Pharmacy, Volume 8, Issue 4 (December 2020) – 66 articles

Several studies have shown that communication between patients and HCPs is still not optimal in integrating patients’ perspectives on how best to manage their diseases and their medication. One such area where encounters between patients and professionals still needs to develop to better incorporate the patient’s perspective is pharmacy practice. The aim of this study was therefore to explore and present new typologies and communication aspects of HCP-patient relationships since a comprehensive literature search in 1997 conducted by Sondell and Söderfeldt, and relate the findings to pharmacy practice. In total, 11 articles were identified by applying the techniques of a purposeful literature search. The articles covered aspects of: shifting and adapting roles during the encounter, techniques to ensure individualizing in the encounter, avoiding inappropriate routines, coping with internet-informed patients, achieving mutual goals, dealing with uncertainty including avoiding rigid preconceptions, using social conversation, incorporating patients’ prior experiences, aligning language, adapting greetings and exploring the cultures and communication patterns of patients from other ethnic backgrounds. The variety of these communication aspects points to the immense complexity of communication as a practice discipline. This article has presented some of the literature that pharmacists can consult, in the endeavor of improving their communication practices. Full article

Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil. Full article

“Smart” infusion pumps include built in drug error reduction software which uses a drug library. Studies have reported the drug library build should be undertaken by a multidisciplinary team, including a pharmacist; however, the extent or nature of the input required by the pharmacist for greatest benefit is unknown. This review aimed to identify key factors for the implementation of the smart infusion pumps, with a focus on the role of pharmacists and compare this to the experience from a case study. A literature review was conducted using Embase and Ovid Medline, and 13 eligible papers were found. Predominant themes relating to the pharmacist’s role and successful implementation of the smart infusion pumps were determined. Key factors for success included team involvement across the entire process from procurement, set-up through to implementation including risk assessment and device distribution, and training, which were comparable to the case study experience. Few studies described the extent or details of the pharmacist’s responsibilities. Full article

Inappropriate use of antibiotics has been reported to contribute to the emergence and increase of antimicrobial resistance (AMR) in the world. The pharmacist has the responsibility to supervise the dispensing of antibiotics with prescriptions to ensure rational use. An online semi-structured questionnaire was shared with approximately 1100 licensed pharmacists in Tanzania. Study data were collected and managed using REDCap electronic data capture tools before use for analysis. Of the 226 (20.5%) received responses, 197 had given consent and provided complete surveys. Notably, 153 (77.7%) of the 197 pharmacists had excellent knowledge about the legal requirements for dispensing antibiotics and the AMR challenge. Of the 197 surveyed pharmacists, 143 (72.6%) admitted to dispensing antibiotics without a prescription in their daily practice. Notably, 84.1% (37/44) of pharmacists with masters or PhD education were more likely to dispense without a prescription compared to 69.3% (106/153) among bachelor holders (p-value = 0.04). The reasons for administering antibiotics without a prescription included the pharmacy business looking for more profit, patient failure to obtain a prescription and the lack of stringent inspection of pharmacies by the regulatory authorities. Penicillins, macrolides and fluoroquinolones were the classes of antibiotics most commonly dispensed without a prescription. Stringent inspections by the regulatory authorities should detect and reduce dispensing antibiotics without a prescription. The community should be educated on the importance of medication prescription from a qualified medical practitioner. Full article

The COVID-19 pandemic has required many pharmacy programs to increase their utilization of technology or shift the course of delivery entirely online. Delivery in this setting has exposed areas in the use of technology where pharmacy programs need to improve (such as staff and student training). This study performed a document analysis of strategic plans to identify technology-related strategies and where gaps in planning currently exist. Accredited pharmacy programs in Canada and the USA were included for analysis. A total of 77 strategic plans were identified. Strategic plans were searched for the phrases: "tech", "online", "distance" and "e-learning" to identify technology-related statements. Statements relating to technology in education were coded for (1) the prioritized “action” and (2) the objective or “goal” of this strategy. Quantitative analysis of these codes revealed that the “action” was most frequently to introduce or improve technology (54.4%), and the “goal” most frequently related to enhancing teaching/course delivery/learning (34.2%). Strategic plans appeared to frequently focus on the technology itself, with little consideration for the human aspect of operating technology or readiness of programs to embrace technology. Moving forward, strategic priorities with respect to technology should be refocused towards system readiness and account for resources necessary for target user upskilling and acceptance. Full article

