Pharmaceutical Care Services in Pharmacy Practice

A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: closed (1 September 2023) | Viewed by 27478

Special Issue Editors

Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
Interests: pharmaceutical care; medication management; pharmacy services
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
Interests: medication management; health care; pharmaceutical care; pharmacy services
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Medicines are among the most common medical interventions for the treatment, prevention, and therapy of chronic diseases. Additionally, a continuous increase in the prevalence of chronic medical conditions is expected alongside the accompanying polypharmacy. This scenario renders chronic patients at an increased risk of experiencing drug therapy problems, hence adding substantial costs to the health care system and exceeding the amount spent on the medications themselves. Thus, to ensure patients’ optimal medication use and improve their clinical outcomes, comprehensive and systematic management of medications is deemed crucial. In the last few decades, pharmacists have played a crucial role in the medication management through provision of various pharmaceutical services. Pharmacy services provided by trained pharmacists can bridge this gap by increasing rational drug use, improving the prescribing of medicines, and reducing the unnecessary and often harmful use of medications and the resulting complications. In the era of aging populations, polypharmacy, multiple chronic conditions, complex and decreasingly manageable therapy regimens, pharmaceutical services (e.g., Comprehensive Medication Management (CMM) services) are especially important for chronic elderly patients taking five or more medicines, often potentially inappropriate ones, who are at an increased risk of experiencing medication errors, ADEs, duplications of therapy and detrimental interactions, and who often fail to reach therapy goals.

We invite you to share your research in relation to the role of pharmaceutical care practitioner providing medication management in various clinical environments (community pharmacy, hospital, primary care-based CMM services). Manuscripts in the form of articles, reviews, meta-analyses, commentaries, and opinion pieces will be considered and accepted for publication. We invite research papers that are both qualitative and quantitative in nature. We hope this Special Issue will inspire pharmacists and researchers to share their own practices and adopt new approaches and innovate to make improvements in health care provision.

Dr. Iva Mucalo
Dr. Andrea Brajkovic
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pharmaceutical care
  • medication management
  • comprehensive medication management services
  • pharmacy services
  • primary care
  • drug therapy problems
  • potentially inappropriate medicines
  • polypharmacy
  • clinical outcomes

Published Papers (12 papers)

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14 pages, 282 KiB  
Article
Migraine Management in Community Pharmacies: Knowledge, Attitude and Practice Patterns of Pharmacists in Saudi Arabia
by Fahad Alzahrani, Yaser M. Alahmadi, Sultan S. Al Thagfan, Sultan Alolayan and Hossein M. Elbadawy
Pharmacy 2023, 11(5), 155; https://doi.org/10.3390/pharmacy11050155 - 24 Sep 2023
Viewed by 1904
Abstract
In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the [...] Read more.
In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the northwestern part of Saudi Arabia. A cross-sectional study was carried out between June and September 2022 among 215 Saudi community pharmacists. Data analysis was performed by descriptive and inferential statistics using SPSS version 27. Most community pharmacists (87.9%) feel that migraine management is essential to their practice, and 83.3% suggest between one and five over-the-counter (OTC) migraine products daily. Among the study pharmacists, 83.7% feel migraine patients should try OTC before prescription medications. Only 9.3% of the community pharmacists do not believe that migraine is a neurological disorder. The medications most prescribed for migraine were triptans, representing 52.1% of prescriptions. There were significant differences between the gender of the pharmacists and their knowledge, attitude, and practice overall score (p-value = 0.04). Male pharmacists exhibited higher knowledge, attitude, and practice scores than female pharmacists. Although many community pharmacists acknowledge their expertise and involvement in managing migraines, there is a requirement for further education and training to enhance their capacity to offer complete care to migraine patients. Pharmacists should also consider non-pharmacological interventions and complementary therapies when treating migraine symptoms. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
12 pages, 280 KiB  
Article
Community Pharmacists’ Knowledge, Attitudes and the Perceived Safety and Effectiveness of Melatonin Supplements: A Cross-Sectional Survey
by Mansour Tobaiqy, Faris A. AlZahrani, Abdulrahman S. Hassan, Abdullah H. Alirbidi, Osama A. Alraddadi, Omar A. AlSadah, Mohammad B. Yamani and Sulafa T. Alqutub
Pharmacy 2023, 11(5), 147; https://doi.org/10.3390/pharmacy11050147 - 15 Sep 2023
Cited by 1 | Viewed by 4141
Abstract
Melatonin, which is classified as a dietary supplement by the Saudi Food and Drug Authority, is used to manage sleep disorders. In this study, community pharmacists’ knowledge and attitudes about dispensing melatonin supplements and the perceived safety and effectiveness of melatonin were assessed. [...] Read more.
