Pharmacy Practice <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> en-US <p>The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to <strong>Pharmacy Practice</strong> with this document.</p> <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_blank" rel="noopener">Creative Commons Attribution License</a> (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> <p><strong><span class="label">Author Self-Archiving Policy</span></strong></p> <p><span class="label"><strong>Pharmacy Practice</strong> permits and encourages authors to post and archive the<strong> final </strong>PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.</span></p> (Fernando Fernandez-Llimos) (Administration) Fri, 17 Jul 2020 14:45:25 +0100 OJS 60 The role of the pharmacist in low back pain management: A narrative review of practice guidelines on paracetamol vs Non-steroidal anti-inflammatory drugs <p>Low back pain (LBP) is a common and costly condition and a leading cause of disabilities across the globe. In Australia and other countries, there has been changes in LBP management guidelines and evidence in recent years, including the use of pharmacotherapy. Inadequately treated LBP is a burden with significant health and economic impacts. Although there is some variability, non-steroidal anti-inflammatory drugs (NSAIDs) have largely replaced paracetamol as the first-choice analgesic for non-specific LBP in many international clinical guidelines, including the current Australian Therapeutic Guidelines. More recent clinical evidence also supports that targeting LBP with the use of NSAIDs can provide superior and more effective relief of LBP symptoms compared with paracetamol. Community pharmacists are one of the most accessible and frequently visited health professionals that offer vital primary healthcare services aimed to provide enhanced clinical outcomes for patients. The position of a community pharmacist is pivotal in LBP assessment and management, from both a pharmacological and non-pharmacological standpoint, including the use of clinical guidelines, yet their roles are often not fully utilized in LBP therapy. Studies investigating the community pharmacist’s views, practices, knowledge, and roles, specifically in LBP management in Australia are variable and limited. This narrative review will briefly cover the impacts of LBP, and to provide a summary on recent evidence, updates and a comparison of the Australian and international low back pain management guidelines on paracetamol vs NSAIDs in LBP, as well as pharmacists’ roles and interventions in a primary healthcare setting in this context.</p> John Mishriky, Ieva Stupans, Vincent Chan Copyright (c) 2020 Pharmacy Practice and the Authors Thu, 06 Aug 2020 09:11:26 +0100 Pharmacists’ perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan <p><strong>O</strong><strong>bjective</strong>: This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists’ role during the coronavirus pandemic in Jordan.</p> <p><strong>Methods</strong>: Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20<sup>th</sup> and April 3<sup>rd</sup>. A total of 184 posts and threads were identified for the purpose of the study.</p> <p><strong>Results</strong>: Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public’s awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time.</p> <p><strong>Conclusions</strong>: Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction.</p> Tareq L. Mukattash, Anan S. Jarab, Ibrahim Mukattash, Mohammad B. Nusair, Rana Abu Farha, May Bisharat, Iman A. Basheti Copyright (c) 2020 Pharmacy Practice and the Authors Fri, 31 Jul 2020 20:24:34 +0100 A survey on feasibility of telehealth services among young Italian pharmacists <p><strong>Background</strong>: Telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status”. This relatively new concept of healthcare is based on the fusion between medical assistance and Information and Communication Technology (ICT) to provide support to people located in remote and underserved areas. It can be found not only in hospitals, but also in other healthcare facilities such as pharmacies. Starting from 2010, telemedicine or telehealth was formally introduced in the Italian pharmaceutical context with the "Pharmacy of Services Decree". In spite of this regulatory framework, the implementation of this technology was very slow and there are no data about the spreading and use of these services in Italian pharmacies.</p> <p><strong>Objective</strong>: The present study has therefore developed a survey to collect information on the diffusion of telemedicine/telehealth services within Italian pharmacies.</p> <p><strong>Methods</strong>: A two-part questionnaire in Italian was developed using SurveyMonkey, setting a mechanism aimed to have different outcomes according to the answers given. Six hundred eighty-three respondents returned the questionnaire. The results were then analysed statistically.