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Background: The potential impact of pharmacist interventions could improve health outcomes of patients with anemia. However, this attempt has not been documented yet in the developing countries. Aim of the study is to investigate the effect of pharmacist interventions in optimizing management of anemia associated with chronic kidney disease. Methods: An interventional randomized control trial was carried out on 120 anemic patients on hemodialysis for eight months. The impact of the pharmacist's interventions in optimizing anemia management to reach hemoglobin target were investigated. Data were analyzed by GraphPad Prism version 8.2.1. Results: During 16-week period, 1646 interventions and recommendations were performed. The interventions were at the physician, patients, drugs, hospital and administrative level. At the physician level a total of 180 (10.9%) recommendations were proposed, at the drug level, the pharmacist provided 595 (36.1%) interventions which were mainly related to erythropoietin and iron dose adjustment. At the patient and the hospital level 734 (44.6%) and 137 (8.3%) interventions have been made respectively. Hemoglobin level increased significantly to (11.25 ± 2.29) after 16-weeks in interventional group (p-value <0.5), while in non-interventional group it was increased to (9.99 ± 2.54) at 16th week although the change was significant compare to the baseline level but it has not reached the target hemoglobin level. In the interventional group 39 (65%) patients reached the target hemoglobin while it was 25 (41.6%) in non-interventional group with a significant difference between both groups (p-value=0.017). Conclusion: In conclusion the implementation of pharmacist intervention in patients with chronic kidney disease-associated anemia improved hemoglobin level and healthcare outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to explore the cardiologist adherence with ACC/AHA guidelines on discharge medications for patients admitted with acute coronary syndrome (ACS), assess the predictors of cardiologist non-adherence and measure the impact of pharmacist intervention on improving guideline adherence. The study included two consecutive phases: observation and intervention. It was carried out at Al-Najaf Center for Cardiac Surgery and Catheterization, Iraq, from August through December 2018. In the observation phase, medical records were reviewed retrospectively in order to assess the adherence to guideline. The intervention phase was performed prospectively by the clinical pharmacist, who conducted interventions including auditing, feedback and discussion with every prescriber. The reference of the recommendations was the guideline of American Heart Association/American College of Cardiology guideline (AHA/ACC). The primary outcome was the proportion of patients discharged with optimal treatment. Independent T-test was used to measure the difference in the means of age between the two patient groups. For categorical variables (gender, diagnosis, and comorbidities), chi-square test was used. Binary logistic regression was used to identify patient and disease characteristics associated with receiving optimal discharge regimen. The observation phase included 100 patients with ACS, while the intervention phase included 105 patients. A total of 50 interventions were performed by pharmacist, of which adding necessary medication was the most frequent (88%), followed by dose optimization (10%), and removing medication duplication (2%). Seventy-four percent of the provided recommendations were accepted by the cardiologists. Pharmacist intervention caused significant (P-value < 0.05) improvement (increasing) in the prescribing of β-blockers, ACE inhibitors/ARBs, statins, and the proportion of patients who received all optimal five therapies (from 35% in observation phase to 80% after intervention). This study showed that pharmacist intervention had a considerable positive impact on the cardiologist prescribing pattern of the essential discharge medications for patients with ACS which could improve patient clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Olmesartan, an antihypertensive drug, has been associated with a severe and potentially life-threatening sprue-like enteropathy, consisting of a serious, chronic diarrhoea and malabsorption syndrome. Treatment with this drug should be discontinued if patients develop such symptoms. Objective To retrospectively determine the reduction in olmesartan prescription following a strategy promoted by pharmacy and therapeutics committees within daily clinical practice to manage updated safety information on olmesartan. Setting Three primary healthcare centres. Method In May 2016, local pharmacy and therapeutics committees integrated by general practitioners, nursing staff and clinical pharmacists sent information about olmesartan safety issues to general practitioners, together with an individual list of their patients who were then being treated with olmesartan. Moreover, information about dose equivalents between angiotensin II receptor blockers and angiotensin II receptor blockers versus angiotensin-converting-enzyme inhibitors was also attached. The strategy aimed to promote individual benefit/risk assessment by general practitioners of the continuation of olmesartan treatment as a means to achieving a decrease in the risk of sprue-like enteropathy. The investigation team retrospectively reviewed the clinical records. Main outcome measure Reduction of olmesartan prescription. Results Olmesartan was discontinued in 44.4% of patients (197/444) in the year after the safety alert e-mail. In their medical records general practitioners registered that, after informing about olmesartan safety warnings, in four cases (0.9%), patients reported gastrointestinal symptoms. Conclusion A multidisciplinary strategy implemented to promote individual benefit/risk assessment regarding continuation of olmesartan treatment showed an important reduction in olmesartan prescriptions 1 year later. [ABSTRACT FROM AUTHOR]

Background Chronic Kidney Disease (CKD) is a global health concern with profound risk of cardiovascular disease, end stage renal failure and early mortality. Pharmacists' interventions during chronic disease management have been promising. However, evidence of pharmacist`s involvement in chronic kidney dosease is limited, particularly in developing countries. Objective To implement and evaluate the impact of pharmacist led intervention among pre-dialysis CKD patients. Setting Nephrology outpatient department of tertiary healthcare hospital. Methods Patients with chronic kidney disease from stage 2 to 4 attending hospital between October to December 2018 were enrolled in a multi-arm pre-post prospective study. Pharmacist interventional model consisted of disease education, dietary recommendations, counseling to improve medication adherence along with telephonic follow-up. Interventional group received pharmacist interventional model; whereas control group only received the usual care. The impact of pharmacist`s involvements were evaluated by observing the improvements in knowledge and adherence scores, physiological profile and body composition analysis assessed by body composition monitor (BF-508®) at the end of follow-up of 3 months. Both intervention and control groups were compared by appropriate statistical techniques. Main outcome measure Knowledge and adherence scores, physiological profile and body composition analysis Results Total 120 patients (60 in each group) completed the study. Baseline variables were comparable between the two groups. Pharmacist interventional model causes significant improvement in knowledge score upon follow up between intervention and control groups (19.10 ± 3.65 versus 17.57 ± 3.55, p = 0.022). Likewise, Medication adherence score of intervention group significantly improved as compared to control group (p < 0.05) following the implementation of pharmacist intervention model. Physiological analysis showed small improvements in the intervention group but were not significant. Body composition analysis revealed higher body and visceral fat in both groups at the end of follow up. Conclusion Our analysis underscored that the tested pharmacist interventional model is an effective tool in improving disease knowledge and medication adherence among patients with chronic kideney disease. [ABSTRACT FROM AUTHOR]

