Pharmacy Practice https://pharmacypractice.org/journal/index.php/pp <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge and will never charge any publication fee or article processing charge (APC) to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> Centro de Investigaciones y Publicaciones Farmaceuticas en-US Pharmacy Practice 1885-642X Authors, peer reviewers, and readers: What is expected from each player in collaborative publishing? https://pharmacypractice.org/journal/index.php/pp/article/view/2284 <p>Scholarly publishing is in a crisis, with the many stakeholders complaining about different aspects of the system. Authors want fast publication times, high visibility and publications in high-impact journals. Readers want freely accessible, high-quality articles. Peer reviewers want recognition for the work they perform to ensure the quality of the published articles. However, authors, peer reviewers, and readers are three different roles played by the same group of individuals, the users of the scholarly publishing system—and this system could work based on a collaborative publishing principle where “nobody pays, and nobody gets paid”.</p> Fernando Fernandez-Llimos Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-01-14 2021-01-14 19 1 2284 2284 10.18549/PharmPract.2021.1.2284 Antibiotic allergy as a cause of hospitalization in adults: a hospital-based study in Ukraine https://pharmacypractice.org/journal/index.php/pp/article/view/2055 <p><strong>Background</strong>: Antibiotic allergy is an important clinical and social-economical issue.</p> <p><strong>Objective</strong>: The main objectives of this study were to determine the incidence, causative drugs, and risk groups of antibiotic allergy as a reason for hospitalization. The secondary objective was to evaluate the treatment of antibiotic allergy through the identification of drug related problems (DRPs).</p> <p><strong>Methods</strong>: This retrospective hospital-based study was carried out in one of Lviv city hospitals (Ukraine) from January 2015 to December 2017. Patients with antibiotic allergy as a cause for hospitalization were included in this study.</p> <p><strong>Results</strong>: In this study the incidence of antibiotic allergy was 2.0% (95%СI 1.6:2.4) of all admissions to the Unit that provides special medical care for adult inpatients with allergy diseases and allergy reactions. The mean age of patients was 48.5 years (SD=17.0; range 18-83 years) with female predominance (78.2%; 95%СI 68.9:85.2). Antibiotic hypersensitivity reactions manifested as urticaria with angioedema (52.5%; 95%СI 42.3:62.5), urticaria (36.6%; 95%СI 27.8:46.8) or angioedema (10.9%; 95%СI 5.6:18.7). Beta-lactams (48.5%; 95%СI 38.5:58.7), fluoroquinolones (13.9%; 95%СI 7.8%:22.2%) and macrolides (7.9%; 95%СI 3.5:15.0) were specified as the main causative drugs. All patients during hospitalization (a mean of 8.2 days; SD=2.2; range 2-13 days) took at least 3 medicines (a mean of 5.4 medicines per patient; SD=1.2; range 3-12 medicines). The total number of identified DRPs was 400, a mean of 4.0 DRPs per patient (SD=1.8). The most frequently identified type of DRPs was inappropriate route of drug administration (25.0%; 95%СI 20.8:29.5). This was followed by duplicate prescriptions (23.5%; 95%СI 19.4:28.0) and insufficient frequency of drug administration (19.0%; 95%СI 15.3:23.2). Potential drug-drug interactions and inappropriate drug prescriptions each accounted for 16.0% (95% СI 12.6:20.0) of all DRPs. Comparing all above items in 2015, 2016 and 2017 showed no statistically significant changes (p˃0.05).</p> <p><strong>Conclusions</strong>: Antibiotic allergy is a common reason for admissions. The treatment of antibiotic allergy is associated with numerous DRPs. Our results could be useful for development of strategies for improving the safety and quality of pharmacotherapy.</p> Oksana Horodnycha Andriy Zimenkovsky Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 19 1 2055 2055 10.18549/PharmPract.2021.1.2055 Self-medication consultations in community pharmacy: an exploratory study on teams’ performance, client-reported outcomes and satisfaction https://pharmacypractice.org/journal/index.php/pp/article/view/2138 <p><strong>Background</strong>: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines.</p> <p><strong>Objective</strong>: The study aimed to describe CPTs’ performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients’ satisfaction with this service.</p> <p><strong>Methods</strong>: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients’ overall satisfaction was explored, using linear regression.&nbsp;</p> <p><strong>Results</strong>: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the ‘other medication’ questioning. Most clients (93%) reported improvement after the consultation. Clients’ satisfaction score was 4.70 out of 5. The variables that seem to better explain clients’ overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender.