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Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study
Kevin P Mc Namara, Johnson George, Sharleen L O'Reilly, Shane L Jackson, Gregory M Peterson, Helen Howarth, Michael J Bailey, Gregory Duncan, Peta Trinder, Elizabeth Morabito, Jill Finch, Stephen Bunker, Edward Janus, Jon Emery, James A Dunbar
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-264
Abstract: This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients' overall CVD risk and individual risk factors, as well as identifying modifiable health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation.This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of the most accessible health services in most developed countries.Australia and New Zealand Clinical Trial Registry Number: ACTRN12609000677202Cardiovascular disease (CVD) is the leading cause of death globally, accounting for an estimated 17.1 million deaths per annum - 29% of all deaths [1]. The relative contribution of CVD to the burden of disease remains high in countries with low-, middle-, and high incomes [1]. Despite significant gaps in research, there is sufficient evidence (particularly from developed nations such as the Unit
General practitioners′ perceptions about the extended roles of the community pharmacists in the state of Karnataka: A study  [cached]
Adepu R,Nagavi B
Indian Journal of Pharmaceutical Sciences , 2006,
Abstract: In developed countries, professional relationships between the prescribers and pharmacists are good due to the professional services offered by the pharmacists. Many researchers have found that, prescribers are in favour of the new extended roles of practising pharmacists as patient counsellors and drug information providers. In India, professional relationships between the prescribers and pharmacists require becoming strong in the interest of profession and patient care. The present study is aimed at analysing the general practitioners′ perception and expectations from practising community pharmacists in four district headquarters of Karnataka. The study was conducted through convenient sampling method using a well-designed 14-item questionnaire to collect the opinions from the respondents. Likert scale was employed to assess the responses. One hundred and fifteen general practitioners have participated in the study. The respondents opined that only qualified pharmacists should run the pharmacies (4.73). Although the present D. Pharm qualification is sufficient to run the pharmacies (3.55), to meet the present health care demands, B. Pharm or M. Pharm is a must (3.86). Pharmacists are considered as a part of health care team (3.43) and should be located within the medical practice (3.82) and accepted as professional partner (3.30). Coming to the question of extended roles, some respondents have mentioned that pharmacists should check the legality and drug interactions in the prescriptions (3.20) and provide the necessary drug information. However, the respondents were against the pharmacist-run diabetic and anticoagulant clinics and against pharmacists prescribing cost-effective suggestions. Age has shown significant influence only on few opinions, whereas experience of the respondents has shown significant influence on majority of the opinions. Many respondents expressed positive opinion about the extended roles of the pharmacists but said the success mainly depends upon the improved knowledge base and effective communication skills.
Malaysian Family Physician , 2009,
Abstract: Aim: This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists. Methods: A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners’ level of agreement using a 5-point Likert-type scale. Results: Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists’ recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients’ pharmacotherapeutic outcomes (77.5%). Conclusion: The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.
The Changing Roles Of Pharmacists In Society  [PDF]
Stephen Arthur Hudson,John Jackson Mc Anaw,Barbara Julienne Johnson
International e-Journal of Science, Medicine & Education , 2007,
Abstract: A clinical role for pharmacists has developed inresponse to the societal need to improve the use ofmedicines. Clinical role development has been led byinitiatives in the hospital sector which have enabledSchools of Pharmacy to make shifts in the pre-graduateeducation of pharmacists. The increasing complexity inthe management of drug therapy has given pharmacistsclear roles that integrate within the healthcare team.The history is one in which the development ofchanging roles of pharmacists is an example of progressin healthcare delivery creating the need for revision ofthe curriculum for a whole profession.
Pharmacists’ social authority to transform community pharmacy practice  [PDF]
Timothy McPherson, PhD, RPh,Patrick Fontane, PhD
INNOVATIONS in Pharmacy , 2011,
Abstract: Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered.
