Yes / Background The patient transition from a hospital to a post-discharge healthcare setting has potential to disrupt continuity of medication management and increase the risk of harm. “Connect with Pharmacy” is a new electronic web-based transfer of care initiative employed by Leeds Teaching Hospitals NHS Trust. This allows the sharing of discharge information between the hospital and a patient’s chosen community pharmacy. Objective We investigated whether the timely sharing of discharge information with community pharmacies via “Connect with Pharmacy” reduced hospital readmission rates in older patients. Method To evaluate intervention efficacy, hospital admission data was retrospectively collected. For primary analysis, admission rates were tracked 6-months prior (baseline) and 6-months post-intervention. Secondary measures included effect on total length of stay if readmitted, emergency department attendance and duration, and impact of polypharmacy. Main outcome measure The rate of non-elective hospital readmissions, 6-months post-intervention. Results In the sample (n = 627 patients; Mean age = 81 years), emergency readmission rates following the intervention (M = 1.1, 95% CI [0.98, 1.22]) reduced by 16.16% relative to baseline (M = 1.31, 95% CI [1.21, 1.42]) (W = 54,725; p < 0.001). There was no reduction in total length of stay. Subsidiary analysis revealed a post-intervention reduction in number of days spent in hospital lasting more than three days (χ2 = 13.37, df = 1, p < 0 .001). There were no statistically reliable differences in the remaining secondary measures. Conclusion The results showed a reduction in readmissions and potential post-intervention length of stay, indicating there may be further benefits for our older patients’ experiences and hospital flow.

Yes / Background The first UK wave of the Covid-19 pandemic in 2020 placed unprecedented stress on community pharmacy. Various policies and initiatives were announced during this period to support community pharmacy to continue to perform in a manner that prioritised patient safety. However, little is understood about how these policies and initiatives were implemented by staff working in community pharmacy, and the system adaptions and responses that were initiated to maintain patient safety. Objective The study aimed to investigate how staff working in UK community pharmacy during the first waves of the COVID-19 pandemic in 2020 responded and adapted to system stressors to maintain patient safety. Methods We adopted a qualitative interview approach, underpinned by Resilient Healthcare theory, with interview data collected between July 2020 and January 2021. Data were synthesised and analysed using Framework Analysis. Results 23 community pharmacy staff from England and Scotland were interviewed. We identified five themes supported by between two and six sub-themes: 1. Covid-19, an impending threat to the system. 2. Patient safety stressors during the first waves of Covid-19. 3. Altering the system, responding to system stressors. 4. Monitoring and adjusting. 5. Learning for the future. Conclusion Privileging the accounts of community pharmacy staff working on the frontline during the pandemic illuminated how responses and adaptions were developed and deployed, how continual monitoring occurred, and the factors that supported or hindered system resilience. The key learning derived from this study can serve to shorten the gap between ‘work as imagined’ and ‘work as done’, and in doing so, support the future resilience performance of community pharmacy during future outbreaks of Covid-19 or similar events. / This research was funded by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).

No description available.

Yes / ackground Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines. Objective To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context. Methods Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives. Findings Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines. Conclusions The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.

Yes / The National Health Service (NHS) Five Year Forward View in 2014 issued a grave warning that if healthcare demand in the UK continued to grow as its current rate, and efficiency or funding changes were not instigated there could be a mismatch between the service (in terms of resource provision) and patients of up to £30 billion a year by 2020/21. The report asserted that in order to “sustain a comprehensive high-quality NHS; action will be needed on all three fronts – demand, efficiency and funding” (2014:5). Based on this escalating issue, and with a focus on the expanded and value-added role of Community Pharmacists, this study chooses to focus on this service operation in light of the pressures as highlighted above by examining what Sustainability means and how it is applied in Community Pharmacy as a service provider in the NHS (UK).

