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.&nbsp;</p> JCFCORP SG PTE LTD en-US Pharmacy Practice 1885-642X Attitudes and beliefs of patients and primary caregivers towards deprescribing in a tertiary health care facility https://pharmacypractice.org/journal/index.php/pp/article/view/2350 <p><strong>Background</strong>: Good prescribing practices form the essence of drug therapy for better patient care. The major aim of better prescribing is to improve rational prescribing. Deprescribing gained momentum in recent decades.</p> <p><strong>Objective</strong>: This study aimed to explore the attitude and beliefs of deprescribing among patients and their caregivers forming dyads in a tertiary health care facility.</p> <p><strong>Methods</strong>: Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescribing was assessed by using validated rPATD (revised Patient attitude towards deprescribing) questionnaire. Cohen's kappa coefficient was used to measure the agreement between the views of people and their caregivers forming dyads about medication cessation.</p> <p><strong>Results</strong>: 312 patients and caregivers (156 forming dyads) participated in the study. Among 156 patients, 25.6% were hypertensives &amp; 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belong to the elderly age group. 2.5% were taking &gt;5 medications. 43.6% of patients and 62.2% of caregivers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the treating physician's advice, but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop taking medicines for a long time.</p> <p><strong>Conclusions</strong>: In our study, more than 50% of people and their caregivers were willing to try medication cessation under their physician's recommendation. There was moderate agreement between patients and their caregivers in the trial of medication cessation. Thus, the results obtained from this study may help towards improving rationalized prescribing practices in the institutional setup.</p> Narayan Gaurang Rajendran Priyadharsini Kandan Balamurugesan Mathiyalagen Prakash Devanathan Reka Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-20 2021-09-20 19 3 2350 2350 10.18549/PharmPract.2021.3.2350 Treatment satisfaction and its association with anxiety, depression and fear of COVID-19 among Lebanese inpatients with schizophrenia https://pharmacypractice.org/journal/index.php/pp/article/view/2364 <p><strong>Background</strong>: The patient's evaluation of treatment and its associated outcomes define the treatment satisfaction. The quality of treatment satisfaction and healthcare service has been affected by depression, anxiety and fear of the current coronavirus disease 2019 (COVID-19) pandemic.</p> <p><strong>Objective</strong>: Therefore, this study aimed to assess factors associated with treatment satisfaction among Lebanese inpatients with schizophrenia, namely depression, anxiety and fear of COVID-19.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted between September and November 2020, enrolled 118 patients with chronic schizophrenia consecutively admitted to Psychiatric Hospital of the Cross, Lebanon. The Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale (FACIT-TS-PS) was used to assess treatment satisfaction, the Lebanese Anxiety Scale -10 (LAS-10) was used to assess anxiety, Montgomery-Asberg Depression Rating Scale (MADRS) to assess depression and the Fear of COVID-19 Scale to assess the level of fear of the COVID-19 pandemic.</p> <p><strong>Results</strong>: The mean scores of the scales were as follows: treatment satisfaction (65.20; SD 16.11; median=71), LAS-10 (13.65; SD 6.02), MADRS (9.09; SD 6.69) and fear of COVID-19 (18.59; SD 6.78). Higher depression (r= -0.46, p&lt;0.001) was significantly associated with lower treatment satisfaction. Female gender (beta=7.51, p=0.029) was significantly associated with higher treatment satisfaction score. Fear of COVID-19 did not show any significant association with the treatment satisfaction score.</p> <p><strong>Conclusions</strong>: Results of this study found that depression and gender were associated with treatment satisfaction among inpatients with schizophrenia. No association has been found between fear of COVID-19 and treatment satisfaction among those patients. More research is warranted to evaluate treatment satisfaction and associated factors among chronic inpatients with schizophrenia, specifically during the COVID-19 pandemic, in order to improve treatment satisfaction and subjective well-being of patients.</p> Zeinab Bitar Chadia Haddad Sahar Obeid Souheil Hallit Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-13 2021-09-13 19 3 2364 2364 10.18549/PharmPract.2021.3.2364 Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment https://pharmacypractice.org/journal/index.php/pp/article/view/2376 <p><strong>Background</strong>: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment.</p> <p><strong>Objective</strong>: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time).</p> <p><strong>Methods</strong>: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.</p> <p><strong>Results</strong>: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed &gt;100 HMRs (73%), were female (71%), and aged &gt;40 years (60%). Regarding time investment for a typical instance of HMR, most spent: &lt;30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).</p> <p><strong>Conclusions</strong>: Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.