Pharmacy

11 pages, 248 KiB

Open AccessArticle

Assessment of Potential Drug–Drug Interactions of Psycholeptics and Antidepressants in Outpatient Settings

by Iva Marović, Ivana Marinović, Vesna Bačić Vrca and Ivana Samardžić

Pharmacy 2024, 12(6), 174; https://doi.org/10.3390/pharmacy12060174 - 22 Nov 2024

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and [...] Read more.

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and clinical significance of potential psychotropic drug interactions in outpatient settings and compare the differences in potential drug–drug interaction (pDDIs) exposure with age. The psychotropic drugs included antipsychotics—N05A, anxiolytics—N05B, hypnotics and sedatives—N05C, and antidepressants—N06A. This retrospective study analyzed prescribed pharmacotherapy in 492 outpatients who were treated with at least one psychotropic drug. We determined 1.64 prescribed psychotropic drugs per patient and 2.2 pDDIs that involved psychotropic drugs. In total, 2285 pDDIs were recorded, of which almost half (47.6%) were pDDIs with psychotropic drugs. More prescribed psychotropic drugs were found in patients younger than 65 years, and equal exposure to pDDIs of psychotropic drugs (p = 0.5077) was found in both age groups. The most commonly identified psychotropics involved in pDDIs were benzodiazepines, promazine, and zolpidem. The results indicate that psychotropic drug interactions represent important drug-related problems for primary health care. The widespread use of psychotropic drugs and the determined clinical significance of their interactions require pharmacist interventions which can reduce the prevalence of pDDIs and increase patient safety. Full article

8 pages, 548 KiB

Open AccessCommentary

Tackling Pharmaceutical Pollution Along the Product Lifecycle: Roles and Responsibilities for Producers, Regulators and Prescribers

by Gillian Parker and Fiona A. Miller

Pharmacy 2024, 12(6), 173; https://doi.org/10.3390/pharmacy12060173 - 22 Nov 2024

Abstract

Pharmaceuticals produce considerable environmental harm. The industry’s resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the “upstream” harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the “downstream” [...] Read more.

Pharmaceuticals produce considerable environmental harm. The industry’s resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the “upstream” harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the “downstream” harms. Effectively addressing pharmaceutical pollution requires an understanding of the key roles and responsibilities along the product lifecycle. In this commentary, we argue that three actors—producers, regulators, and prescribers—have unique and interdependent responsibilities to address these issues. Producers and market access regulators are upstream actors who can manage and mitigate harms by both shifting manufacturing, business practices, and regulatory requirements and producing transparent, robust data on environmental harms. By contrast, prescribers are downstream actors whose capacity to reduce environmental harms arises principally as a “co-benefit” of reducing inappropriate prescribing and overuse. Potentially complicating the prescriber’s role are the calls for prescribers to recommend “environmentally preferable medicines”. These calls continue to increase, even with the sparsity of transparent and robust data on the impact of pharmaceuticals on the environment. Recognizing the interdependencies among actors, we argue that, rather than being ineffectual, these calls draw needed attention to the critical responsibility for upstream actors to prioritize data production, reporting standards and public transparency to facilitate future downstream efforts to tackle pharmaceutical pollution. Full article

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7 pages, 213 KiB

Open AccessArticle

Evaluating Pharmacists’ Knowledge of Food–Drug Interactions in Croatia: Identifying Gaps and Opportunities

by Josipa Bukić, Doris Rušić, Antonela Turic, Dario Leskur, Toni Durdov, Joško Božić, Martin Kondža, Darko Modun and Ana Šešelja Perišin

Pharmacy 2024, 12(6), 172; https://doi.org/10.3390/pharmacy12060172 - 21 Nov 2024

Abstract

Food–drug interactions (FDIs) are pharmacokinetic or pharmacodynamic changes in drug effects caused by the presence of specific foods. To identify and prevent FDIs, pharmacists, alongside other healthcare professionals, should possess a certain level of knowledge. This study aimed to assess knowledge of FDIs [...] Read more.