Lietuvai tapus Europos Sąjungos nare, farmacijos specialistai susidūrė su naujais iššūkiais: VVKT duomenimis per laikotarpį nuo 2007 01 09 iki 2009 09 09 Lietuvoje gamybinių vaistinių skaičius sumažėjo nuo 118 iki 95 t.y. 19.5 proc. Problema – gamybinių vaistinių bei vaistinėse gaminamų vaistų kiekio mažėjimas. Tai skatina giliau pažvelgti į šio reiškinio priežastį kitu aspektu: kaip besiklostanti tendencija lemia farmacinės paslaugos kokybę, ar nenukenčia pacientas nebegalėdamas gauti jo individualius poreikius tenkinančius ekstemporalios gamybos vaistus. Aktualumas- poreikis išsiaiškinti ar ekstemporalūs vaistai reikalingi visuomenei, ar yra poreikis iš pacientų, bei gydytojų pusės. Tokia tema darbai nepublikuoti. Tyrimo tikslas- išanalizuoti ekstemporalių vaistų gamybos ypatumus visuomenės gamybinėse vaistinėse ir pateikti rekomendacijas sveikatos politikos formuotojams, gydytojus rengiančioms institucijoms ir gamybinėms vaistinėms. Magistro studijų baigiamajame darbe apžvelgta gamybinių vaistinių raida skirtingais Lietuvos vystymosi laikotarpiais; pateikta norminių aktų, reglamentuojančių ekstemporalių vaistų gamybą, apžvalgą; įvertintos ir nusakytos sąlygos, kurios užtikrina individualios gamybos vaistų išlikimą bei plėtojimą; atskleistos pagrindinės priežastys, lėmusios gamybinių vaistinių skaičiaus mažėjimą. Tyrimas atliktas dviem etapais: pilotinis 2007 metais, pagrindinis 2010 metais. Tyrimo metodai: teoriniai (profesinės literatūros šaltinių analizė pasirinktu... [toliau žr. visą tekstą] / After Lithuania joined European Union (EU) our pharmacists faced with new challenges. According to data of State Medicines Control Agency (SMCA) at the period from 2007-01-09 till 2009-09-09 the total number of community pharmacies which produce extemporaneous preparations have decreased by 19.5 % (from 118 till 95). The problem. The total number of community pharmacies which are able to produce extemporaneous preparations and the quantities of produced medicines are decreasing. Such situation encourages for further analysis in order to evaluate the reasons of such situation – does it make any influence on the quality of pharmaceutical services or does it affect the personal needs of patients who cannot get extemporaneous preparations for individual needs. The topicality. There is a need to determine whether extemporaneous preparations are still required by community, patients and physicians. There is insufficient data which would be published on such topic. The aim of this survey was to analyze the features of extemporaneous manufacturing in community pharmacies in order to provide recommendations for health policy makers, Medical faculties and community pharmacies. In this overview I present the development of extemporaneous manufacturing processes in Lithuanian pharmacies in different periods. Also the overview of legal acts on extemporaneous manufacturing, designated conditions which would help to ensure that extemporaneous preparations remain on the market and the main... [to full text]

