Samoprocjena kompetencija javnih ljekarnika-mentora u okviru stručnog osposobljavanja za ljekarnike

Posljednjih desetljeća svjedočimo intenzivnim promjenama u ljekarničkoj profesiji zbog čega se razvoj kompetencija u ljekarništvu nameće kao jedan od osnovnih preduvjeta za pružanje ljekarničke skrbi te unapređenje terapijskih ishoda i kvalitete života bolesnika. Stoga su kompetencijski okviri koji potiču osobni i stručni razvoj postali važna komponenta cjeloživotnog učenja te odgovor na potrebu za usavršavanjem i prepoznatljivošću stručnjaka u zdravstvu. Cilj istraživanja: Cilj ovog istraživanja bio je definirati kompetencije koje je neophodno razvijati u kliničkih farmaceuta s ciljem poboljšanja kvalitete pružene skrbi. Dodatno, cilj je bio procijeniti kompetencije javnih ljekarnika-mentora pomoću Hrvatskog ljekarničkog kompetencijskog okvira (HLJKO-a). Ispitanici i metode: Ova opservacijska prospektivna studija uključila je tzv. javne ljekarnike-mentore, odnosno javne ljekarnike koji su se na poziv Farmaceutsko-biokemijskog fakulteta (FBF-a) dobrovoljno prijavili za pružanje potpore i mentorstvo studentima-pripravnicima u okviru Stručnog osposobljavanja za ljekarnike (SO). Navedeni javni ljekarnici-mentori prisustvovali su edukaciji na FBF-u u listopadu 2015. i veljači 2016. godine kada su se imali prigodu upoznati s Programom SO temeljenom na HLJKO-u. Javni ljekarnici-mentori procijenili su svoje kompetencije u početnoj točci vremena prije uključivanja u program SO te su svoje samoprocjene naknadno dostavili elektroničkom poštom. Podaci su prikupljani pomoću HLJKO-a, validiranog alata za procjenu i samoprocjenu kompetencija javnih i bolničkih ljekarnika u razdoblju od listopada 2015. godine do travnja 2016. godine. Rezultati: Od ukupno 260 javnih ljekarnika pozvanih u istraživanje u konačnu analizu je uključeno 223 ispitanika (Ž: 204; M: 19) iz 168 javnih ljekarni. Stopa odaziva iznosila je 85,8 %. Medijan dobi ispitanika iznosio je 41 godinu (raspon 27 - 65), a medijan radnog staža provedenog u javnoj ljekarni 14 godina (raspon 2 - 40). Javni ljekarnici-mentori samoprocijenili su se najboljima u kompetencijama iz klastera „Organizacijske i upravljačke kompetencije“ (3,64 ± 0,336), dok se najmanje kompetentnima smatraju za kompetencije iz klastera „Javnozdravstvene ljekarničke kompetencije“ (2,75 ± 0,769). Pri tome su se najboljima ocijenili u kompetenciji „Stručna i etička praksa“ (3,77 ± 0,393), dok je najniža srednja ocjena zabilježena za kompetenciju „Osiguravanje sigurne primjene lijekova“ (2,62 ± 0,685). Zaključak: Ovo istraživanje predstavlja prvo testiranje HLJKO-a u praksi kao vrijednog alata u procjeni i samoprocjeni ljekarničkih kompetencija. Analizom prikupljenih podataka identificirane su kompetencije koje je neophodno razvijati u javnih ljekarnika s ciljem poboljšanja kvalitete ljekarničkih intervencija u javnim ljekarnama. Posljedično, definirana su područja iz kojih je javnim ljekarnicima u našoj zemlji potrebna dodatna stručna izobrazba.Last decades we have witnessed intense changes in the pharmacy profession which is the reason for the development of competencies in pharmacy imposed as one of the basic prerequisites for the provision of pharmaceutical care as well as improving therapeutic outcomes and patients quality of life. Therefore, competency frameworks which prompt personal and professional development have become an important component of lifelong learning and are driven by the need for development and professional recognition of healthcare professionals. Objectives: The aim of this study was to define competencies that need to be developed in clinical pharmacists with an aim of improving pharmaceutical care. Additionally, aim was to assess competencies of community pharmacists-preceptors using Croatian Competency Framework (CCF). Subjects and methods: This observational prospective study has included so-called community pharmacists-preceptors or community pharmacists who have voluntarily accepted invitation of Faculty of Pharmacy and Biochemistry to provide support and mentoring to students-trainees within Pre-registration training of pharmacy students. Mentioned community pharmacists-preceptors have attended education at Faculty of Pharmacy and Biochemistry in October 2015. and February 2016. where they had an opportunity to meet with the Pre-registration training of pharmacy students Program, based on CCF. Community pharmacists-preceptors assessed their competencies at starting point of time, before involving into the program of Pre-registration training of pharmacy students and delivered their self-assessments by e-mails afterwards. Data were collected using CCF, validated toll for assessment and self-assessment of community and hospital pharmacists, during the period from October 2015. until April 2016. Results: Of the total of 260 community pharmacists invited in this study, final analysis included 223 respondents (F: 204; M: 19) from 168 community pharmacies. The response rate was 85,8 %. The median age of the respondents was 41 year (range 27 - 65) and a median of service spent in a community pharmacy was 14 years (range 2 - 40). Community pharmacists-preceptors assessed themselves as the most competent in competencies from the cluster „Organizational and management competencies” (3.64 ± 0.336), while they considered themselves at least competent for the competencies from the cluster „Pharmaceutical public health competencies”(2.75 ± 0.769). Highest score was assessed for the competency „Professional and ethical practice” (3.77 ± 0.393), while the lowest score was recorded for competency „Ensuring the safe application of medicines” (2.62 ± 0.685). Conclusion: This research represents first testing of the CCF in practice as a valuable tool in assessment and self-assessment of pharmacists competencies. Analyzing collected data identified competencies that need to be improved in community pharmacist with an aim of improving the quality of pharmacists interventions in community pharmacies. Consequently, areas in which community pharmacist in our country require additional professional education are defined