</p> <p><strong>Conclusions</strong>: Clients’ reported outcomes were favourable, as well as satisfaction with the service. Clients’ satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists’ clinical role. A larger study is warranted to confirm these findings.</p> Paulo Veiga Afonso M. Cavaco Luís V. Lapão Mara P. Guerreiro Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-09 2021-02-09 19 1 2138 2138 10.18549/PharmPract.2021.1.2138 Public perceptions and experiences of the minor ailment service in community pharmacy in Scotland https://pharmacypractice.org/journal/index.php/pp/article/view/2152 <p><strong>Background</strong>: The Minor Ailment Service (MAS) in Scottish community pharmacy allows eligible people to gain improved access to care by providing free treatment for self-limiting conditions.</p> <p><strong>Objective</strong>: To determine the perceptions and experiences of individuals using MAS and to quantify the potential impact on usage of other healthcare services.</p> <p><strong>Methods</strong>: A cross-sectional survey was conducted of patients accessing MAS across Scotland during June and July 2018. Questionnaire items included reasons for choosing treatment through MAS, which other services they may have accessed had MAS not been available, experiences of consultation, overall satisfaction, and perceived effectiveness of treatment. Those accessing MAS were given a study pack including an information sheet, pre-piloted questionnaire, and pre-paid return envelope. Participants had the option to consent to an optional one-week follow up questionnaire that focused on perceived effectiveness of treatment after seven days and any further access to healthcare services such as general practice, emergency departments or repeat pharmacy visits.&nbsp;</p> <p><strong>Results</strong>: There were 1,121 respondents to the initial questionnaire. Most reported ‘convenient Location’ as the main reason for their access to community pharmacy (n=748; 67.1%). If MAS had not been available, 59% (n=655) of participants reported that they would have accessed general practice for treatment of their minor ailment. Experience of consultations was also rated highly with all ten outcome measures scoring ‘Excellent’ overall. Satisfaction was reported positively with most participants reporting full satisfaction with the overall experience (n=960; 87.2%). At one-week follow up, 327 participants responded, over 85% (n=281) did not require further access to care to treat their minor ailment and 99.7% (n=326) said they would use MAS again.&nbsp;</p> <p><strong>Conclusions</strong>: Positive perceptions and experiences of those using MAS demonstrate a highly regarded service in terms of satisfaction and experience of consultation. The capacity for MAS to impact on the use of higher-cost healthcare services is evidenced through the number of participants who reported these services as a point of access to care should community pharmacy not be available. This national evaluation demonstrates MAS to be a positively experienced service and outlines the factors determining access for treatment of minor ailments.</p> Lee Boag Katie Maclure Anne Boyter Scott Cunningham Gazala Akram Harry McQuillan Derek Stewart Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-12 2021-02-12 19 1 2152 2152 10.18549/PharmPract.2021.1.2152 Adherence to the Mediterranean diet decreases the risk of stroke in the Lebanese population: a case-control study https://pharmacypractice.org/journal/index.php/pp/article/view/2157 <p><strong>Objective</strong>: The objective of this study was to assess adherence to the Mediterranean diet (MeD) and the risk of stroke in the Lebanese population.</p> <p><strong>Methods</strong>: A hospital based case-control study was conducted in Lebanon between January 1<sup>st</sup>, 2015 and December 31<sup>st</sup>, 2016. Data were collected prospectively using a standardized questionnaire. Adherence to the MeD was assessed based on the total number of points a patient can have on the MeD scale. Data were analysed using SPSS version 24. The strength of association between the risk of stroke and adherence to MeD was expressed in odds ratio (OR) through 95% confidence interval. P-value &lt;0.05 determined statistical significance.</p> <p><strong>Results</strong>: Around 205 stroke cases and 445 hospitalized stroke-free patients were included in this study. In the total study sample, the MeD had a minimum of 2 and a maximum of 11 points with a median of 7 points. Stroke patients had a lower MeD median compared to controls (6 vs 8 points). Around 29.5% of the total sample had a MeD score within the first quartile (52.3% of them had a stroke) and 24% of all included subjects scored within the last quartile (7% of them hospitalized for stroke) (p&lt;0.001). The higher the adherence to MeD the lower the risk of stroke. High adherence to MeD was associated with a decreased risk of stroke, OR 0.1 (95%CI, 0.04-0.24; p&lt;0.001).