<p><b>Background</b><br></p> <p>More than 90% of individuals aged 65 years or older in the United States (US) are taking at least one prescription medication, and more than 40% are taking five or more prescription medications. The potential for non-adherence and risk of medication therapy problems (MTPs) increases with the use of multiple medications. To enhance patient understanding of appropriate medication use, improve medication adherence, and reduce MTPs, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Prescription Drug (Part D) policy; however, “best practices” for achieving positive MTM outcomes are not well understood.</p><p><br></p> <p> </p> <p><b>Objectives</b></p> <p>This study had two objectives. The first objective was to identify and explain reasons for concordance and discordance between a) consistently high, moderate, and low performing pharmacies and b) pharmacies that improve or worsen in performance overtime. The second objective was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on widely accepted MTM quality measures. </p><p><br></p> <p> </p> <p><b>Methods</b></p> <p>This comparative mixed-methods, case study design incorporated two complementary conceptual models. First, an adaptation of the Positive Deviance (PD) model explains reasons for deviations in MTM quality measure performance among community pharmacies and informs study design. Second, the Chronic Care Model (CCM) guided data collection and analysis. Data consisted of pharmacy/staff demographics and staff interviews. When appropriate, quantitative and qualitative data were analyzed within and across pharmacy MTM performance (i.e., high, moderate, low) or change-in-performance (i.e., consistent, improved, worsened) categories using descriptive statistics and cross-tabulation respectively. MTM performance component measures used to evaluate and rank pharmacy MTM performance mirrored measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 CMS Medicare Part D Plan’ Star Rating measures. This study was approved by the Institutional Review Board for the Purdue University Human Research Protection Program. </p><p><br></p> <p> </p> <p><b>Results </b></p> <p>Across the sample of eligible pharmacies (N = 56), MTM performance composite scores varied by 21.3%. Of the five component scores, the <i>Comprehensive Medication Review (CMR)</i> component score had the highest percent variation (88.3%). Pharmacy staff at 13 pharmacies of the 18 pharmacies selected as case study sites participated in interviews, yielding a 72.2% case pharmacy participation rate. Of the 13 pharmacies, five were categorized as high performers, four were moderate performers, and four were low performers. Of the 39 pharmacy staff approached across all pharmacies, 25 participated in interviews, yielding a 64.1% participation rate. Interviewees included 11 pharmacists, 11 technicians and three student interns. Eight strategies were hypothesized as positively (7) or negatively (1) contributing to pharmacies’ MTM performance. Hypotheses generated were organized by CCM elements and included: <i>Delivery System Design (DSD)</i> – Having a high degree of technician involvement with MTM activities; Inability to meet cultural, linguistic, and socioeconomic needs of patients (negative); Having sufficient capacity to provide CMRs to patients in person compared to telephone alone; Pharmacy staff placing high priority on addressing MTM activities<i>; Clinical Information Systems (CIS) </i>– Faxing adherence-related MTP recommendations and calling providers on indication-related MTP recommendations; Technicians’ use of CISs to collect/document information for pharmacists; Using maximum number of available CISs to identify eligible MTM patients; <i>Health System Organizations (HSO) </i>– Strong pharmacist-provider relationships and trust. No hypotheses were generated for the remaining three CCM elements.</p><p><br></p> <p> </p> <p><b>Conclusions </b></p> <p></p>A total of eight strategies were hypothesized as contributing to community pharmacies’ ability to achieve high performance on MTM quality measures. Notable strategies were related to three of the six chronic care model elements. Future research should engage stakeholders to assist with prioritizing hypotheses to be statistically tested in a larger representative sample of pharmacies.

