6), 171; https://doi.org/10.3390/pharmacy11060171 - 27 Oct 2023
Viewed by 1910
Abstract
Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication [...] Read more.
Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected. Full article
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13 pages, 937 KiB  
Article
Are Community Pharmacists Ready to Deliver Pharmacogenomics Testing Services?
Pharmacy 2023, 11(6), 170; https://doi.org/10.3390/pharmacy11060170 - 26 Oct 2023
Viewed by 1352
Abstract
This study assesses the readiness and willingness of community pharmacists in England to deliver the pharmacogenomic (PG) testing service. A survey covering demographics and four key themes including awareness and training, general views and experience, barriers, willingness, and confidence was distributed to community [...] Read more.
This study assesses the readiness and willingness of community pharmacists in England to deliver the pharmacogenomic (PG) testing service. A survey covering demographics and four key themes including awareness and training, general views and experience, barriers, willingness, and confidence was distributed to community pharmacies in the boroughs of Croydon and Sutton in South London. A total of 51 pharmacists responded to the survey. The study revealed that most respondents had a limited familiarity or understanding of pharmacogenomics (n = 32, 63%). Moreover, on average, around 60% of participants were unable to accurately identify drugs that currently have or could have potentials for PG testing. They indicated that their pharmacogenomic education and training is inadequate, with only 2/51 pharmacists reported receiving relevant training. Time constraints, shortage of staff and lack of knowledge were identified as barriers that could hinder the implementation of PG. Over 60% of respondents expressed willingness to provide PG testing service after receiving adequate training. The study found that currently not all community pharmacists are prepared to provide PG testing services, with newly qualified pharmacists appearing to have an upper hand when it comes to understanding the subject. Therefore, consistent, and uniform training is required to allow community pharmacists with all years of experience to equally contribute to the implementation of PG testing. Full article
(This article belongs to the Collection Pharmacy Services)
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12 pages, 689 KiB  
Review
Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis
Pharmacy 2023, 11(6), 169; https://doi.org/10.3390/pharmacy11060169 - 24 Oct 2023
Viewed by 1689
Abstract
Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with [...] Read more.
Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with <10% resistance among urinary pathogens. However, increasing antibiotic resistance rates among Escherichia coli and other Enterobacterales to fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), and beta-lactams has left patients without reliable oral antibiotic treatment options for APN. This narrative review proposes using precision medicine concepts to improve empirical antibiotic therapy for APN in ambulatory settings. Whereas resistance rates to a particular antibiotic class may exceed 10% at the population-based level, the predicted antibiotic resistance rates based on patient-specific risk factors fall under 10% in many patients with APN on the individual level. The utilization of clinical tools for the prediction of fluoroquinolones, TMP-SMX, and third-generation cephalosporin resistance improves the ambulatory antibiotic management of APN. It may also reduce the need to switch antibiotic therapy later based on the in vitro antibiotic susceptibility testing results of bacterial isolates in urinary cultures. This approach may mitigate the burden of increasing antibiotic resistance in the community by ensuring that the initial antibiotic prescribed has the highest likelihood of treating APN appropriately. Full article
(This article belongs to the Special Issue Pharmacy Reviews in 2022)
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