Melatonin, which is classified as a dietary supplement by the Saudi Food and Drug Authority, is used to manage sleep disorders. In this study, community pharmacists’ knowledge and attitudes about dispensing melatonin supplements and the perceived safety and effectiveness of melatonin were assessed. A cross-sectional survey of community pharmacists in Jeddah, Saudi Arabia was conducted from March–June 2023. Community pharmacists’ knowledge and attitudes towards prescribing and dispensing melatonin supplements, the methods of dispensing melatonin supplements (prescription, over the counter, self-administered), indications, ages of users, dosage forms, and adverse drug reactions related to melatonin use among consumers were surveyed using a questionnaire. Potential participants were approached face to face, a questionnaire was administered to those agreeing to participate in the study, and responses were recorded electronically. The response rate of the 300 community pharmacists who participated in this study was 83.5%. The mean age of participants was 33.6 years, and 89.3% (n = 268) of community pharmacists reported dispensing melatonin supplements. Self-medication and over the counter (n = 213; 71.2%) were the most common dispensing and prescribing patterns (p = 0.001). Awareness rates about melatonin supplement pharmacokinetics and pharmacodynamics among community pharmacists were 38% and 37%, respectively. Despite its popularity, community pharmacists reported relatively low rates of awareness of melatonin supplement pharmacokinetics and pharmacodynamics. Further attention to this issue is needed. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
22 pages, 696 KiB  
Article
Pharmacists and Pharmacy Technicians’ Perceptions of Scopes of Practice Employing Agency Theory in the Management of Minor Ailments in Central Indonesian Community Pharmacies: A Qualitative Study
by Vinci Mizranita, Jeffery David Hughes, Bruce Sunderland and Tin Fei Sim
Pharmacy 2023, 11(5), 132; https://doi.org/10.3390/pharmacy11050132 - 22 Aug 2023
Viewed by 1407
Abstract
Community pharmacy staff assist in the management of minor ailments. Agency Theory underpins relationships between health professionals and patients. This study explores pharmacists’ and pharmacy technicians’ perceived scopes of practice of minor ailment services in community pharmacies. Twelve one-on-one semi-structured interviews used an [...] Read more.
Community pharmacy staff assist in the management of minor ailments. Agency Theory underpins relationships between health professionals and patients. This study explores pharmacists’ and pharmacy technicians’ perceived scopes of practice of minor ailment services in community pharmacies. Twelve one-on-one semi-structured interviews used an open-ended interview guide for each cohort of community pharmacists and pharmacy technicians, between June and July 2021. Purposive sampling selected a diversity of pharmacists and pharmacy technicians. Interviews were transcribed verbatim, thematically analysed assisted by NVivo version 20. Agency Theory aided the interpretation. Three main themes emerged: (1) inconsistencies in practice, (2) the lack of understanding of the scopes of practice of pharmacists and pharmacy technicians, and (3) provision of prescription-only medicines for some minor ailments or to fulfil patient requests. Several sub-themes included pharmacy staff involvement, education and training, provision of prescription-only medicines, and weak regulatory enforcement. Agency Theory indicated pharmacy patients (principals) delegated authority to pharmacists and pharmacy technicians (agents), which was confused by partial pharmacist absence. The lack of defined scopes of practice for pharmacists and pharmacy technicians disrupted established professional relationships. The scopes of practice and roles of the pharmacist and pharmacy technicians should be clearly defined, assisted by practice guidelines. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
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18 pages, 1826 KiB  
Article
Development, Feasibility, Impact and Acceptability of a Community Pharmacy-Based Diabetes Care Plan in a Low–Middle-Income Country
by Fatima S. Abdulhakeem Ikolaba, Ellen I. Schafheutle and Douglas Steinke
Pharmacy 2023, 11(4), 109; https://doi.org/10.3390/pharmacy11040109 - 26 Jun 2023
Viewed by 1401
Abstract
Informed by existing research, mostly from high-income countries, this study aimed to develop and test the feasibility of a community pharmacy person-centred goal-setting intervention for people living with type 2 diabetes in a low–middle-income country—Nigeria. The Medical Research Council (MRC) guidance for developing [...] Read more.