</p> Marea Patounas Esther T. Lau Vincent Chan Deborah Rigby Gregory J. Kyle Jyoti Khatri Arjun Poudel Lisa M. Nissen Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-08-02 2021-08-02 19 3 2376 2376 10.18549/PharmPract.2021.3.2376 Monitoring the transition of patients on biologics in rheumatoid arthritis: Consensus guidance for pharmacists https://pharmacypractice.org/journal/index.php/pp/article/view/2377 <p><strong>Background</strong>: Recent approvals for novel agents such as the small molecule Janus kinase inhibitors (JAKi), combined with the advent of biosimilars has widened the gamut of available therapeutic options in the treatment of rheumatoid arthritis (RA). This combined with the introduction of mandatory non- medical switches to biosimilars in some jurisdictions by both public and private payors has led to a significant increase in the volume of therapeutic changes for patients. Pharmacists are well positioned to ensure effective and safe transitions, however there is a significant unmet need for objective and subjective clinical guidance around therapy as well disease state monitoring in RA that facilitates best practices throughout the patient journey.</p> <p><strong>Objective</strong>: In this paper we aim to create a consensus derived monitoring algorithm for pharmacists to facilitate best practices throughout therapeutic transitions from originator biologic to other originator biologics, biosimilars, and Janus kinase inhibitors in RA.</p> <p><strong>Methods</strong>: The Nominal Group Technique (NGT) was used to understand if consensus could be found among the participants. Clinically relevant questions were developed to capture solutions to the identified unmet need. The faculty considered the questions as individuals, and privately generated answers/ideas. After discussion and consideration, the participants ranked the ideas and established a consensus.</p> <p><strong>Results</strong>: Based on the outcome of the consensus discussions, an algorithm was created to help guide pharmacists through therapeutic transitions in RA. The tool covers important topics such as pre-transition considerations, avoiding the nocebo effect for biosimilars, specific considerations for each drug or class, monitoring efficacy, and when to refer.</p> <p><strong>Conclusions</strong>: New classes of anti-rheumatic drugs including JAKi, along with the introduction of biosimilars are presenting more opportunity for therapeutic changes and monitoring in patients with RA. We hope our evidence-based consensus derived guidance tool will assist frontline pharmacists in supporting their patients to a successful therapeutic transition in RA.</p> Denis Choquette Jonathan Chan Mohammad Bardi Carolyn Whiskin Gabriel Torani Brennan K. Smith Aaron Sihota Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-14 2021-09-14 19 3 2377 2377 10.18549/PharmPract.2021.3.2377 The Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial https://pharmacypractice.org/journal/index.php/pp/article/view/2397 <p><strong>Background</strong>: Successful diabetes treatment requires commitment and understanding of disease management by the patients.</p> <p><strong>Objective</strong>: This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage.</p> <p><strong>Methods</strong>: A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively.</p> <p><strong>Results</strong>: No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p&lt;0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p&lt;0.001) and the number of DRP (p&lt;0.001) were noted.</p> <p><strong>Conclusions</strong>: HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted. </p> M. Rozaini Rosli Chin F. Neoh David B. Wu Nazariah W. Hassan Mahani Mahmud Afifah Rahimi Mahmathi Karuppannan Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-09 2021-09-09 19 3 2397 2397 10.18549/PharmPract.2021.3.2397 Preferences based interventions to address the use of antibiotics without prescription: a discrete choice experiment https://pharmacypractice.org/journal/index.php/pp/article/view/2401 <p><strong>Background</strong>: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community.</p> <p><strong>Objective</strong>: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics.</p> <p><strong>Methods</strong>: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions.</p> <p><strong>Results</strong>: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics.</p> <p><strong>Conclusions</strong>: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.</p> Johanna Aponte-González Paul Brown Javier Eslava-Schmalbach Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-11 2021-09-11 19 3 2401 2401 10.18549/PharmPract.2021.3.2401 Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria https://pharmacypractice.org/journal/index.php/pp/article/view/2402 <p><strong>Background</strong>: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals.</p> <p><strong>Objective</strong>: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes</p> <p><strong>Methods</strong>: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms.</p> <p><strong>Results</strong>: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p&lt;0.001; eta-square= 0.144). The proportion of those that achieved target A1C of &lt;7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C&lt;7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes.</p> <p><strong>Conclusions</strong>: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.