Após décadas de afastamento, o farmacêutico busca retornar ao seu local primeiro de atuação, a farmácia. Esse retorno apresenta-se como tendência em muitos países, e também no Brasil. Entidades governamentais e profissionais esforçam-se para revalorizar a atuação do farmacêutico junto às atividades assistenciais, e uma contribuição significativa ocorreu com a publicação, pela Agência Nacional de Vigilância Sanitária (ANVISA), da Resolução de Diretoria Colegiada - RDC 44, em 17/08/2009. A Resolução estabelece critérios e condições mínimas para o cumprimento das Boas Práticas Farmacêuticas, e dá respaldo a vários Serviços Farmacêuticos no ambiente das farmácias e drogarias. Diante da tendência de retorno do farmacêutico à assistência, do crescimento dos cursos de Farmácia no país e do grande número de recém-formados que ingressam no segmento de farmácias e drogarias a cada ano, justifica-se verificar com se desenvolve o trabalho desses profissionais. O objetivo do presente trabalho consistiu em avaliar o perfil e a atuação dos farmacêuticos na vigência da Resolução 44/2009, em farmácias e drogarias do município de São Paulo. O estudo descritivo transversal desenvolveu-se junto às farmácias e drogarias do município de São Paulo, com aplicação de questionário ao farmacêutico. Abordou características gerais desse profissional e do estabelecimento, conhecimento do mesmo sobre a Resolução 44/2009, atividades assistenciais, relacionamento com os componentes da equipe de trabalho, aspectos de documentação, e a visão do farmacêutico, tanto de sua atividade como de si mesmo. As respostas foram testadas estatisticamente, e procurou-se verificar se a Resolução 44/2009 tem provocado mudanças em sua atuação, em relação aos Serviços Farmacêuticos (SF). Buscou-se identificar os principais fatores que se apresentam como obstáculos para o retorno do farmacêutico ao seu papel de agente de saúde. Os resultados indicaram que os farmacêuticos das farmácias e drogarias do município de São Paulo são jovens, formaram-se principalmente em instituições privadas, estão familiarizados com o termo \"atenção farmacêutica\", mas nem todos conhecem as condutas que esta prática envolve. Foram observados aspectos positivos, como a percepção dos profissionais de que a Resolução 44/2009 valorizou seu trabalho e que tem havido reconhecimento crescente de sua atuação. Existe inclinação para a prática assistencial, mas os farmacêuticos não desenvolvem plenamente os SF da Resolução 44/2009. Há, no entanto, muitas barreiras para a efetivação da atenção farmacêutica e demais serviços, o que dificulta a inserção do farmacêutico nas práticas assistenciais. Dentre as mais citadas estão a falta de tempo para tais práticas, formação deficiente ou inadequada, falta de autonomia e autoridade dos farmacêuticos, e a resistência dos empresários em considerar os serviços farmacêuticos como um diferencial de atendimento e possibilidade de ganhos financeiros. / After decades of absence the pharmacist seeks to return to his first workplace, the pharmacy. This return is shown as a trend in many countries, and also in Brazil. Government and professional entities strive to revalue the pharmacist\'s care activities, and in Brazil, a valuable contribution in this direction came with the publication of Collegiate Board Regulation RDC 44, in August 2009, by the National Agency of Sanitary Surveillance (ANVISA). This regulation establishes minimum conditions for Good Pharmaceutical Practices and gives legal backing to several pharmaceutical services in pharmacies. The trend of return to pharmaceutical care, the growth of Pharmacy courses in our country and the large number of new professionals who enter the pharmacy segment every year justify checking how this professional activity develops. The purpose of this study was to evaluate the profile and acting of pharmacists in the presence of Regulation 44/2009, in pharmacies of São Paulo. Data were collected through cross-sectional study with a questionnaire to pharmacists, including general characteristics of pharmacists and pharmacies, checking about the knowledge of Regulation 44/2009 and assistencial activities, documentation aspects (in the context of this Regulation), relationship with other components of the working team, and the vision of the community pharmacist, of himself and of his work. The answers were tested statistically, to check if Regulation 44/2009 has changed the performance of the pharmacists in relation to services listed therein, and which has been the main obstacles to its application. We attempted to identify the most relevant factors that stand out as obstacles to pharmacists on returning to their role as a health agent. The results showed that pharmacists in São Paulo are young, formed mainly in private institutions, are familiar with the term \"pharmaceutical care\", but not all knew about the practices involved. Positive aspects were observed, such as the Regulation 44/2009 valued pharmacist´s job, and there was an increasing recognition of him by the population. There is a tendency to care practice, but pharmacists do not develop, in a regular way, the SF of Regulation 44/2009. Several barriers were identified, however, for the effectiveness of pharmaceutical care and other services: the most cited were lack of appropriate working environment, poor training of pharmacists, lack of autonomy and authority for them, and the vision of businessmen, who show resistance in considering the pharmaceutical services as a differential in attendance.