Correction to: Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment (Scientific Reports, (2024), 14, 1, (6235), 10.1038/s41598-024-56780-1)

Correction to: Scientific Reportshttps://doi.org/10.1038/s41598-024-56780-1, published online 14 March 2024 The original version of this Article contained an error in the Funding section. “All the research work was funded by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by the Grants: InoMed, Reg. No CZ.02.1.01/0.0/0.0/18_069/0010046, the European Horizon 2020 I-CARE4OLD Grant No 965341, START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551 Grant and Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Therapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.” now reads: “Publication of this work was supported by the I-CARE4OLD project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 96534. Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them. More information on the I-CARE4OLD project can be found at http://www.icare4old.eu and https://cordis.europa.eu/project/id/965341. Except secondary analyses and works on the publication, data collection and teamwork were funded also by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by grants: START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551, Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Terapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607.” The original Article has been corrected.Link to the corrected article:[ https://farfar.pharmacy.bg.ac.rs/handle/123456789/5571

Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment

Pharmacist’s geriatric assessment can provide valuable insights into potential deprescribing targets, while including important information on various health-related domains. Data collected from a geriatric assessment questionnaire, for 388 patients, from the Croatian cohort of the EuroAgeism H2020 ESR 7 international project, along with guideline-based deprescribing criteria, were used to analyse potentially inappropriate prescribing of four medication groups (benzodiazepines (BZN), proton pump inhibitors (PPI), opioids, and non-steroidal anti-inflammatory drugs (NSAID)), and to assess the deprescribing potential. Binary logistic regression was used to explore the effects of age, gender, number of medicines and diagnoses, self-reported health, frailty score, and healthcare utilization on the likelihood of needing deprescribing. More than half of participants (n = 216, 55.2%) are candidates for deprescribing, with 31.1% of PPI, 74.8% of NSAID, 75% of opioid, and 96.1% of BZN users meeting at least one criterion. Most common criteria for deprescribing were inappropriately long use and safety concerns. Women (aOR = 2.58; p < 0.001), those reporting poor self-reported health (aOR = 5.14; p < 0.001), and those exposed to polypharmacy (aOR = 1.29; p < 0.001) had higher odds of needing to have medicines deprescribed. The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy. Pharmacist’s geriatric assessment and deprescribing-focused medication review could be used to lead a personalised approach.https://farfar.pharmacy.bg.ac.rs/handle/123456789/562

Pregled dostupnih skala za procjenu opterećenja aritikolinergičkim lijekovima

Anticholinergic medications are frequently used by older adults. They act on muscarinic acetylcholine receptors and antagonise the effects of acetylcholine by competitively binding to these receptors. Usually, they are used to manage a wide range of clinical conditions, including urinary frequency, urgency and incontinence, irritable bowel syndrome, depression, psychosis, chronic obstructive pulmonary disease and Parkinson's disease. Unfortunately, simultaneously they are associated with a wide range of adverse effects to which elderly patients are particularly sensitive. Most common adverse effects include 1dry mouth, constipation, urinary retention, falls, blurred vision and delirium. Anticholinergic burden refers to the cumulative effect of taking multiple medications with anticholinergic effects. Over the past few decades many scales have been developed to measure anticholinergic burden. These scales usually rank the anticholinergic activity of medications into 3-5 levels, ranging from no anticholinergic activity (O) to definite anticholinergic activity (3 to 5). There is high variability in existing scales; there is still no consensus on the definition, and both the number and ranking of the anticholinetgic medications listed vary considerably between the scales. Also, some scales consider the impact of different routes of administration when ranking the anticholinergic activity of medications, while others exclude topical, ophthalmic, and inhaled preparations. Future imperative is developing of one reference composite anticholinergic scale which would be a useful tool for clinicians to identify medications with anticholinergic activity