In the United States, patients face increasing practical barriers and concerns about stigma when seeking sexual and reproductive healthcare, specifically family planning services involving hormonal contraception, emergency contraception, and abortion. The pharmacist is a member of the interprofessional care team with the ability to provide non-judgmental, high-quality, and patient-centered care. The community pharmacy setting itself offers specific advantages which promote access, including availability in most neighborhoods, broad hours of operation, lack of need for an appointment, and a stigma-free space which is frequented for other goods and services. This commentary suggests specific ways for pharmacies to improve access to contraception, emergency contraception, and abortion in line with national quality recommendations. Particular focus is given to the intersection of sexual and reproductive health resources and referrals within the pharmacy profession as well as the training and technical assistance tools which can help address unmet patient need. Full article

Introduction: Drug utilization of analgesics in a private healthcare setting is useful to examine their prescribing patterns, especially the newer injectable cyclooxygenase (COX)-2 inhibitors (coxibs). Objectives: To evaluate the utilization of coxibs and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) indicated for postoperative orthopaedic pain control using defined daily dose (DDD) and ratio of use density to use rate (UD/UR). Method: A retrospective drug utilization review (DUR) of nonsteroidal anti-inflammatory drugs (NSAIDs) at an inpatient department of a private teaching hospital in Seremban, Malaysia was conducted. Patients’ demographic characteristics, medications prescribed, clinical lab results, visual analogue scale (VAS) pain scores and length of hospital stay were documented. Orthopaedic surgeries, namely arthroscopy, reconstructive, and fracture fixation, were included. Stratified random sampling was used to select patients. Data were collected through patients’ medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization’s DDD as a benchmark. The inclusion criteria were patients undergoing orthopaedic surgery prescribed with coxibs (celecoxib capsules, etoricoxib tablets, parecoxib injections) and tNSAIDs (dexketoprofen injections, diclofenac sodium tablets). Data were analysed descriptively. This research was approved by the academic institution and the hospital research ethics committee. Result: A total of 195 records of patients who received NSAIDs were randomly selected among 1169 cases. In term of the types of orthopaedic surgery, the ratio of included records for arthroscopy:fracture fixation:reconstructive surgery was 55.4:35.9:8.7. Most of the inpatients had low rates of common comorbidities such as cardiovascular disease as supported by their baseline parameters. The majority were not prescribed with other concomitant prescriptions that could cause drug interaction (74.9%), or gastroprotective agents (77.4%). Overall, DDDs per 100 admissions for all NSAIDs were less than 100, except for parecoxib injections (389.23). The UD/UR for all NSAIDs were less than 100, except for etoricoxib tablets (105.75) and parecoxib injections (108.00). Discussion: As per guidelines, the majority (96.9%) received other analgesics to ensure a multimodal approach was carried out to control pain. From the UD/UR results, the arthroscopy surgery was probably the most appropriate in terms of NSAID utilization. Conclusion: The prescribing pattern of NSAIDs except parecoxib was appropriate based on adverse effect and concurrent medication profile. The findings of this DUR provide insight for a low-risk patient population at a private specialized teaching hospital on the recommended use of NSAIDs for postoperative orthopaedic pain control. Full article