Background Renal dosage adjustment for patients with reduced kidney function is a common function of clinical pharmacy service. Assessment of pharmacist's intervention in the aspect of quality and economic impact should be conducted to evaluate the benefit of this service. Objective This study aimed to assess the quality and cost saving of clinical pharmacists' recommendation on renal dosage adjustment among patients with reduced kidney function. Setting Eight medical wards of the Siriraj Hospital, a tertiary-care hospital in Bangkok, Thailand. Method A retrospective study was conducted using medical records and clinical pharmacist's intervention database. All patients admitted to the study wards whose estimated creatinine clearance were less than 60 mL/min or presented with acute kidney injury on admission during October 2016-December 2017 were included. The targeted medications were antimicrobial agents. Main outcome measure Percentage of the concordance between pharmacists' recommendation compared to standard dosing references and related cost saving. Results Among 158 patients, pharmacists provided 190 recommendations, including 151 (79.1%) dose reduction, 17 (8.9%) dose increase and 22 (11.5%) recommendations to provide supplemental dose after dialysis. These recommendations were 90.5% consistent with standard references. Physician accepted and complied with 89.5% of pharmacists' recommendations. Average direct cost saving was €5,114.11 while cost avoidance was €863.47. Conclusion Trained clinical pharmacists were able to provide high-quality recommendation on dosage adjustment in these patients in accordance to standard dosing guidelines. In addition, dosage adjustment also led to a significant direct cost saving and cost avoidance from prevention of adverse drug reactions. [ABSTRACT FROM AUTHOR]

During the dispensing process of medical orders (MOs), community pharmacists (CPs) can manage drug-related problems (DRPs) by performing pharmacist interventions (PIs). There is little evidence that the PI rate is higher with MOs from hospitals (MOHs) than ambulatory (MOAs) settings, and their impact on the patient and community pharmacy is unknown. The primary objective of this study was to compare the MOH and MOA PI rates. The secondary objective was to describe PIs and their clinical and organizational impacts on patient and community pharmacy workflow. A total of 120 CPs participated in a prospective study. Each CP included 10 MOH and 10 MOA between January and June 2020. DRP and PI description and clinical and organizational impacts between MOH and MOA were assessed and compared. We analyzed 2325 MOs. PIs were significantly more frequent in MOH than in MOA (9.7% versus 4.7%; p < 0.001). The most reported PI was the difficulty of contacting hospital prescribers (n = 45; 52.2%). MOHs were associated with a longer dispensing process time and a greater impact on patient pathway and community pharmacy workflow than MOAs. Lack of communication between hospital and primary care settings partly explains the results. Implementation of clinical pharmacy activities at patient discharge could alleviate these impacts.

Abstract Background When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients’ medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients’ medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions. Methods This was a case-cohort study conducted in two acute hospitals in the UK. Pharmacists performed a telephone follow-up intervention to discharged patients to provide medicines management support. Patients who received pharmacist telephone follow-up calls within 14 days of discharge formed the intervention group. A subset of medical patient population discharged in the month of May 2013 formed the comparison group. During a series of two-telephone follow-up, pharmacists identified post-discharge pharmaceutical problems and provided patient-tailored interventions accordingly. The impact of pharmacist interventions was assessed using a risk assessment matrix tool by two senior pharmacists. Overall 30-day readmission rates in the intervention group were measured and compared with the comparison group using a chi-square test. Results Between 5th and 25th June 2013, a total of 62 medical patients participated in the study. Pharmacists provided 192 interventions as a result of pharmacist telephone follow-up intervention. The most prevalent type of interventions was the provision of drug information (n=40), followed by screening patient adherence (n=30) and advising on adverse drug reactions (n=27). The impact of interventions was assessed, and 49.3% of the identified risks intervened by pharmacists were associated with moderate risk. The 30-day readmission rates in the intervention group were 11.3% compared to 9.0% in the control group (p = 0.376); this was not statistically significant. Conclusions A pharmacist TFU intervention did not show a benefit in 30-day hospital readmissions. However, a pharmacist TFU intervention was an effective method to solve or avoid critical pharmaceutical problems. A future study using a larger scale trial is warranted.

Sarcopenia (or muscle insufficiency) is a geriatric syndrome characterized by a progressive and generalized loss of skeletal muscle mass and function which has adverse consequences, particularly physical disability, falls and death. It can develop slowly, as a chronic condition that emerges over many years, or acutely, generally due to immobilization associated with an acute disease. The physiopathology of sarcopenia is complex, and affects both the muscle and its neurological and hormonal regulation. The prevalence of sarcopenia increases with age and in certain healthcare settings (nursing homes, hospitals, rehabilitation centres). Its diagnosis is based on the documentation of a low muscle mass associated with low muscle strength and/or low physical performance. Once confirmed, a syndromic approach is needed, based on a comprehensive geriatric assessment in order to determine its causes and prepare a treatment plan which addresses the treatment of symptoms as well as the etiology. Prevention of sarcopenia starts in the adult age, through the promotion of adequate nutritional habits, an increase in physical activity and, ideally, resistance exercise. Sarcopenia treatment must necessarily include resistance exercises (that can be associated with other types of exercise) and an improvement in diet, increasing protein intake up to 1.2-1.5 g/kg/day and covering caloric requirements. In some cases, this will require the use of nutritional supplements, which can contain leucine, beta-hydroxy beta-methylbutyrate acid (HMB) and vitamin D, in order to optimize its effects on the muscle. There are still no medications available to treat sarcopenia