</p> <p><strong>Results</strong>: The questionnaire results have shown a limited diffusion of telemedicine/telehealth services among Italian pharmacies and an apparently limited interest of health authorities in supporting the integration of this technology.</p> <p><strong>Conclusions</strong>: More efforts should be spent by national public health stakeholders to better analyse the contribution of telemedicine services available in public pharmacies and to find the best solutions to implement this innovative technology as an established service.</p> Simone Baldoni, Graziano Pallotta, Enea Traini, Getu G. Sagaro, Giulio Nittari, Francesco Amenta Copyright (c) 2020 Pharmacy Practice and the Authors Thu, 06 Aug 2020 09:27:29 +0100 The role of the community pharmacist in veterinary patient care: a cross-sectional study of pharmacist and veterinarian viewpoints <p><strong>Background</strong>: The role of the community pharmacist is rapidly expanding to encompass the care of veterinary patients in the United States of America This change makes it imperative for pharmacists and veterinarians who practice in community settings to establish mutual agreement on the roles of pharmacists in the care of these patients.</p> <p><strong>Objective</strong>: To examine community-based pharmacist and veterinarian viewpoints on interprofessional collaboration and the role of the community pharmacist in veterinary patient care.</p> <p><strong>Methods</strong>: Cross-sectional surveys were sent to pharmacists and veterinarians who practice in a community setting in Ohio. Surveys collected demographic information and addressed the following themes: attitudes toward collaboration, perceived roles of the pharmacist, expectations of the pharmacist, and previous collaborative experiences. A chi-square test was used for statistical analysis.</p> <p><strong>Results</strong>: In total, 357 pharmacists and 232 veterinarians participated in the study. Both professions agreed that pharmacist-veterinarian collaboration is important in order to optimize veterinary patient care (chi-square (1, N=589)=7.7, p=0.006). Overall, veterinarians were more likely to identify an important role of the community pharmacist to be compounding medications (chi-square (1, N=589)=26.7, p&lt;0.001) compared to counseling pet owners (chi-square (1, N=589)=171.7, p&lt;0.001). Both groups reported similar levels of agreement regarding the importance for pharmacists to have adequate knowledge of veterinary medicine.</p> <p><strong>Conclusions</strong>: Our study found that while both pharmacists and veterinarians conveyed a positive attitude regarding interprofessional collaboration, they disagreed on what role the pharmacist should play in the care of veterinary patients. Rectifying the discordant perceptions of these health care professionals may be critical to developing collaborative initiatives and optimizing veterinary patient care.</p> Mary E. Fredrickson, Hayley Terlizzi, Rikki L. Horne, Stanley Dannemiller Copyright (c) 2020 Pharmacy Practice and the Authors Thu, 06 Aug 2020 15:25:47 +0100 Applicability of American College of Clinical Pharmacy (ACCP) competencies to clinical pharmacy practice in Egypt <p><strong>Background</strong>: The American College of Clinical Pharmacy (ACCP) prepared clinical pharmacist competencies that have specific recommendations. Recently, many efforts to advance clinical pharmacy services in Egypt exist. The literature revealed that no country has assessed the extent of applicability of ACCP competencies in its current pharmacy practice setting. Egyptian pharmacists can provide feedback about applicability of such competencies in clinical pharmacy settings in Egypt.</p> <p><strong>Objective</strong>: The objective of this study was to investigate the extent to which ACCP competencies were implemented by Egyptian clinical pharmacists and therefore evaluate development of clinical pharmacy practice in Egypt. The study also investigated factors affecting the applicability of such competencies in the current clinical pharmacy practice setting in Egypt.</p> <p><strong>Methods</strong>: Four hundred and ninety-five randomly selected clinical pharmacists from several hospitals were invited to participate in a cross sectional survey using a self-administered validated questionnaire composed of 31 questions classified into six domains. This questionnaire was designed to determine the pharmacists’ perception about applicability of ACCP competencies to clinical pharmacy practice in Egypt.