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Innovations in Clinical Pharmacy: Towards Optimized Patient Care

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A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 8231

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Special Issue Editor

Prof. Dr. Laura Jane Sahm

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Guest Editor

School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland
Interests: clinical pharmacy; cancer research; health literacy; medication adherence; vaccine health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am delighted to invite contribution to this Special Issue; Innovations in Clinical Pharmacy: Towards Optimized Patient Care.

Innovations can be simple or complex, can be done as an individual or as part of a team, but their aim is to enhance the patients experience. As pharmacists, we can be working in the community, hospital or any other practice setting, but we are always focused on making things better for the patient.

This innovation may involve interprofessional collaborations, as part of a multidisciplinary team or may be a unique strategy that other pharmacists can implement into their practice.

Many patients are challenged by swallowing difficulties and the subsequent modification of dosage forms is an area requiring specialist pharmacist knowledge combined with communication skills.

I am particularly interested in contribution that enhance the accessibility or acceptability of medication or medicines information, to empower patients and the public to make informed healthcare decisions.

I welcome contributions relating to health literacy, medication adherence, modification of medicines, evolving role of the pharmacist in specialist settings, e.g., oncology, vaccine uptake and acceptance, prescribing cascades or deprescribing. However, please do not hesitate to send me an abstract for consideration.

Prof. Dr. Laura Jane Sahm
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health literacy
medication adherence
vaccines
cancer
deprescribing
medicines modification

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Published Papers (8 papers)

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Research

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

Viewed by 424

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 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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9 pages, 454 KiB

Open AccessArticle

Discrepancy between Subjective and Objective Measurements for the Evaluation of Medication Adherence—A Cross-Sectional Study in Patients with Cardiovascular Diseases

by Motoyasu Miyazaki, Hitomi Hirata, Satoko Takaki, Momoko Misaki, Yukako Mori, Kaoko Tokura, Natsuki Sato, Akio Nakashima, Atsuko Yanagida, Isa Okajima, Hidenori Urata and Osamu Imakyure

Pharmacy 2024, 12(5), 153; https://doi.org/10.3390/pharmacy12050153 - 6 Oct 2024

Viewed by 801

Abstract

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient’s lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387–9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up. Full article

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

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9 pages, 365 KiB

Open AccessArticle

Efficacy of Ciprofloxacin in Treating Gram-Negative Infections: Does Obesity Matter?

by Sultan Alotaibi, Nader Damfu, Ahmed Alnefaie, Abdullah Alqurashi, Sami Althagafi, Aown Alotaibi, Musim Alotaibi and Abdullah Alsuwat

Pharmacy 2024, 12(5), 147; https://doi.org/10.3390/pharmacy12050147 - 26 Sep 2024

Viewed by 726

Abstract

Background: Obesity is considered a health issue associated with increased morbidity and a risk factor for multiple conditions, such as type 2 diabetes, cardiovascular diseases and infections. It may affect the pharmacokinetics and pharmacodynamics of many drugs, including antimicrobials like ciprofloxacin. Regrettably, data on ciprofloxacin’s efficacy in obese patients remain scarce. This study aims to evaluate the impact of obesity on the efficacy of ciprofloxacin in treating Gram-negative bacterial infections. Methods: A retrospective multicenter cohort study was conducted in two tertiary hospitals in Saudi Arabia. Adult patients (≥18 years) treated with ciprofloxacin for confirmed Gram-negative infection between January 2017 and April 2023 were included. Patients were excluded if they received ciprofloxacin empirically, had inadequate source control within 72 h, or had missing weight and height information at ciprofloxacin initiation. The primary outcome was clinical cure, defined as the resolution of the clinical infection manifestations without additional therapeutic management by the end of treatment. Other secondary and safety outcomes were also assessed. Results: A total of 99 patients were included, divided into obese (n = 42) and non-obese (n = 57) groups. The obese group had a significantly lower median age (50 years) compared to the non-obese group (64 years) (p = 0.002). The obese group had fewer male patients (38.10% vs. 68.42%; p = 0.004), higher body weight (90 (81–97) vs. 63 (55–70) days; p < 0.001), and lower height (158 (155–165) vs. 165 (158–172) days; p = 0.008) compared to non-obese. Urinary tract infection was the most common type, with Escherichia coli being the most common isolate. The median hospital length of stay was shorter in the obese group than in the non-obese group (1 vs. 3 days, p = 0.007). There were no significant differences in clinical cure rates between obese (85.71%) and non-obese (85.96%) patients (p = 1). No significant differences were observed in terms of in-hospital mortality, 30-day mortality, or 60-day infection recurrence rates between the two groups. Microbiological eradication was not achieved in the obese group, whereas a 10.53% eradication rate was observed in the non-obese group (p = 0.037). However, the majority of the patients had indeterminate eradication. The incidence of adverse drug reactions (ADRs) was lower in the obese group (4.76%) compared to the non-obese group (17.54%, p = 0.066). Conclusions: Treatment with ciprofloxacin in obese patients has similar efficacy and safety outcomes compared to non-obese patients with infections due to Gram-negative pathogens. Full article