Résumé: Le pharmacien d'officine est reconnu comme un acteur de la prévention et de l'éducation thérapeutique. Un projet pédagogique mené dans les officines du Nord-Pas-de-Calais et coordonné par la faculté de pharmacie de Lille avec le réseau Néphronor nous a permis de collecter des données permettant d'évaluer l'intérêt d'une évaluation pharmaceutique officinale de la MRC. Nous rapportons ici le résultat de l'intervention réalisée dans 109 pharmacies d'officine. Les entretiens pharmaceutiques ont concerné 2 populations de patients. Le groupe A concerne des patients se connaissant porteurs d'une IRC (entretien pharmaceutique d'optimisation thérapeutique). Le groupe B regroupe des patients à risque de MRC pour lesquels est proposée une stratégie de dépistage. Ainsi, 354 patients ont été inclus dans le groupe A, majoritairement des femmes (51,2 %), en stade 3 d'IRC, d'âge moyen 73 ans, diabétiques (44 %). Environ 70 % des patients avaient déjà été vus par un néphrologue et 45 % d'entre eux présentaient une bonne adhésion thérapeutique selon le questionnaire de Morisky Green. Par ailleurs, 20 % des patients n'avaient pas de traitement néphroprotecteur en stades 3 et 4 de la MRC et plus de la moitié ne connaissaient pas les situations à risque d'insuffisance rénale aiguë. Le groupe B a inclus 532 patients (âge moyen 70 ans). L'intervention pharmaceutique a permis de dépister 10 % de patients avec un DFG < 60 mL/min/1,73 m2. L'entretien pharmaceutique en officine a permis d'optimiser la prise en charge thérapeutique et l'information des patients IRC, ainsi que le dépistage précoce chez certains patients à risque. Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists' interventions for preventing and screening CKD. In our observational prospective study of 5 months conducted in 109 community pharmacy, we included 2 groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In group A, we included 354 patients, mainly women (51.2%), in stage 3 of CKD, mean age 73 years old, with hypertension alone (40.6%) or associated with diabetes (44%). About 70% of the patients had a follow up by a nephrologist and 45% of them were good adherent according to the Morisky Green self-report. However, approximately 20% of patients did not have nephroprotective treatments in their regimen although they were on stage 3 or 4 CKD patients, and about half of them were not aware of medical situations at risk. Concerning group B, 532 patients were included. The pharmaceutical interventions screened 10 % of patients with a GFR < 60 mL/min/1.73m2. The community pharmacists' interventions helped to optimize the therapeutic management of CKD patients and in the early screening of patients at risk. More studies are needed to extrapolate our observations to a larger population. [ABSTRACT FROM AUTHOR]

Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted.Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€.Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Medication management (MM) refers to all clinical activities that a pharmacist performs to ensure safe and effective medication therapy for patients.Objective: To characterize pharmacist-driven MM services via retrospective analysis of real-world data collected in a community pharmacy in British Columbia (BC), Canada.Methods: This was a retrospective longitudinal study from January 2014-December 2015. Patient demographics, clinical problems, identified drug-related problems (DTPs), and pharmacists' interventions were summarized using descriptive statistics. The relationship between DTPs and the clinical conditions, as well as DTPs and the interventions, were analyzed. Other outcomes included: the relationship between patients' age and visit time with the number of DTPs; the number of clinical conditions; and the number of interventions.Results: 1,572 patients received MM (mean visit time = 29.1 min). 2,133 DTPs were identified, which resulted in 7176 recommended interventions. The clinical problems most frequently encountered were cardiovascular (20%), and mental (15.7%). The most frequently identified DTP was "needs additional therapy" (61.8%), while the most frequently initiated or recommended interventions were education (43.4%), and changing therapy (21.6%). Elderly patients with multiple comorbidities had more DTPs and required more interventions and even when no DTPs were identified, some patients still received counselling and education in these visits.Conclusion: Using real-world data, this research demonstrated that patients benefit from identification and resolution of DTPs through pharmacists-driven MM programs. [ABSTRACT FROM AUTHOR]

Background: Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting.Review Methods: To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data.Results: Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge.Conclusion: A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effectiveness of pharmacist intervention in reducing and preventing prescribing errors of investigational drugs for cancer patients. Materials and methods: A retrospective study was conducted during two periods: a baseline period from December 2015 to June 2016 and an intervention period from July 2016 to February 2017. The investigational drug service (IDS) pharmacists performed active interventions during the intervention period. Results: Among 12,387 investigational drug orders, 395 (6.1%) prescribing errors were detected in 6477 orders at the baseline period, and 278 errors (4.7%) were detected in 5,910 orders at the intervention period. To identify factors that affect prescribing errors, three models were constructed for the multivariate analysis. Among factors affecting prescribing errors, sponsor initiated trial (SIT) was the strongest factor (AOR: 4.16, 95% CI: 3.31–5.23). Pharmacist intervention reduced prescribing errors by at least 25% in all constructed models after adjusting for confounding variables. Prescribing errors were 1.3 times higher when dealing with intravenous medications than when dealing with oral medications. There were 60% fewer prescribing errors in the blinded study than in the open study. SIT and multi-center/multi-nation studies had 4.2 and 2.4 times more frequent prescribing errors than in investigator-initiated trials (IIT) and single-center/single-nation studies, respectively. Fewer errors occurred in phase 2 and trials covering both phase 1 and phase 2 (phase 1/2) than in phase 3 trials. Conclusions: The IDS pharmacist intervention in cancer clinical trials was associated with significant reductions in prescribing errors and may lead to increased medication safety. [ABSTRACT FROM AUTHOR]

