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 any publication fee 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 pr 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> (Fernando Fernandez-Llimos) (Administration) Tue, 18 Jun 2019 00:00:00 +0100 OJS 60 Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization <p><strong>Objectives</strong>: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified.</p> <p><strong>Methods</strong>: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified.</p> <p><strong>Results</strong>: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not.</p> <p><strong>Conclusions</strong>: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.</p> Rebecca M. Fitzpatrick, Matthew J. Witry, William R. Doucette, Kelly Kent, Michael J. Deninger, Randal P. McDonough, Stevie Veach Copyright (c) 2019 Pharmacy Practice and the Authors Thu, 30 May 2019 18:17:01 +0100 Trends in high intensity statin use among secondary prevention patients 76 years and older <p><strong>Background</strong>: High intensity statin therapy (HIST) is the gold standard therapy for decreasing the risk of recurrent atherosclerotic cardiovascular disease (ASCVD); however, little is known about the use of HIST in older adults with ASCVD.</p> <p><strong>Objectives</strong>: The aim of this cross-sequential study was to determine trends in statin intensity in older adults over a 10-year timeframe.</p> <p><strong>Methods</strong>: The study was conducted in an integrated healthcare delivery system. Patients were 76 years or older with validated coronary ASCVD. Data were collected from administrative databases. Statin intensity level was assessed in eligible patients on January 1st and July 1st from January 1, 2007 to December 31, 2016.</p> <p><strong>Results</strong>: Overall, a total of 5,453 patients were included with 2,119 (38.9%) and 3,334 (61.1%) categorized as HIST and Non-HIST, respectively. Included patients had a mean age of 79.8 years and were primarily male and white and had a cardiac intervention. The rate of HIST use increased from 14.5% to 41.3% over the study period (p&lt;0.001 for trend). Conversely, the rates of moderate and low intensity statin use decreased from 61.8% and 9.8% to 41.2% and 4.8%, respectively (both p&lt;0.001 for trend). Similar trends were identified for females and males.</p> <p><strong>Conclusions</strong>: The percentage of patients with ASCVD 76 years and older who received HIST substantially increased from 2007 to 2016. This trend was identified in both females and males. Future comparative effectiveness research should be conducted in this patient population to examine cardiac-related outcomes with HIST and Non-HIST use.</p> Michele Wood, Thomas Delate, Sheila L. Stadler, Anne M. Denham, Leslie K. Ruppe, Roseanne Hornak, Kari L. Olson Copyright (c) 2019 Pharmacy Practice and the Authors Wed, 29 May 2019 14:51:14 +0100 Influencing the timing of parenteral nutrition initiation in the pediatric intensive care unit <p><strong>Background</strong>: Lack of benefit and potential harm of early parenteral nutrition (PN) initiation in critically ill children was highlighted in the 2016 published results of a large multicenter, randomized controlled trial.</p> <p><strong>Objectives</strong>: The purpose of this project was to implement a process to delay PN initiation for up to five days after admission to our pediatric intensive care unit (PICU).</p> <p><strong>Methods</strong>: Patients greater than thirty days of age, admitted to the PICU beginning July 1, 2016 were included in the analysis of the healthcare improvement initiative to decrease early PN initiation. A meeting was held with PICU fellows, attending physicians, dietitians, and pharmacists to reach a consensus to delay initiation of parenteral nutrition until PICU day five. The dietitian, with pharmacist support, reiterated recommendations on rounds and in formal notes.</p> <p><strong>Results</strong>: A total of 2333 patients were identified in the pre-intervention group and a total of 2491 patients in the post-intervention group. The percentage of patients receiving PN prior to day five within the PICU was 5.5% in the pre-intervention group versus 3.1% in the delayed PN group (p&lt;0.001). PICU patients receiving PN less than or equal to three days decreased from 2.6% pre-intervention to 1.5% post-intervention (p=0.01). For the subset of patients who were initiated on PN after admission to the PICU, median PICU length of stay was 7 days versus 6 days in the pre-intervention versus post-intervention group (p=0.26).