Food–drug interactions (FDIs) are pharmacokinetic or pharmacodynamic changes in drug effects caused by the presence of specific foods. To identify and prevent FDIs, pharmacists, alongside other healthcare professionals, should possess a certain level of knowledge. This study aimed to assess knowledge of FDIs among Croatian pharmacists. A total of 206 participants were included in this cross-sectional study. The median knowledge score among Croatian pharmacists was 69.44%, with an interquartile range of 19.44. Croatian pharmacists most commonly recognized FDIs involving theophylline, warfarin, and tetracycline, while the lowest rate of correct answers was observed with digoxin interactions. Future studies should evaluate pharmacists’ clinical practice concerning FDIs. Additionally, more research is needed to develop educational programs on this topic, either at the university level or for continuing education. Full article

(This article belongs to the Special Issue Medication Safety and Pharmacy Practice)

17 pages, 319 KiB

Open AccessArticle

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study

by Rony M. Zeenny, Rachel Abdo, Chadia Haddad, Aline Hajj, Rouba Karen Zeidan, Pascale Salameh and Jean Ferrieres

Pharmacy 2024, 12(6), 171; https://doi.org/10.3390/pharmacy12060171 - 20 Nov 2024

Abstract

Objective: This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients’ subgroups. Methods: A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, [...] Read more.

Objective: This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients’ subgroups. Methods: A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status. Results: The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia. Conclusions: This study’s findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries. Full article

15 pages, 277 KiB

Open AccessArticle

Medication Reconciliation of Patients by Pharmacist at the Time of Admission and Discharge from Adult Nephrology Wards

by Hossein Ahmadi, Yalda Houshmand, Ghanbar Ali Raees-Jalali and Iman Karimzadeh

Pharmacy 2024, 12(6), 170; https://doi.org/10.3390/pharmacy12060170 - 18 Nov 2024

Abstract

Purpose: The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases. Methods: A prospective study was performed in adult nephrology wards of a teaching referral [...] Read more.

Purpose: The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases. Methods: A prospective study was performed in adult nephrology wards of a teaching referral hospital in Iran from September 2020 to March 2021. All patients hospitalized in the nephrology ward for at least 1 day who received the minimum of one medication during their ward stay within the study period were considered eligible. Medication reconciliation was performed by taking a best-possible medication history from eligible patients during the first 24 h of ward admission. Medications were evaluated for possible intentional as well as unintentional discrepancies. Results: Here, 178 patients at admission and 134 patients at discharge were included. The mean numbers of unintentional drug discrepancies for each patient at admission and discharge were 6.13 ± 4.13 and 1.63 ± 1.94, respectively. The mean ± SD numbers of prescribed medications for patients before ward admission detected by the nurse/physician and pharmacist were 6.06 ± 3.53 and 9.22 ± 4.71, respectively (p = 0.0001). The number of unintentional discrepancies at admission and discharge had a significant correlation with the number of drugs used and underlying diseases. The number of unintentional discrepancies at admission was also correlated with patients’ age. The number of comorbidities was significantly associated with the number of unintentional medication discrepancies at both admission and discharge. At the time of ward discharge, all patients were given medication consultations. Conclusions: The rate of reconciliation errors was high in the adult nephrology ward. The active contribution of pharmacists in the process of medication reconciliation can be significantly effective in identifying these errors. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

11 pages, 397 KiB

Open AccessArticle

A Qualitative Study of Pharmacists’ Perceptions of the Advantages and Disadvantages of Telepharmacy

by Masaki Shoji and Mitsuko Onda

Pharmacy 2024, 12(6), 169; https://doi.org/10.3390/pharmacy12060169 - 16 Nov 2024

Abstract

In Japan, telepharmacy is becoming increasingly popular due to deregulation triggered by the outbreak of COVID-19. The purpose of this study was to gain an understanding of the actual state of telepharmacy in Japan by interviewing pharmacists who have experience with telepharmacy and [...] Read more.

