The role of pharmacists in the management of chronic disease and prevention of adverse drug reactions

Community pharmacists are increasingly expected to improve disease management both by aiming to improve the effective use of medicines and by reducing the occurrence and severity of preventable adverse drug reactions (ADRs). The current PhD research began by assessing the challenges to the medicines reconciliation from patients' perspectives. A questionnaire based audit identified two important risk factors for reporting ADRs: being unaware of why medicines were prescribed and not recalling prior warnings about possible ADRs. These findings led to the evaluation of pharmacists' engagement with patients within pharmacy services such as the New Medicine Service (NMS). A questionnaire-based service evaluation of the NMS provided support for this service as an opportunity to improve identification and management of ADRs. This evaluation also highlighted the poor contribution of pharmacists towards reporting of ADRs. The findings led to the evaluation of ADR reporting by community pharmacists. This audit-based study identified lack of time and uncertainty about the seriousness of ADRs as the main barriers towards spontaneous reporting. The reporting of ADRs linked to high blood pressure medicines in this study indicated the need to assess the role of community pharmacists in the management of high blood pressure. A systematic review and meta-analysis suggested that pharmacist-led interventions made a significant impact on the management of systolic and diastolic blood pressure. Learning from two audits, a service evaluation and a systematic review led to the development of a randomised controlled trial that assessed the impact of written pharmacistled education on patients with high blood pressure. Interventions by pharmacists working in community pharmacies were associated with improvements in the control of hypertension, however, the mean difference in blood pressure between the intervention and control group was not statistically significant. Compared to participants in the control group, there was a significant improvement in the knowledge about hypertension and its treatment in the intervention group. The participants in this study gave a positive response about the involvement of pharmacists in the management of long-term medical conditions such as hypertension. The UK government wants to see a central role for pharmacists in patient care. The evidence presented in this research suggests that pharmacists have the potential to play a bigger role in patient care. Patients also recognize this potential and appear to be willing to seek pharmacists' advice on health-related issues. Pharmacists would need to identify their specific learning needs to help them deliver a more patient-centred care. They would also require the support and recognition from other stakeholders in particular the GPs

COMMUNITY PHARMACIST-LED NEW MEDICINE SERVICE FOR PATIENTS WITH A LONG TERM MEDICAL CONDITION: A CROSS-SECTIONAL STUDY

Objective: This study assessed the impact of the new medicine service (NMS) on medication use in patients starting a new medication for a long-term medical condition in the United Kingdom (UK). Methods: A cross-sectional study was conducted in community pharmacies in the West Midlands area for three months from July to September 2012. The drug therapies/agents included in the study were antihypertensive, antidiabetics, anti-asthmatics and antiplatelet/anticoagulants.Results: 20 community pharmacists completed questionnaires related to 285 patients (160 female and 125 male). On the first NMS assessment, 82 patients reported drug-related problems including adverse effects and incorrect use of medications. Of these 82 patients, 58 received pharmacists' advice and 24 did not receive any advice. At the NMS follow up 39 (67%) of the 58 patients who received pharmacists' advice reported resolution of their drug-related problems while only four (17%) of the 24 patients who did not receive pharmacists' advice reported resolution of their problems (odds ratio 10.2, 95% CI 3.0-34.2 p<0.0001). The improvement in the correct use of medications by patients reported in this study for example by improving the inhaler technique of asthmatic patients is expected to have important implications for improving the healthcare outcome of patients with long-term conditions.Conclusion: This study provides support for the NMS as an opportunity to improve detection of adverse effects and improve the incorrect use of medicines by patients. Further research is needed to address the policy implications of the NMS, including analyses of the clinical and cost-effectiveness of this service, and the sustainability of this form of pharmacist intervention in the long-term in clinical practice

Evaluating the role and integration of general practice pharmacists in England:a cross-sectional study