</p> <p><strong>Conclusions</strong>: Decrease in PN utilization was seen in the pre and post-intervention groups as assessed by percentage of patients initiated on PN prior to day five of PICU admission. Consensus among practitioners with consistent recommendations from the frontline dietitian and pharmacist, with nutrition support team collaboration, contributed to the evidence based quality initiative results. Delaying PN did not adversely affect length of stay pre versus post-intervention.</p> Collin R. Anderson, Jennifer Lueckler, Jared A. Olson Copyright (c) 2019 Pharmacy Practice and the Authors Thu, 06 Jun 2019 21:00:39 +0100 Views on the role of community pharmacy in local communities: a case study of stakeholders’ attitudes <p><strong>Objectives</strong>: To investigate the view of the role of community pharmacy by selected stakeholders in local Danish communities.</p> <p><strong>Methods</strong>: A mixed method approach combining qualitative and quantitative methods was used: observations at pharmacies, questionnaires for pharmacy staff and customers, and interviews with pharmacy owners, general practitioners (GPs) and politicians. Role theory was the theoretical foundation. Data was analyzed using directed content analysis and descriptive statistics.</p> <p><strong>Results</strong>: Five Danish towns were visited, resulting in five pharmacist interviews, 48 questionnaire replies from pharmacy staff, 59 customer interviews, three GP interviews and four interviews with local politicians. All stakeholders found the pharmacy to have a medical focus, although to a differing degree. While pharmacy staff and GPs had the greatest knowledge and expectations regarding the pharmacy staff’s level of medical knowledge, local politicians had the least. Pharmacy staff wanted to take on more responsibility. Customers generally considered the pharmacy part of the healthcare sector with a high level of knowledge on medications. GPs’ attitudes appeared to be related to the amount of communication between GP office and pharmacy. Local politicians interviewed did not seem to be aware of the competencies within the pharmacy, but once informed were open to using the pharmacy as an integrated part of the local healthcare system.</p> <p><strong>Conclusions</strong>: There was general consensus between stakeholder groups that medicine is the main area of focus at the pharmacy. However, investigated stakeholders did not appear to be aware of the full extent of the competencies within the pharmacy, and there was a general lack of consensus about the services the pharmacy should perform. If the competencies within the pharmacy are to be fully utilized, the pharmacy must not only tell but also show the local community what they can do.</p> Josefine D. Nørgaard, Sofia K. Sporrong Copyright (c) 2019 Pharmacy Practice and the Authors Sat, 01 Jun 2019 18:07:54 +0100 An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines <p><strong>Background</strong>: Fever and pain are common conditions in the Australian healthcare setting. Whilst clinical guidelines provide important therapeutic recommendations, evidence suggests they are not always followed. Given that community pharmacy is one of the most frequently accessed primary healthcare services, it is important to understand the views and practices of community pharmacists in pain and fever.</p> <p><strong>Objectives</strong>: To investigate the views and practices of Australian community pharmacists in pain and fever management, and their views on relevant clinical guidelines.</p> <p><strong>Methods</strong>: A cross-sectional study of community pharmacists in Australia was conducted using a customised, anonymous, self-administered, online questionnaire between March and May 2018. To capture a broad range of demographics, pharmacists were recruited via local industry contacts and the Pharmaceutical Society newsletter, with further recruitment through snowball sampling. The main outcomes measured were pharmacists’ views, practices and treatment recommendation of choice in pain and fever management, as well as views on clinical guidelines and training.</p> <p><strong>Results</strong>: A total of 113 pharmacists completed the survey. In general, paracetamol (72%) was preferred as a recommendation over ibuprofen, and was the drug of choice for most mild to moderate pain and fever scenarios. Majority of pharmacists reported good knowledge of pain and fever management, however, only approximately half reported recent pain management training. Greater than 87% of pharmacists believe that clinical guidelines are useful in fever management, and 79% of pharmacists believe that following clinical guidelines is important in pain management.