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

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11 pages, 241 KiB

Open AccessArticle

Pharmacist-Led Deprescribing of Opioids and Benzodiazepines in Older Adults: Examining Implementation and Perceptions

by Tamera D. Hughes, Elizabeth Sottung, Juliet Nowak and Kimberly A. Sanders

Pharmacy 2024, 12(4), 119; https://doi.org/10.3390/pharmacy12040119 - 30 Jul 2024

Viewed by 924

Abstract

Background: This study examines the implementation and perceptions of a pharmacist consultant deprescribing program aimed at reducing the risk of falls in older adults using opioids and benzodiazepines. Methods: This qualitative study conducted interviews with healthcare providers. The interviews were conducted from August to December 2021 and analyzed using inductive coding techniques. Results: Five participants, predominantly female MDs or PA-Cs from rural clinics, were interviewed. The participants adopted a pharmacist-led deprescribing program due to their heightened awareness of the opioid crisis, dedication to patient safety, and a desire for opioid deprescribing education. Initially, concerns included patient resistance and provider-driven barriers. However, over time, patient attitudes shifted toward greater openness to the program. The providers emphasized several critical needs for the success of the program: guaranteed access to pharmacists, tailored patient education, resources specific to providers, and financial support, including telehealth options. These factors were deemed essential to overcoming initial barriers and ensuring effective implementation. Conclusion: Integrating pharmacists into primary care settings shows promise for deprescribing opioids and benzodiazepines in older adults. Future research should explore telehealth options for patient–pharmacist consultations and expand the application of these findings to other healthcare settings. The study highlights the importance of awareness, patient education, access to resources (pharmacists), and provider support in addressing deprescribing among older adults. Full article

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

8 pages, 423 KiB

Open AccessArticle

Impact of a Pharmacist-Led HCV Treatment Program at a Federally Qualified Health Center

by Jerika T. Lam and Sharon Xavioer

Pharmacy 2024, 12(4), 115; https://doi.org/10.3390/pharmacy12040115 - 24 Jul 2024

Viewed by 787

Abstract

Pharmacists are key players who can help to eliminate the hepatitis C virus (HCV) epidemic in the United States. This pilot retrospective study evaluated the impact of a pharmacist-led HCV treatment program in a federally qualified health center (FQHC) primary care clinic setting. The primary outcome was to assess sustained virologic response (SVR) rates 12 weeks after patients were initiated and completed their oral direct acting antiviral (DAA) treatment regimens. Methods: This pilot retrospective study included historical analyses of patients who received DAA treatment in the pharmacist-led HCV treatment program in a FQHC clinic between 1 January 2019 and 31 January 2021. SVR was the primary outcome measure for treatment response. Results: Sixty-seven patients with HCV mono- and HIV co-infection were referred, and 59 patients were initiated on DAA regimens after treatment. Fifty of those who were started on DAA regimens completed their treatment, and 38 achieved SVR (modified intention to treat [mITT] SVR rate of 76%). Conclusion: Our study’s findings demonstrated SVR rates that were comparable with other pharmacist-directed HCV treatment services in the United States despite the impact of the COVID-19 pandemic. Our study included a higher proportion of individuals with HCV/HIV co-infection and of Hispanic ethnicity. Full article

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

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15 pages, 1099 KiB

Open AccessArticle

Development and Validation of a Tool to Explore Attitudes Towards meDication adHErence Using a Novel Self-Reported QuestionnairE (ADHERE-7)

by Iva Bužančić, Mislav Balen, Dahna Arbanas, Slaven Falamić, Katarina Fehir Šola, Ana Galić Skoko, Mirna Momčilović, Ante Orbanić, Alena Tatarević and Maja Ortner Hadžiabdić

Pharmacy 2024, 12(4), 113; https://doi.org/10.3390/pharmacy12040113 - 18 Jul 2024