In Japan, telepharmacy is becoming increasingly popular due to deregulation triggered by the outbreak of COVID-19. The purpose of this study was to gain an understanding of the actual state of telepharmacy in Japan by interviewing pharmacists who have experience with telepharmacy and describing its advantages and disadvantages, as well as their outlook for its use going forward. The interviews were conducted online using Zoom. Each interview lasted approximately 30 min. Eleven people were interviewed. The advantages mentioned by the pharmacists were classified into three main categories: “Better communication”, “Time savings”, and “Improved safety”. The disadvantages were classified into the following nine categories: “Drug delivery problems”, “Communication failures”, “Ease of use for patients”, “Emotional reactions”, “Pharmacy system”, “Communication issues”, “Healthcare system issues”, “App system issues”, and “Cost”. Many of these factors correspond to the Unified Theory of Acceptance and Use of Technology (UTAUT) constructs presented by Venkatesh, et al. Many of the pharmacists mentioned that the use of telepharmacy is likely to expand further in the future, but that this will require further development of communication technology and the widespread use of systems such as electronic prescriptions. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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17 pages, 3463 KiB

Open AccessArticle

Potential Adverse Drug Events Identified with Decision Support Algorithms from Janusmed Risk Profile—A Retrospective Population-Based Study in a Swedish Region

by Tora Hammar, Emma Jonsén, Olof Björneld, Ylva Askfors, Marine L. Andersson and Alisa Lincke

Pharmacy 2024, 12(6), 168; https://doi.org/10.3390/pharmacy12060168 - 15 Nov 2024

Abstract

Adverse drug events (ADEs) occur frequently and are a common cause of suffering, hospitalizations, or death, and can be caused by harmful combinations of medications. One method used to prevent ADEs is by using clinical decision support systems (CDSSs). Janusmed Risk Profile is [...] Read more.

Adverse drug events (ADEs) occur frequently and are a common cause of suffering, hospitalizations, or death, and can be caused by harmful combinations of medications. One method used to prevent ADEs is by using clinical decision support systems (CDSSs). Janusmed Risk Profile is a CDSS evaluating the risk for nine common or serious ADEs resulting from combined pharmacodynamic effects. The aim of this study was to examine the prevalence of potential ADEs identified using CDSS algorithms from Janusmed Risk Profile. This retrospective, cross-sectional study covered the population of a Swedish region (n = 246,010 inhabitants in year 2020) using data on all medications dispensed and administered. More than 20% of patients had an increased risk of bleeding, constipation, orthostatism, or renal toxicity based on their medications. The proportion of patients with an increased risk varied from 3.5% to almost 30% across the nine categories of ADEs. A higher age was associated with an increased risk of potential ADEs and there were gender differences. A cluster analysis identified groups of patients with an increased risk for several categories of ADEs. This study shows that combinations of medications that could increase the risk of ADEs are common. Future studies should examine how this correlates with observed ADEs. Full article

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14 pages, 572 KiB

Open AccessArticle

Views from Multinational Pharmaceutical Companies on Allocation of Clinical Trials in Saudi Arabia—Qualitative Study

by Nouf M. Aloudah and Ahmed M. Shaman

Pharmacy 2024, 12(6), 167; https://doi.org/10.3390/pharmacy12060167 - 12 Nov 2024

Abstract

Clinical trials conducted by pharmaceutical companies are essential for bridging local research efforts with broader populations, facilitating the transfer of valuable insights and solutions. This study aimed to explore the barriers and facilitators affecting clinical trials in Saudi Arabia from the perspective of [...] Read more.