Informed by existing research, mostly from high-income countries, this study aimed to develop and test the feasibility of a community pharmacy person-centred goal-setting intervention for people living with type 2 diabetes in a low–middle-income country—Nigeria. The Medical Research Council (MRC) guidance for developing complex interventions framed the intervention development. Patients participated in monthly community pharmacist consultations over six months. Self-reported and clinical outcome measures were collected at baseline and study completion and analysed in STATA V.14. Twenty pharmacists in 20 pharmacies completed the research and enrolled 104 patients. Of these, 89 patients had complete study data, and 70 patients also completed a post-study evaluation questionnaire. In addition, 15 patients and 10 pharmacists were interviewed. All outcome measures showed statistically significant improvements (p < 0.05). Clinical outcomes (BMI, waist circumference, and fasting plasma glucose) improved significantly. Mean patient activation measure (PAM©), quality of life (EQ-VAS©), and medication adherence improved from baseline to study completion. Eighty-eight per cent of questionnaire respondents were satisfied with the service. Interviews indicated care plan acceptability, patient satisfaction, empowerment, and service enthusiasm. Identified barriers to the consultations included time and technology. This study developed a feasible, effective, well-perceived community pharmacy diabetes care plan in Nigeria. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
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12 pages, 524 KiB  
Article
Antimicrobial Stewardship and Dose Adjustment of Restricted Antimicrobial Drugs in Hospital Setting
by Iva Vlak, Ivana Samardžić, Ivana Marinović, Nikolina Bušić and Vesna Bačić Vrca
Pharmacy 2023, 11(2), 68; https://doi.org/10.3390/pharmacy11020068 - 2 Apr 2023
Viewed by 2170
Abstract
Antimicrobial consumption is increasing. In order to maximize the effectiveness of antimicrobial stewardship and provide safe and optimal use of restricted antimicrobial drugs, renal dosing should be evaluated. The aim of this study was to determine the prevalence of restricted antimicrobial drugs that [...] Read more.
Antimicrobial consumption is increasing. In order to maximize the effectiveness of antimicrobial stewardship and provide safe and optimal use of restricted antimicrobial drugs, renal dosing should be evaluated. The aim of this study was to determine the prevalence of restricted antimicrobial drugs that required dose adjustment according to renal function. A retrospective, consecutive study was conducted at University Hospital Dubrava. This study analyzed requests for restricted antimicrobial drugs (n = 2890) during a 3-month period. Requests for antimicrobial agents were evaluated by the antimicrobial therapy management team (A-team). This study included 412 restricted antimicrobial drug requests requiring dose adjustment, of which 39.1% did not have an adjusted dose. Meropenem, Ciprofloxacin, Piperacillin/Tazobactam, Vancomycin, Colistin and the antimycotic Fluconazole were the most frequent restricted antimicrobial drugs that required dose adjustment according to impaired renal function. The results of this research highlight the importance of the A-team in the optimization of restricted antimicrobial therapy. Non-adjusted doses of restricted antimicrobial drugs increase the possibility of adverse drug reactions and therefore jeopardize pharmacotherapy outcomes and patient safety. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
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15 pages, 792 KiB  
Article
Medication-Related Complaints in Residential Aged Care
by Juanita L. Breen, Kathleen V. Williams and Melanie J. Wroth
Pharmacy 2023, 11(2), 63; https://doi.org/10.3390/pharmacy11020063 - 23 Mar 2023
Viewed by 3031
Abstract
Complaints reflect a person’s or family’s experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas [...] Read more.