</p> <p><strong>Results</strong>: The response rate was 64% as 317 out of 495 pharmacists completed the questionnaire. These pharmacists were categorized according to age; gender; qualifications; years of previous work experience, years since BSc. and type of hospitals they are currently working at. Analysis of data revealed the professionalism domain to have the highest percentage of acceptance among pharmacists, while the system-based care &amp; population health domain had the lowest percentage of acceptance. Results also showed that qualifications of participants did not affect their response in three domains; “Direct Patient Care”, “Systems-based Care &amp; Population Health” and “Continuing Professional Development” (p=0.082, 0.081, 0.060), respectively. Nevertheless, qualifications of participants did affect their response in the other three domains; “Pharmacotherapy Knowledge”, “Communication” and “Professionalism” (p&lt;0.05). The age of pharmacists, gender, years of previous work experience, and graduation year did not affect their responses in all six domains. The type of hospital they are currently working at, though, affected their responses where, there was a highly statistically significant increase of the mean score of all domains among participants working at the NGOs/private hospitals compared to governmental hospitals (p&lt;0.001).</p> <p><strong>Conclusions</strong>: Egyptian pharmacists generally apply high percentage of ACCP competencies but the provided clinical pharmacy services need to be improved through applying the standards of best practice.</p> Mahmoud A. Elmaaty, Ahmed A. Elberry, Raghda R. Hussein, Doaa M. Khalil, Amani E. Khalifa Copyright (c) 2020 Pharmacy Practice and the Authors Sun, 06 Sep 2020 14:01:33 +0100 Pharmacists’ practices for non-prescribed antibiotic dispensing in Mozambique <p><strong>Background</strong>: Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance.</p> <p><strong>Objective</strong>: We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique.</p> <p><strong>Methods</strong>: A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed.</p> <p><strong>Results</strong>: Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients’ behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians’ prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms.</p> <p><strong>Conclusions</strong>: The practices of non-prescribed antibiotic dispensing characterize the ‘daily life’ of the pharmacists. On the one hand, the patient’s demand for antibiotics without valid prescriptions, and pharmacist’s wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.</p> Neusa F. Torres, Vernon P. Solomon, Lyn E. Middleton Copyright (c) 2020 Pharmacy Practice and the Authors Tue, 18 Aug 2020 10:34:52 +0100 Exploring discrimination towards pharmacists in practice settings <p><strong>Background</strong>:&nbsp; Discrimination towards pharmacists, as a public-facing health professional group, is reported but not well-studied.</p> <p><strong>Objectives</strong>:&nbsp; The aims of this study were to identify accounts of discrimination in pharmacy practice and to explore the nature and impacts of and discrimination experienced by pharmacists.</p> <p><strong>Methods</strong>:&nbsp; A cross-sectional survey was emailed to practice-based preceptors associated with the School of Pharmacy at the University of Otago. The survey included demographic questions, in addition to questions asking about the frequency and sources of different types of discrimination and abuse encountered in practice. Survey respondents could also provide their contact information for follow-up interviews. Interviews occurred after completion of the survey to better understand the nature of discrimination in pharmacy practice. A thematic analysis of interview transcripts was conducted to identify pertinent themes.</p> <p><strong>Results</strong>: A total of 43 participants completed the survey. A total of 29 (67.4%) respondents reported experiencing discrimination in pharmacy practice. The most common types of discrimination experienced included discrimination based on gender, appearance, or past, present, or expected pregnancy. Verbal abuse and sexual harassment were also frequently reported. Most discrimination was sourced from patients, colleagues, or supervisors/leaders. Discrimination specific to pregnancy was largely sourced from supervisors/leaders. Verbal abuse was sources primarily from patients, patient’s family, supervisors/leaders, and other healthcare professionals. Patients were the primary source of sexual harassment. Three themes were identified from the interview phase: Discrimination occurs for a variety of reasons from different sources with different behaviors, the impact on a person is individualized/personal, and preventative strategies can be broad and encompass multiple layers of society.</p> <p><strong>Conclusions</strong>:&nbsp; Findings of this study support the notion that training programs must adjust to adequately train pharmacists with effective coping strategies, prevention mechanisms, and resilience building strategies. Pharmacist employers should also be accountable to creating zero tolerance workplaces and providing route maps for how pharmacists report and navigate situations when faced with discrimination. Doing so may result in a better equipped workforce that is able to navigate the pressures encountered through discrimination in practice.