Japanese Community Pharmacists’ Barriers to Conducting or Participating in Practice Research  [PDF]
Yasuhiro Sawada, Rieko Takehira, Shigeo Yamamura
Pharmacology & Pharmacy (PP) , 2015, DOI: 10.4236/pp.2015.69043
Abstract: Objectives: This study identified barriers to Japanese community pharmacists’ active conduct or participation in practice research. Methods: Community pharmacists (n = 478) who gave presentations at three major pharmacy-related conferences in 2012 and 2013 were questioned about their difficulties of giving presentations, support for better presentations, and barriers to conducting pharmacy practice research in their practical setting. A questionnaire was mailed to and returned by the pharmacists directly. Results: We obtained 230 responses (47.9%). Presentation difficulties included pharmacists’ time constraints and lack of experience organizing the report’s results or discussion. Many thought statistical analysis support was necessary. The barriers were in sufficient time, community pharmacies’ lack of research supervisors, and other community pharmacists’ lack of understanding practice research’s importance. These were comparable to pharmacists’ barriers in other countries, except for money and funds. Conclusions: Japanese community pharmacists should clarify that practice research in their professional roles improves patients’ outcomes. Barriers were similar to pharmacists in other countries. Publication of pharmacists’ practice research results is important to expand their roles. Collaboration between faculties and pharmacists is a challenge for practice research development in the Japanese community setting.
Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)
Marleen Hendriks, Lizzy Brewster, Ferdinand Wit, Oladimeji Bolarinwa, Aina Odusola, William Redekop, Navin Bindraban, Albert Vollaard, Shade Alli, Peju Adenusi, Kayode Agbede, Tanimola Akande, Joep Lange, Constance Schultsz
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-186
Abstract: Design: prospective observational hospital based cohort study.Setting: a primary health care centre in rural Nigeria.Study population: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan.Measurements: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. Measurements will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated.Outcomes: 1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2) The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3) The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained.Analysis: The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model.Results of QUICK-I can be used by policy makers and professionals who aim to implement CVD prevention programs in settings with limited resources. The context of the insurance program will provide insight in the opportunities community health insurance may offer to attain sustainable chronic disease management programs in low resource settings.This protocol has been registered at ISRCTN, ID number: ISRCTN47894401.Cardiovascular diseases (CVD) are well established as a leading contributor to the burden of disease in low-income and middle-income countries (LMIC). Over 80% of global CVD mortality occurs in LMIC [1]. The burden of non-communicable diseases in LMIC is likely to increase substantially over the nex
Pharmacists’ Research Contributions in the Fight against HIV/AIDs  [PDF]
Alexis E. Horace
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/869891
Abstract: Pharmacists have made many contributions to HIV/AIDs research and are still showing their significance as members of the healthcare team through innovative clinical trials. Pharmacists are showing advances in several healthcare settings including inpatient, outpatient, and community pharmacies. Because of the complex regimens of highly active antiretroviral therapy (HAART), the increased life span of patients living with HIV, and other concomitant medications taken for comorbid disease states, there is a high risk for health-related complications and the development of adverse events. These adverse events may lead to decreased adherence to HAART, which may cause the development of HIV drug resistance. Pharmacists are providing examples through growing research on how they help combat medication-related errors and also continue to contribute as healthcare providers as a part of a holistic healthcare team. 1. Introduction With the invention and administration of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) has transformed from an acute disease to a chronic disease. The Centers for Disease Control and Prevention estimate that between the years 1996–2003, HAART extended life expectancy of patients living with HIV from 10 to 20 years [1]. Care for patients infected with HIV has shifted from primarily requiring acute treatment in the inpatient setting to needing chronic treatment in the primary and ambulatory care settings. During this time, pharmacists have assumed larger roles as members of healthcare teams who specialize in caring for patients of this population. The responsibilities of pharmacists surpass caring for HIV patients in a community pharmacy setting and have evolved into participating in direct patient care in hospitals and outpatient clinics. Concerns for patients with HIV extend beyond increasing CD4 cell counts and decreasing viral loads. Successful treatment for patients with this disease state depends on a holistic, patient-specific approach by a multidisciplinary team [9]. Management of all aspects of HAART is needed for successful treatment. Clinical pharmacists can provide many services such as pharmacokinetic drug monitoring, medication reconciliation, therapeutic medication recommendations, patient counseling, adherence consult services, and medication therapy management. These services have prevented medication errors, decreased medication misuse, and increased health-related outcomes [10–12]. Due to the complexity of HAART, there is a greater need to monitor adverse effects, drug-drug