</p> <p><strong>Conclusions</strong>: Higher adherence to MeD significantly decreases the risk of stroke in the Lebanese population. Good lifestyle choices are encouraged in order to prevent many vascular diseases including stroke.</p> Maya El-Hajj Pascale Salameh Samar Rachidi Amal Al-Hajje Hassan Hosseini Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-07 2021-02-07 19 1 2157 2157 10.18549/PharmPract.2021.1.2157 Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients? https://pharmacypractice.org/journal/index.php/pp/article/view/2167 <p><strong>Background</strong>: The provision of information by pharmacy staff is a key factor to ensure patients’ understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia.</p> <p><strong>Objective</strong>: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting.</p> <p><strong>Methods</strong>: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items – i.e. 14 essential and one secondary – were observed. Descriptive analysis was used to summarise data on the checklists (‘given’ versus ‘not given’) as well as responses from the interviews (‘recalled’ versus ‘missed’).</p> <p><strong>Results</strong>: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p&lt;0.001). The most frequently information items provided (&gt;90%) included “antibiotic identification”, “indication”, administration directions (i.e. “dosage”, “frequency”, “hour of administration”, “administration before/after meal”, “route of administration”), and “duration of use”. A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. “route of administration” (97.0%), “frequency” (95.2%), “dosage” (92.6%), “hour of administration” (85.7%), “administration before/after meal” (89.1%)] and “duration of use” (90.9%). Fewer patients were able to recall “antibiotic identification” (76.5%) and “indication” (77.0%).</p> <p><strong>Conclusions</strong>: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia.</p> Melani Naurita Yosi I. Wibowo Adji P. Setiadi Eko Setiawan Steven V. Halim Bruce Sunderland Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-01-18 2021-01-18 19 1 2167 2167 10.18549/PharmPract.2021.1.2167 Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil) https://pharmacypractice.org/journal/index.php/pp/article/view/2168 <p><strong>Background</strong>: Polypharmacy has become an increasingly public health issue as population age and novel drugs are developed. Yet, evidence on low- and middle-income countries (LMIC) is still scarce.</p> <p><strong>Objective</strong>: This work aims to estimate the prevalence of polypharmacy among Brazilians aged 50 and over, and investigate associated factors.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted using data from the baseline assessment of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n=9,412). Univariate and bivariate analyses described the sample. Robust Poisson regression was used to estimate prevalence ratios and predict probabilities of polypharmacy.</p> <p><strong>Results</strong>: Prevalence of polypharmacy was estimated at 13.5% among older adults in Brazil. Important disparities were observed in regard to gender (16.1% among women and 10.5% among men), race (16.0% among whites and 10.1% among blacks) and geographic region (ranging from 5.1% in the North to 18.7% in the South). The multivariate analysis showed that polypharmacy is associated with various sociodemographic/individual factors (age, gender, race, education, region, health status, body mass index) as well as with several variables of healthcare access/utilization (number of visits, same physician, provider’s knowledge of patient’s medications, gate-keeper, and difficulty managing own medication). Overall, the more utilization of health services, the higher the probability of polypharmacy, after adjusting for all other model covariates.</p> <p><strong>Conclusions</strong>: Polypharmacy prevalence is relatively low in Brazil, compared to European countries. After controlling for variables of healthcare need and demographic characteristics, there is still substantial residual variance in polypharmacy prevalence. Policies to identify inappropriate prescribing and reduce regional discrepancies are necessary.</p> Brayan V. Seixas Gabriel R. Freitas Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-01-22 2021-01-22 19 1 2168 2168 10.18549/PharmPract.2021.1.2168 Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors https://pharmacypractice.org/journal/index.php/pp/article/view/2170 <p><strong>Objectives</strong>: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon.</p> <p><strong>Methods</strong>: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors.</p> <p><strong>Results</strong>: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p&lt;0.05).</p> <p><strong>Conclusions</strong>: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors.</p> Lama Soubra Samar Karout Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-02 2021-03-02 19 1 2170 2170 10.18549/PharmPract.2021.1.2170 Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists https://pharmacypractice.org/journal/index.php/pp/article/view/2179 <p><strong>Objective</strong>: To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status.</p> <p><strong>Methods</strong>: Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis.</p> <p><strong>Results</strong>: For the overall EPA ITM domain, “Collaborate as a member of an interprofessional team population” pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was “Use setting appropriate communication skills when interacting with others” (mean=4.1, SD 1.8), followed by “Communicate a patient’s medication-related problem(s) to another health professional” (mean=3.3, SD 2.0), and “Contribute medication-related expertise to the team’s work” (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors.</p> <p><strong>Conclusions</strong>: North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.</p> David M. Scott Michael P. Kelsch Anqing Zhang Daniel L. Friesner Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-09 2021-02-09 19 1 2179 2179 10.18549/PharmPract.2021.1.2179 Assessment of job satisfaction among community pharmacists in Baghdad, Iraq: a cross-sectional study https://pharmacypractice.org/journal/index.php/pp/article/view/2190 <p><strong>Background</strong>: Pharmacists have the unique position of providing safe and effective care. Hence, addressing their feelings about their working life is crucial to provide good pharmacy services.</p> <p><strong>Objective</strong>: this study aimed to assess job satisfaction among Iraqi community pharmacists and determine the effect of pharmacist characteristics on job satisfaction.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted among community pharmacists in Baghdad, the capital of Iraq. A simple random sample technique was adopted to select community pharmacists. A survey questionnaire using Warr-Cook-Wall satisfaction scale (ranging from extremely dissatisfied to extremely satisfied) was used to assess job satisfaction.</p> <p><strong>Results</strong>: Community pharmacists experienced moderate satisfaction with their jobs. The mean satisfaction score for all pharmacists was 20.4 (SD 3.7). The lowest mean scores occurred for recognition (1.4; SD 0.7), public respect (1.8; SD 0.9), and pharmacy regulations (1.9; SD 0.9). Job satisfaction was significantly affected by pharmacist characteristics, including gender (p&lt;0.001), age (p&lt;0.001), degree level (p=0.003), years in practice (p&lt;0.001), working patterns (p&lt; 0.001), and working hours (p&lt;0.001). Regression analysis indicated pharmacist gender and age had the highest effect on job satisfaction, while, years in practice, working hours, and working pattern had the lowest effect.</p> <p><strong>Conclusions</strong>: Community pharmacists expressed moderate satisfaction with their jobs with satisfaction levels being affected by gender, age, years in practice, working patterns, and working hours. New strategies will require support for Iraqi pharmacists by the Ministry of Health and Syndicate of Iraqi Pharmacists before being included in extended pharmacy services.</p> Inas R. Ibrahim Mohamed I. Ibrahim Ibrahim A. Majeed Zahraa Alkhafaje Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-09 2021-03-09 19 1 2190 2190 10.18549/PharmPract.2021.1.2190 Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals https://pharmacypractice.org/journal/index.php/pp/article/view/2192 <p><strong>Background</strong>: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program.</p> <p><strong>Objectives</strong>: To examine physicians’ attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals.</p> <p><strong>Methods</strong>: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians’ attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements.</p> <p><strong>Results</strong>: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians’ autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents.</p> <p><strong>Conclusions</strong>: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.</p> Nathalie Sayegh Souheil Hallit Rabih Hallit Nadine Saleh Rouba K. Zeidan Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-17 2021-02-17 19 1 2192 2192 10.18549/PharmPract.2021.1.2192 Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand https://pharmacypractice.org/journal/index.php/pp/article/view/2201 <p><strong>Objective</strong>: This study examined the effects of a national policy advocating rational drug use (RDU), namely, the ‘RDU Service Plan’, starting in fiscal year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on trends in antibiotic prescribing rates for outpatients. The policy was implemented subsequent to a voluntary campaign involving 136 hospitals, namely, the ‘RDU Hospital Project’, which was implemented during fiscal years 2014-2016.