What is known and objective: The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug‐related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. Method: We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEOde). Results and discussion: Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost‐neutral. What is new and conclusion: This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards. [ABSTRACT FROM AUTHOR]

Background The participation of clinical pharmacists in the treatment of acute pancreatitis has rarely been reported. Objective The aim of this study was to retrospectively evaluate the impact of intervention of clinical pharmacists on the treatment of acute pancreatitis. Setting An academic teaching hospital in Taizhou, Jiangsu, China. Method Two hundred and twenty-eight patients with acute pancreatitis were retrospectively enrolled from July 2017 to July 2018 and divided into an intervention group (n = 119) and a control group (n = 109) according to whether a clinical pharmacist was involved. No significant differences in the baseline clinical characteristics were found between the groups. Clinical pharmacists participated in drug formulation and adjustment, pharmaceutical care, and follow-up. Main outcome measure Clinical outcomes, average hospital stays, costs, incidence of adverse drug reactions, 1-month subsequent visit rate, and patient satisfaction between the two groups were measured. Results The clinical symptoms of patients in both groups were relieved after treatment. There were no significant differences between the groups in computed tomography grades after treatment, incidence of adverse drug reactions, or average hospital stays. However, the intervention group had lower total costs of hospitalization, drugs and antibiotics but higher rates of 1-month subsequent visits and satisfaction compared with the control group. Conclusion The intervention of clinical pharmacists in the treatment of acute pancreatitis can effectively reduce costs of hospitalization, drug and antibiotics and improve follow-up compliance and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is a highly prevalent metabolic disorder in the Arab world. Uncontrolled DM is associated with serious microvascular and macrovascular complications. Reduction of such complications can be achieved by good glycemic control through utilization of pharmacological and non-pharmacological treatments. Patient education programs can improve treatment outcomes. Thus, the present study reviewed articles that evaluate pharmacist's interventional (educational/care) programs in the management of diabetic patients in Arab countries in order to quantify benefits of such programs. Methods: A careful manual literature search was done in PubMed and Google Scholar for clinical trials that focus on the role of the pharmacist in care, education, or management of all types of DM in Arab countries. Information from these studies was summarized in relation to general study characteristics (study design and area of study); description of study population, sample size, and the type and components of pharmaceutical intervention; follow-up time, frequency, and duration of contact moments during intervention; and assessment criteria, results, and conclusions. The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Results: Six studies were included in this review. The included studies were conducted in four Arabic countries, two in Jordan and United Arab Emirates, and one each in Sudan and Iraq. Five studies assessed the benefits of implementing pharmaceutical interventions (pharmaceutical-led patient care or education) among type 2 DM patients and only one study assessed such benefits among patients with gestational DM. Follow-up of patients ranged from 15 weeks to 12 months. Only one study had a high risk of bias. All studies showed a significant improvement in patient knowledge, adherence to treatment, and glycemic control. Conclusion: Pharmacists' interventions in the management of DM patients in Arab countries tend to result in positive outcomes such as enhanced patient knowledge, greater adherence to treatment, and eventually better glycemic, lipid, and blood pressure control. [ABSTRACT FROM AUTHOR]

A strict and adherence treatment is required by the patient with diabetes mellitus and it demands a proper self-medication by the patient. Pharmacists are involved in providing self-management support to the patients. This review evaluates the interventions of pharmacist for patients to improve self-management with diabetes mellitus and also to improve the clinical outcomes of diabetes mellitus. A comprehensive literature search was performed by using different keywords "pharmacist-led intervention," "diabetes," "effect of pharmacist on outcome of diabetes," and "self-management of diabetes" with the help of various electronic databases such as PubMed, Science Direct, Embase, Web of Science, and the Cochrane Library from the beginning of the database through September 2018. The primary outcome was glycated hemoglobin (HbA1c), whereas the secondary outcomes were blood glucose level, blood pressure (BP) measure, body mass index, lipids, adherence to medication, and quality of life. Twenty-five studies comprising 2997 diabetic patients were included in the analysis. Pharmacist-led intervention was involved in all included studies in the form of education on diabetes and its complications, medication adherence, lifestyle, and education about self-management skills. Pharmacist-led interventions are able to reduce HbA1c levels with a mean of 0.75%. Most studies do not expose the material and methods used in pharmacist-led intervention. The variation in the reduction of HbA1c, fasting blood sugar, BP, and lipid profile was due to the lack of this standardization. The included studies indicated that pharmacist-led interventions in diabetes mellitus can significantly improve the outcomes of diabetes mellitus and its complication later on. Hence, these long-term improvements in outcomes added more value of pharmacists in health-care system of the world. [ABSTRACT FROM AUTHOR]