</p> Lik De Chun, Rebecca Ye, Kyle J. Wilby Copyright (c) 2020 Pharmacy Practice and the Authors Tue, 11 Aug 2020 23:53:31 +0100 Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists <p>Objective.<em>&nbsp; </em>Entrustable Professional Activities (EPAs) are a list of professional tasks (with associated competency ratings) that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. This manuscript assesses the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota.</p> <p>Methods. &nbsp;This survey assessed the self-reported EPA activities (inclusive of the PHP domain) of registered pharmacists living and practicing in North Dakota. There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded.</p> <p>Results. Within the PHP domain, pharmacists reported performing “Minimize adverse drug events and medication errors” most frequently (mean=3.4, SD=2.0), followed by “Ensure that patients have been immunized against vaccine-preventable diseases” (mean=2.3, SD 2.3), “Maximize the appropriate use of medications in a population” (mean=2.2, SD 2.3), and “Identify patients at risk for prevalent diseases in a population” (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists.</p> <p>Conclusion. Pharmacists in North Dakota reported that EPAs in the PHP domain are practiced regularly. Thus, EPAs in the PHP domain have potential as a means to assess outcomes in pharmacy education and practice.</p> <p>&nbsp;</p> David M. Scott, Michael Kelsch, Anqing Zhang, Daniel L. Friesner Copyright (c) 2020 Pharmacy Practice and the Authors Wed, 12 Aug 2020 00:16:13 +0100 Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review <p><strong>Background</strong>: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements.</p> <p><strong>Objective</strong>: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes.</p> <p><strong>Methods</strong>: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities.</p> <p><strong>Results</strong>: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m<sup>2</sup> to -1.94 kg/m<sup>2</sup>; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable.</p> <p><strong>Conclusions</strong>: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.</p> Sarah Pousinho, Manuel Morgado, Ana I. Plácido, Fátima Roque, Amílcar Falcão, Gilberto Alves Copyright (c) 2020 Pharmacy Practice and the Authors Fri, 28 Aug 2020 15:29:32 +0100 Pharmacist’s attitudes and knowledge of pharmacogenomics and the factors that may predict future engagement <p><strong>Background</strong>: While pharmacists are well positioned to implement pharmacogenomic testing in healthcare systems, uptake has been limited.</p> <p><strong>Objective</strong>: The primary objective of this survey was to determine how post-graduate education and training influences pharmacist’s knowledge and attitudes of pharmacogenomic testing.</p> <p><strong>Methods</strong>: Survey questions were developed by the study team, and responses were collected electronically using REDCap<sup>TM</sup>. The electronic survey was sent to all pharmacists (n=161) within a large, multi-state healthcare system by email.</p> <p><strong>Results</strong>: A total of 75 (47%) respondents completed all aspects of the survey. The majority of respondents were female (60%), worked in acute care settings (57%), were full-time employees (80%), and worked in an urban area (85%), with many graduating in or after 2010 (43%). For post-graduate education, 36% of respondents completed a Post-Graduate Year One Residency (PGY-1), and 27% had a board certification. Those that completed a PGY-1 residency were significantly more likely to have received formal training or education on pharmacogenomics than those who had not. They also assessed their own knowledge of pharmacogenomic resources and guidelines higher than those without PGY-1 training. More recent graduates were also significantly more likely to have received formal training or education on pharmacogenomics. Additionally, pharmacists who completed a PGY-1 residency were more likely to respond favorably to pharmacogenomics being offered through pharmacy services. Pharmacists with board certification were more comfortable interpreting results of a pharmacogenomic test than those without board certification.</p> <p><strong>Conclusions</strong>: Pharmacists who have completed a PGY-1 residency or received board certification appear more comfortable with interpretation and implementation of pharmacogenomic testing.</p> Megan E. Hundertmark, Stephen C. Waring, David D. Stenehjem, Danielle A. MacDonald, David D. Sperl, Ann Yapel, Jacob T. Brown Copyright (c) 2020 Pharmacy Practice and the Authors Thu, 27 Aug 2020 11:20:02 +0100 Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment <p><strong>Background</strong>: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country.