The latest medical research on Clinical Pharmacology
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Projecting the future size of the Lebanese pharmacy workforce: forecasts until the year 2050.International Journal of Epidemiology
Despite the rigorous regulations governing the pharmacy profession in Lebanon, the increasing numbers of pharmacy graduates seem to be the greatest threat of demise. No forecast is available to assess the long-term projections of pharmacists supply.
The objective of this manuscript is to project the future size of the Lebanese pharmacy workforce till 2050 and discuss their potential consequences on the labour market.
This study was carried out in collaboration with the Lebanese Order of Pharmacists (OPL), where official numbers were retrieved from the registered pharmacists' database from 2006 to 2017. The data were analyzed as time series using the Auto-Regressive Integrated Moving Average (ARIMA) method. Projected numbers were plotted using Microsoft Excel office.
The ratio of pharmacists to 10 000 inhabitants up till the end of 2017 was estimated at 17.52, compared with a worldwide mean of 5.09, with a continuous increase seen with the coming years, possibly reaching an estimated 41.17 pharmacists per 10 000 inhabitants by the year 2050. The total number of pharmacies increased from 1546 in 2006 up to 3174 at the end of 2017 nationwide, with a major increase seen in Bekaa (206.35%) and South Lebanon (171.08%) governorates, respectively.
Our study shows that the dramatic increase in pharmacy graduates will worsen with time. To curb it, it is important to vote and apply new laws, and initiate a collaborative work between academia, professional associations, and employers from all sectors to find innovative solutions.
Perceived motivators, training supports and challenges to career advancement among pharmacists in the Malaysian public healthcare system.International Journal of Epidemiology
To explore the perceived motivators, training supports and challenges to career advancement among fully and provisionally registered pharmacists (FRPs and PRPs) in the Malaysian public service.
Nine hundred and fifty-three pharmacists in the public service of Perak State, Malaysia, were invited for participation in an online survey that was conducted in October 2018. Based on a 5-point Likert scale, they were required to respond to 56 items, ranging from the perceived availability and importance of both motivators and training supports, the challenges to career advancement, to the awareness of the need for career planning. Their responses were subsequently dichotomized into 'agree'/'important' and 'disagree'/'not important'.
Four hundred and eighty pharmacists participated in the survey, yielding a response rate of 51.2%. More than half of them agreed with the inflexibility of working time and the absence of a performance-based salary and promotion scheme. More than 80% of them also highly valued the training in both pharmacy-related areas and management. Apart from inadequate training, no specialization in pharmacy as a profession and the absence of a performance-based promotion scheme were identified as the major challenges to their career advancement. As compared with the PRPs, the FRPs had greater concern over the absence of a performance-based salary and promotion scheme, flexible working time and periodic feedback for their work performance.
The findings indicate the inadequacy of the current system in providing recognition, training, feedback for work performance and a clear career pathway to pharmacists in the Malaysian public service, which warrants a change.
Evaluation of pharmacy-based telephone interventions on medication pick-up rates: a retrospective, quality improvement study at charity outpatient clinics.International Journal of Epidemiology
To evaluate a live telephonic outreach intervention made by clinical pharmacists and clinical pharmacy technicians on medication pick-up rates.
A retrospective, quality improvement study conducted at six outpatient charity clinics in Dallas-Fort Worth area between 1 January 2017 and 31 July 2017. A live telephonic call was made by a pharmacy team member if the patient did not pick-up at least one prescription item. Patients may receive more than one call if they did not pick-up medication(s) more than once during the study period. A live telephonic call resulted in three categories: contacted, left a voice message and unable to contact. Medication pick-up rates were obtained from a pharmacy claims database.
The study population included 1726 individual patients who failed to pick-up at least one medication from Baylor Scott & White Health pharmacy. A total of 2551 live telephonic calls were made for the study population. A total of 1175 live telephonic calls (46.1%, n = 2551) resulted in a patient picking up medication(s). Results from the generalized estimating equation logistic regression models showed that patients who received a voice message (OR: 1.37; 95% CI: 1.05 to 1.80; P < 0.021) or was contacted (OR: 1.99; 95% CI: 1.54 to 2.60; P < 0.001) were more likely to pick-up their medications as compared to the 'unable to contact' group.
Telephonic interventions from the pharmacy team can serve as a successful means to increase medication pick-up rates among charity clinic patients.
Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences.International Journal of Epidemiology
Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.
We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources - Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria - articles published in English, related to implementation of PP and articulated barriers to PP.
Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.
If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
Evaluating recruitment methods of patients with advanced cancer: a pragmatic opportunistic comparison.International Journal of Epidemiology
Recruitment of patients with advanced cancer into studies is challenging.
To evaluate recruitment methods in a study of pharmacist-led cancer pain medicine consultations and produce recommendations for future studies.
Two methods of recruitment were employed: (1) community-based (general practitioner computer search, identification by general practitioner, community pharmacist or district nurse and hospital outpatient list search) and (2) hospice-based (in and outpatient list search). Patients identified in method 1 were invited by post and in method 2 were invited face-to-face. Information was designed in collaboration with patients and carers.
A total of 128 patients were identified (85 from the community and 43 from the hospice), and 47 met the inclusion criteria. Twenty-three agreed to take part and 19 completed the study, 17 of whom were already under specialist palliative care. Recruitment rates were 7% for community-based methods and 40% for hospice. The recruitment methods differed in intensity of resource use. Recruitment via letter and a lack of engagement by healthcare professionals were found to be barriers. Facilitators included the researcher having personal involvement in recruitment.
