METHODS: We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.
RESULTS: The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.
CONCLUSIONS: The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
METHODS: A cross-sectional nationwide online survey was conducted over a 6-week period between May and June 2019. Invitation was sent to all the Heads of pharmacy department or pharmacists in charge of infectious diseases (ID) or antimicrobial pharmacists in tertiary hospitals in Nigeria. A validated questionnaire that consist of 24-items was used for data collection.
RESULTS: Forty-five hospitals were invited and 37 completed the survey (response rate, 82.2%). Five (13.5%) hospitals had a formal antimicrobial stewardship (AMS) team, with each of them having pharmacist representation. Regardless of the existence of an AMS team, hospital pharmacists have implemented AMS strategies, including evaluation of the appropriateness of antimicrobial prescriptions (54.1%) and monitoring of antimicrobial consumption (48.6%). The most common barriers to pharmacists' involvement in ASP were lack of training in AMS and ID (51.4%), lack of pharmacists with ID specialisation (40.5%) and lack of support from hospital administrators (37.8%). The majority of the pharmacists recommended training in AMS and ID (100%), participation on ward rounds (89.2%) and employment of more pharmacists (73%) as strategies to improve pharmacists' participation in ASP.
CONCLUSIONS: Hospital pharmacists are actively involved in AMS activities despite the lack of established AMS teams in most tertiary hospitals in Nigeria. However, lack of training and personnel were major barriers to pharmacist's involvement in ASP.
METHODS: A descriptive cross-sectional study was conducted among community pharmacists in Lahore from 1 November 2017 to 31 December 2017. A self-administered questionnaire was used for data collection. Non-probability convenience sampling was performed to select community pharmacists. Descriptive statistics were applied and Mann-Whitney U-tests and Kruskal-Wallis tests were performed to compare independent groups using SPSS v.20.0. A P-value of <0.05 was considered statistically significant. Perception and practice scores were determined to access community pharmacist knowledge regarding AMS. A score of 0.5-1 was considered to be very good.
RESULTS: The overall response rate was 70.9%. Sex, age, work experience and education level did not significantly influence the perception and practices of community pharmacists. Experienced pharmacists showed a better response to AMS. The majority of pharmacists strongly agreed that they educate patients on the use of antimicrobials and resistance-related issues.
CONCLUSION: It was concluded that community pharmacists in Lahore have good perception regarding AMS and they are practicing it well. But there are several gaps in their practices that must be filled, such as dispensing without a prescription and dispensing for a longer duration than prescribed. Additionally, there should be strict implementation of guidelines for dispensing antibiotics in order to rationalise antibiotic use and decrease antimicrobial resistance.
METHODS: The economic evaluation was conducted alongside the randomised controlled trial (RCT) to estimate the intermediate cost-effectiveness of HMR-CP for patients with T2DM. A Markov model was then constructed to project the lifetime cost-effectiveness data beyond the RCT. The primary outcomes for the economic evaluation were HbA1c and quality-adjusted life-years (QALYs).
RESULTS: The intervention and health services costs throughout the 6-month HMR-CP trial were RM121.45 (USD28.64) [95%CI: RM115.89 to 127.08 (USD27.33-29.97)] per participant. At a 6-month follow-up, a significant reduction in HbA1c of 0.902% (95% CI: 0.388% to 1.412%) was noted in the HMR-CP group compared to the control group. The ICER of HMR-CP intervention versus standard care was RM178.82 (USD 42.17) [95%CI: RM86.77-364.03 (USD20.46-85.86)] per reduction of HbA1c. HMR-CP intervention [RM12,764.82 (USD3010.57)] was associated with an incremental cost of RM83.34 (USD19.66) over control group [RM12,682.95 (USD2,991.26)] with an additional of 0.07 QALY gained. The ICER associated with HMR-CP intervention was RM1,190.57 (USD280.79) per QALY gained, which was below the ICER threshold in Malaysia, indicating that HMR-CP was a cost-effective option.
CONCLUSION: HMR-CP was a cost-effective intervention that had significantly reduced the HbA1c among the T2DM patients, although associated with higher mean total costs per participant.
DESIGN: We introduced the shared learning experience in clinical pharmacy and pharmacotherapeutic practice experiences involving 87 third-year and 51 fourth-year students. Both student groups undertook the practice experiences together, with third-year students working in smaller groups mentored by fourth-year students.
ASSESSMENT: A majority of the students (> 75%) believed that they learned to work as a team during their practice experiences and that the shared learning approach provided an opportunity to practice their communication skills. Similarly, most respondents (> 70%) agreed that the new approach would help them become effective members of the healthcare team and would facilitate their professional relationships in future practice. Almost two-thirds of the students believed that the shared learning enhanced their ability to understand clinical problems. However, about 31% of the pharmacy students felt that they could have learned clinical problem-solving skills equally well working only with peers from their own student group.
CONCLUSIONS: The pharmacy students in the current study generally believed that the shared-learning approach enhanced their ability to understand clinical problems and improved their communication and teamwork skills. Both groups of students were positive that they had acquired some skills through the shared-learning approach.
OBJECTIVE: To systematically review the literature regarding the knowledge, attitudes and practice of community pharmacists in managing oral healthcare problems.
METHODS: A systematic review was conducted through Scopus, PubMed and Google Scholar databases. Studies regarding knowledge, attitudes and practice of management of dental care by community pharmacists between 1990 and 2019 were included.
RESULTS: Forest plot was performed to access knowledge, attitudes and practice of community pharmacist on oral healthcare. The results showed there were 44% of community pharmacists have a lack of knowledge on oral healthcare to provide an appropriate recommendation to patients with dental problems. Eighty-eight per cent of community pharmacists were willing to improve their knowledge of oral healthcare. There were 86% of them recognised that their role was significant in oral health. However, there were 59% of community pharmacists who had poor attitude in providing oral health information.
CONCLUSIONS: Community pharmacists were lacking knowledge on oral health mainly because of paucity in providing appropriate training courses. This has led to poor practices towards oral healthcare as they were unable to provide suitable products recommendations to the patients. This has led the community pharmacists into lack of attitudes in providing oral health information. However, most of the community pharmacists were conscious of their role in the oral healthcare system and were willing to improve their knowledge of oral healthcare.
OBJECTIVES: The study aims to develop and validate scales (direct and indirect) based on a modified Theory of Planned Behavior (TPB) to measure factors associated with the provision of PCare for HDS users by Thai CPs.
METHOD: Item generation for the scales was based on the theoretical constructs of the modified TPB framework, literature review, and authors' previous qualitative study. Draft items were then subjected to content validity and face validity. Psychometric testing was carried out among CPs in Bangkok, Thailand. Refinement of the scales utilized factor analysis and validity was assessed using factor analysis and Rasch analysis. Internal consistency reliability and construct reliability were used to assess the scales' reliability.
RESULTS: Initially, the direct and indirect scales contained 15 and 28 items, respectively and were reduced to 12 and 16 items, after experts' review. Factor analysis further reduced the number of items of the indirect scale to 13. For both scales, confirmatory factor analysis showed model-data fit. Each construct of the direct scale was significant predictors of intention. Moreover, each construct of the direct scale correlated positively and significantly with the respective construct of the indirect scale, signifying concurrent validity. No misfit item was identified in the Rasch analysis and the majority of items were invariant across gender. Internal consistency reliability and construct reliability of the scales were acceptable.
CONCLUSION: This study presents the development and validation of theoretically-grounded scales to measure the factors associated with the provision of PCare for HDS users by Thai CPs.