</p> <p><strong>Conclusions</strong>: While most pharmacists recognise the importance of guidelines and demonstrated good pain and fever management, results suggests opportunities to promote additional education, upskilling, and research in this space to further optimise pain and fever management in the community.</p> John Mishriky, Ieva Stupans, Vincent Chan Copyright (c) 2019 Pharmacy Practice and the Authors Tue, 11 Jun 2019 11:07:40 +0100 Attitudes of Lebanese pharmacists towards online and live continuing education sessions <p><strong>Background</strong>: Continuing education (CE) is an internationally recommended approach as a lifelong learning model for pharmacists, enabling them to maintain the necessary knowledge, skills and ethical attitudes so as to remain current and competent in their practice.</p> <p><strong>Objectives</strong>: The objective of this study is to 1) describe factors associated with taking different types of CE courses among pharmacists in Lebanon, and 2) assess the correlation between types of CE activity and the attitude of Lebanese pharmacists (motivation and value) and their computer literacy.</p> <p><strong>Methods</strong>: This is a cross-sectional observational study conducted between February and May 2017, using a random sample of Lebanese pharmacists from all districts of Lebanon. All pharmacists were eligible to participate; the sample consisted of those who agreed to complete the questionnaire. The questionnaire includes questions about computer literacy, motivation and value about CE, in addition to sociodemographic characteristics of pharmacists.</p> <p><strong>Results</strong>: Out of the 750 questionnaires distributed, 628 (83.73%) were filled out and returned to be analyzed. The mean age of the participants was 39.04 (SD 10.57) years, 66.9% of them were females, and 41.1% of them had a bachelor degree in pharmacy and worked in Mount Lebanon. Among the 628 respondents, 567 (90.3%) have earned at least one CE credit. Of those, 5.4% took mainly online courses, 15.4% took mainly live courses and the remaining took both types of CE. Higher motivation (aOR=1.05; CI 0.994-1.109) and higher value (aOR=1.076; CI 0.968-1.197) were associated with higher odds of taking live CE courses. Higher motivation (aOR=1.07; 95%CI 0.994-1.152) was associated with higher odds of taking online CE courses. Higher motivation (aOR=1.059; 95%CI 1.006-1.114) and higher general confidence with computer use (aOR=1.058; 95%CI 1.012-1.106) were significantly associated with higher odds of taking both types of CE courses.</p> <p><strong>Conclusions</strong>: A high percentage of Lebanese pharmacists enrolled in the CE system, mainly driven by motivation and value of CE, in addition to a higher general confidence in computer use. Further efforts should be exerted by the Lebanese Order of Pharmacists to motivate pharmacists and help them improve their computer literacy, which is expected to improve not only enrollment in CE activities, but also the completion of their CE requirements.</p> Hala Sacre, Samah Tawil, Souheil Hallit, Aline Hajj, Georges Sili, Pascale Salameh Copyright (c) 2019 Pharmacy Practice and the Authors Tue, 04 Jun 2019 12:00:16 +0100 Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study <p><strong>Background</strong>: Due to aging, along with its associated physiological changes, older adults are extremely vulnerable to be afflicted with multiple chronic conditions (multimorbidity).&nbsp; Accordingly, prescribing a large number of drugs to older adults would be inevitable.&nbsp; Resulted complex drug regimens can lead to prescribing of Potentially Inappropriate Medications (PIMs) with subsequent negative health and economic outcomes.&nbsp;</p> <p><strong>Objectives</strong>: The main objective of this study is to investigate the prevalence and predictors of PIMs prescribing among Jordanian elderly outpatients, using the last updated version of the American Geriatrics Society (AGS) Beers Criteria (2015 version).</p> <p><strong>Methods</strong>: A Unicenter, cross-sectional study were data was assessed using medical records of included study subjects conducted over three months period from beginning of October to the end of December 2016 at King Abdullah University Hospital, Al Ramtha, Jordan.&nbsp; Our study included patients aged 65 years or above who visited the outpatient clinics at King Abdullah University hospital (KAUH) and were prescribed at least one oral medication during the study period.