Background Since 2015, NHS England has facilitated the recruitment of pharmacists in general practice (GP) to reduce workload of general practitioners. The role of pharmacists is therefore expected to become more clinical and patient oriented. However, little is known about the current roles performed and the integration of GP pharmacists. Objective To assess the role performed by GP pharmacists and their integration into practice exploring facilitators and barriers to integration. Setting A cross-sectional survey of GP pharmacists in England. Method This study used both online and paper-based questionnaires for a period of six months. Survey items included demographics, roles performed, integration including available support and practice environment. Quantitative data were analysed using descriptive statistics and 95% confidence intervals. Open comments were analysed thematically to identify pharmacists’ perceptions of barriers and facilitators to their integration into practice. Main outcome measure Current role and integration of pharmacists into GP. Results 195 participants completed the questionnaire. Three quarters of pharmacists (76%) had only been in GP since 2015. Most pharmacists (81%) were independent prescribers (PIPs). The most reported pharmacists’ roles were medicine reconciliation (95%), telephone support for patients (95%) and face-to-face medication review (91%). 82% (95% CI: 76% to 86.8%) were satisfied with their overall integration into practice. Half of pharmacists (45%) were working in a shared office or at a hot desk and 9% had no designated workspace. PIPs had more access to a convenient workplace (p = 0.016) compared to non-IPs. Conclusion Practice pharmacists are fulfilling a wide range of clinical and non-clinical roles in England. Findings highlight relatively a satisfactory level of pharmacists’ integration into practice and shed the light on their integration issues. These findings could be significant for the development of future roles of pharmacists in GP

A randomised controlled trial of the impact of structured written and verbal advice by community pharmacists on improving hypertension education and control in patients with high blood pressure

Purpose: This study was aimed to determine whether structured written and verbal education provided to patients by community pharmacists about high blood pressure (BP) and its treatment would be (a) better retained and (b) be associated with improved BP control as compared to patients receiving verbal advice only. Methods: The study was designed as a randomised controlled trial and was conducted in the West Midlands, UK, between January 2014 and June 2014. The primary outcome measures were differences in systolic and diastolic BP from baseline and retention of information about high BP assessed with a questionnaire at 2-, 4- and 26-week follow-up points. Results: A total of 64 adults were included in the study. At the week 26 follow-up, compared to participants in the control group, there was a significant improvement in the knowledge of intervention participants about the risks associated with high BP (p < 0.001) and awareness about potential adverse effects of the new BP medicine (p < 0.001). Similarly, there was a greater and more significant reduction in systolic BP in favour of the intervention group 8 mmHg (95% CI 2.1–13.3 p = 0.009) compared to 6 mmHg (95% CI 0.6–11.7 p = 0.02) in the control group at the week 4 follow-up. However, this greater effect of an intervention on BP was not sustained at the 26-week follow-up. For diastolic BP, there was no added effect of the intervention. Conclusion: This randomised controlled trial suggests that although written advice provided by community pharmacists in comparison to verbal advice was more effective in improving knowledge and understanding of patients about hypertension and its treatment, it did not lead to better blood pressure control

Translation, cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ) 2.0 into the Arabic language among people with diabetes

Background: Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated tool in the Arabic language to measure patient satisfaction with pharmacy services. Objective: To translate the English version of the PSPSQ 2.0 into Arabic language, culturally adapt, and verify its reliability and validity. Setting: A community pharmacy in Riyadh, Saudi Arabia. Method: A cross-sectional study was conducted between April 2021 and June 2022 among patients with diabetes attending a community pharmacy. The International Society for Pharmacoeconomics and Outcomes Research good practice guidelines for linguistic translation and cultural adaptation were used to translate and culturally adapt the English version of PSPSQ 2.0 into Arabic. The Arabic version of PSPSQ 2.0 was subjected to factor analysis using principal component analysis with varimax rotation to evaluate its validity and Cronbach’s alpha was used to assess the reliability of PSPSQ 2.0. Results: A total of 129 (68.2% male, and mean age 50 (SD: 11.9) years) patients with diabetes participated in the study. The analysis was undertaken for the items in each of the three domains of PSPSQ 2.0: quality of care, interprofessional relationship and overall care. Exploratory factor analysis revealed validity of 92.7%, 80.5% and 96.2%, respectively. The Arabic version of PSPSQ 2.0 had high internal consistency with Cronbach’s alpha scores 0.99, 0.95 and 0.98 for the three measured domains, respectively. The sample adequacy was 0.924. Conclusion: The PSPSQ 2.0 was successfully translated and culturally adapted into the Arabic language and had acceptable validity and reliability to measure patient satisfaction with services provided by pharmacists in community pharmacies