Clinical trials conducted by pharmaceutical companies are essential for bridging local research efforts with broader populations, facilitating the transfer of valuable insights and solutions. This study aimed to explore the barriers and facilitators affecting clinical trials in Saudi Arabia from the perspective of key personnel within the pharmaceutical industry and Contract Research Organizations (CROs). We conducted in-depth semi-structured interviews with nine participants, which provided a holistic understanding of the intricate dynamics shaping the landscape of clinical trials in the country. The analysis revealed three prominent themes: operational challenges, complexities in navigating approval hurdles, and the unique value proposition for conducting clinical trials in Saudi Arabia. The participants expressed pride in the local infrastructure but acknowledged existing flaws, particularly in regulatory processes that contribute to delays in trial initiation. They emphasized the importance of conducting clinical trials in areas such as diabetes, crowd management during pilgrimages, and rare diseases, which are prevalent in the region. Despite the limited number of clinical trials registered (354 from 2009 to 2020, with only 1% being phase 1 studies), Saudi Arabia’s total pharmaceutical market exceeds SAR 13 billion, positioning it as the largest market in the region. Stakeholders recognized the country’s potential as a research hub, particularly within the Gulf Cooperative Council (GCC) region. However, to attract more trials and enhance the medical research landscape, it is crucial to address the identified barriers, streamline processes, and improve stakeholder alignment. The findings highlight the need for targeted interventions to overcome these challenges and leverage Saudi Arabia’s investments in healthcare infrastructure since its transformation program launched in 2010. By enhancing the regulatory environment and fostering collaboration among stakeholders, Saudi Arabia can solidify its role as a key player in international clinical research. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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13 pages, 1080 KiB

Open AccessArticle

Drug Shortages in Albania: Pharmacists’ Experiences and Perspectives

by Delina Xhafaj, Sonila Vito and Alban Xhafaj

Pharmacy 2024, 12(6), 166; https://doi.org/10.3390/pharmacy12060166 - 7 Nov 2024

Abstract

Drug shortages are a significant global issue, particularly affecting healthcare systems in resource-limited countries such as Albania. Pharmacists play a critical role in managing these shortages, yet little is known about their experiences and perspectives. This study aims to explore pharmacists’ views on [...] Read more.

Drug shortages are a significant global issue, particularly affecting healthcare systems in resource-limited countries such as Albania. Pharmacists play a critical role in managing these shortages, yet little is known about their experiences and perspectives. This study aims to explore pharmacists’ views on the current drug shortages in Albania, identifying the most affected drug classes, and suggesting potential strategies for mitigating these shortages. A cross-sectional survey was conducted with 93 pharmacists across Albania between December 2023 and May 2024. Data were collected using an online questionnaire that addressed the types of drugs experiencing shortages, the causes of these shortages, and pharmacists’ coping strategies. Cardiovascular and central nervous system medications were reported as the most frequently affected, with supply chain disruptions, regulatory hurdles, and low domestic production cited as key contributors. The findings suggest an urgent need for national policy reforms focusing on improving supply chain resilience and boosting the local pharmaceutical production. The pharmacists proposed mitigation strategies, including stricter regulatory oversight, improved communication channels, and increased local production to reduce dependence on imports. These recommendations underscore the study’s contribution to understanding how tailored, pharmacist-informed strategies could strengthen Albania’s healthcare system. Full article

(This article belongs to the Special Issue Women's Special Issue Series: Pharmacy and Pharmacists)

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11 pages, 616 KiB

Open AccessArticle

Deciphering the Roots of Pharmacists’ Critical Thinking About Pseudoscientific Claims: Insights from a Cross-Sectional Survey

by Tomofumi Watanabe, Mari Matsumoto, Masami Ukawa, Makoto Ohira and Masaru Tsunoda

Pharmacy 2024, 12(6), 165; https://doi.org/10.3390/pharmacy12060165 - 6 Nov 2024

Abstract

The global trend toward self-medication has increased public reliance on over-the-counter treatments and health-related information, contributing to the spread of pseudoscientific claims in healthcare and posing serious public health risks. Pharmacists, as accessible healthcare professionals, play a crucial role in critically evaluating these [...] Read more.

The global trend toward self-medication has increased public reliance on over-the-counter treatments and health-related information, contributing to the spread of pseudoscientific claims in healthcare and posing serious public health risks. Pharmacists, as accessible healthcare professionals, play a crucial role in critically evaluating these claims and providing evidence-based guidance. However, little quantitative research has assessed pharmacists’ critical thinking regarding pseudoscientific claims or the factors influencing them. This study aims to evaluate the demographic factors affecting pharmacists’ critical thinking about pseudoscientific claims. A cross-sectional survey was conducted among pharmacists in hospitals, insurance pharmacies, and drugstores across Japan. The newly developed Pseudoscience Criticism Scale (PCS) measured attitudes toward pseudoscientific claims. Statistical analysis identified factors that form and influence critical thinking. This study revealed two primary dimensions: “Medical Superstitions and Unscientific Treatments” and “Natural Healing Superstitions”. Gender and educational background significantly impacted PCS scores, with male pharmacists and graduates from six-year pharmacy programs exhibiting higher skepticism. These findings underscore the importance of ongoing professional development in pharmacy education to strengthen critical thinking. The PCS is an effective tool for assessing this competency. Enhancing educational efforts is essential to equip pharmacists to effectively counter pseudoscientific claims and improve public health. Full article