Objective: To systematically review literature reporting processes, impact and outcomes of medication review and reconciliation in Australian residential aged care facilities (RACFs). Methods: PubMed/MEDLINE, EMBASE, CINAHL, Informit Health and grey literature were searched from 1995 to July 2018. Studies reporting outcomes of a stand‐alone medication review or reconciliation interventions in Australian RACFs were included. Results: Thirteen studies investigated medication review, eight of which studied Residential Medication Management Reviews (RMMRs). Five studies reported that medication reviews identified an average of 2.7‐3.9 medication‐related problems (MRPs) per resident. One study reported medication reviews had no impact on quality of life, hospitalisation or mortality, but was not powered to assess these. Three studies reported general practitioners' acceptance of pharmacists' recommendations to resolve MRPs, ranging between 45 and 84%. Conclusions: Medication review may be a useful strategy to identify and prompt resolution of MRPs. However, the impact on clinical and resident‐centred outcomes remains unclear. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is associated with blood loss and an increased risk of transfusion. Guidelines for antifibrinolytic drug tranexamic acid (TXA) treatment in TKA patients are available. We evaluated the effects of anticoagulant pharmacist intervention on perioperative blood conservation treatment in TKA patients. Methods: In a retrospective, observational experimental study, patients admitted for TKA were allocated into the control or pharmacist intervention group. In the intervention phase, multiple interventions of TXA treatment based on guidelines were implemented. The primary endpoint was blood loss. Other outcome included postoperative haemoglobin and haematocrit levels, allogeneic blood transfusion, cost savings and safety. Results: A total of 177 patients were included (88 and 89 in the control and intervention group, respectively). In the intervention group, 24.72% orders of TXA dosage, 20.22% orders of drug choice, 26.97% orders of TXA timing and 30.34% orders of TXA administration manner were adjusted. Eighty‐nine (100%) patients received blood conservation therapy compared with 21 (23.86%) patients in the control group (P < 0.001). Total blood loss was 1133.31 ± 627.08 mL in the control group compared with 604.34 ± 459.09 mL in the intervention group (P < 0.001). Postoperative drops in haemoglobin and haematocrit in the control group were greater than in the intervention group (P < 0.001). The rate of allogeneic blood transfusion was 40.91% in the control group compared with 21.35% in the intervention group (P = 0.01). Pharmacist intervention was conducted to cost savings resulting from reduced transfusion, but with comparable safety profile. Conclusions: Anticoagulant pharmacist intervention on blood conservation treatment of TKA patients leads to favourable clinical and economic outcome. [ABSTRACT FROM AUTHOR]

Background Early interventions with clinical decision support system (CDSS) guidance have ensured appropriate drug dosing for patients with renal impairment. However, the low rates of physician compliance with CDSS alerts have been reported. Objective We investigated whether designated pharmacist interventions were associated with physician' acceptance of the knowledge-based renal dosage adjustment system (K-RDS) for patients with reduced renal function. Setting A retrospective, single-center study was conducted using a healthcare information system at a tertiary teaching hospital. Methods This study compared physicians' acceptance of the K-RDS with and without designated pharmacists. The severity of prescription errors and the impact of service provided by the pharmacist were evaluated using the validated method developed by Overhage and Lukes. From April to June 2017, we enrolled patients who were ≥ 20 years of age and admitted with an estimated glomerular filtration rate under 50 ml/min on medications that required dose adjustments. Main outcomes measure The number of dosing alerts of the K-RDS and physicians' acceptance rates were compared between a control group guided by the central pharmacy only and a group with assigned designated pharmacists. The factors associated with the physicians' acceptance rate were also analyzed using a multivariate logistic regression method. The impact of service provided by the pharmacist were considered as 'highly significant' (categories: 1-2). Severity of prescription errors were defined as 'serious' if they corresponded to categories 1-2 of the Overhage and Lukes scale for severity, and interventions were relevant if they corresponded to categories 1-3 in the impact of  service provided by the pharmacist scale. Results Among 1363 prescription interventions, 491 (36.0%) were performed by designated pharmacists. The K-RDS alert acceptance rate by the physicians was 54.4% in the designated pharmacist group and 47.0% in the control group (p = 0.0233). The statistically significant association was found in the designated pharmacists group in 'highly significant' service provided by the pharmacist (p < 0.001, OR 1.772; 95% CI 1.362-2.305) and 'serious' severity of prescription errors (p = 0.012, OR 1.657; 95% CI 1.116-2.460). The presence of designated pharmacists (OR 1.353, p = 0.0272), patient's gender (OR 0.758, p = 0.0016), department specialty (OR 0.659, p < 0.0001), eGFR (OR 1.538 if < 10 ml/min; OR 1.519 if 10-40 ml/min, p < 0.0001), and medications (OR 6.058-43.992 depending on the medication category, p < 0.0001) were significant factors affecting physicians' acceptance. Conclusion Pharmacists' interventions effectively improved physicians' acceptance of the K-RDS alerts. [ABSTRACT FROM AUTHOR]

Pharmacist intervention has valuable input to the healthcare system by reducing medication errors, costs of treatment and improving therapeutic outcomes. This study aimed to analyze pharmacists’ interventions during the verification of computerized physician order entry and to determine the association between prescribers’ level and type of prescribing errors. In this cross-sectional, observational study, data collection was carried out over three months starting from 1 January 2020 to 31 March 2020. Included were 2405 interventions documented by 52 different pharmacists. The prevalence of prescribing order entry errors was 9.1%. The most identifiable type of intervention was incorrect dilution (40.2%) followed by dose substitution (27.7%). The drug category associated with a high percentage of interventions was perfusion solutions (41%), followed by antibacterial (35%). The number of junior physician orders that required pharmacist intervention was higher than other prescribers (45.2%), followed by specialist and senior physicians, (31.4% and 15.5%, respectively). Prescriber ordering time and types of prescribing errors were shown to have a significant (p < 0.05) association. Internal medicine physicians entered the highest percentage of prescribing errors, representing 22.7%. The current study concluded that TID has significant potential to reduce drug-related problems; TID fatigue is a real problem that might be under-reported and addressing this point in future studies would be of great value.