</p> Emmanuel A. David Rebecca O. Soremekun Isaac O. Abah Roseline I. Aderemi-Williams Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-08-15 2021-08-15 19 3 2402 2402 10.18549/PharmPract.2021.3.2402 Self-reported vs RUCA rural-urban classification among North Carolina pharmacists https://pharmacypractice.org/journal/index.php/pp/article/view/2406 <p><strong>Background</strong>: The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.</p> <p><strong>Objective</strong>: The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.</p> <p><strong>Methods</strong>: This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.</p> <p><strong>Results</strong>: Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications – 94 (56.6%) of the 166 participants who reported working in “rural” areas were considered “urban” according to RUCA.</p> <p><strong>Conclusions</strong>: A significant discordance between pharmacists’ self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as “rural” as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.</p> Micah E. Castle Casey R. Tak Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-08-21 2021-08-21 19 3 2406 2406 10.18549/PharmPract.2021.3.2406 Physical activity promotion in community pharmacies: pharmacists’ attitudes and behaviours https://pharmacypractice.org/journal/index.php/pp/article/view/2413 <p><strong>Background</strong>: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active.</p> <p><strong>Objective</strong>: This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice.</p> <p><strong>Methods</strong>: A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies.</p> <p><strong>Results</strong>: In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3).</p> <p><strong>Conclusions</strong>: Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.</p> Ruben Viegas Cristina A. Godinho Sónia Romano Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-11 2021-09-11 19 3 2413 2413 10.18549/PharmPract.2021.3.2413 Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand https://pharmacypractice.org/journal/index.php/pp/article/view/2422 <p><strong>Background</strong>: Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.</p> <p><strong>Objective</strong>: This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.</p> <p><strong>Methods</strong>: A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.</p> <p><strong>Results</strong>: Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.</p> <p><strong>Conclusions</strong>: A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.</p> Yasmin Abdul Aziz Susan J. Heydon Stephen B. Duffull Carlo A. Marra Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-07-31 2021-07-31 19 3 2422 2422 10.18549/PharmPract.2021.3.2422 Participants’ perceptions of a residency teaching certificate program: the quality, impact and benefits https://pharmacypractice.org/journal/index.php/pp/article/view/2423 <p><strong>Background</strong>: Currently, there are no accreditation requirements for pharmacy resident teaching certificate programs (RTCPs) but rather suggested guidelines and documents for individual programs to follow. RTCP curriculums are often “handed-down” from past personnel and vary based on individual interpretation. Quality improvement may be overlooked when programs do not report to governing bodies.</p> <p><strong>Objective</strong>: The primary objective of this quality improvement project was threefold: 1) to identify past RTCP participants’ perceptions regarding program seminars, activities, and requirements; 2) to determine the short-term and long-term impact on participant careers and interaction with learners; and 3) to improve the program to meet participants' needs.</p> <p><strong>Methods</strong>: A 25 item Qualtrics survey was sent to 93 past pharmacy residents who completed the RTCP. Delivery of the survey was confirmed to 89 previous residents. Participants provided consent and were given 12 days to complete the survey. Data was collected and coded by the research team independently.</p> <p><strong>Results</strong>: The participants hold positions in a variety of roles, with 68.3% of participants currently holding a non-academia position. The top five most beneficial activities during the RTCP were: giving a large room lecture, facilitating small group learning, developing test questions, delivering professional CE, and meeting with their teaching mentor. Most seminar topics were beneficial to residents during the RTCP, with over two-thirds of the topics (n=23) found beneficial by at least 90% of the participants. A total of 92.9% of respondents said that the most beneficial aspect of having an assigned mentor was the teaching advice and feedback provided.</p> <p><strong>Conclusions</strong>: The perceptions and beliefs of past RTCP participants were obtained regarding how beneficial the programming, activities, and mentorship offered were during and after RTCP completion. Quality improvement ideas from this work include redistribution of time in seminars compared to hands-on activities, the adoption of tracks or concentrations within the RTCP, and the creation of mentor training and development.