The movement to integrate pharmacists into primary care team-based settings is growing in countries such as Canada, the United States, the United Kingdom, and Australia. In the province of Ontario in Canada, almost 200 pharmacists have positions within interdisciplinary primary care team settings, including Family Health Teams and Community Health Centers. This article provides a narrative review of the evolving roles of pharmacists working in primary care teams, with a focus on evidence from Ontario, as well as drawing from other jurisdictions around the world. Pharmacists within primary care teams are uniquely positioned to facilitate the expansion of the pharmacist’s scope of practice, through a collaborative care model that leverages, integrates, and transforms the medication expertise of pharmacists into a reliable asset and resource for physicians, as well as improves the health outcomes for patients and optimizes healthcare utilization. Full article

Clinic- and hospital-based home care describes models of care where services commonly associated with hospital inpatient care are provided at the patient’s home or in an outpatient or community-based clinic. Hospital in the Home (HITH), also termed Hospital at Home (HaH) in parts of Europe and America, is a common and important example of this type of care. Other examples include infusion centers, skilled nursing facilities (particularly in the USA), self-administration models (including home infusion services) and administration through outpatient or community clinics. Different models of HITH care are used internationally and these encompass a wide range of services. Medication administration, particularly outpatient parenteral antimicrobial therapy (OPAT), is an important element in many of these models of care. There is a key role for pharmacists since the provision of medication is integral in this model of patient care outside the hospital setting. Data on the growing importance of HITH and OPAT as well as the administration of medications suited to clinic- and hospital-based home care, including subcutaneous and intramuscular injectables, immunoglobulins and other blood fractions, cancer chemotherapy, total parenteral nutrition, biologicals/biosimilars, vasopressors and enzymes, using differing service models, are described. The pharmacist’s role is evolving from that involved primarily with dose preparation and supply of medications. Their clinical expertise in medication management ensures that they are an integral member and leader in these models of care. Their role ensures the safe and quality use of medicines, particularly across transitions of care, with the pharmacist taking on the roles of educator and consultant to patients and health professional colleagues. Activities such as antimicrobial stewardship and ongoing monitoring of patients and outcomes is fundamental to ensure quality patient outcomes in these settings. Full article

Background and Aims: Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders. Methods: A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words “naloxone”, “opioid” and “overdose” were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population. Results: The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use. Conclusion: Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals’ perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community. Full article

Early identification and treatment of malignant melanoma is crucial to prevent mortality. The aim of this work was to describe the uptake, profile of users and service outcomes of a mole scanning service in the community pharmacy setting in the UK. In addition, health care costs saved from the perspective of general practice were estimated. The service allowed patients to have concerning skin lesions scanned with a dermatoscopy device which were analyzed remotely by clinical dermatology specialists in order to provide recommendations for the patient. Patients were followed up to ascertain the clinical outcome. Data were analyzed for 6355 patients and 9881 scans across 50 community pharmacies. The majority of the scans required no further follow-up (n = 8763, 88.7%). Diagnosis was confirmed for 70.4% (n = 757/1118) of scans where patients were recommended to seek further medical attention. Of these, 44.3% were ultimately defined as normal (n = 335) and 6.2% as malignant melanoma (n = 47/757). An estimated 0.7% of scans taken as part of the service led to a confirmed diagnosis of malignant melanoma. This service evaluation has shown that a mole scanning service available within community pharmacies is effective at triaging patients and ultimately playing a part in identifying diagnoses of malignant melanoma. Full article

Background: Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners’ clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant. Methods: A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords. Results: Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste. Conclusion: This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme. Full article

Pharmacists’ tasks are multifaceted and include, for example, vital counseling and communication skills. Objective Structured Clinical Examinations (OSCEs) could be used to train pharmacy students in these skills. Our study sought to determine the efficacy of our OSCE training approach for training pharmacy students’ counseling and communication skills on diabetes mellitus compared to a control group. This randomized controlled study was conducted with pharmacy students using a pre-post-design. The intervention group completed diabetes OSCE training, while the control group solved diabetes patient cases using subjective, objective, assessment, and plan notes. Before and after the respective training, both groups completed OSCEs evaluating counseling and communication skills. Before each OSCE encounter, the participants completed a self-assessment questionnaire and, upon completion of the seminar, filled out a satisfaction survey. The OSCE-trained group demonstrated a significantly greater increase in counseling and communication skills and self-confidence than the control group. Both groups were generally satisfied with the seminar. These results demonstrate that our OSCE training approach allows for the effective training of pharmacy students’ diabetes counseling and communication skills and suggests the inclusion of such a skill-based approach more widely in pharmacy students’ education. Full article