Knowledge of folic acid and counseling practices among Ohio community pharmacists
Rodrigues CR,DiPietro NA
Pharmacy Practice (Granada) , 2012,
Abstract: Objective: To determine knowledge of folic acid use for neural tube defect (NTD) prevention and counseling practices among community pharmacists registered in Ohio.Methods: A cross-sectional study was performed on a random sample (n=500) of community pharmacists registered with the Ohio Board of Pharmacy and practicing in Ohio. A survey previously used by researchers to assess folic acid knowledge and practices among samples of other healthcare provider groups in the United States was adapted with permission for this study. The final tool consisted of 28 questions evaluating the knowledge, counseling practices, and demographics of respondents. The cover letter did not reveal the emphasis on folic acid, and surveys were completed anonymously. The university institutional review board deemed the study exempt.Results: Of the 122 pharmacists who completed the survey, 116 (95.1%) knew that folic acid prevents some birth defects. Twenty-eight (22.9%) responded that they “always” or “usually” discuss multivitamins with women of childbearing potential, and 19 (15.6%) responded that they “always” or “usually” discuss folic acid supplements. Some gaps in knowledge specific to folic acid were revealed. While 63.1% of pharmacists selected the recommended dose of folic acid intake for most women of childbearing potential, 13.1% could identify the dose recommended for women who have had a previous NTD-affected pregnancy. Respondents identified continuing education programs, pharmacy journals/magazines, and the Internet as preferred avenues to obtain additional information about folic acid and NTD.Conclusion: This study represents the first systematic evaluation of folic acid knowledge and counseling practices among a sample of pharmacists in the United States. As highly accessible healthcare professionals, community pharmacists can fulfill a vital public health role by counseling women of childbearing potential about folic acid intake. Educational materials may be beneficial in augmenting knowledge of folic acid and facilitating patient education.
Implementation of a Pharmacist-Directed Cardiovascular Risk and Medication Management Program for Participants in a Construction Trade Benefit Trust Fund  [PDF]
Yifei Liu, PhD,Randal P. McDonough, PharmD,Kara M. Carruthers, PharmD,William R. Doucette, PhD
INNOVATIONS in Pharmacy , 2010,
Abstract: Objectives: (1) To report the results of a pharmacist-directed cardiovascular risk management program; and (2) to identify obstacles faced by the pharmacists in the program implementation. Methods: The collaborators in this study included two local unions, a health benefit consulting company, and a community pharmacy. A total of 750 union workers with cardiovascular risk were informed about the cardiovascular risk management program. The program lasted six months, and the participation was voluntary. There were three group educational sessions with each session followed by a medication management service. A staff person of the health benefit consulting company and two pharmacists were interviewed via telephone. The interview questions were created according to the Gaps Model of Service Quality. The Gaps Model theorizes five gaps among consumerexpectations, consumer perceptions, management perceptions of consumer expectations, service quality, service delivery, and external communications to consumers. The following data were collected: (1) types and quantity of drug therapy problems, (2) pharmacists’ recommendations and prescribers' response, (3) patients’ quality of life, disability days, and sick days, and (4) the experience of involved parties. Descriptive statistics were calculated.Results: Fifteen union workers participated in the program. For the participants, 35 drug-related problems were identified, with “need for additional therapy” and “dose too low” being the most common problems. To address these drug-related problems, pharmacists made 33 recommendations to prescribers, and prescribers accepted 55% of the recommendations. According to the interviews, there were three barriers faced by pharmacists to implement the program: lack of consensus about the recruitment, union workers’ unawareness of the program’s benefits, and limited support from the unions and the health benefitconsulting company.Conclusions: It was difficult to recruit participants into the program. Clear agreement among collaborators on both the program’s benefits and the specific roles of each collaborator may be the key to successfully implement similar programs in the future.
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