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18 pages, 245 KiB

Open AccessArticle

Assessing the Impact of a Leadership Development Programme for Community Pharmacy Neighbourhood Leads in South East London

by Finlay Royle, Sarah Guard and Ricarda Micallef

Pharmacy 2024, 12(6), 164; https://doi.org/10.3390/pharmacy12060164 - 2 Nov 2024

Abstract

Community pharmacists continue to deliver a growing number of services, with an increased need for collaborative work between local teams in community settings. In South East London, the Integrated Care Board and Pharmacy Alliance have invested in the development of community pharmacy neighbourhood [...] Read more.

Community pharmacists continue to deliver a growing number of services, with an increased need for collaborative work between local teams in community settings. In South East London, the Integrated Care Board and Pharmacy Alliance have invested in the development of community pharmacy neighbourhood leads (CPNLs), who represent community pharmacies in a locality and provided a tailored five-session leadership course that ran between November 2023 and March 2024, covering theory and implementation. This study aimed to evaluate the experiences of the CPNLs and other colleagues who participated in the leadership development programme. Participants were asked to complete an evaluation survey after each session, along with individual interviews taking place with those who volunteered. Ethical approval was received. There was a total of 37 participants at the sessions, and 7 participated in an interview. Overall confidence increased throughout the course, with males statistically more confident than females. Relationships with new stakeholders also increased throughout the course. The proposed actions after each session echoed the topics covered, with planning meetings being prioritised. The interviews highlighted new opportunities identified and being acted on, a greater understanding of the role, and an increase in confidence and key relationships. Barriers in the role included time for meetings. Overall, investment in the CPNL role showed that learning from the programme was applied in practice, with an increase in confidence and understanding of the role and improved local relationships. The findings from this study can be used by others to support community pharmacy transformation and integration. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

19 pages, 1616 KiB

Open AccessReview

Nexus of Quality Use of Medicines, Pharmacists’ Activities, and the Emergency Department: A Narrative Review

by Tesfay Mehari Atey, Gregory M. Peterson, Mohammed S. Salahudeen and Barbara C. Wimmer

Pharmacy 2024, 12(6), 163; https://doi.org/10.3390/pharmacy12060163 - 1 Nov 2024

Abstract

Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, [...] Read more.

Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as “choosing suitable medicines and using them safely and effectively”, remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED. Full article

(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)

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12 pages, 3801 KiB

Open AccessArticle

Impact of a Clinical Decision Support System on the Change over Time in the Anticholinergic Load in Geriatric Patients: The SADP-Antichol Study

by Grégoire Delvallée, Lisa Mondet, Chloé Cornille, Guillaume Deschasse and Aurélie Lenglet

Pharmacy 2024, 12(6), 162; https://doi.org/10.3390/pharmacy12060162 - 30 Oct 2024

Abstract

Purpose: Anticholinergic drugs can cause adverse events (AEs) in older adults. Clinical decision support systems (CDSSs) can detect prescriptions with a high anticholinergic load. Our starting hypothesis was that the anticholinergic load could be reduced by combining a CDSS with a strategy for [...] Read more.