</p> <p><strong>Methods</strong>: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for respiratory infections, acute diarrhea, and fresh wounds were aggregated for two hospital groups using equally weighted averages: early adopters of RDU activities through the RDU Hospital Project and late adopters under the RDU Service Plan. Pre-/post-policy annual changes in the prescribing levels and trends were compared between the two groups using an interrupted time-series analysis.</p> <p><strong>Results</strong>: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for respiratory infections and acute diarrhea in both groups reflected a trend that existed before the RDU Service Plan was implemented. The immediate effect of the RDU Service Plan policy occurred in fiscal year 2017, when the prescribing level among the late adopters dropped abruptly for all three conditions with a greater magnitude than in the decrease among the early adopters, despite nonsignificant differences. The medium-term effect of the RDU Service Plan was identified through a further decreasing trend during fiscal years 2017-2019 for all conditions in both groups, except for acute diarrhea among the early adopters.</p> <p><strong>Conclusions</strong>: The national policy on rational drug use effectively reduced antibiotic prescribing for common but questionable outpatient conditions.</p> Onanong Waleekhachonloet Thananan Rattanachotphanit Chulaporn Limwattananon Noppakun Thammatacharee Supon Limwattananon Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-09 2021-02-09 19 1 2201 2201 10.18549/PharmPract.2021.1.2201 Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India https://pharmacypractice.org/journal/index.php/pp/article/view/2206 <p><strong>Background</strong>: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population.</p> <p><strong>Objective</strong>: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions.</p> <p><strong>Methods</strong>: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis.</p> <p><strong>Results</strong>:&nbsp; Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money.&nbsp; Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics.</p> <p><strong>Conclusions</strong>: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.</p> Anita Kotwani Jyoti Joshi Anjana S. Lamkang Ayushi Sharma Deeksha Kaloni Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-21 2021-03-21 19 1 2206 2206 10.18549/PharmPract.2021.1.2206 Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study https://pharmacypractice.org/journal/index.php/pp/article/view/2234 <p><strong>Background</strong>: Dentists play an essential role in providing high-quality dental care, taking into consideration the clinical context and concomitant medications taken by the patients.</p> <p><strong>Objective</strong>: This study aimed to assess drug-prescribing perception and practices in addition to drug-related educational needs among Lebanese dentists; it also evaluated the need for interprofessional collaboration between dentists and pharmacists.</p> <p><strong>Methods</strong>: An exploratory cross-sectional study using an online questionnaire targeted a sample of dentists from all Lebanese districts. Participants gave their consent by accepting to complete the survey (ethics approval reference: USJ-2016-63). The questionnaire consisted of closed-ended questions exploring: 1) drug-prescribing perception, 2) drug-prescribing practice, and 3) collaboration with pharmacists regarding their respective roles in providing appropriate counseling to patients. Two indexes were created: the first evaluated self-confidence in prescribing medications, and the second assessed dentists’ confidence in pharmacists. Logistic regressions were performed, taking each index as a dependent variable.</p> <p><strong>Results</strong>: A total of 137 dentists completed the survey (59% females; mean age: 42.17; SD: 13.78 years). The majority had a fair to good perceived knowledge in pharmacology and therapeutics (80.3%), only 30.7% reported to be sufficiently equipped to prescribe safely. Dentists exhibited particularly low perceived knowledge about prescribing in elderly patients, dosing, medication use in pregnancy, drug interactions, and adverse reactions. Dentists specialized in periodontics had the lowest odds of having self-confidence in prescribing drugs (aOR=0.25; p&lt;0.001). Also, 64.3% declared that they routinely check a reference source before prescribing, and 78% relied on pharmaceutical companies and medical representatives to get information on medications. While 61% declared that pharmacists should provide oral care counseling, only half of them encouraged their patients to talk to their pharmacists about their medications. Only 15% considered that patients are getting enough counseling from the pharmacist, with a global confidence index below the median value, suggesting the need for more collaboration, especially with periodontists who exhibited the lowest confidence in pharmacists (aOR=0.45).