It is well documented that the use of medications in asthma and allergic rhinitis is often suboptimal, and consequently, patients remain symptomatic. This study aimed to determine the extent and type ...of medication-related issues contributing to poor asthma control by profiling medication management in those most at risk—a population with clinically uncontrolled asthma. Participants (n = 363) were recruited from Australian community pharmacies, and a dispensed medication history report for the previous 12 months was collected to examine medication adherence and factors affecting adherence. Information was also collected regarding participant asthma control and asthma/allergic rhinitis (if applicable) management. The participants’ mean asthma control score was 2.49 (± 0.89 SD, IQR = 1.20) (score ≥ 1.5 indicative of poorly controlled asthma), and 72% were either non-adherent or yet to initiate preventer therapy. Almost half had been prescribed high doses of inhaled corticosteroid and 24% reported use of oral corticosteroids. Only 22% of participants with concomitant allergic rhinitis were using first line treatment. A logistic regression model highlighted that participant health care concession status and hospital admissions were associated with better adherence. Suboptimal medication management is evident in this at-risk population.
Background
In the field of pharmacist intervention research it is often difficult to conform to the rigorous requirements of the “true experimental” models, especially the requirement of ...randomization. When randomization is not feasible, a practice based researcher can choose from a range of “quasi-experimental designs” i.e., non-randomised and at time non controlled.
Objective
The aim of this article was to provide an overview of quasi-experimental designs, discuss their strengths and weaknesses and to investigate their application in pharmacist intervention research over the previous decade.
Results
In the literature quasi experimental studies may be classified into five broad categories: quasi-experimental design without control groups; quasi-experimental design that use control groups with no pre-test; quasi-experimental design that use control groups and pre-tests; interrupted time series and stepped wedge designs. Quasi-experimental study design has consistently featured in the evolution of pharmacist intervention research. The most commonly applied of all quasi experimental designs in the practice based research literature are the
one group pre
-
post
-
test design
and
the non
-
equivalent control group design
i.e., (
untreated control group with dependent pre
-
tests and post
-
tests
) and have been used to test the impact of pharmacist interventions in general medications management as well as in specific disease states.
Conclusion
Quasi experimental studies have a role to play as proof of concept, in the pilot phases of interventions when testing different intervention components, especially in complex interventions. They serve to develop an understanding of possible intervention effects: while in isolation they yield weak evidence of clinical efficacy, taken collectively, they help build a body of evidence in support of the value of pharmacist interventions across different practice settings and countries. However, when a traditional RCT is not feasible for logistical and/or ethical reasons researchers should endeavour to use the more robust of the quasi experimental designs.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Pharmacies represent a valuable opportunity to deliver weight management services, rather than just the routine supply of weight-loss products. In order to provide optimal services and ...translation of evidence-based weight management in community pharmacy, a best practice model program was designed and pilot tested to facilitate implementation of such services in pharmacies in Australia.
Objective
To develop and pilot a pharmacist-delivered, evidence-based, non-product-centred weight management service for community pharmacy in Australia.
Setting
Sydney, New South Wales, Australia.
Method
A pharmacy-based weight management service called the A Healthier Life Program (AHLP), for overweight and obese individuals, was developed based on current Australian weight management guidelines and recommendations made by key stakeholders. The pharmacist undertook training to acquire specific competencies to deliver the program. The AHLP involved six individual face-to-face sessions with the pharmacist over 3 months. The intervention targeted three areas: diet, physical activity and behavioural change.
Main outcome measures
Weight, BMI, waist circumference, blood pressure, dietary intake, and physical activity levels at 3 months were compared with values at baseline. Qualitative feedback on participants’ satisfaction and willingness to pay were also analysed.
Results
Eight pharmacies provided the AHLP between February and December 2013. Thirty-four participants were enrolled in the AHLP; mean age 50.7 years (SD 15.7) and mean BMI 34.3 kg/m
2
(SD 5.3). Of the 22 (65 %) participants who completed the program, six had achieved the target weight loss of ≥5 %. The mean change in weight was −3.5 kg (95 % CI −4.8, −2.2) and waist circumference −2.0 cm (95 % CI −2.8, −1.3) for program completers at 3 months. Furthermore, participants reported overall positive experiences of the program, and identified accessibility of the pharmacy and high comfort level with the pharmacist, as the major advantages.
Conclusion
The AHLP was well received and participants achieved targeted weight loss. This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Early identification and management of modifiable CVD risk factors are highly effective in preventing disease onset and/or ...improving outcomes in CVD. As highly accessible primary health professionals, pharmacists can assume a role in screening and risk factor management in collaboration with physicians; however, such prevention services are not established practice in Saudi pharmacies. Therefore, the aim was to explore physicians' perceptions about the utility of a role in CVD risk screening and management for Saudi pharmacists.
Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim in Arabic or English. All transcripts were thematically analyzed in an inductive approach after translation into English if required.
A total of 26 physicians recruited from public hospitals and primary healthcare centers were interviewed. Most were unaware of pharmacists' potential to undertake a role in CVD risk prevention. Although there was broad support for the concept, they recommended physician-pharmacist collaborative models, extensive provider pharmacist training, and strict oversight by the Saudi Ministry of Health (MoH)/other official authorities to ensure service quality and sustainability, should implementation occur. Healthcare system reform was considered key to expanding private sector (i.e., community pharmacy) involvement in healthcare, as was incentivizing providers and ‘marketing’ for patient acceptance.
Physicians were positive about setting up a collaborative community pharmacist-physician CVD risk screening and management service model with the help of an authorized body within the Saudi Arabian healthcare system.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Objective To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of ...self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction). Methods Pharmacists ( n = 109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists’ knowledge and skills in supporting patients’ diabetes self-management. Results A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management. Conclusion The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes. Practice implication Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health ...sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy.
Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed.
A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists' capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant's implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models.
Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.
Background Population screening and monitoring of cardiovascular risk is suboptimal in Australian primary care. The role of community pharmacy has increased considerably, but without any policy ...framework for development. The aim of this study was to explore the nature of community pharmacy-based screening models in Australia, capacity to increase delivery of pharmacy screening, and barriers and enablers to increasing capacity. Methods An online survey weblink was emailed to pharmacy managers at every quality-accredited pharmacy in Australia by the Quality Pharmacy Care Program. The 122-item survey explored the nature of screening services, pharmacy capacity to deliver services, and barriers and enablers to service delivery in considerable detail. Adaptive questioning was used extensively to reduce the participant burden. Pharmacy location details were requested to facilitate geo-coding and removal of duplicate entries. A descriptive analysis of responses was undertaken. Results There were 294 valid responses from 4890 emails, a 6% response rate. Most pharmacies (79%) had private counselling areas. Blood pressure assessment was nearly universal (96%), but other common risk factor assessments were offered by a minority. Most did not charge for assessments, and 59% indicated capacity to provide multiple risk factor assessments. Fewer than one in five (19%) reported any formal arrangements with general practice for care coordination. Financial viability was perceived as a key barrier to service expansion, amid concerns of patient willingness to pay. Support from government and non-governmental organisations for their role was seen as necessary. Conclusion There appears to be a critical mass of pharmacies engaging in evidence-based and professional services. Considerable additional support appears required to optimise performance across the profession.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objectives: To develop, implement, and evaluate a pharmacist‐led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. ...The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested.
Design: Evidence‐based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patient's requirement for antithrombotic therapy was assessed.
Setting: A major Sydney teaching hospital.
Participants: Two hundred eighteen consecutively admitted elderly patients (mean age 85.2) were recruited over a 6‐month period.
Intervention: A pharmacist‐coordinated multidisciplinary review process was implemented to coordinate risk assessments and subsequently recommend appropriate antithrombotic therapy, as per the algorithms.
Measurements: The proportion of patients receiving antithrombotic therapy was assessed on admission (preintervention), at discharge (postintervention), and postdischarge (follow‐up at 3 and 6 months).
Results: As a result of the intervention, 78 patients (35.8%) required changes to their existing antithrombotic therapy. Of these changes, 60 (76.9%) were “upgrades” to more‐effective treatment options (e.g., from no therapy to any agent or from aspirin to warfarin). The remaining 18 (23.1%) changes were “downgrades” to less‐effective, albeit safer, options. Despite a significant increase in anti thrombotic use overall (59.6% vs 81.2%, P<.001), fewer patients received warfarin postintervention, after having been assessed as inappropriate candidates (20.7% vs 17.4%, P=.39).
Conclusion: A pharmacist‐led multidisciplinary process was successfully developed and implemented within the hospital setting to increase overall antithrombotic use. Having addressed some of the known barriers and limitations to warfarin use, these algorithms may allow allied health workers, patients, and clinicians to work collaboratively to achieve optimal and, importantly, appropriate (i.e., safe and effective) antithrombotic use in at‐risk elderly patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
BACKGROUND:
The Consumer Information Rating Form (CIRF) was developed as a direct method for measuring consumers' perceptions of the comprehensibility, utility, and design quality of written medicine ...information. The validity and reliability of the CIRF were evaluated in a small convenience consumer sample in the US. Its validity and reliability have yet to be established in a larger sample of consumers who are on chronic therapy in different settings.