Complaints reflect a person’s or family’s experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: ‘pain management’, ‘sedation’, and ‘infectious disease/infection control’. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
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8 pages, 203 KiB  
Article
Providers’ Perceived Value of Clinical Pharmacist and Technician Services within Primary Care Clinics
by Alan Abbinanti, Stacey Slager, Kyle Turner, Erin Gurney, Golden Benjamin Berrett and Nicholas Cox
Pharmacy 2022, 10(6), 175; https://doi.org/10.3390/pharmacy10060175 - 17 Dec 2022
Viewed by 1237
Abstract
Several studies have demonstrated the benefit of clinical pharmacy services in primary care. However, studies are limited on providers’ perceived value of embedded primary care pharmacy teams. The purpose of this project was to determine how primary care clinical pharmacists and technicians provide [...] Read more.
Several studies have demonstrated the benefit of clinical pharmacy services in primary care. However, studies are limited on providers’ perceived value of embedded primary care pharmacy teams. The purpose of this project was to determine how primary care clinical pharmacists and technicians provide value to medical providers. Primary care providers in University of Utah health clinics where primary care clinical pharmacists are embedded were invited to participate in one-on-one, semi-structured interviews. Interview sessions were recorded, transcribed, and de-identified. The transcripts were coded and analyzed to determine common themes. Questions were on various topics, including what is of greatest value to them, pharmacy integration into care teams, provider burnout, provider happiness at work, provider workload, and provider retention in the health system. In total, 25 interviews were conducted from nine different clinics (response rates of 19.7% for providers and 81.8% for clinics). Coding revealed themes of increased job satisfaction, enhanced patient care, decreased workload and burnout, and a desire for increased access to clinical pharmacy services. The responses related to clinical pharmacists in primary care were overwhelmingly positive, and providers almost unanimously expressed the need for more pharmacy services in primary care. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
10 pages, 225 KiB  
Article
Attitudes of Community Pharmacy Service Users towards Vaccination Programs in Pharmacy: A Cross-Sectional Survey-Based Study in Croatia
by Doris Rusic, Doris Nanasi, Josko Bozic, Anamarija Jurcev Savicevic, Dario Leskur, Ana Seselja Perisin, Darko Modun, Marino Vilovic and Josipa Bukic
Pharmacy 2022, 10(6), 167; https://doi.org/10.3390/pharmacy10060167 - 1 Dec 2022
Viewed by 1684
Abstract
Background: The aim of this study was to explore community pharmacy service users’ attitudes and opinions towards vaccination programs in pharmacy conducted by a doctor of medicine or a pharmacist. Methods: The questionnaire used in this study comprised 40 items about demographics, sources [...] Read more.
Background: The aim of this study was to explore community pharmacy service users’ attitudes and opinions towards vaccination programs in pharmacy conducted by a doctor of medicine or a pharmacist. Methods: The questionnaire used in this study comprised 40 items about demographics, sources of information, attitudes about vaccination, attitudes about vaccination in community pharmacies, and willingness to pay for such a service. Results: A total of 385 people participated in this study. Injection was the preferred route of administration of vaccine for more than half of study participants (50.6%). Univariate analysis showed that those who had a healthcare worker as a family member and those familiar with the HPV vaccine had better attitudes; however, those results were no longer significant after factoring in other variables in multivariate analysis. More than half (59.2%) of the study population would consider vaccination service in community pharmacies only if it were free or covered by the national health insurance. Conclusions: More than half of the participants believed that providing vaccination services in community pharmacies would result in greater vaccination rates for seasonal illnesses. However, around half would prefer that it were conducted exclusively by a physician. Less than 10% of the study participants would pay out of their pocket for such a service. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
12 pages, 294 KiB  
Communication
Evaluation of Point-of-Care Testing in Pharmacy to Inform Policy Writing by the New Brunswick College of Pharmacists
by Lauren Hutchings and Anastasia Shiamptanis
Pharmacy 2022, 10(6), 159; https://doi.org/10.3390/pharmacy10060159 - 26 Nov 2022
Viewed by 2757
Abstract
Pharmacy practice continues to advance, allowing professionals to contribute further to patient care and the healthcare system. Pharmacists are authorized to perform point-of-care testing (POCT) in seven out of ten Canadian provinces. In considering the potential for enhanced clinical decision-making with the opportunity [...] Read more.