(1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, p = 0.02). There was no significant change between control group pre- and post-test segments (p = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting. Full article

Background: Healthcare systems worldwide adapt to patients’ needs and expectations, following social evolutions. Pharmaceutical practice has shifted towards activities such as therapeutic education. Such new missions require to prioritize human and social sciences, which now play a predominant role in training. Objective: This work consists of assessing the contribution of human and social sciences to the field of pharmacy, with a twofold focus on practice and training. Method: A literature review was carried out according to the PRISMA guidelines focusing on the last 10 years. Selected full texts were read and analyzed to elicit the contribution of human and social sciences to pharmacy. Results: Overall 36 articles were included. Three specific topics were identified during an inductive process of full text analysis: public health policy, patient care, and interprofessional collaboration. Conclusions: Although human and social sciences are essential to the evolution of the pharmacist profession, their impact on health care costs remains difficult to evaluate. Moreover, teaching human and social sciences can prove difficult to standardize. Such approaches must be supported and organized by governments and universities with a view of upscaling practices. Full article

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents’ and health care providers’ experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2–4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD. Full article

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease (COVID-19) pandemic, has challenged practitioners with complex clinical scenarios as well as conflicting and scarce data to support treatment strategies. The pandemic has also placed strains on institutions due to drug shortages, alterations in medication use processes, economic losses, and staff exposure to the virus. This article provides pharmacist-led suggestions and strategies to various case questions, describing some of the challenges faced by practitioners at an urban teaching hospital during the COVID-19 pandemic. The strategies suggested can be explored at other institutions. Full article

We assessed the same-day availability of oral emergency contraception (EC) in five Louisiana communities, and evaluated this data for relationships between availability and local population demographics. Researchers called all retail pharmacies in five municipalities of varying sizes in order to inquire about the same-day stockage of EC products and their availability to teens. Individual pharmacies were then geolocated to a census tract, and call data was analyzed against neighborhood census data regarding population size, income, gender, race, family structure, and educational level. A multivariable logistic regression model was performed to predict the same-day availability of emergency contraception. EC was available on the same day in 66% of all pharmacies. The same-day availability of EC decreased with the local population size (p < 0.001), and the availability increased with higher levels of educational attainment (p = 0.0015). The largest census level predictor of access to same-day EC was the city population, with the availability increasing by 6.6% for every 10,000 person increase in population. Despite changing to over-the-counter sales in 2013, EC is still not widely available in all geographic areas. Its availability is partially predictable by local population demographics, and this difference may represent a health disparity for teens and women seeking EC. Full article

Background: Continuing education (CE) is important for developing and updating pharmacists’ knowledge, skills, and attitudes. CE programs should be developed according to social requirements but also based on personal requirements depending on the sectors the pharmacists work in. This research aims to explore perspectives on CE programs for foundation-level drugstore pharmacists in Japan. Method: Foundation-level drugstore pharmacists were asked what CE programs or training they needed to develop patient care or customer satisfaction. Results: We obtained 417 opinions (multiple answers were allowed) in 280 responses from 460 pharmacists (male: 245 and female: 215). The products and goods about which drugstore pharmacists wanted to learn covered a wide range. They wanted to learn about taping skills, tests, and products and devices related to care of the elderly. Taping skill would be quite unique for drugstore pharmacists. For special populations, they wanted knowledge and skills related to pregnancy tests and the safe use of medication by pregnant or lactating women. Conclusion: Drugstore pharmacists in Japan have different CE and continuing professional development (CPD) requirements from community pharmacists. The benefits of CE programs meeting pharmacists’ requirements should be evaluated in future research. Full article