Pregled dostupnih skala za procjenu opterećenja aritikolinergičkim lijekovima

Anticholinergic medications are frequently used by older adults. They act on muscarinic acetylcholine receptors and antagonise the effects of acetylcholine by competitively binding to these receptors. Usually, they are used to manage a wide range of clinical conditions, including urinary frequency, urgency and incontinence, irritable bowel syndrome, depression, psychosis, chronic obstructive pulmonary disease and Parkinson's disease. Unfortunately, simultaneously they are associated with a wide range of adverse effects to which elderly patients are particularly sensitive. Most common adverse effects include 1dry mouth, constipation, urinary retention, falls, blurred vision and delirium. Anticholinergic burden refers to the cumulative effect of taking multiple medications with anticholinergic effects. Over the past few decades many scales have been developed to measure anticholinergic burden. These scales usually rank the anticholinergic activity of medications into 3-5 levels, ranging from no anticholinergic activity (O) to definite anticholinergic activity (3 to 5). There is high variability in existing scales; there is still no consensus on the definition, and both the number and ranking of the anticholinetgic medications listed vary considerably between the scales. Also, some scales consider the impact of different routes of administration when ranking the anticholinergic activity of medications, while others exclude topical, ophthalmic, and inhaled preparations. Future imperative is developing of one reference composite anticholinergic scale which would be a useful tool for clinicians to identify medications with anticholinergic activity

Identifying self-assessed competencies and areas for improvement within community pharmacist-preceptors support during pre-registration training

Abstract Background Competency frameworks that prompt personal and professional development have become an important component of lifelong learning; they are driven by healthcare professionals’ need for development and professional recognition. This study aimed to evaluate the self-assessed competencies of community pharmacist-preceptors by using Croatian Competency Framework (CCF) and to identify competencies to be improved. The secondary aim was to explore the association between community pharmacists’ characteristics (i.e. age, education etc.) and self-assessed competency performance. Methods The study subjects were community pharmacist-preceptors who provide support to and mentor student trainees enrolled in pre-registration training for pharmacy students. At the beginning of their mentorship, the pharmacist-preceptors assessed their competencies on a four-point Likert scale by using the Croatian Competency Framework (CCF), a validated tool for assessment and self-assessment of community and hospital pharmacists. Data were collected via e-mail in the period from October 2015 to April 2016. Results Of the 260 community pharmacists approached, final analysis included 223 respondents. The response rate was 85.8%. Community pharmacist-preceptors assessed themselves as the most competent in competencies pertaining to the cluster “Organization and management competencies” (M = 3.64, SD = 0.34), while they considered themselves as the least competent in the competencies pertaining to the cluster “Pharmaceutical public health competencies” (M = 2.75, SD = 0.77). Younger pharmacists with a postgraduate qualification who worked for large pharmacy chains in the capital city area and who had been in their current posts for a shorter period perceived themselves to be more competent. Conclusion This research represents the first analysis of the CCF in practice and identifies community pharmacist-preceptor competencies that require improvement. Consequently, areas for additional professional education were defined. Implementing modalities to measure and support development of preceptors’ competences is essential for improvement of student training programmes

Clinical decision-making in benzodiazepine deprescribing by healthcare providers vs. AI-assisted approach

Aims: The aim of this study was to compare the clinical decision-making for benzodiazepine deprescribing between a healthcare provider (HCP) and an artificial intelligence (AI) chatbot GPT4 (ChatGPT-4). Methods: We analysed real-world data from a Croatian cohort of community-dwelling benzodiazepine patients (n = 154) within the EuroAgeism H2020 ESR 7 project. HCPs evaluated the data using pre-established deprescribing criteria to assess benzodiazepine discontinuation potential. The research team devised and tested AI prompts to ensure consistency with HCP judgements. An independent researcher employed ChatGPT-4 with predetermined prompts to simulate clinical decisions for each patient case. Data derived from human-HCP and ChatGPT-4 decisions were compared for agreement rates and Cohen's kappa. Results : Both HPC and ChatGPT identified patients for benzodiazepine deprescribing (96.1% and 89.6%, respectively), showing an agreement rate of 95% (κ=.200,P=.012). Agreement on four deprescribing criteria ranged from 74.7% to 91.3%(lack of indicationκ=.352,P< .001; prolonged useκ=.088,P=.280; safety concernsκ=.123,P=.006; incorrect dosageκ=.264,P=.001). Important limitationsof GPT-4 responses were identified, including 22.1% ambiguous outputs, genericanswers and inaccuracies, posing inappropriate decision-making risks.Conclusions : While AI-HCP agreement is substantial, sole AI reliance poses a risk forunsuitable clinical decision-making. This study's findings reveal both strengths andareas for enhancement of ChatGPT-4 in the deprescribing recommendations within areal-world sample. Our study underscores the need for additional research on chatbot functionality in patient therapy decision-making, further fostering the advance-ment of AI for optimal performance