Pharmacy practice continues to advance, allowing professionals to contribute further to patient care and the healthcare system. Pharmacists are authorized to perform point-of-care testing (POCT) in seven out of ten Canadian provinces. In considering the potential for enhanced clinical decision-making with the opportunity to gain patient data at the site of care, the New Brunswick College of Pharmacists (NBCP) proceeded to draft regulatory amendments and a policy to enable POCT scope in New Brunswick. Policy writing is a core function of Provincial Regulatory Authorities in Canada as the process determines principles that direct pharmacy practice. Each province has a differing scope of practice and method for developing documents. This paper highlights the approach, analysis, and findings of the NBCP pursuant to drafting a POCT policy. The policy development process included a literature search and environmental scan of the ten Canadian provincial regulatory authorities along with other countries. The findings highlighted in this paper describe the use of POCT, quality assurance, regulatory framework, educational opportunities, and the role of pharmacy technicians in relation to POCT in a pharmacy setting. The approach NBCP took to engage professionals and decisions on the direction of the policy are described. As point-of-care services continue to expand in pharmacies, the insights by the NBCP can be utilized by other regulatory bodies or pharmacy professionals who are implementing or enhancing POCT policies or procedures within their organizations. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
14 pages, 288 KiB  
Article
Pharmacotherapy Problems in Best Possible Medication History of Hospital Admission in the Elderly
by Ivana Marinović, Ivana Samardžić, Slaven Falamić and Vesna Bačić Vrca
Pharmacy 2022, 10(5), 136; https://doi.org/10.3390/pharmacy10050136 - 18 Oct 2022
Viewed by 1812
Abstract
Transfer of care is a sensitive process, especially for the elderly. Polypharmacy, potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and renal risk drugs (RRDs) are important issues in the elderly. The aim of the study was to expand the use of the Best [...] Read more.
Transfer of care is a sensitive process, especially for the elderly. Polypharmacy, potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and renal risk drugs (RRDs) are important issues in the elderly. The aim of the study was to expand the use of the Best Possible Medication History (BPMH) and to evaluate polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs on hospital admission, as well as to determine their mutual relationship and association with patients’ characteristics. An observational prospective study was conducted at the Internal Medicine Clinic of Clinical Hospital Dubrava. The study included 383 elderly patients. Overall, 49.9% of patients used 5–9 prescription medications and 31.8% used 10 or more medications. EU(7)-PIMs occurred in 80.7% (n = 309) of the participants. In total, 90.6% of participants had ≥1 potential DDI. In total, 43.6% of patients were found to have estimated glomerular filtration rate < 60 mL/min/1.73 m2, of which 64.7% of patients had one or more inappropriately prescribed RRDs. The clinical pharmacist detected a high incidence of polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs on hospital admission. This study highlights the importance of early detection of pharmacotherapy problems by using the BPMH in order to prevent their circulation during a hospital stay. The positive correlations between polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs indicate that they are not independent, but rather occur simultaneously. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
11 pages, 265 KiB  
Article
Pharmacist-Managed Therapeutic Drug Monitoring Programs within Australian Hospital and Health Services—A National Survey of Current Practice
by Paul Firman, Ken-Soon Tan, Alexandra Clavarino, Meng-Wong Taing and Karen Whitfield
Pharmacy 2022, 10(5), 135; https://doi.org/10.3390/pharmacy10050135 - 18 Oct 2022
Cited by 2 | Viewed by 2106
Abstract
Pharmacist-managed therapeutic drug monitoring (TDM) services have demonstrated positive outcomes in the literature, including reduced duration of therapy and decreased incidence of the adverse effects of drug therapy. Although the evidence has demonstrated the benefits of these TDM services, this has predominately been [...] Read more.