This study aimed to assess public knowledge about medicine information, safety, and adverse drug reaction reporting (ADR) in Dammam, Saudi Arabia. A cross sectional study was conducted using purposive stratified sampling in different settings of Dammam city for three months (January–March 2020). The target population was identified as consumers who had used the medicines in the last 3 months. The questionnaire was adopted from the literature and was validated. Content and face validities were established, and reliability was assessed. The study was approved by the concerned ethics committee. A total of 915 participants returned completed questionnaires. A total of 54.4% participants aged between 18 and 30 years, 65.8% were females and 53.1% had obtained bachelor level education. The mean score for knowledge of medicines (K1) was 5.46 ± 1.07. The mean score for knowledge regarding medication safety (K2) was 5.94 ± 1.73. The mean score for tendency to report a suspected ADR (T1) was 3.43 ± 1.57. Gender was a determinant of knowledge regarding medication safety (K2) (p < 0.01) and ADR reporting tendency (T1) (p < 0.01). The marital status of patients was a determinant for both knowledge of medicines (K1) (p < 0.01) and, knowledge regarding medication safety (K2) (p < 0.01). The results of this study highlighted that although the scores for knowledge of medicines, and tendency to report ADR were better, the score for knowledge regarding medication safety was unsatisfactory. Full article

Background: The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity strategies for pharmaceuticals are not currently implemented in many countries, due to quality and safety barriers. The aim of this study was to determine whether the application of circular economy principles can minimise pharmaceutical waste and support sustainability in the pharmaceutical supply chain; Methods: a detailed narrative literature review was conducted in order to examine pharmaceutical waste creation, management, disposal, and the application of circular economy principles; Results: the literature scrutinised revealed that pharmaceutical waste is created by multiple routes, each of which need to be addressed by pharmacists and healthcare bodies through the Circular Economy 9R principles. These principles act as a binding mechanism for disparate waste management initiatives. Medicines, or elements of a pharmaceutical product, can be better managed to reduce waste, cost, and reduce negative environmental impacts through unsafe disposal. Conclusions: the study findings outline a Circular Pharmaceutical Supply Chain and suggests that it should be considered and tested as a sustainable supply chain proposition. Full article

Pharmacists play a key role in deprescribing medications. Incorporation of this concept into pharmacy school curricula is important in ensuring that graduates can address the complex needs of an aging population. The aims of this study were to assess if and how student pharmacists were exposed to deprescribing within their curriculum, to assess students’ perceptions regarding their attitudes, ability and confidence in deprescribing, and to assess if reported curricular exposure to this topic resulted in improved perceptions or objective knowledge assessment scores. An electronic survey was distributed to third- and fourth-year pharmacy students at 132 schools of pharmacy. The survey included three sections including: (i) demographics and questions on their exposure to deprescribing and other experiences within their curriculum; (ii) questions regarding their attitudes, ability, and confidence regarding deprescribing on a 5-point Likert-scale; (iii) a knowledge assessment on polypharmacy and deprescribing in the form of 12 multiple-choice questions. Likert-scale questions were analyzed as scales utilizing the mean score for items measuring student perceptions regarding deprescribing attitudes, ability, and confidence. Comparisons were made on each variable between students with and without curricular exposure to deprescribing using t-tests. Ninety-one responses were included in the analysis. Only 59.3% of respondents reported exposure to deprescribing in their didactic coursework. The mean scores on the polypharmacy and deprescribing knowledge assessments were 61.0% and 64.5%, respectively. Those with exposure to deprescribing concepts within their curriculum were more likely to agree that their school’s curriculum prepared them to deprescribe in clinical practice (t(89) = −2.26, p = 0.03). Pharmacy schools should evaluate their curricula and consider the addition of specific deprescribing objectives and outcome measures for didactic and experiential training. Full article

Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes. Aim: To evaluate the extent of PIM use in the older population with T2DM during hospitalization in a tertiary care hospital in India. Methods: A cross-sectional study was carried out from August 2019 to January 2020 in a tertiary care teaching hospital among the older population (aged ≥ 65 years) hospitalized with T2DM. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. Binary logistic regression was applied to determine the factors associated with PIM use. Results: The mean age of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, most of whom were men (54.7%). The participants had at least four comorbidities and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. Significant factors associated with the use of PIM during hospitalization are patients taking a higher number of medications (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female patients (OR: 2.29; 95% CI: 1.05–4.97). Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher PIM use. Engaging clinical pharmacists in evaluating medication appropriateness can improve the outcomes of older patients. Full article

Pharmaceutical care in sports is a new field of work to clinical pharmacists, focused on promoting pharmacotherapeutic follow up and clinical services to athletes, physical activity practitioners and enthusiasts of any sports modality. A broad range of pharmaceuticals, dietary supplements and herbal drugs have been used historically as performance promoters, doping or ergogenic aids. In this context, the role of pharmacists in prevent adverse events, drug interactions or any drug related problems, as doping issues, was described. Its actions can be important to contribute with a multi professional clinical health team, leading athletes to use these resources in a rational way, promoting and optimizing the therapeutic when its necessary. Full article

A modern approach to clinical skill education is the use of educational videos, yet there is a shortage of literature investigating the effect of self-instruction videos (SIVs) in pharmacy students. Therefore, our objective was to investigate whether an SIV is non-inferior compared to face-to-face instruction (FTFI) in acquiring blood pressure measurement skills. The participants in this randomized controlled study were pharmacy students. The control group was taught by FTFI, while the intervention group watched an SIV. Before and after the instruction, the participants’ performance was assessed by an objective structured clinical examination (OSCE). The participants completed a self-assessment survey before each OSCE session. Moreover, the participants’ perception and satisfaction were assessed using another survey. The OSCE score and self-assessment score increased significantly from pre- to post-instruction in both groups. The SIV was non-inferior compared to FTFI in terms of the OSCE score, considering a predefined non-inferiority margin of −10%. The participants’ self-assessment yielded inconclusive results for non-inferiority. Both instructional approaches were well received. Considering our findings, SIVs might be a valuable option for teaching pharmacy students’ blood pressure measurement skills. However, depending on the skill intended to be taught, a combination of an instructional video with instructor-led teaching may be necessary. Full article

For businesses that store physical goods, managing product inventories and financial cost accounting controls are critical. Pharmacies are under considerable scrutiny, due to the nature of their merchandise, making internal controls even more vital. Due to the emergence of COVID-19 and government mitigation strategies, the US economy has seen significant macro- and microeconomic effects. COVID-19 has changed the pharmacy working environment, which could theoretically increase rates of employee drug diversion. Therefore, better inventory management could reduce the misuse of pharmaceutical drugs from fraudulent and drug diversion activities. The author explored secondary findings to create a multidisciplinary conceptual analysis of the reasons why internal controls executed with greater diligence may be needed to avoid damaging financial, legal, and health outcomes. The author also provides a review of available internal control methods that can be used to mitigate diversion. Full article

Insulin therapy is frequently required to achieve glycemic targets (A1c) in type 2 diabetes (T2D); however, clinicians and patients face barriers with the complexities of multiple daily injection regimens. Patch-like wearable insulin devices, such as V-Go, may simplify and optimize this complexity. This study evaluated the change in A1C and insulin total daily dose (TDD) in a suboptimally-controlled (not achieving A1C targets) T2D population after switching to V-Go. A retrospective chart analysis at a diabetes clinic was performed to evaluate change in A1c measurements from baseline (V-Go initiation) to end of study observation. Of the 139 patients enrolled, A1C significantly decreased from baseline (−1.5 ± 1.79%; p < 0.001). Patients prescribed insulin at baseline (n = 122) used significantly less insulin TDD (−8 u/day; p = 0.006). The percentage of patients meeting the target of A1C < 8% increased from 14% at baseline to 48% at study completion (p = 0.008). Patients prescribed a basal-bolus regimen prior to V-Go achieved an A1C reduction of 1.5 ± 2.0% (p < 0.0001) and experienced the greatest reduction in TDD (−24 u/day; p < 0.0001). Thus, patients switching to V-Go from a variety of therapies at baseline experienced reductions in A1C while using less insulin, with a reduction in clinically relevant hypoglycemia, indicating the potential benefit of V-Go in optimizing and simplifying T2D care. Full article

