Defining pharmacy and its practice: a conceptual model for an international audience

Background: There is much fragmentation and little consensus in the use of descriptors for the different disciplines that make up the pharmacy sector. Globalization, reprofessionalization and the influx of other disciplines means there is a requirement for a greater degree of standardization. This has not been well addressed in the pharmacy practice research and education literature. Objectives: To identify and define the various subdisciplines of the pharmacy sector and integrate them into an internationally relevant conceptual model based on narrative synthesis of the literature. Methods: A literature review was undertaken to understand the fragmentation in dialogue surrounding definitions relating to concepts and practices in the context of the pharmacy sector. From a synthesis of this literature, the need for this model was justified. Key assumptions of the model were identified, and an organic process of development took place with the three authors engaging in a process of sense-making to theorize the model. Results: The model is “fit for purpose” across multiple countries and includes two components making up the umbrella term “pharmaceutical practice”. The first component is the four conceptual dimensions, which outline the disciplines including social and administrative sciences, community pharmacy, clinical pharmacy and pharmaceutical sciences. The second component of the model describes the “acts of practice”: teaching, research and professional advocacy; service and academic enterprise. Conclusions: This model aims to expose issues relating to defining pharmacy and its practice and to create dialogue. No model is perfect, but there are implications for what is posited in the areas of policy, education and practice and future research. The main point is the need for increased clarity, or at least beginning the discussion to increase the clarity of definition and consistency of meaning in-and-across the pharmacy sector locally, nationally and internationall

Evaluating insulin information provided on discharge summaries in a secondary care hospital in the United Kingdom

Abstract Background: Prescribing errors at the time of hospital discharge are common and could potentially lead to avoidable patient harm, especially when they involve insulin, a high-risk medicine widely used for the treatment of diabetes mellitus. When information regarding insulin therapy is not sufficiently communicated to a patient’s primary care provider, continuity of care for patients with diabetes may be compromised. The objectives of this study were to investigate the nature and prevalence of insulin-related medication discrepancies contained in hospital discharge summaries for patients with diabetes. A further objective was to examine the timeliness and completeness of relevant information regarding insulin therapy provided on discharge summaries. Methods: The study was undertaken at a large foundation trust hospital in the North of England, UK. A retrospective analysis of discharge summaries of all patients who were being treated with insulin and were included in the 2016 National Inpatient Diabetes Audit was conducted. Insulin regimen information provided on discharge summaries was scrutinised in light of available medical records pertaining to the admission and current national recommendations. Results: Thirty-three (79%) out of the 42 patients included in the study had changes made to their insulin regimen during hospital admission. Eighteen (43%) patients were identified as having an error or discrepancy relating to insulin on their discharge summary. A total of 27 insulin errors or discrepancies were identified on discharge, most commonly involving non-communication of an insulin dose change (n = 8) and wrong insulin device (n = 7). Seventeen issues relating to completeness of insulin information were identified, including the omission of the prescribed time of insulin administration (n = 10) and unexplained insulin dose change (n = 4). Two patients who had insulin-related errors identified on their discharge summaries were readmitted to hospital within 30 days of discharge due to poor diabetic control. Conclusions: This small-scale study demonstrates that errors and discrepancies regarding insulin therapy on discharge persist despite current insulin safety initiatives. Poorly communicated information regarding insulin therapy may jeopardise optimal glycaemic control and continuity of patient care. Insulin-related information should be comprehensively documented at the point of discharge. This is to improve communication across the interface and to minimise risks to patient safet

Pharmaceutical pricing policies in Qatar and Lebanon: narrative review and document analysis

Objectives: This study aimed at reviewing and analysing the pharmaceutical pricing policies implemented in two middle-east countries. Methods: Official documents related to national pharmaceutical pricing policies were reviewed, and meetings with key informants in the registration and pricing departments in the Qatari and Lebanese ministries of public health were conducted. Key findings: As of April 2017, the laws currently in effect in Qatar and Lebanon are based on the latest versions of decrees enacted in 2011 and 2005 respectively. Both countries have implemented similar pharmaceutical pricing policies which apply only to the private sectors in both countries. Landing price in Lebanon is either free-on-board (FOB) or cost-insurance-freight (CIF) while it is only CIF in Qatar. External reference pricing and mark-up regulations were two of the common policies identified in both countries. For external reference pricing, the basket of countries considered and the price adopted were different. Mark-ups were applied with different schemes along the pharmaceutical supply chain in each country with Qatar imposing an overall higher mark-up margin. Moreover, Qatar utilized health technology assessment whenever such economic evaluation studies were available at the time of medicine registration. These pricing strategies applied to both public and private sectors in Lebanon, while they only applied to the private sector in Qatar. Conclusions: The pharmaceutical pricing policies implemented in Qatar and Lebanon are reflective of both the advancements in the human capital and financial resources of the nations and are in line with the World Health Organization-recommended pricing policies for developing countries.This work was supported by Qatar University [QUST-CPH-SPR-15/16-7 and QUST-CPH-SPR\2017-18].Scopu

Accounting Discretion, Loan Loss Provision in Financial Distress: Evidence from Commercial Banks

This study explores the association between earning management practices and financial distress in commercial banks. Earning management is measured through discretionary loan loss provisions and non-discretionary loan loss provisions. Modified Altman’s Z-score has been used as a proxy for financial distress. Panel regression with fixed and random effect has been employed for empirical analysis. The study finds a significant positive association between DLLP, NDLLP and financial distress in terms of the Altman Z-score. In the case of NDLLP, liquidity reduces the probability of financial distress. Whereas, a bank’s SIZE, LEVG and AQ enhance the likelihood of financial distress. The robustness tests were applied to find the association between NDLLP and FD using logistic regression to validate baseline estimates results of the random effect model. The findings of this study have implications for the policymakers, regulators and internal stakeholders to devise effective regulatory measures for well-informed investment decisions