&nbsp; PIMs were identified for these patients and further classified according to the 2015 AGS Beers Criteria. We measured the prevalence of PIMs prescribed among elderly outpatients in Jordan.</p> <p><strong>Results</strong>: A total of 4622 eligible older adults were evaluated in this study, of whom 62.5% (n=2891) were found to have at least one PIM prescribed during the three months study period. &nbsp;69% of identified PIMs were medications to be used with caution in elderly, 22% were medications to avoid in many or most older adults, 6.3% were medications to be avoided or have their dosage adjusted based on kidney function in older adults, 2.04% medications were to avoid in older adults with specific diseases/syndromes, and 1.6% were potentially clinically important non-anti-infective drug-drug interactions to be avoided in older adults.&nbsp; Female gender and polypharmacy were found to be significant predictors of PIMs use among elderly.&nbsp;</p> <p><strong>Conclusions</strong>: Potentially Inappropriate Medication prescribing is common among Jordanian elderly outpatients.&nbsp; Female gender and polypharmacy are associated with more PIMs prescribing and so need further attention.</p> Ahmad Al-Azayzih, Rawan AlAmoori, Shoroq M. Altawalbeh Copyright (c) 2019 Pharmacy Practice and the Authors Wed, 05 Jun 2019 18:42:42 +0100 Setting the agenda for clinical pharmacy in Qatar: thematic and content analyses of news media headlines <p><strong>Background</strong>:&nbsp; Public awareness of the role of pharmacists and availability of pharmacy services in Qatar is low. As per agenda-setting theory, mass media may be contributing toward this problem by selecting and disseminating headlines and stories according their own objectives and not those of the profession.</p> <p><strong>Objectives</strong>: The objective of this study was to examine the agenda set by mass media organizations in Qatar pertaining to the profession of pharmacy and to determine the frequency of professional identifiers that appear within news headlines.</p> <p><strong>Methods</strong>:&nbsp; Publicly available news headlines published between November 2016 and November 2018 were obtained from local news websites. Thematic analysis was performed using agenda-setting theory to explore how the public’s agenda was set for pharmacy practice in Qatar. Content analysis was used to determine the proportion of headlines that contained a professional identifier linking the news report to the pharmacy profession.&nbsp;</p> <p><strong>Results</strong>: A total of 81 headlines were included in the analysis. The agenda for pharmacy practice in Qatar was set according to two themes: achievement and outreach/engagement. Achievement related to awards, use of new technologies, interprofessional education, and novel student training accomplishments. Outreach/engagement reported student and pharmacist involvement upon completion of a health awareness event. Approximately half (47%) of headlines contained a professional identifying word linking the headline to the profession of pharmacy.</p> <p><strong>Conclusions</strong>:&nbsp; The findings of this study demonstrate that the mass media’s agenda for the pharmacy profession in Qatar does not inform the public of pharmacist’s services or expanded scopes of practice. Furthermore, a lack of professional identifiers within headlines likely limits the public’s agenda of pharmacist roles. The pharmacy profession must work collaboratively with news media to better align the public’s agenda with pharmacists’ roles and services.</p> Mohammad Diab, Kyle J. Wilby Copyright (c) 2019 Pharmacy Practice and the Authors Thu, 06 Jun 2019 20:44:55 +0100 Mobile authentication service in Nigeria: An assessment of community pharmacists’ acceptance and providers’ views of successes and challenges of deployment <p><strong>Background</strong>: Mobile Authentication Service (MAS) is a mobile health technology deployed to hinder the retailing of falsified medicines to consumers in Nigeria. But, some community pharmacists reported that points of failures of MAS have negatively impacted their practices.</p> <p><strong>Objectives</strong>: The objectives of this study were (1) to assess the acceptance of MAS by community pharmacists; (2) to explore the views of MAS providers on the challenges and successes of MAS deployment in Nigeria.