Impact of a community pharmacy-based medication therapy management program on clinical and humanistic outcomes in patients with uncontrolled diabetes:a randomised controlled trial

This study was aimed to evaluate the impact of community pharmacy (CP)-based medication therapy management (MTM) program on clinical and humanistic outcomes in patients with uncontrolled diabetes. An open label, parallel-group randomised controlled trial was undertaken at a community pharmacy in Riyadh city, Kingdom of Saudi Arabia. Patients with a diagnosis of uncontrolled diabetes (HbA1c of ≥ 8%) meeting the eligibility criteria were randomised to receive either the MTM programme provided by pharmacists or standard care. The primary outcome was change in HbA1c over 6 months. Secondary outcomes included: changes in clinical parameters (blood pressure (BP), lipid profile, serum creatinine (SCr) and albumin-to- creatinine ratio (ACR)), types of drug-related problems (DRPs), health service utilization (HSU), adherence, diabetes distress and overall patient satisfaction with the service at 6-month. A sufficiently powered sample of 160 participants with a mean age was 50 years (SD ± 11.9) was recruited. The majority of the patients (68.1%) were male and had diabetes for more than eight years [IQR 3, 14]. After adjusting for baseline HbA1c, compared to the control group, the mean HbA1c level was 0.02% (p = 0.929) and 0.2% (p = 0.47) lower in the intervention arm at 3-month and 6-month respectively. However, these differences were not statistically significant. Nonetheless, within each arm, there was a significant improvement in HbA1c from baseline. Furthermore, the intervention arm demonstrated improvement in BP control (SBP lowered by 3.2 mmHg (p = 0.05) and DBP lowered by 3.8 mmHg (p = 0.008)). During the study period, none of the participants in the intervention group reported hospitalization or ER visits compared to 14 patients in the control group [OR 0.069 (95% CI 0.004, 1.3)]. Patient satisfaction as measured by Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) was significantly higher among MTM program participants compared to standard care (p = 0.00001). Patients in the MTM program were eight times more likely to be adherent compared to the patients in the standard care [OR 7.89 (95% CI 3.6, 17.4)]. MTM program metrics showed that per patient, the pharmacists spent a median of 35 [IQR 30, 44.5] minutes at the initial visit and 20 [IQR 10, 25] minutes during the 6-month visit. The number of DRPs had significantly dropped in the intervention arm at 3 and 6-month (p = 0.0001). In conclusion, CP-based MTM program can improve health outcomes and prevent hospitalisations in patients with diabetes. These findings support the implementation of CP-based MTM services for patients with diabetes in the Kingdom of Saudi Arabia

Experiences of COVID-19 Recovered Patients: A Qualitative Case Study from a Hotspot in Saudi Arabia

It is difficult to maintain social distancing in highly populated areas where people live in proximity. This study aimed to qualitatively explore experiences of COVID-19 recovered patients residing in one such area. We employed semi-structured face-to-face interviews. An interview guide was developed, validated, piloted, and minor changes were made. People living in this area, above 18 years of age, and recovered from COVID-19 were approached for the interviews, 11 of them were recruited to be interviewed, and their verbal informed consent was audio recorded. The interviews were conducted in the Arabic language in a semi-private area of the community center, audio-recorded, transcribed verbatim, and thematically analyzed later. Thematic analysis generated 30 subthemes, which were categorized into seven overarching themes: information about COVID-19; life during COVID-19 illness; spreading of COVID-19; precautionary measures; interventions that helped in recovery; impact of COVID-19 on life; support received during COVID-19 illness. Experiences of people from the hotspot who had recovered from COVID-19 highlighted what life had been like in the hotspot under lockdown, especially with having been afflicted with the infection, factors that facilitated their recovery, and the way their lives were and have been affected due to COVID-19