</p> <p><strong>Objective</strong>: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI).</p> <p><strong>Methods</strong>: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population.</p> <p><strong>Results</strong>: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)].</p> <p><strong>Conclusions</strong>: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.</p> Klejda Harasani, Delina Xhafaj, Anxhela Begolli, Maria C. Olvera-Porcel Copyright (c) 2020 Pharmacy Practice and the Authors Sat, 22 Aug 2020 10:38:20 +0100 Evaluation of traditional initial vancomycin dosing versus utilizing an electronic AUC/MIC dosing program <p><strong>Background</strong>: Area under the curve to minimum inhibitory concentration (AUC/MIC) has been recommended by the 2020 updated vancomycin guidelines for dosing vancomycin for both efficacy and safety. Previously, AUC/MIC has been cumbersome to calculate so surrogate trough concentrations of 15-20 mg/dL were utilized. However, trough-based dosing is not a sufficient surrogate as AUC/MIC targets of 400-600 can usually be reached without achieving troughs of 15-20 mg/dL. Targeting higher trough levels may also lead to adverse events including acute kidney injury (AKI) and nephrotoxicity.</p> <p><strong>Objective</strong>: To compare the mean total first day vancomycin dose in traditional trough-based dosing versus dosing recommended by an AUC/MIC dosing program.</p> <p><strong>Methods</strong>: Adult inpatients who received at least 24 hours of IV vancomycin treatment were included in this single-center, retrospective cohort study. The primary endpoint was difference in mean total first day vancomycin dose in milligrams (mg) received between patients’ traditional trough-based dosing and recommended dose via AUC/MIC electronic dosing calculator. Patients served as their own control by analyzing both actual dose received and dose recommended by the electronic AUC/MIC program. Rates of vancomycin induced adverse events, including acute kidney injury, elevated steady-state trough concentrations, and Red Man’s syndrome were also compared between patients who received doses consistent with the AUC/MIC dosing recommendation versus those who did not.</p> <p><strong>Results</strong>: 264 patients were included in this study. Initial 24-hour vancomycin exposure was significantly lower with the recommended AUC/MIC dose versus the dose received (2380.7; SD 966.6 mg vs 2649.6; SD 831.8 mg, [95% CI 114.7:423.1] p=0.0007).</p> <p><strong>Conclusions</strong>: Utilizing an electronic AUC/MIC vancomycin dosing calculator would result in lower total first day vancomycin doses.</p> Kerri A. McGrady, Makenzie Benton, Serina Tart, Riley Bowers Copyright (c) 2020 Pharmacy Practice and the Authors Mon, 14 Sep 2020 23:35:47 +0100 Complementing or conflicting? How pharmacists and physicians position the community pharmacist <p><strong>Background</strong>: Interprofessional collaboration between pharmacists and physicians in primary care has been linked to improved patient outcomes. How professionals position themselves and each other can shed light upon their relationship, and positioning theory can be used as a tool to better understand intergroup relations.</p> <p><strong>Objectives</strong>: 1) To identify how community pharmacists position themselves, and how they are positioned by general practitioners. 2) To assess how well these positions correspond, how the positions align with a proactive position for the pharmacists, and discuss how the positions could potentially impact collaboration.</p> <p><strong>Methods</strong>: In this qualitative study, data were collected through six focus group interviews held between June and October 2019, three with pharmacists and three with physicians. The focus group interviews were conducted using a semi-structured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the Systematic text condensation method. Positioning theory was used as a theoretical framework to identify the positions assigned to community pharmacists by the pharmacists themselves and by the physicians.</p> <p><strong>Results</strong>: Twelve pharmacists and ten physicians participated. The pharmacists positioned themselves as the “last line of defense”, “bridge-builders”, “outsiders” – with responsibility, but with a lack of information and authority – and “practical problem solvers”. The physicians positioned pharmacists as “a useful checkpoint”, “non-clinicians” and “unknown”.</p> <p><strong>Conclusions</strong>: The study revealed both commonalities and disagreements in how community pharmacists position themselves and are positioned by general practitioners. Few of the positions assigned to pharmacists by the physicians support an active role for the pharmacists, while the pharmacists´ positioning of themselves is more diverse. The physicians´ positioning of pharmacists as an unknown group represents a major challenge for collaboration. Increasing the two professions´ knowledge of each other may help produce new positions that are more coordinated, and thus more supportive towards collaboration.