</p> <p><strong>Conclusions</strong>: Lebanese dentists reported some lack of knowledge and confidence in prescribing practices. Education, training, and close collaboration between pharmacists and dentists are essential to overcome these problems and avoid potential harm to patients.</p> Aline Hajj Christel Azzo Souheil Hallit Pascale Salameh Hala Sacre Frederic Abdou Nada Naaman Lydia Khabbaz Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-09 2021-03-09 19 1 2234 2234 10.18549/PharmPract.2021.1.2234 Community pharmacists’ use, perception and knowledge on dietary supplements: a cross sectional study https://pharmacypractice.org/journal/index.php/pp/article/view/2251 <p><strong>Background</strong>: Pharmacists are commonly tasked with recommending the appropriate dietary supplement and advising the patients of their correct and safe use. Previous research, conducted on pharmacy students, showed that they did not always use the evidence based sources of information, with personal use identified as a significant predictor influencing the decision to recommend a supplement.</p> <p><strong>Objectives</strong>: To compare use, perceptions and knowledge of dietary supplements of pharmacists with different years of work experience and to explore factors that could influence their recommendation of supplements.</p> <p><strong>Methods</strong>: A questionnaire based cross-sectional study was conducted on Croatian community pharmacists in September 2017. The questionnaire explored pharmacists’ demographic characteristics, use, perceptions and knowledge of dietary supplements. Pharmacists (N=102) were divided in two groups based on their work experience: P0 (&lt;10 years) and P1 (≥10 years).</p> <p><strong>Results</strong>: All included pharmacists had high knowledge scores without differences between groups (P0=10, IQR 9-12 vs P1=11, IQR 9-12, expressed as median and interquartile range (IQR), p=0.275). Less experienced pharmacists perceived there was less research conducted on the dietary supplements compared to their more experienced counterparts (P0=1, IQR 1-2 vs P1=2, IQR 2-3, expressed as median and interquartile range, p&lt;0.001). Groups differed in sources used when choosing the appropriate supplement with P0 using higher quality sources such as systematic reviews in comparison to P1 (32.1% vs 8.7%, p=0.004). Pharmacists’ decision to recommend a dietary supplement was influenced by their personal use (odds ratio 0.216, 95%CI 0.068:0.689, p=0.01) and work experience (odds ratio 0.154, 95%CI 0.045:0.530, p=0.003).</p> <p><strong>Conclusions</strong>: Pharmacists did not use the high quality sources when recommending dietary supplements and their decision to recommend the supplement was not based on objective evaluation of evidence. Further education about the practice of evidence-based pharmacy is necessary, with special emphasis on senior pharmacists who might have missed that aspect during their formal education.</p> Josipa Bukic Branka Kuzmanic Doris Rusic Mate Portolan Ante Mihanovic Ana Seselja Perisin Dario Leskur Ana Petric Josko Bozic Sinisa Tomic Darko Modun Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-25 2021-02-25 19 1 2251 2251 10.18549/PharmPract.2021.1.2251 Determinants of COVID-19 vaccine acceptance in a high infection-rate country: a cross-sectional study in Russia https://pharmacypractice.org/journal/index.php/pp/article/view/2276 <p><strong>Background</strong>: COVID-19 vaccine development is proceeding at an unprecedented pace. Once COVID-19 vaccines become widely available, it will be necessary to maximize public vaccine acceptance and coverage.</p> <p><strong>Objective</strong>: This research aimed to analyze the predictors of COVID-19 vaccine acceptance in Russia.</p> <p><strong>Methods</strong>: A cross-sectional online survey was conducted among Russian adults from September 26<sup>th</sup> to November 9<sup>th</sup>, 2020. Predictors of the intent to take up COVID-19 vaccination were explored using logistic regression.</p> <p><strong>Results</strong>: Out of 876 participants, 365 (41.7%) would be willing to receive the vaccine if it became available. Acceptance increased for a vaccine with verified safety and effectiveness (63.2%). Intention to receive the COVID-19 vaccine was relatively higher among males (aOR=2.37, 95% CI 1.41-4.00), people with lower monthly income (aOR=2.94, 95%CI 1.32-6.57), and with positive trust in the healthcare system (aOR=2.73, 95% CI 1.76-4.24). The Russian people were more likely to accept the COVID-19 vaccine if they believed that the vaccine reduces the risk of virus infection (aOR=8.80, 95%CI 5.21-14.87) or relieves the complications of the disease (aOR=10.46, 95%CI 6.09-17.96). Other barriers such as being unconcerned about side-effects (aOR=1.65, 95%CI 1.03-2.65) and the effectiveness and safety of the vaccination (aOR=2.55, 95%CI 1.60-4.08), also affected acceptance.