Purpose: Anticholinergic drugs can cause adverse events (AEs) in older adults. Clinical decision support systems (CDSSs) can detect prescriptions with a high anticholinergic load. Our starting hypothesis was that the anticholinergic load could be reduced by combining a CDSS with a strategy for generating pharmacist interventions. The objective of the present study was to assess the impact of this combination on the change over time in the anticholinergic load in hospitalized older adults. Methods: This prospective, single-centre study was divided into two 6-week periods. During the interventional period, a pharmacist analyzed the alerts generated by the CDSS for 30 targeted anticholinergic drugs and decided whether to issue a pharmacist intervention. A control period corresponds to standard care. The primary endpoint of the study is the delta of the anticholinergic load between the alert and hospital discharge; the secondary endpoint is the incidence of anticholinergic adverse events (AEs). Results: Of the 144 alerts generated, 87 were considered to be relevant (36 in the interventional period and 51 in the control period). A significant difference was observed between the delta anticholinergic load between the experimental and control periods (1.61 vs. 0.67, p-value = 0.0115). For the targeted drugs (n = 94) over the 87 alerts, 46.8% were for antihistamines and 21.3% were for desloratadine. Of the 36 pharmacist interventions sent by the pharmacist, 19 (52.8%) were accepted. The most deprescribed drug class was the antihistamine class (n = 7), and the most deprescribed drug was amitriptyline (n = 5). Among these 87 patients with alerts, the correlation between the anticholinergic load and the number of AEs was not statistically significant (p = 0.887). The most common AE affecting the peripheral nervous system was constipation (28.6%), and the most common AE affecting the central nervous system was confusion (29.9%). Conclusions: Our results showed that the combination of specific CDSS rules with pharmacist-mediated risk management procedures could further reduce the anticholinergic load in hospitalized older adults, relative to routine care. It remains to be determined whether this reduction in the anticholinergic load has an impact on the incidence of peripheral and central anticholinergic AEs, and thus the health of these patients. Full article

(This article belongs to the Special Issue Innovations in Clinical Pharmacy: Towards Optimized Patient Care)

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14 pages, 1271 KiB

Open AccessReview

Pharmacy Education and Clinical Pharmacy Training in France

by Florence Ranchon, Sébastien Chanoine, ANEPC Pedagogical Committee, Antoine Dupuis, Gaël Grimandi, Michel Sève, Stéphane Honoré, Benoît Allenet and Pierrick Bedouch

Pharmacy 2024, 12(6), 161; https://doi.org/10.3390/pharmacy12060161 - 29 Oct 2024

Abstract

Clinical pharmacy education varies widely between European countries, and several major changes have taken place in France. This review aims to describe the current state of pharmacy education in France, focusing on clinical pharmacy. Research into legislative texts on pharmacy education in France [...] Read more.

Clinical pharmacy education varies widely between European countries, and several major changes have taken place in France. This review aims to describe the current state of pharmacy education in France, focusing on clinical pharmacy. Research into legislative texts on pharmacy education in France was conducted based on the national database “legifrance”. A complementary search on clinical pharmacy teaching methods used in France was carried out on the Medline, Embase, Pascal and Francis database for articles published from 2008 to 30 April 2021. Pharmacy studies are taught in universities and last from six to ten years, depending on the student’s chosen options. The scientific curriculum is defined at the national level. Students choose their professional path after the fourth year with specialized courses. Whatever the direction chosen, all students have several internships, including a half-time one-year hospital internship, with patient-centered hospital functions within medical and pharmaceutical teams. The status of clinical pharmacy has been enhanced under French law and regulations, improving clinical pharmacy education, which is now skill-based, in a progressive, active, and dynamic process, with community or hospital pharmacists as university teachers and closer to real-life clinical pharmacy. Teaching is increasingly innovative, and this needs to be shared and reported in the literature. Several important reforms have modernized French pharmacy studies in recent years, conferring a pivotal place for clinical pharmacy. Full article

(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)

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9 pages, 454 KiB

Open AccessArticle

Categorisation of Patients’ Anticholinergic Burden at Admission and Discharge from the Geriatric Ward of Sønderjylland Hospital

by Cecilie Marie Bæk Kehman, Maja Schlünsen and Lene Juel Kjeldsen

Pharmacy 2024, 12(6), 160; https://doi.org/10.3390/pharmacy12060160 - 25 Oct 2024

Abstract

Background: High anticholinergic burden is associated with an increased risk of hospitalisation, readmission, and mortality in geriatric patients. The objectives were to develop an updated anticholinergic burden scale for drugs registered in Denmark and to estimate the burden at admission and discharge for [...] Read more.