In patients with chronic obstructive pulmonary disease (COPD), non-adherence remains challenging to achieve optimal disease control. Our study aimed to determine the impact of pharmacist-led educational interventions on COPD management, focusing mainly on medication adherence. We conducted a 1-month open-labeled, randomized, controlled study at Ba Ria Hospital, Vietnam. COPD outpatients were randomly assigned to the intervention group or control group. Pharmacist-delivered education emphasized medication adherence, disease, and medication knowledge. The primary outcome was the between-group difference in medication adherence after the intervention, as assessed by the general medication adherence scale (GMAS). Of 181 recruited patients, 180 completed the follow-up. After the intervention, the results indicated a significant improvement in medication adherence rate between the two groups (90.1% vs. 66.3%, p < 0.001). Patient behavior was the most common barrier to non-adherence but was effectively reduced at the endpoint. The Modified Medical Research Council (mMRC) scale of dyspnea and inhalation technique also improved significantly in intervention patients. Pharmacist intervention can considerably improve medication adherence and knowledge of COPD patients. This study promotes the value of clinical pharmacists in patient education to achieve better adherence and enhance population health, especially in resource-limited nations like Vietnam. • In patients with chronic obstructive pulmonary disease (COPD), non-adherence remains challenging in disease management. • The role of the pharmacist is still not fully recognized in low-income and middle-income countries. • We describe applicable measures to determine the impact of pharmacists in the intervention group and control group. • We assessed medication adherence by the general medication adherence scale (GMAS). • We demonstrated the value of educational intervention performed by clinical pharmacists in medication adherence, symptom control, and COPD knowledge. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the impact of pharmacist-conducted educational intervention on reducing errors related to inappropriate insulin pen use.Methods: This was a prospective, before-after study with an educational intervention component. The study was conducted on 122 elderly diabetic patients. Data were collected through interviews using researcher-administered questionnaires as well as patients' medical records. Patients were asked about the preparation, injection, and storage techniques, they followed when using insulin pens. Blood glucose parameters were extracted from laboratory records. After the detection of errors, patients and their caregivers were instructed about the insulin pen use by the pharmacist. Patients were reevaluated after 12 weeks. Findings: Patients' mean age was 67.2 ± 3.5 with male: female ratio of 71:51. Mean diabetes duration was 7.1 ± 2.8 years. Fifty-four patients (44.2%) stated that they had received instructions for insulin pen use previously. The majority of this group (24 cases, 44.4%) reported that the instructions were given by a pharmacist. The mean number of errors decreased from 3.99 ± 0.22 errors per patient to 1.49 ± 0.13 errors (odds ratio: 0.28, 95% confidence interval: 0.23–0.33,P < 0.05). Of eleven evaluated insulin pen-related medication error items, nine items experienced a significant decrease after patient education. Fasting plasma glucose (FPG) levels decreased significantly from 161.7 ± 12.5 to 147.3 ± 13.1 mg/dL (P < 0.05). However, glycated hemoglobin levels did not change significantly after 3 months (P = 0.18). Controlled FPG had a significant rise from 45% before education to 63.9% postintervention (P < 0.05). Conclusion: Pharmacists can play an important role in safe and efficient use of insulin pen in elderly diabetic patients by minimizing the likelihood of medication errors associated with insulin pen use.

Objective: To describe the role of Clinical Pharmacists in the Medication Refill Clinic area as a part of a multidisciplinary team in which he/she can provide education to patients and caregivers on the safe and appropriate use of medications, counsel on medication compliance, monitor and manage medication side effects, as well as screen for dangerous drug interactions. Methods: The data of this prospective, single-centered, chart review based study have been collected since the clinic launched in June 2011 till December 2013 in King Khalid Eye Specialist Hospital which is a Tertiary Hospital in KSA. Types of interventions documented during the patient–pharmacist visit are categorized as medication review and patient compliance. Key findings: Out of the total 16,417 patients, 3641 (22.2%) are noncompliant. The Clinical Pharmacist identified 18 intervention types. The most frequent interventions are as follows: Eye screening (24.8%), Counseling (13%), Physician/ER referral (12.4%), Therapeutic substitution/switch (10.8%), and Frequency changed (7%). Summary: This prospective analysis is a document evidence showing Clinical Pharmacist positive outcomes in the management of ophthalmic patients. Dissemination of this information would be valuable because it could raise the awareness of other Healthcare Professionals regarding Pharmacist as effective clinicians in care of ophthalmic patients.

Objective: To analyze the outcomes of a medication reconciliation process at admission in the hospital setting. To assess the role of the Pharmacist in detecting reconciliation errors and preventing any adverse events entailed. Method: A retrospective study was conducted to analyze the medication reconciliation activity during the previous six months. The study included those patients for whom an apparently not justified discrepancy was detected at admission, after comparing the hospital medication prescribed with the home treatment stated in their clinical hospital records. Those patients for whom the physician ordered the introduction of home medication without any specification were also considered. In order to conduct the reconciliation process, the Pharmacist prepared the best pharmacotherapeutical history possible, reviewing all available information about the medication the patient could be taking before admission, and completing the process with a clinical interview. The discrepancies requiring clarification were reported to the physician. It was considered that the reconciliation proposal had been accepted if the relevant modification was made in the next visit of the physician, or within 24-48 hours maximum; this case was then labeled as a reconciliation error. For the descriptive analysis, the Statistics® SPSS program, version 17.0, was used. Outcomes: 494 medications were reconciled in 220 patients, with a mean of 2.25 medications per patient. More than half of patients (59.5%) had some discrepancy that required clarification; the most frequent was the omission of a medication that the patient was taking before admission (86.2%), followed by an unjustified modification in dosing or way of administration (5.9%). In total, 312 discrepancies required clarification; out of these, 93 (29.8%) were accepted and considered as reconciliation errors, 126 (40%) were not accepted, and in 93 cases (29,8%) acceptance was not relevant due to a change in the situation of the patient. The highest opportunities for improvement were identified in the Gastroenterology, Internal Medicine and Surgery Units, and in the following therapeutic groups: blood and hematopoietic organs, cardiovascular system, and nervous system. Conclusions: In our hospital, only a third of interventions were accepted and acknowledged as reconciliation errors. However, the medication reconciliation process conducted at admission by a Pharmacist has proven to be useful in order to identify and prevent medication errors. A better understanding of the cases in which interventions were not accepted could lead to an improvement in outcomes in the future.

Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The treatment of patients with cancer in an outpatient setting is important for maintaining patients' QOL and reducing the social burden of therapy, thus requiring extensive intervention by pharmacists in the outpatient setting. Japan has a system to certify pharmacists with specialized knowledge and skills in palliative care. However, few studies have investigated the impact of certified pharmacists' activities and of pharmacists' interventions on hospitalization and outpatient visits. Therefore, in this study, we retrospectively investigated the effects of interventions by certified pharmacists during the period from the introduction of opioid analgesics to hospitalization for pain management and the duration of outpatient visits at a single acute care hospital. Analysis using the Cox proportional hazards model showed that interventions by certified pharmacists significantly reduced hospitalizations for pain management (p = 0.014). Further, the results of the log-rank test showed that interventions by certified pharmacists significantly prolonged the period from the introduction of opioid analgesics to hospitalization compared with the absence of such interventions (p = 0.013). Additionally, interventions by certified pharmacists significantly increased the duration of outpatient visits compared with the absence of such interventions (p < 0.001). These results suggest that active and careful interventions by pharmacists, including certified pharmacists, contribute to the maintenance of the patients' QOL and healthcare economics by extending the period from the introduction of opioid analgesics to hospitalization for pain management and the duration of outpatient visits.

Aim: A study on effectiveness and success factors of educational inhaler technique intervention in asthma and COPD. Objectives: To identify the percentage of common errors done by people who use inhalers. To identify the risk factors associated with asthma and COPD. Method: Data was collected from the subject's face to face interview in a community setup and the lung capacities were measured using spirometer and peak flow meter; the values were noted and the subjects were asked to demonstrate their inhaler technique using placebo inhalers; numbers of correct and incorrect steps were noted. After a period of one month; the subjects were taken to follow up and measured the lung capacities and checked the inhaler steps; number of correct and incorrect steps were noted. Results: A total of 572 samples were collected and 500 were followed up, in which 300 had Asthma and 200 had COPD. Out of which 189 were female and 311 were male. Low education level was the single most important factor leading to incorrect technique. Formal training resulted in a statistically significant increase in the percentage of correct techniques for all the devices. For pMDI (54.01% vs. 91.03%, *p=0.005 before & after training respectively). For pMDI+Spacer (52.75% vs. 94.85%, *p=0.007 before & after training respectively). For Accuhaler (54.07% vs. 91.27%, *p=0.017 before & after training respectively). For Rotahaler (63.94 vs. 98.64%. *p=0.029 before & after training respectively). For Nebuliser (56.97% vs. 91.88%, *p=0.001 before & after training respectively. Conclusion: Proper education to patients on correct usage may not only improve control of the symptoms of the disease but might also allow dose reduction in long term. The number of subjects doing correct steps gradually increased after the pharmacist led intervention. Thus, proper counselling for the inhaler use in patients must be encouraged as it is directly linked to the quality of life of patient. [ABSTRACT FROM AUTHOR]

Background Citalopram and escitalopram can both induce dose-dependent QT prolongation. The risk of arrhythmia may be increased with concomitant use of other drugs that induce QT prolongation. Objective To evaluate the prevalence and impact of pharmacist interventions on the combination of citalopram or escitalopram with other drugs that induce QT prolongation. Setting A French hospital with 517 computerized beds. Method All cardiac adverse drug reactions (ADRs) related to citalopram or escitalopram reported to the French pharmacovigilance database (FPDB) were analyzed. Then, over a 6-month period, all computerized prescriptions including citalopram or escitalopram and drug-drug interactions (DDI) were analyzed by pharmacists using a computerized provider order entry system (DXCare®, Medasys). Results Only 27 cardiac ADRs related to citalopram or escitalopram were reported in the database. Among the 57,857 prescriptions and 2116 contraindicated DDIs (3.7 %) that were analyzed. 444 DDIs (0.8 %) were considered to be clinically relevant by pharmacists and physicians and 168 (i.e., approximately 30 %) were related to a combination including citalopram or escitalopram. Most of the prescriptions related to DDIs including citalopram or escitalopram were discontinued in response to a pharmacist intervention when initiated during the hospital stay. Conclusion A high number of hospital prescriptions including citalopram or escitalopram with another QT-prolonging drug occurred, highlighting the importance of involvement of clinical pharmacists in prevention of potential ADRs related to such contraindications. [ABSTRACT FROM AUTHOR]

Background: COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence.Objective: This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital.Methods: In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0.Results: Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P < 0.001). It increased from 49% at the baseline to 80% after 24 months (P < 0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPD patients, but was effectively reduced by the intervention.Conclusions: This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling. [ABSTRACT FROM AUTHOR]

Background Community pharmacists can play an important role in optimizing warfarin treatment, which is very important in vulnerable patient groups such as the elderly patients in rural areas. Objective To evaluate the impact of a community pharmacist's interventions on the quality of anticoagulation in elderly rural patients receiving warfarin. Setting A community pharmacy in Donji Miholjac in Croatia's province of Slavonia. Method We conducted a prospective randomized trial. Eligible patients were recruited at the pharmacy and randomized into two groups. All participants were followed up monthly for a period of 6 months. Repeated education and a follow up plan were provided to the participants in the intervention group, and their general practitioners were contacted to correct the warfarin dose or to avoid drug interactions. Main outcome measure Time in therapeutic range (TTR) calculated by the Rosendaal method. Results A total of 140 patients were randomized and 131 patients finished the study, 65 patients in the intervention group. Median age was 73 years. At the end of the follow-up period, the median TTR was significantly higher in the intervention group (93 vs. 31.2% for intervention and control, respectively; P < 0.001). The proportion of patients with TTR ≥ 65% was also significantly higher in the intervention group (86.2 vs. 7.6% for intervention and control, respectively; P < 0.001). Factors independently associated with TTR ≥ 65% were intervention (P < 0.001), less frequent dose change (P = 0.005), better adherence (P < 0.001) and less variable vitamin K intake (P = 0.010). [ABSTRACT FROM AUTHOR]