</p> <p><strong>Methods</strong>: A quantitative cross sectional survey was used to investigate community pharmacists’ acceptance of MAS. A validated structured questionnaire, based on Technology Acceptance Model, was distributed to 326 community pharmacists. In addition, a structured interview guide was employed to explore MAS providers’ views of challenges and successes of MAS deployment in Nigeria.</p> <p><strong>Results</strong>: Just about half (53%) of responding community pharmacists were keen on using MAS. In addition, 51% of them would recommend the service to other practitioners and 54% would encourage their clients to use it. The results of the study indicated that both awareness and perceived reliability played important role in the behavioural intention to use the MAS. The findings from the exploration of MAS providers’ views showed that the problems encountered with MAS (no response and wrong response) were mainly due to contextual challenges in the Nigerian setting. These contextual challenges like the Global System Mobile downtime, incessant power outages and limited ability of consumers to use the Short Message Service, all contributed to the limited success of MAS in Nigeria.</p> <p><strong>Conclusions</strong>: Acceptance of mobile authentication service by community pharmacists is moderate. Perceived reliability and awareness are important factors that affect behavioural intention to use MAS. The limited success of MAS deployment appeared to be as a result of its interaction with the local context, where it has been deployed.</p> Olubukola O. Oyetunde, Olayiwola Ogidan, Mary I. Akinyemi, Adeteju A. Ogunbameru, Olubunmi F. Asaolu Copyright (c) 2019 Pharmacy Practice and the Authors Wed, 05 Jun 2019 17:24:32 +0100 The provision of advice by pharmacy staff in eastern Indonesian community pharmacies <p><strong>Background</strong>: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region.</p> <p><strong>Objectives</strong>: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios.</p> <p><strong>Methods</strong>: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts.</p> <p><strong>Results</strong>: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately.</p> <p><strong>Conclusions</strong>: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed.</p> Cecilia Brata, Carl R. Schneider, Brahmaputra Marjadi, Rhonda M. Clifford Copyright (c) 2019 Pharmacy Practice and the Authors Mon, 03 Jun 2019 20:50:07 +0100 A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia <p><strong>Objectives</strong>: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists’ experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored.</p> <p><strong>Methods</strong>: Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre- and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach.</p> <p><strong>Results</strong>: Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists’ role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients’ laboratory data in Australia.</p> <p><strong>Conclusions</strong>: The targeted training improved pharmacists’ knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.</p> Shamala Ayadurai, Bruce Sunderland, Lisa B. Tee, H. Laetitia Hattingh Copyright (c) 2019 Pharmacy Practice and the Authors Fri, 14 Jun 2019 16:43:08 +0100 Investigating the efficacy of an interactive warning for use in labeling strategies used by U.S. pharmacies <p><strong>Background</strong>: United States pharmacies repackage medications into multi-dose vials, enabling customized dosing for prescription drugs. Investment in infrastructure has made this the predominant approach to packaging for US prescriptions. Although recent changes to labeling now discourage the use of auxiliary labels (small stickers highlighting information germane to the safe and effective use), they are still allowed by USP&lt;17&gt;, provided their use comes from an evidence-based perspective.</p> <p><strong>Objectives</strong>: Evaluate how ‘interactive,’ placements of auxiliary labels (placement requiring physical manipulation of the warning to accomplish a task (e.g. opening)) garner attention as compared to those placed vertically or horizontally.</p> <p><strong>Methods</strong>: Ninety-six participants were eye tracked while opening three prescription vials (each with an auxiliary warning label with a different placement: vertical, horizontal and interactive). Recall and recognition were tested subsequently. Linear mixed models were used to analyze the continuous variables while the binary response variables were analyzed using generalized linear mixed models. The effect of auxiliary labels was fitted as a fixed effect and the subject-to-subject variation was considered as a random effect in the model. Participants’ age, health literacy and sex were added to the models if their effect was statistically significant at alpha=0.05.