</p> Hilde Rakvaag, Gunn E. Søreide, Eivind Meland, Reidun L. Kjome Copyright (c) 2020 Pharmacy Practice and the Authors Wed, 16 Sep 2020 00:22:53 +0100 Primary health care policy and vision for community pharmacy and pharmacists in Portugal <p>The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes.</p> Nadine Ribeiro, Helder Mota-Filipe, Mara P. Guerreiro, Filipa A. Costa Copyright (c) 2020 Pharmacy Practice and the Authors Fri, 17 Jul 2020 14:44:26 +0100 Primary health care policy and vision for community pharmacy and pharmacists in Indonesia <p>The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.</p> Andi Hermansyah, Luh Wulandari, Susi A. Kristina, Sherly Meilianti Copyright (c) 2020 Pharmacy Practice and the Authors Wed, 22 Jul 2020 14:43:00 +0100 Primary health care pharmacists and vision for community pharmacy and pharmacists in Chile <p>The Chilean healthcare system is composed of public and private sectors, with most of the higher-income population being covered privately. Primary healthcare in the public system is provided in more than 2,500 public primary care centers of different sizes with assigned populations within territories. Private insurance companies have their own healthcare networks or buy services from individual health providers. Patients from the public system receive most medications free of charge in primary care pharmacies embedded in each care center. Private patients must purchase their medicines from community pharmacies. Some government policies subsidize part of the cost of medications, but original medicines remain as the most expensive of Latin America. Three chain pharmacies have more than 90% of the market share, and these pharmacies have negative public perception because of price collusion court sentences. A non-profit, municipal pharmacy model was developed but has limited implementation. Most privately owned independent and chain community pharmacies do not provide pharmaceutical services as there is no remuneration or cover by insurers. The limited number of publicly owned Municipal pharmacies could implement pharmaceutical services in community settings as they are non-profit establishments and have full-time pharmacists but are not resourced for these services. A limited number of pharmaceutical services are almost exclusively provided in public primary care, including medication reviews, pharmaceutical education, home visits and pharmacovigilance services, but several barriers to their implementation remain. A risk-based multimorbidity care model was implemented in 2020 for public primary care with additional employment of part-time pharmacists to provide services. We believe that this model will help pharmacists to optimize their time by prioritizing the much-needed clinical tasks. We propose within this multimorbidity care model that the more time-consuming services are provided to higher risk patients. Pharmacy prescribing i.e. amending or approving changes in medications in primary care for chronic conditions could also be useful for the health system, but pharmacists would require additional training. The landscape for pharmaceutical services for primary care in Chile is promising, but the integration with community pharmacies will not be possible until they are funded by public and private insurance, and the public perception of these establishments is improved.</p> Francisco Martinez-Mardones, Antonio Ahumada-Canale, Loreto Gonzalez-Machuca, Jose C. Plaza-Plaza Copyright (c) 2020 Pharmacy Practice and the Authors Fri, 28 Aug 2020 16:24:15 +0100 Primary healthcare policy and vision for community pharmacy and pharmacists in the United States <p>The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.</p> Teresa M. Salgado, Meagen M. Rosenthal , Antoinette B. Coe, Tana N. Kaefer, Dave L. Dixon, Karen B. Farris Copyright (c) 2020 Pharmacy Practice and the Authors Fri, 18 Sep 2020 20:05:50 +0100 Student pharmacists’ role in enhancing ambulatory care pharmacy practice <p>With a primary care physician shortage, utilization of pharmacists in the ambulatory care setting has proven to have positive economic and clinical outcomes for the practice and for patients. To extend the reach of the pharmacists, students may assist with patient care activities, such as medication reconciliation, point-of-care testing, and counseling. Evidence has shown that students benefit in building confidence, as well as improved perceptions of interprofessional care, while positive patient outcomes are maintained. There are many methods for schools to integrate these experiences early into their curriculum, as well as for students to explore opportunities on their own.</p> Lauren G. Pamulapati, Danielle Hess Copyright (c) 2020 Pharmacy Practice and the Authors Mon, 07 Sep 2020 20:04:34 +0100