Background Phone calls between pharmacists and prescribers play an important role in resolving potential errors and other issues. Despite their importance in patient care, and sometimes causing frustration for pharmacists, there is little research on these calls. Objective To quantify how long calls between pharmacists and prescribers are, how often phone calls occur, why calls are made, and who is called. Method An observational study was conducted with 130.5 h observed in 11 community pharmacies over 8 weeks in Dunedin, New Zealand, recording information about all incoming and outgoing calls. Data captured included information on length, date, time, reason for call, pharmacy staff involved, health professionals involved, and the place being called. We also surveyed pharmacists' perceptions of this communication. Results Data on 95 phone calls was captured. The mean length was 110 s (95% CI 88-133), at an average of 0.7 calls per hour. The most frequent reasons for calling were clarifications and dose inquiries. Conclusion Calling prescribers is perceived as a frustrating; however the frequency of calls we observed was low, but some were long. The amount of time spent for pharmacist interventions may be reduced using alternative communication methods but these need further study. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women.Design: A prospective cross-sectional, observational study.Setting: A high-risk obstetric inpatient unit of a Women's Hospital in Brazil.Participants: About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included.Interventions: When the pharmacist detected potential prescribing errors, interventions were suggested.Main Outcome Measures: Prescriptions were evaluated by clinical pharmacist to identify the type, frequency and severity of prescribing errors and rate of clinical pharmacist intervention acceptance in a high-risk obstetric inpatient.Results: A total of 1826 prescriptions were reviewed with 128 errors (7.0%). The most frequent errors were drug interaction (43.8%), incorrect frequency (21.5%) and improper dose (13.1%). One-hundred and sixty-eight interventions were made by pharmacists, 98.8% of which were accepted by prescribers. Higher maternal age (OR 1.0 (95%CI 1.0-1.1)), higher number of prescribed medications (OR 1.2 (95%CI 1.1-1.3)), obstetric conditions (OR 2.2 (95%CI 1.4-3.3)) and non-breastfeeding postpartum women (OR 3.9 (95% CI 2.5-6.1)) were the independent factors associated with prescribing errors identified through multivariate analysis.Conclusions: The most common prescription errors related to drug interactions, incorrect frequency and higher number of prescribed medications. The rate of pharmacist acceptance intervention was high. [ABSTRACT FROM AUTHOR]

Purpose. The development and implementation of a clinical decision support system (CDSS) for pharmacists to use for identification of and intervention on patients with Staphylococcus aureus bacteremia (SAB) are described. Summary. A project team consisting of 3 informatics pharmacists and 2 infectious diseases (ID) pharmacists was formed to develop the CDSS. The primary CDSS component was a scoring system that generates a score in real time for a patient with a positive blood culture for S. aureus. In addition, 4 tools were configured in the CDSS to facilitate pharmacists' workflow and documentation tasks: a patient list, a patient list report, a handoff note, and a standardized progress note. Pharmacists are required to evaluate the patient list at least once per shift to identify newly listed patients with a blood culture positive for S. aureus and provide recommendations if necessary. The CDSS was implemented over a period of 2.5 months, with a pharmacy informatics resident dedicating approximately 200 hours in total. An audit showed that the standardized progress note was completed for 100% of the patients, with a mean time to completion of 8.5 hours. Importantly, this initiative can be implemented in hospitals without specialty-trained ID pharmacists. This study provides a framework for future antimicrobial stewardship program initiatives to incorporate pharmacists into the process of providing real-time recommendations. Conclusion. A pharmacist-driven patient scoring system was successfully used to improve adherence to quality performance measures for management of SAB. A pharmacist-driven CDSS can be utilized to assist in the management of SAB. [ABSTRACT FROM AUTHOR]

Background: Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients.Purpose: The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders.Methods: A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control.Results: The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms.Conclusions: The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes.Article Synopsis: Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. [ABSTRACT FROM AUTHOR]

The study is aimed to assess the incidence of drug-related problems (DRPs) and provide pharmacist interventions for identified DRPs. A prospective, observational study was conducted among 189 patients with cardiovascular disease who were aged 18 years or older and admitted to the general medicine in-patient ward. During the 6 months study period, the incidence of DRPs was identified using Pharmaceutical Care Network Europe Foundation classification system version 6.2. A total of 189 patients were screened for DRPs. Among them, 130 patients have at least one DRP. A total of 416 DRPs were identified (on average, 2.2 DRPs per each patient). Of the 416 DRPs, 125 (30.04%) interventions were accepted, 7 (1.68%) interventions were not accepted, while remaining (68.26%) accepted but no action taken. The results of the study indicate that incidence of DRPs is substantial and pharmacist-led interventions resulted in resolution of DRPs. This represents the need for the active role of the clinical pharmacist in the developing countries like India.

Objective: To determine whether pharmacist is able to guaranteecold chain maintenance of thermolabile drugs during transportusing the available information in the reception processand to compare these results with those obtained in a subsequentintervention phase, in which the manufacturing laboratorieswere contacted. Methods: Intervention study, prospective and comparative“before-after”. It was analyzed the storage conditions duringtransport of all thermolabile drugs received in a 400-bed hospitalfor 3 months, excluding those from clinical trials. Results: The intervention allowed to ensure cold chain maintenancein 76,5% (n = 488) of received drugs, representing anincrease of 41,8% (IC 95% 36,7-46,6%; p < 0,001) comparedwith the percentage obtained before the intervention. Conclusions: The pharmacist isn’t able to ensure the cold chainmaintenance of received thermolabile drugs without temperaturemonitoring device (64,6%). Reports requested from laboratoriesallowed to increase significantly that percentage.