</p> <p><strong>Conclusions</strong>: The study showed the usefulness of the health belief model constructs in understanding the COVID-19 vaccination acceptance rate in the Russian population. This rate was influenced by sociodemographic and health-related characteristics, and health beliefs. These findings might help guide future efforts for policymakers and stakeholders to improve vaccination rates by enhancing trust in the healthcare system.</p> Van D. Tran Tatiana V. Pak Elena I. Gribkova Galina A. Galkina Ekaterina E. Loskutova Valeria V. Dorofeeva Rebecca S. Dewey Kien T. Nguyen Duy T. Pham Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-22 2021-03-22 19 1 2276 2276 10.18549/PharmPract.2021.1.2276 Attitudes towards COVID-19 vaccination, vaccine hesitancy and intention to take the vaccine https://pharmacypractice.org/journal/index.php/pp/article/view/2317 <p><strong>Background</strong>: The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake.</p> <p><strong>Objective</strong>: The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine.</p> <p><strong>Methods</strong>: Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling.</p> <p><strong>Results</strong>: A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p&lt;0.00005). Opinions of significant others- family and friends (r=0.22, p&lt;0.005) and health professionals (r=0.74, p&lt;0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p=0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine.</p> <p><strong>Conclusions</strong>: COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women.</p> Maria Cordina Mary A. Lauri Josef Lauri Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-21 2021-03-21 19 1 2317 2317 10.18549/PharmPract.2021.1.2317 Integration of and visions for community pharmacy in primary health care in Denmark https://pharmacypractice.org/journal/index.php/pp/article/view/2212 <p>In 2014, the Danish government launched a plan for health entitled: “Healthier lives for everyone – national goals for the health of Danes within the next 10 years”. The overall objective is to prolong healthy years of life and to reduce inequality in health. In Denmark, the responsibility for health and social care is shared between the central government, the regions and the municipalities. National and local strategies seek to enhance public health through national and local initiatives initiated by different stakeholders. The Danish community pharmacies also contribute to promoting public health through distribution of and counselling on medication in the entire country and through offering several pharmacy services, six of which are fully or partly remunerated on a national level. Because of greater demands from patients, health care professionals and society and a lack of general practitioners, the Danish community pharmacies now have the opportunity to suggest several new functions and services or to extend existing services. The Danish pharmacy law changed in 2015 with the objective to maintain and develop community pharmacies and to achieve increased patient accessibility. The change in the law made it possible for every community pharmacy owner to open a maximum of seven pharmacy branches (apart from the main pharmacy) in a range of 75 km. This change also increased the competition between community pharmacies and consequently the pharmacies are now under financial pressure. On the other hand, each pharmacy may have been given an incentive to develop their specific pharmacy and become the best pharmacy for the patients. Community pharmacies are working to be seen as partners in the health care system. This role is in Denmark increasingly being supported by the government through the remunerated pharmacy services and through contract with municipalities. Concurrent with the extended tasks for the Danish community pharmacies and utilisation of their excellent competencies in medication the community pharmacies need to focus on their main tasks of supplying medicines and implementing services. This requires efficient management, an increased use of technology for distribution and communication and continuing education and training.