Pharmacist-managed therapeutic drug monitoring (TDM) services have demonstrated positive outcomes in the literature, including reduced duration of therapy and decreased incidence of the adverse effects of drug therapy. Although the evidence has demonstrated the benefits of these TDM services, this has predominately been within international healthcare systems. The extent to which pharmacist-managed TDM services exist within Australia, and the roles and responsibilities of the pharmacists involved compared to their counterparts in other countries, remains largely unknown. A cross-sectional online survey was conducted evaluating pharmacist-managed TDM programs within Australian hospital and healthcare settings. Pharmacist perceptions were also explored about the strengths, weaknesses, opportunities, and barriers associated with implementing a pharmacist-managed TDM service. A total of 92 surveys were returned, which represents a response rate of 38%. Pharmacist-managed TDM programs were present in 15% of respondents. It is only in the minority of hospitals where there is a pharmacist-managed service, with pharmacists involved in recommending pathology and medication doses. The programs highlighted improved patient outcomes but had difficulty maintaining the educational packages and training. For hospitals without a service, a lack of funding and time were highlighted as barriers. Based on the findings of this survey, there is minimal evidence of pharmacist-managed TDM models within Australian hospital and health services. A standardized national approach to pharmacist-managed TDM services and recognition of this specialist area for pharmacists could be a potential solution to this. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)

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19 pages, 284 KiB  
Case Report
Risk Factors for Rivaroxaban-Related Bleeding Events—Possible Role of Pharmacogenetics: Case Series
by Livija Šimičević, Ana Marija Slišković, Majda Vrkić Kirhmajer, Lana Ganoci, Hrvoje Holik, Jozefina Palić, Jure Samardžić and Tamara Božina
Pharmacy 2023, 11(1), 29; https://doi.org/10.3390/pharmacy11010029 - 5 Feb 2023
Cited by 4 | Viewed by 2442
Abstract
Non-vitamin K antagonist oral anticoagulants’ interindividual trough concentration variability affects efficacy and safety, especially in bleeding events. Rivaroxaban is metabolised via CYP3A4/5-, CYP2J2-, and CYP-independent mechanisms and is a substrate of two transporter proteins: ABCB1 (MDR1, P-glycoprotein) and ABCG2 (BCRP; breast-cancer-resistance protein). The [...] Read more.
Non-vitamin K antagonist oral anticoagulants’ interindividual trough concentration variability affects efficacy and safety, especially in bleeding events. Rivaroxaban is metabolised via CYP3A4/5-, CYP2J2-, and CYP-independent mechanisms and is a substrate of two transporter proteins: ABCB1 (MDR1, P-glycoprotein) and ABCG2 (BCRP; breast-cancer-resistance protein). The polymorphisms of these genes may possibly affect the pharmacokinetics of rivaroxaban and, consequently, its safety profile. Rivaroxaban variability may be associated with age, liver and kidney function, concomitant illness and therapy, and pharmacogenetic predisposition. This case series is the first, to our knowledge, that presents multiple risk factors for rivaroxaban-related bleeding (RRB) including age, renal function, concomitant diseases, concomitant treatment, and pharmacogenetic data. It presents patients with RRB, along with their complete clinical and pharmacogenetic data, as well as an evaluation of possible risk factors for RRB. Thirteen patients were carriers of ABCB1, ABCG2, CYP2J2, and/or CYP3A4/5 gene polymorphisms. Possible drug–drug interactions with increased bleeding risk were identified in nine patients. Six patients had eGFR <60 mL/min/1.73 m2. Our data suggest a possible role of multiple factors and their interactions in predicting RRB; however, they also indicate the need for further comprehensive multidisciplinary research to enable safer use of this product based on a personalised approach. Full article
(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice)
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