</p> Lindsey Peters Brittany Long Emily Eddy Kayli Kuhn Chelsea Huppert Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-08-29 2021-08-29 19 3 2423 2423 10.18549/PharmPract.2021.3.2423 Immunization training for pharmacy students: a student-centered evaluation https://pharmacypractice.org/journal/index.php/pp/article/view/2427 <p><strong>Background</strong>: Persistent and emerging public health challenges mean Pharmacy students require training in immunization services. Curtin University, Australia, integrated blended-delivery immunization training into the final-year Bachelor of Pharmacy (Hons) and graduate-entry Master of Pharmacy curricula in 2019 and 2020, utilizing materials licenced from the Pharmaceutical Society of Australia.</p> <p><strong>Objective</strong>: This study evaluated changes in students’ attitude, confidence, self-perceived knowledge and self-perceived skills pre- and post-training delivered in 2020.</p> <p><strong>Methods</strong>: Pre- and post-training questionnaires featured 42 opinion statements grouped under headings ‘Attitudes’, ‘Confidence’, ‘Self-Perceived Knowledge’ and ‘Self-Perceived Skills’, and answered using five-point Likert scales (1 = strongly disagree to 5 = strongly agree). Completed pre- and post-training questionnaires were matched using respondent-generated codes. Data were subjected to descriptive and multivariate regression analysis to test pre-post changes and associations and changes in mean scores.&nbsp;&nbsp;</p> <p><strong>Results</strong>: 128 (95.5%) and 132 (98.5%) students completed the pre- and post-training questionnaires, respectively. Immunization training resulted in significant (p&lt;0.05) improvement in students’ mean Confidence score (3.33 vs 3.96), Self-Perceived Knowledge score (3.08 vs 4.47) and Self-Perceived Skills score (2.81 vs 4.55). Improvement in students’ mean Attitude score was also statistically significant (4.45 vs 4.61), yet more positively skewed pre-training. No significant pre-post differences were found between the Bachelor and Master students. Post-training, all respondents agreed that the training program increased their attitude, confidence, perceived knowledge and perceived skills, rating the training experience as either Excellent (91.6%) or Good (8.4%).</p> <p><strong>Conclusions</strong>: Immunization training integrated into final-year BPharm (Hons) and MPharm curricula improved Attitudes, Confidence, Self-Perceived Knowledge and Self-Perceived Skills, all key to further role development in public health. This method is recommended to other Pharmacy schools to determine the impact and acceptability of immunization training programs amongst students.</p> Shaylee Mills Lynne Emmerton Tin F. Sim Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-08-29 2021-08-29 19 3 2427 2427 10.18549/PharmPract.2021.3.2427 Implementation of pharmacist-led services in primary care: A mixed-methods exploration of pharmacists’ perceptions of a national educational resource package https://pharmacypractice.org/journal/index.php/pp/article/view/2440 <p><strong>Background</strong>: To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016.</p> <p><strong>Objective</strong>: To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility.</p> <p><strong>Methods</strong>: Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role.</p> <p><strong>Results</strong>: Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available).</p> <p><strong>Conclusions</strong>: The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources.</p> Kate Preston Natalie M. Weir Tanja Mueller Rosemary Newham Marion Bennie Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-13 2021-09-13 19 3 2440 2440 10.18549/PharmPract.2021.3.2440 Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia https://pharmacypractice.org/journal/index.php/pp/article/view/2469 <p><strong>Background</strong>: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities.</p> <p><strong>Objective</strong>: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique.</p> <p><strong>Methods</strong>: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule.</p> <p><strong>Results</strong>: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005).</p> <p><strong>Conclusions</strong>: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.</p> Kian K. Kong Siew C. Ong Guat S. Ooi Mohamed A. Hassali Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-05 2021-09-05 19 3 2469 2469 10.18549/PharmPract.2021.3.2469 Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students https://pharmacypractice.org/journal/index.php/pp/article/view/2471 <p><strong>Background</strong>: Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution.</p> <p><strong>Objective</strong>: To evaluate the number and type of medication discrepancies identified by pharmacy students.</p> <p><strong>Methods</strong>: Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies.</p> <p><strong>Results</strong>: There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p&lt;0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system.</p> <p><strong>Conclusions</strong>: Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.</p> Louise Deep Carl R. Schneider Rebekah Moles Asad E. Patanwala Linda L. Do Rosemary Burke Jonathan Penm Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-15 2021-09-15 19 3 2471 2471 10.18549/PharmPract.2021.3.2471 Pharmacists’ roles in mental healthcare: Past, present and future https://pharmacypractice.org/journal/index.php/pp/article/view/2545 <p>Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.</p> Sarira El-den Jack C. Collins Timothy F. Chen Claire L. O’Reilly Copyright (c) 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/ 2021-09-11 2021-09-11 19 3 2545 2545 10.18549/PharmPract.2021.3.2545