The overall recruitment rate was in line with other studies for this patient cohort. Attempts to identify and engage patients through community-based postal contact were less effective than where personal contact with patients was both possible and occurred. Methods were less successful at recruiting patients who were not already engaged with hospice services.
Evaluation of antidiabetic medication adherence in the Lebanese population: development of the Lebanese Diabetes Medication Adherence Scale.International Journal of Epidemiology
To evaluate factors affecting adherence to oral antidiabetic treatment in the Lebanese population and to develop the Diabetes Medication Adherence Scale (DMAS) based on these factors.
A cross-sectional study was conducted on a sample of Lebanese diabetic patients. Data were collected using a structured questionnaire. The level of adherence was measured using the Lebanese Medication Adherence Scale (LMAS-14). Bivariate analyses and multivariable analysis was done using SPSS. Psychometric evaluation of DMAS included an assessment of internal consistency, factor analysis, evaluation of sensitivity and specificity. Criterion-related validity was assessed by comparison with LMAS-14 measure of adherence.
A total of 500 patients were recruited. 39.2% were adherent to treatment. Long working hours, increased number of oral antidiabetic medication per day, drug discontinuation when travelling, longer duration of diabetes and treatment burden were among factors that decreased adherence. While understanding the treatment regimen, following up physician recommendations and following up the recommended diet contributed to good medication adherence. The final 7-item scale (DMAS) had a good internal consistency (Cronbach's α = 0.612) and a good correlation and agreement with LMAS-14 (Spearman's rho = 0.699, Cohen's kappa = 0.566). Patients with high DMAS scores were significantly more likely to have controlled glycaemia (P < 0.05). Sensitivity and specificity reached 70.39% and 51.47%, respectively.
Adherence to oral antidiabetic treatment is suboptimal in Lebanon. The DMAS is a reliable instrument for assessing adherence and predicting poor glycaemic control in clinical practice, but requires further validation in other populations.
Quality indicators and community pharmacy services: a scoping review.International Journal of Epidemiology
Quality indicators are a commonly used improvement tool in health care. There is growing interest and activity in the use of quality indicators to improve community pharmacy practice.
To conduct a scoping review of the use of quality indicators for community pharmacy practice, including their methods of development and evaluation.
Electronic databases (EMBASE and PubMed) were searched to identify papers published between January 2008 and April 2018. No limits were applied for language of publication or country of origin. Studies were included if they reported empirical data regarding the development or evaluation of quality indicators. All study designs were eligible for inclusion. Duplicate independent screening was undertaken of the search results. Data extraction was performed by one reviewer.
Of the 988 records identified from the database search, 15 articles were included. The studies were conducted in 12 countries from six continents. Eleven studies described the development of quality indicators, eight of which included the evaluation of the psychometric properties of the indicators developed. Four studies examined the impact of quality indicators on practice all of which reported improvements in some aspects of quality, mainly with structure indicators rather than those relating to process and outcome.
Whilst there is a growing emphasis on promoting improvement in community pharmacy services, evidence is lacking of the effect of indicators on improving quality. Measurable process and outcome indicators are needed. The future development of quality indicators would also benefit from a multi-stakeholder approach.
An analysis of hospital pharmacy practice in six countries of sub-Saharan Africa based on the International Pharmaceutical Federation Basel Statements on the future of hospital pharmacy.International Journal of Epidemiology
The objective of this study was to update the self-assessment tool and to evaluate current hospital pharmacy practices in six sub-Saharan African countries.
Questions in the validated survey were edited if the revised Basel Statement changed intent. A total of 13 updates were made. The survey was administered via e-mail to pharmacy personnel in any hospital centre in Ghana (258 total hospitals), Nigeria (17 038 total hospitals), Malawi (499 total hospitals), Uganda (155 total hospitals), Zambia (98 total hospitals) and Zimbabwe (1389 total hospitals). Snowball sampling increased reach of the survey across each country.
Responses were received from all six countries, with nine respondents from Ghana, 15 from Nigeria, two from Malawi, five from Uganda, nine from Zambia and four from Zimbabawe. Uganda had the highest achievement rates for tier one and tier three constructs, and Ghana had the highest achievement rate for tier two constructs. Malawi showed the lowest achievement rates in all three tiers. The six countries achieved an average of 82 per cent (SD = 24) of tier one constructs. Three tier one constructs were achieved less than 25 per cent of the time.
Multiple tier one (minimum standards in hospital pharmacy practice) constructs were achieved greater than 90% of the time, possibly reflecting efforts made towards hospital pharmacy practice advancement in select countries of sub-Saharan Africa. Additionally, all countries achieved a majority of tier one overarching constructs. Despite these achievements, there are still many areas for growth, including select tier one constructs with low achievement rates.
Health-related quality of life of exposed versus non-exposed androgen deprivation therapy patients with prostate cancer: a cross-sectional study.International Journal of Epidemiology
Background The survival rate of prostate cancer is relatively higher than other cancers, therefore, the health-related quality of life (HRQoL) beco...
Improving medication safety in oncology care: impact of clinical pharmacy interventions on optimizing patient safety.International Journal of Epidemiology
Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible pr...
Initiation and continuation of antipsychotic medicines in older people following non-psychiatric hospital admission.International Journal of Epidemiology
Background Internationally, antipsychotics are frequently initiated during hospital admission for older patients and use often continues post-disch...
Multidisciplinary care in patients with systemic lupus erythematosus: a randomized controlled trial in China.International Journal of Epidemiology
Background For the large number of systemic lupus erythematosus (SLE) patients in China, it is critical to carry out effective disease management t...