Viewed by 1253

Abstract

Despite the availability of various tools for measuring medication adherence, efficiently identifying non-adherence levels and reasons at the point of care remains challenging. Existing tools often lack the ease of use needed for practical clinical application. This study aimed to develop and validate a user-friendly tool to provide healthcare professionals with a concise yet comprehensive means of identifying adherence behaviors. The methodology consisted of two phases: tool items were first developed using the nominal group technique with healthcare professionals, followed by a cross-sectional pilot study involving community-dwelling adults in Croatia. Validation analysis indicated acceptable face and content validity and satisfactory criterion validity, with Attitudes towards meDication adHErence self-Reported questionnairE (ADHERE-7) scores correlating with both the self-reported five-item Medication Adherence Report Scale (MARS-5 tool) (ρ = 0.765; p < 0.001) and an objective measure of the proportion of days covered (PDC) from pharmacy prescription claims data (G = 0.586; p = 0.015). Construct validity revealed three factors: Aversion, Comfort, and Practical Non-Adherence, with Cronbach’s alpha values of 0.617 for Aversion and 0.714 for Comfort Non-Adherence. The mean total score for ADHERE-7 was 26.27 ± 2.41 (range 17 to 28). This robust validation process confirms the ADHERE-7 tool as a reliable instrument for assessing medication adherence, addressing aversion, comfort, practical issues, and both intentional and unintentional nonadherence. Full article

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

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10 pages, 864 KiB

Open AccessArticle

Considering the Possible Role of Pharmacists According to the Presence or Absence of Lifestyle-Related Diseases at the Time of Coronary CT Examination and Trends of Medication Use for These Diseases by Medical Doctors

by Erika Miura-Takahashi, Kohei Tashiro, Yuhei Shiga, Yuto Kawahira, Sara Higashi, Yuki Otsu, Hidetoshi Kamimura and Shin-ichiro Miura

Pharmacy 2024, 12(4), 99; https://doi.org/10.3390/pharmacy12040099 - 27 Jun 2024

Viewed by 723

Abstract

Background: Because patients often already have coronary artery disease (CAD) at the time of a coronary artery computed tomography angiography (CCTA) examination, we examined the medications prescribed by medical doctors for lifestyle-related diseases and investigated what possible role pharmacists can play in prescribing. Methods: Patients (n = 1357) who underwent CCTA examination were divided into two groups according to the presence or absence of lifestyle-related diseases [hypertension (HTN), dyslipidemia (DL) and diabetes mellitus (DM)], and the relationship between the presence or absence of CAD was examined. Results: The rate of CAD was significantly higher in patients with HTN, DL or DM than in patients without these diseases. The blood pressure in the HTN group was 140 ± 20/79 ± 13 mmHg, the low-density lipoprotein cholesterol value in the DL group was 119 ± 35 mg/dL, and the hemoglobin A1c value in the DM group was 7.0 ± 1.1%, all of which were poorly controlled. Anti-hypertensive drugs were used at low rates in the HTN group, statins were used in 47% and ezetimibe was used in 4% of the DL group, and dipeptidyl peptidase-4 inhibitors were used in 41% of the DM group. Conclusions: Since the rate of CAD (+) was high and control of the three major lifestyle-related diseases was poor, pharmacists should advise medical doctors to use combinations of drugs. Full article

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

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11 pages, 2287 KiB

Open AccessArticle

Enteral Delivery of Pravastatin Sodium Tablets: Effect of Compounding into a Liquid Form and Co-Administration of Enteral Nutrition

by Serena Logrippo, Roberta Ganzetti, Matteo Sestili, Diego Romano Perinelli, Marco Cespi and Giulia Bonacucina

Pharmacy 2024, 12(1), 32; https://doi.org/10.3390/pharmacy12010032 - 9 Feb 2024

Viewed by 1646

Abstract

Background: Compounding solid oral dosage forms into liquid preparations is a common practice for administering drug therapy to patients with swallowing difficulties. This is particularly relevant for those on enteral nutrition, where factors such as the administration procedure and co-administration of enteral nutrition play crucial roles in effective drug delivery. Due to the limited studies focused on this practice, the impact of co-administered nutrition remains unclear. Methods: Pravastatin tablets were compounded into two liquid formulations and administered through three independent tubes for ten cycles. The drug amount was quantified upstream and downstream of the tubes both with and without different (fiber content) nutritional boluses. Results: The compounding procedure did not lower the drug amount with respect to the original tablets. However, when the liquid formulation was pumped through the tubes, a statistically significant reduction in the pravastatin administered (between 4.6% and 11.3%) was observed. The co-administration of different nutritional boluses or the compounding procedure did not affect the general results. Conclusions: Pravastatin loss appears unavoidable when administered via the enteral tube. Although, in this case, the loss was of limited clinical relevance, it is important not to underestimate this phenomenon, especially with drugs having a narrow therapeutic index. Full article

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

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