</p> <p><strong>Results</strong>: The placement of the warnings significantly impacted the time spent viewing the information they contained at alpha=0.05; people spent significantly longer on interactive placements (0.96; SD 0.13 seconds) than either, horizontal placements (0.27; SD 0.037 seconds) or those placed vertically (0.18 seconds; SD 0.035). Participants were equally as likely to see information presented in an interactive placement (90%; SD 3.8) or horizontal placement (78%; SD 05.5) but less likely to view warnings placed vertically (60%; SD 6.9). Free recall responses also supported the use of interactive placement (62%; SD 6.8 recall) as compared to horizontal placements which were 29%; SD 3.0 and 20%; SD 6.0 for vertical placements.</p> <p><strong>Conclusions</strong>: Data provides evidence which suggests that interactive and horizontal placements out-perform auxiliary labels placed vertically on prescription vials with regard to garnering patient attention.</p> Jiyon Lee, Moslem Ladoni, James Richardson, Raghav P. Sundar, Laura Bix Copyright (c) 2019 Pharmacy Practice and the Authors Fri, 14 Jun 2019 17:18:10 +0100 Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study <p><strong>Background</strong>: Hormonal contraceptive pills have evolved as a common form of contraception worldwide. Pharmacists play a vital role in providing safe and effective access to these medicines. In many developing countries such as the United Arab Emirates (UAE), these medicines are available to the general public without the presentation of a prescription which requires the pharmacist to shoulder responsibility by assessing and educating patients to assure their appropriate use.</p> <p><strong>Objectives</strong>: To evaluate community pharmacists’ current practice of dispensing and counseling on hormonal contraceptives</p> <p><strong>Methods</strong>: Simulated patient methodology was used in this study. A single simulated patient visited community pharmacies requesting an oral contraceptive as per a preplanned scenario. Information from the visits were recorded on a data collection form including: pharmacist assessing patient eligibility to take hormonal contraceptives, selecting the appropriate oral contraceptive, providing complete counseling on how to use the pill, adherence, missed dose handlings and side effects of the medication. The Pharmacist was prompted by the simulated patient to provide the information if they did not provide spontaneous counseling. The quality of pharmacists’ counseling was rated and consequently coded as complete, incomplete or poor.</p> <p><strong>Results</strong>: A total of 201 community pharmacies were visited. More than 92% of the pharmacists did not ask the simulated patient any question to assess their eligibility to use contraceptives. Twenty three pharmacists (11.4%) selected the proper product. One hundred seventeen (58.2%) of the pharmacists provided spontaneous counseling on how to use the pill, 17 of them had their counsel rated as complete, but none of the pharmacists provided spontaneous counseling regarding adherence or side effects of the medications. On prompting, 10 pharmacists (12%) provided complete counseling regarding how to use oral contraceptives, 14 pharmacists (7.0%) provided complete counseling on adherence and missing dose handling and five pharmacists (2.5%) provided complete counseling about expected side effects.</p> <p><strong>Conclusions</strong>: Pharmacists’ practice regarding hormonal contraceptive dispensing and counseling was suboptimal in this study. Areas needing intervention were related to pharmacist assessment of eligibility for oral contraceptive use, choice of optimal oral contraceptive for patient-specific co-morbidities and provision of adequate counseling regarding proper use, adherence and missed dose handlings.</p> Dalal M. Mobarak, Moawia M. Al-Tabakha, Sanah Hasan Copyright (c) 2019 Pharmacy Practice and the Authors Tue, 11 Jun 2019 10:52:24 +0100 Availability and rationality of fixed dose combinations available in Kaduna, Nigeria <p><strong>Background</strong>: Fixed-dose drug combinations (FDCs), are combinations of two or more active drugs in a single dosage form. Despite the advantages obtained from the use of these agents, there is increasing evidence questioning the rationality of several FDCs found in pharmaceutical markets-especially those in developing countries like Nigeria.