OBJECTIVE:
To determine the validity and reliability of the CIRF in Australian consumers on chronic therapy.
METHODS:
Consumers read and subsequently evaluated a Consumer Medicine Information (CMI) leaflet for one of their own medications, using an adapted version of the CIRF. The construct validity and internal reliability of the adapted version of the CIRF were tested using principal components analysis (PCA) and Cronbach's α, respectively.
RESULTS:
The adapted CIRF was completed by 282 consumers (aged 19–90 y; median 66; interquartile range 53–75 y; 60.3% females). Most respondents spoke primarily English at home (85.5%), had attained at least secondary education (84%), and had adequate health literacy levels (88.2%). Consumers rated CMI easy to read, understand, and navigate, but less easy to remember and keep. Most also found it to be useful and to contain the right amount of information. The design aspects also scored favorably, although CMI did score relatively poorly in terms of its attractiveness and tone (whether alarming or not). PCA yielded 3 factors (explaining 59.3% of the total variance) identical to those in the original CIRF: comprehensibility, utility, and design quality. All factors demonstrated good reliability (Cronbach's α 0.74, 0.92, and 0.75, respectively).
CONCLUSIONS:
The CIRF appears to be a robust instrument for assessing consumers' perceptions of written medicine information. However, validity always needs to be reestablished when using a previously validated measure in a different population.
TRASFONDO:
El Formulario para la Clasificación/Valoración de la Información para los Consumidores (CIRF) se desarrolló como un método directo para medir las percepciones de los consumidores con relación a cuan comprensible es la información, la utilidad y la calidad del diseño de la información escrita sobre medicamentos. La validez y la fiabilidad de la CIRF fueron evaluadas en una muestra propicia pequeña de consumidores en los Estados Unidos. Su validez y su fiabilidad aún están por establecerse en una muestra mayor de consumidores en terapia crónica en diferentes circunstancias.
OBJETIVOS:
Determinar la validez y la fiabilidad de la CIRF en consumidores australianos en terapia crónica.
MÉTODOS:
Los consumidores leyeron y, subsiguientemente evaluaron, una hoja impresa de Información sobre Medicamentos para los Consumidores (CMI), para uno de sus propios medicamentos, utilizando una versión adaptada de la CIRF. La validez conceptual y la fiabilidad interna de la versión adaptada de la CIRF fueron evaluadas usando el análisis de los componentes principales (PCA) y el α de Cronbach, respectivamente.
RESULTADOS:
La CIRF adaptada fue completada por 282 consumidores (edades entre 19–90 años con una mediana de 66 años e IQR = 53–75 años; 60.3% mujeres). La mayoría de las personas que respondió hablaba principalmente inglés en el hogar (85.5%), había obtenido educación secundaria o mayor (84%) y tenía niveles adecuados de alfabetización sobre la salud (88.2%). Los consumidores calificaron la CMI como fácil de leer, de entender y de utilizar, pero menos fácil de recordar y de conservar. La mayoría también la encontró útil y con la cantidad adecuada de información. El aspecto de diseño también calificó favorablemente, aunque la CMI calificó relativamente pobre en términos de su atractivo y de su tono (si era alarmante o no). La PCA produjo 3 factores (explicando 59.3% de la varianza total) idénticos a aquellos en la CIRF: cuan comprensible es la información, la utilidad y la calidad del diseño. Todos los factores demostraron una buena fiabilidad (α de Cronbach 0.74, 0.92, y 0.75, respectivamente).
CONCLUSIONES:
La CIRF parece ser un instrumento robusto para evaluar las percepciones de los consumidores con respecto a la información escrita sobre medicamentos. Sin embargo, la validez siempre necesita re-establecerse cuando se utiliza una medida validada anteriormente en una población diferente.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The introduction of Universal Healthcare Coverage (JKN) in 2014 has changed the landscape of the Indonesian healthcare and affected the community pharmacy sector. This paper investigates perceptions ...of healthcare and pharmacy stakeholders about the impact of JKN on the practice of pharmacists and pharmacy in both public (Puskesmas) and private (Community or Retail pharmacy) settings. In‐depth, semi‐structured interviews were conducted from February to August 2016 involving 29 participants representing key stakeholders from different provinces in Indonesia. While JKN was actually designed with good policy objectives for pharmacy integration within primary care network, it has created some unintended and unanticipated distortion in the healthcare system which may be detrimental to the community pharmacy sector. In fact, community pharmacy practice is still limited to dispensing and continued to be hampered by ongoing challenges mainly pharmacists' absence, lack of clinical competence and limited support from regulation changes. It is a missed opportunity for pharmacists to play a greater role in primary care services indicating the need for an overhaul to pharmacy education and policy system.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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