Background: High anticholinergic burden is associated with an increased risk of hospitalisation, readmission, and mortality in geriatric patients. The objectives were to develop an updated anticholinergic burden scale for drugs registered in Denmark and to estimate the burden at admission and discharge for hospitalised patients at the Geriatric Ward of Sønderjylland Hospital. Methods: The updated scale was developed through a systematic evaluation of the anticholinergic effect for all active pharmaceutical ingredients (APIs) listed on validated burden scales. APIs registered in 2020 and 2021 were evaluated separately for possible anticholinergic effect. The anticholinergic effect of each API was scored from 1 (low) to 3 (high). The scale was applied to medical records for patients hospitalised between October 2021 and March 2022. Results: The scale comprised 87 APIs with anticholinergic effect. We applied the scale on 196 patients aged (median [IQR]) 84 (78–89) years. Of these patients, 75 (38.3%) had a high burden (

\geq 3)

on admission. These patients had significantly higher drug use and higher risk of 30-day readmission but no relationship with length of stay. Overall, the anticholinergic burden was unchanged at discharge for 109 (55.1%) patients. Conclusion: An updated scale for estimation of the anticholinergic burden in geriatric patients was successfully developed, and a high burden among the admitted geriatric patients was found. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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10 pages, 201 KiB

Open AccessArticle

Pharmaceutical Advertising and Public Perceptions in Saudi Arabia

by Mohammed A. Alnuhait, Hana A. Althobaiti, Meshari H. Alharbi, Raef A. Alahmadi, Yasser E. Althubaiti, Abdulrahman A. Alsaedi, Abdullah S. Alshammari, Mahmoud E. Elrggal, Mohammed A. Alrashed, Mohamed A. Albekery, Abdullah A. Alhifany and Abdulmalik S. Alotaibi

Pharmacy 2024, 12(6), 159; https://doi.org/10.3390/pharmacy12060159 - 23 Oct 2024

Abstract

Introduction: As the pharmaceutical advertising landscape evolves with digital advancements, this study examines public awareness and perceptions of medication advertisements in Saudi Arabia. It focuses on the effects of regulatory frameworks and evaluates how they influence public understanding and attitudes toward these advertisements. [...] Read more.

Introduction: As the pharmaceutical advertising landscape evolves with digital advancements, this study examines public awareness and perceptions of medication advertisements in Saudi Arabia. It focuses on the effects of regulatory frameworks and evaluates how they influence public understanding and attitudes toward these advertisements. Method: A cross-sectional study was conducted using an electronic survey in Saudi Arabia in December 2023. The survey was distributed on social media platforms and reached a diverse sample of 440 participants. It covered public perception and attitudes toward drug advertisements, knowledge of regulatory laws, and preferences regarding advertising mediums. Results: Out of the 440 participants in the study, who were primarily employees with bachelor’s degrees, there was a clear awareness of drug advertisements. The average age of the group was 33 years, and a significant portion (71.1%) held a bachelor’s degree, with 51.1% being employed. The findings revealed that 25.5% of participants frequently noticed drug ads, while 22.7% saw them very often. Although many found the ads informative, there were significant concerns about unrealistic expectations and the risk of overmedication; 89.8% believed the ads set unrealistic expectations about the effectiveness of medications. Additionally, 60.7% thought that celebrity endorsements might mislead the audience, and 91.1% felt that ads should provide more detailed information about potential risks and side effects. Regarding preferred advertising platforms, mobile apps and websites were favored (47%), followed closely by social media (46.4%). A striking 93.2% of participants believed that drug ads on social media should be subject to stricter regulations, and 96.4% wanted more proactive monitoring of online advertising. Many also reported using other sources, such as medical review sites, to verify medication information. Conclusions: Pharmaceutical advertising in Saudi Arabia must balance ethical transparency with educational value. The influence of digital platforms underscores the necessity for stricter regulation and accurate information dissemination. A collaborative approach is essential to align advertising practices with public health interests and regulatory standards. Full article

9 pages, 560 KiB

Open AccessArticle

Evaluating the Efficiency and Staff Satisfaction of the Point-of-Care IV Activated System Versus Traditional Piggyback in Administering IV Antibiotics at a Saudi Tertiary Hospital

by Khaled Elshammaa, Abubakr A. Yousif, Abdullah Alshammari, Mohammed Alnuhait, Abdulmalik S. Alotaibi, Mahmoud E. Elrggal and Mohamed Hassan Elnaem

Pharmacy 2024, 12(5), 158; https://doi.org/10.3390/pharmacy12050158 - 21 Oct 2024

Abstract

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed [...] Read more.