</p> <p><strong>Objectives</strong>: To describe the availability of FDCs in drug retailing outlets located in Kaduna Nigeria, and to assess FDC registration status and inclusion on national and international essential medicines lists (EMLs). Rationality of selected FDCs was also assessed.</p> <p><strong>Methods</strong>: A cross-sectional survey was carried out from June to September 2018 in 60 registered pharmacies and patent medicine shops selected through multi-stage sampling. A data collection form was used to obtain information on the generic names and strengths of the active ingredients of the FDCs, their country of manufacture and evidence of registration with the Nigerian drug regulatory agency. To assess rationality, a scoring rubric developed from earlier studies was used. Data collected was coded and entered into a Microsoft excel 2016 spreadsheet for analysis. Descriptive statistics (frequencies and percentages) were used to report the data collected.</p> <p><strong>Results</strong>: FDCs encountered included 74 oral tablets/capsules, 52 oral liquids and 23 topical semi solids. Majority of the available FDCs were registered by Nigerian drug regulatory agency (91.5%), although only 8.5% and 6.5% in total were included on the Nigerian EML and the WHO model list respectively. Of the 99 FDCs assessed for rationality, 58 (58.6%) were found to be rational. Irrational FDCs included drugs acting on the respiratory tract (29.3%), analgesics (26.8%) and anti-infectives (22%).</p> <p><strong>Conclusions</strong>: A wide variety of FDCs were available in the study area, even though not all of them were rational. There is an urgent need for policy makers within the country to develop better detailed guidelines for FDC registration.</p> Fatima Auwal, Mohammed N. Dahiru, Samirah N. Abdu-Aguye Copyright (c) 2019 Pharmacy Practice and the Authors Mon, 10 Jun 2019 20:12:05 +0100 Information seeking behavior and awareness among physicians regarding drug information centers in Saudi Arabia <p><strong>Background</strong>: The role of Drug Information Center (DIC) in a health-care setting has increased tremendously owing to the high influx of pharmaceutical molecules that pose serious challenges to physicians. DIC promotes rational prescribing behavior among physicians, leading to better patient outcome.</p> <p><strong>Objectives</strong>: This study aimed to explore information-seeking behaviors and awareness of physicians regarding DIC services in the Kingdom of Saudi Arabia.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted among physicians working in government and private sectors between June to November 2018 by using an 18-item electronic anonymous questionnaire. Descriptive and inferential statistics were performed using IBM SPSS (Version 21). A P-value of &lt;0.05 was taken as the level of significance between responses.</p> <p><strong>Results</strong>: In total, 500 questionnaires were distributed among the included hospitals, and only 254 physicians (response rate: 50.8%), including 193 males (76%), participated in the study. The majority of participants (n = 83, 32.7%) had more than ten years of experience, and many of the respondents (n=131) worked as residents. Most of the physicians (62.9%) were aware of their institutional DIC. UpToDate was the most preferred drug information database among physicians. Regarding the improvement required in the DIC services, most of the physicians (23.6%) opined that the contact details should be available in all clinical wards.</p> <p><strong>Conclusions</strong>: Only 10% of the respondents were not aware of the presence of DIC at their institution. The UpToDate online drug information database was the most frequently used database by the physicians. Our findings showed that there is a need for conducting educational programs for physicians regarding DIC services. Such an attempt can increase the frequency of drug-related queries and promote patient safety.</p> Dlal A. Almazrou, Sheraz Ali, Dalal A. Al-Abdulkarim, Ahmed F. Albalawi, Jasser A. Alzhrani Copyright (c) 2019 Pharmacy Practice and the Authors Tue, 11 Jun 2019 10:33:34 +0100 Pharmacist-administered pediatric vaccination services in the United States: major barriers and potential solutions for the outpatient setting Nicole E. Omecene, Julie A. Patterson, John D. Bucheit, Apryl N. Anderson, Danielle Rogers, Jean-Venable R. Goode, Lauren M. Caldas Copyright (c) 2019 Pharmacy Practice and the Authors Tue, 18 Jun 2019 11:02:10 +0100