</p> Rikke N. Hansen Lotte S. Nørgaard Ulla Hedegaard Lone Søndergaard Kerly Servilieri Susanne Bendixen Charlotte Rossing Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-01-22 2021-01-22 19 1 2212 2212 10.18549/PharmPract.2021.1.2212 Primary healthcare policy and vision for community pharmacy and pharmacists in Germany https://pharmacypractice.org/journal/index.php/pp/article/view/2248 <p>Germany is the highest populated country in Europe with a population of 82.3 million in 2019. As in many other developed countries, it has an aging population. Approximately 10% of the gross domestic product is spent on healthcare. The healthcare system is characterized by its accessibility. Patients are generally free to choose their primary care physicians, both family doctors and specialists, pharmacy, dentist, or emergency service. Up to a certain income, health insurance is mandatory with the statutory health insurance (SHI) system, covering 88% of the population. Major challenges are the lack of cooperation and integration between the different sectors and healthcare providers. This is expected to change with the introduction of a telematic infrastructure that is currently being implemented. It will not only connect all providers in primary and secondary care in a secure network but will also enable access to patients’ electronic record/medical data and at the same time switch from paper to electronic prescriptions. Approximately 52,000 of the 67,000 pharmacists are working in approximately 19,000 community pharmacies. These pharmacies are owner-operated by a pharmacist. Pharmacists may own up to three subsidiaries nearby to their main pharmacy. Community pharmacy practice mainly consists of dispensing drugs, counselling patients on drug therapy and safety, and giving advice on lifestyle and healthy living. Many cognitive pharmaceutical services have been developed and evaluated in the past 20 years. Discussions within the profession and with stakeholders on the national level on the roles and responsibilities of pharmacists have resulted in nationally agreed guidelines, curricula, and services. However, cognitive services remunerated by the SHI funds on the national level remain to be negotiated and sustainably implemented. A law passed in November 2020 by parliament will regulate the remuneration of pharmaceutical services by the SHI funds with an annual budget of EUR 150 million. The type of services and their remuneration remain to be negotiated in 2021. The profession has to continue on all levels to advocate for a change in pharmacy practice by introducing pharmacy services into routine care.</p> Christiane Eickhoff Nina Griese-Mammen Uta Mueller André Said Martin Schulz Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-01-20 2021-01-20 19 1 2248 2248 10.18549/PharmPract.2021.1.2248 Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs https://pharmacypractice.org/journal/index.php/pp/article/view/2288 <p>Finland’s community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists’ role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs.</p> Marja Airaksinen Terhi Toivo Lenita Jokinen Eeva Savela Stina Parkkamäki Charlotta Sandler Hanna Kalliomäki Maarit Dimitrow Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-04 2021-02-04 19 1 2288 2288 10.18549/PharmPract.2021.1.2288 Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions https://pharmacypractice.org/journal/index.php/pp/article/view/2302 <p>In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists’ roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies – including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models’ perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.</p> Fernanda S. Tonin Ignacio Aznar-Lou Vasco M. Pontinha Roberto Pontarolo Fernando Fernandez-Llimos Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-02-21 2021-02-21 19 1 2302 2302 10.18549/PharmPract.2021.1.2302 Development of a centralized, remote clinical pharmacy service to enhance primary care https://pharmacypractice.org/journal/index.php/pp/article/view/2348 <p>More than 50% of Americans possess at least one chronic condition and another 25% suffer from two or more, leaving primary care teams tasked to care for the chronic, acute, and preventive care needs of their large patient panels. Pharmacists can reduce the burden on busy providers by effectively managing chronic diseases as members of health care teams. Many private physician practices lack the resources to include pharmacists on their teams.&nbsp; A centralized, remote clinical pharmacy services model allows pharmacists to remotely manage chronic disease in patients in collaboration with primary care providers. The purpose of this report is to describe how a centralized, remote clinical pharmacy team was developed, trained, and effectively integrated into multiple, diverse primary care settings across the U.S.</p> Rachel J. Finkelstein Christopher P. Parker Barcey T. Levy Barry L. Carter Korey Kennelty Copyright (c) 2021 Pharmacy Practice and the Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-03-10 2021-03-10 19 1 2348 2348 10.18549/PharmPract.2021.1.2348