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. Results: The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. Conclusions: The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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19 pages, 700 KiB

Open AccessReview

A Review of Survey Instruments and Pharmacy Student Outcomes for Stress, Burnout, Depression and Anxiety

by Kelly C. Lee, Austin Yan, Tram B. Cat and Shareen Y. El-Ibiary

Pharmacy 2024, 12(5), 157; https://doi.org/10.3390/pharmacy12050157 - 18 Oct 2024

Abstract

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used [...] Read more.

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used validated scales for burnout, stress and mental health among pharmacy students to provide recommendations for implementation at schools/colleges of pharmacy. Thirty-two out of 153 articles published in the United States from 1 January 2000 to 30 September 2022 were included and categorized into studies measuring stress (20), burnout (4) and depression/anxiety (8). The most common validated scales used to assess stress and burnout among pharmacy students were the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory and the Oldenburg Burnout Inventory, respectively. For mental health, anxiety was most commonly investigated using a variety of scales such as the Generalized Anxiety Disorder-7; the Patient Health Questionnaire, 9-item was used to measure depression in two studies. Validity, ease of use, cost and generalizability are important considerations for selecting a scale. The PSS has been studied extensively in pharmacy students and has been correlated with other well-being domains. Studies that measured burnout and mental health (specifically, depression and anxiety) have less published evidence among pharmacy students. Full article

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10 pages, 797 KiB

Open AccessArticle

Pharmacist-Prescribed Hormonal Contraception: A Survey of Perceptions of Georgia Community Pharmacists and Non-Community Pharmacists

by Rebecca H. Stone, Megha D. Patel and Lara L. Beene

Pharmacy 2024, 12(5), 156; https://doi.org/10.3390/pharmacy12050156 - 18 Oct 2024

Abstract

Pharmacist-prescribed hormonal contraception (HC) is supported by a majority of pharmacists and pharmacy students; however, few studies have evaluated perceptions of non-community pharmacists, or differences in geographic areas. The primary objective of this study is to assess differences between community and non-community pharmacists [...] Read more.

Pharmacist-prescribed hormonal contraception (HC) is supported by a majority of pharmacists and pharmacy students; however, few studies have evaluated perceptions of non-community pharmacists, or differences in geographic areas. The primary objective of this study is to assess differences between community and non-community pharmacists in perceptions of pharmacist-prescribing HC in Georgia, a state that does not currently permit this practice. Secondary objectives include assessment of community pharmacist interest in prescribing HC, and differences in perceptions between pharmacists in metropolitan and nonmetropolitan areas. A survey was emailed in early 2022 to 2592 Georgia pharmacists, with Likert questions assessing interest, perceptions, comfort, and perceived barriers regarding pharmacist-prescribed HC. Chi square testing identified differences between groups. The completed survey response rate was 11.8%. Regardless of practice site, a majority agreed that pharmacists are well trained to prescribe HC (community 61.8% vs. non-community 68.1%, p = 0.25) and provision of HC services is within pharmacists’ scope (community 73.6% vs. non-community 74.2%, p = 0.90). Overall, metropolitan and nonmetropolitan community pharmacist perceptions were similar; however, more metropolitan pharmacists believed pharmacists are well trained to prescribe HC (66.7% vs. 48.7%, p = 0.049) and that it is within their scope of practice (78.1% vs. 61.5%, p = 0.045). In summary, the majority of pharmacists, regardless of practice type, believe that pharmacists are prepared to prescribe HC and that it is a part of pharmacists’ professional scope of practice. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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