Continuing professional development (CPD) is an essential component of professional practice for registered health practitioners to maintain and enhance knowledge, skills and abilities. There are many topics that practitioners may pursue relevant to their practice environment, and, in recent years, providing culturally safe and respectful practice is an emerging area of need. Unfortunately, many health professionals, whilst willing to offer cultural safe healthcare, may be uncertain of how to enact that practice. The World Health Organisation recognises attainment of the highest possible standard of health as a basic human right, and cultural safety is increasingly becoming an expectation of health professionals. To address this need and the insufficiency of support in the literature, the authors have presented a discussion paper on various aspects of cultural safety and the underlying constructs, such as cultures, that support it. The discussion takes into account core constructs that signpost the path to cultural safety and recognises the role and accountability of all levels of the healthcare system, not merely the practitioner. Finally, we propose a model program for a cultural humility CPD activity incorporating pre-work, online modules, interactive workshop, reflection on professional practice and a post-workshop evaluation. Full article

Background: A range of pro-environmental behaviors are recognized, promoted, and investigated, but urgent action is also needed to tackle the direct and indirect environmental impact of medication waste. One solution is to reissue medicines, returned unused to pharmacies (i.e., reuse medicines). Yet, if medicines reuse is to be formally introduced in the UK, it is imperative also to understand people’s willingness to take part in such a scheme and importantly, the underpinning drivers. This study aimed to develop, validate, and evaluate a Theory of Planned Behavior model aimed at predicting medicines reuse behavioral intentions. Methods: The behavior of interest, medicines reuse, was defined according to its Target, Action, Context, and Time. Then themes from an existing qualitative study were used in order to draft, validate and pilot a Theory of Planned Behavior-based questionnaire before its completion by a representative sample (n = 1003) of participants from across the UK. Results: The majority expressed pro-medicines reuse intentions. The three direct measures accounted for 73.4% of the variance in relation to people’s intention to reuse medicines in the future, which was statistically significant at p < 0.001. People’s specific beliefs about medicines reuse and how they evaluate other people’s expectations of them had a substantial impact on their intentions to reuse medication in the future, mediated in an intricate way via attitudes, subjective norms and perceived behavioral control (PBC). Conclusions: This study shows how people could embrace medicines reuse via practical measures that illustrate the safety and quality assurance of reissued medicines, educational interventions that bolster beliefs about the pro-environmental benefits, and norm-based interventions encouraging doctors and pharmacists to endorse the practice. The findings add to the emerging work on medicines reuse and, significantly, provide a theoretical framework to guide policymakers and other organizations looking to decrease the impact of medication waste through medicines reuse schemes. Full article

Prognostic prediction has been reported to affect the decision of doctors and non-physician health care providers such as nurses, social workers, pastors, and hospice volunteers on the selection of appropriate medical interventions. This was a case of a 65-year-old woman who presented with a poor oral intake. The patient had a history of sigmoid colon cancer with abdominal wall metastasis and peritoneal dissemination. On the day of admission, nausea, anorexia, and malaise were noted, requiring immediate intervention. The patient’s prognosis was predicted using the Palliative Prognostic Index. The pharmacist suggested the use of dexamethasone tablets in order to alleviate the patient’s symptoms. Indeed, the administration of dexamethasone alleviated the symptoms of nausea, loss of appetite, and malaise. To the best of our knowledge, this is the first case report to demonstrate that prognosis prediction is important not only for other medical staff but also for pharmacists when deciding the need to initiate a treatment and continue such treatment, and when providing pharmacist interventions. Full article