Introduction: Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst older adults prescribed polypharmacy. However, complex interventions aimed at improving adherence have shown only limited effectiveness. To maximise effectiveness, the Medical Research Council (MRC) supports the use of both evidence and theory in developing interventions. Feasibility and pilot testing is then recommended to optimise interventions in advance of definitive trials. The aim of this research was to develop a novel complex intervention (using evidence and theory) to improve adherence in older adults (prescribed polypharmacy) and to test the feasibility of delivering this in community pharmacies. Methods: The presented research models the MRC complex intervention framework and focuses on development and feasibility testing phases. Firstly, a systematic review was conducted to address an identified evidence gap in relation to theory-based adherence interventions previously delivered to older adults prescribed polypharmacy. Qualitative research was then conducted to explore older patients’ adherence behaviour and identify determinants (barriers, facilitators) to target for change. Using the Theoretical Domains Framework (TDF) as a lens, key domains were selected for targeting and mapped to behaviour change techniques (BCTs) using established methods. These BCTs formed the basis of a complex intervention that was delivered to older patients by community pharmacists (CPs) as part of a small-scale feasibility study. In addition to exploring older patients’ adherence behaviours, further research focused on CPs’ clinical behaviour in relation to providing medication adherence support (MAS). The qualitative TDF-based methods used in the patient study were extended and a mixed methods (qualitative, quantitative) approach was used to identify determinants influencing CPs’ behaviour. Key target domains were identified and mapped to BCTs that could be directed at CPs (e.g. in a training package) to improve future implementation of the patient intervention. Results: The systematic review found that adherence interventions delivered to older patients prescribed polypharmacy were rarely based on theory, supporting the need for further research. The qualitative research conducted with older patients identified eight key domains (e.g. ‘Beliefs about consequences’, Memory, attention and decision process’) that could be targeted and these domains were mapped to 11 BCTs (e.g. ‘Prompts/cues’, ‘Self-monitoring’) which formed the basis of a complex intervention. The feasibility study demonstrated that the intervention was highly acceptable to both patients and CPs but some modifications were suggested. It also highlighted the need for additional research that focuses on CPs’ behaviour (i.e. MAS provision). Findings from the mixed methods study on CPs’ behaviour led to the identification of seven key domains that could be targeted for change (e.g. ‘Skills’, ‘Motivation and goals’). Eighteen BCTs were then selected for inclusion in a training package (e.g. ‘Demonstration of the behaviour’) or for delivery alongside the patient intervention in future research (e.g. ‘Rewards/incentives’) to improve implementation. Discussion/Conclusion: The MRC framework served as a useful guide for developing a complex intervention to improve adherence in older patients prescribed polypharmacy. This systematic theory-based approach that involved explicitly linking theoretical domains to intervention components (BCTs) will aid future replication and understanding of how the intervention aims to bring about behaviour change. Aside from targeting patients’ adherence behaviours, this research emphasised the importance of exploring the behaviours of intervention providers (i.e. CPs) to enhance implementation. Future research will involve pilot testing a refined version of the patient intervention and CP training package to establish if a definitive trial of effectiveness (e.g. randomised controlled trial) is warranted.

Aims The aims of this study were to increase community pharmacists’ willingness and confidence to provide consultations for people with depression, and to enhance patients’ awareness of the pharmacists’ developing role. Research Design To observe pharmacist-patient consultations, the researcher developed a patient scenario. Pharmacist knowledge and attitude questionnaires were adapted, and a skills observation checklist was developed. Assessments of patient satisfaction levels took place before and after pharmacist training, which included a simulated consultation and action planning. The consultations were both video recorded and observed. Participants undertook a short interview with the researcher and each pharmacist developed his/her own plan for continuing professional development (CPD). An exploration of the interview transcripts was undertaken qualitatively. A University Ethics Panel approved the project. Results There were twenty-two pharmacists who took part in the study, comprising eighteen males and four females. MPharm students comprised one female and two males, and community pharmacists made up three females and sixteen males. The quantitative results: It was found that pharmacists possessed appropriate knowledge (the mean score was 75%, which showed that the pharmacists were aware of the safety and action of anti-depressants). The mean score for attitude was 54%, which tends towards the positive. When observing the simulated consultations, the mean score for initiating a consultation session was recorded at 28%. This indicates that the pharmacists were not very interested in initiating rapport with patients. However, the highest mean score calculated was 61%, which corresponded with closing a consultation. For data collection and action, the mean scores were 42% and 35%, respectively, and this indicates the need for improvement in these areas. The qualitative findings: The pharmacists demonstrated good knowledge about anti-depressants and held positive attitudes towards people with depression. However, the pharmacists were not very willing to exercise the responsibilities of their extended role or provide additional services for patients. The pharmacists lacked certain skills and opportunities to be able to enhance the patients’ satisfaction. The pharmacists in this study needed to improve their soft skills in some areas and engage in mutual discussion with patients in order to enhance patients’ expectations with the service provided. Conclusion/discussion The knowledge and attitude of pharmacists were good, but their consultation skills could be improved. Although simulated consultation allowed pharmacists to review their skills and practice the apparent impact on patient care was limited. This study has enable greater understanding of pharmacist strategies when consulting people with depression, and the findings could be used by those developing training programmes for enhancing pharmacists skills.