Physicians’ perceptions, expectations, and experiences of clinical pharmacists in Jordan-2017 Abstract Background A decade ago, clinical pharmacy was a new concept in hospital settings in Jordan, as evidenced in our 2006/2007 study. Changes in the perceptions, expectations, and experiences of physicians regarding the role of clinical pharmacists need to be investigated. Objective To document physicians’ perceptions and expectations of, and experiences with, clinical pharmacists in hospital settings in 2017, and to assess differences in these areas between the 2017 and the 2006/2007 samples. Setting: The study was conducted at four hospitals in the north of Jordan. Method Physicians completed a self-administered questionnaire similar to the one used in our 2006/2007 study, which recorded demographics and assessed physicians’ perceptions, expectations, and experiences regarding clinical pharmacists. Data of the 2017 sample were analyzed and compared descriptively to those of the 2006/2007 sample. Main outcome measure Physicians’ perceptions, expectations, and experiences of pharmacists in hospital settings in 2017. Results Two hundred and ninety-five physicians completed the questionnaire. Physicians in the 2017 sample were most comfortable with pharmacists suggesting the use of prescription medications such as antibiotics (53.6%). Physicians in the 2017 cohort agreed with the eight expectations stated in the questionnaire. Physicians’ experiences with clinical pharmacists improved in 2017 from 2006/2007 in all eight areas evaluated. Conclusion Physicians’ perceptions, expectations, and experiences towards the professional role of pharmacists have changed over the past 10 years in Jordan.

Claudia Rijcken (ed): Pharmaceutical care in digital revolution, insights towards circular innovation

Consumption of methylphenidate and atomoxetine in the private healthcare sector in South Africa: a longitudinal study Abstract Background Globally Attention-Deficit/Hyperactivity Disorder (ADHD) has been in the spotlight. Despite some controversies, treatment of ADHD remains the cornerstone of patient care. Objective To describe the consumption of methylphenidate and atomoxetine in the private healthcare sector in South Africa over a four-year period (2013–2016). Method Data were extracted from the Intercontinental Marketing Service (IMS) database for the drug utilisation study. Consumption patterns were expressed as number of Defined Daily Doses (DDDs)/1000 inhabitants/day and number of DDDs/1000 inhabitants/month. Results Methylphenidate (95.85%) was the medication of choice when compared to atomoxetine (4.15%) in 2013. The corresponding figures for 2016 were 96.40% and 3.60%. Consumption of ADHD medication showed slight changes over the 4-year period. If only the private healthcare sector population is considered, consumption of methylphenidate was 6.010 DDDs/1000 inhabitants/day in 2013, and 7.827 DDDs/1000 inhabitants/day in 2016. A previous study (1994–1996) reported 0.12 DDDs/1000 inhabitants/day for methylphenidate. Consumption of atomoxetine was 0.044 DDDs/1000 inhabitants/day in 2013 and 0.050 DDDs/1000 inhabitants/day in 2016. Conclusion Consumption showed an increase in use of methylphenidate in South Africa, with small changes observed over the study period. Further studies are required.

Health-related quality of life of exposed versus non-exposed androgen deprivation therapy patients with prostate cancer: a cross-sectional study Abstract Background The survival rate of prostate cancer is relatively higher than other cancers, therefore, the health-related quality of life (HRQoL) becomes a critical issue for the patients. There are limited quality of life data evaluating the difference between androgen deprivation therapy and non-androgen deprivation therapy. Objective To evaluate the HRQoL among prostate cancer patients with androgen deprivation therapy and non-androgen deprivation therapy in an Asian population. Setting The study was conducted at the urology outpatient department in a medical center and a regional hospital in southern Taiwan. Methods We collected the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire-Prostate (QLQ-PR25) among prostate cancer patients with and without androgen deprivation therapy from December 2017 to June 2018. The androgen deprivation therapy subjects in this study were using goserelin, leuprolide, degarelix, bicalutamide, enzalutamide, cyproterone, and abiraterone. The non-androgen deprivation therapy subjects were only receiving radiation therapy or radical prostatectomy. To investigate the determinants of HRQoL between androgen deprivation therapy and non-androgen deprivation therapy, multiple linear regression was used. Main outcomes measures The scores of EORTC QLQ-C30 and QLQ-PR25. Results In total, 182 subjects participated in the study of which 116 (63.74%) were in androgen deprivation therapy user group with a mean age (± SD, standard deviation) of 75.94 years (± 8.31), and 66 (36.26%) subjects were in non-androgen deprivation therapy user group with a mean age of 70.6 years (± 7.1). androgen deprivation therapy users’ quality of life was significantly lower than non-androgen deprivation therapy users (72.1 ± 19.3 vs. 77.8 ± 16.6, p = 0.0493). Conclusions The quality of life of patients with all-stages prostate cancer differs significantly between androgen deprivation therapy users and non-androgen deprivation therapy users. The HRQoL for androgen deprivation therapy users is worse than for the non-androgen deprivation therapy users. Additionally, the symptoms are the key determinants of the quality of life.

Adverse events in patients with ankylosing spondylitis treated with TNF inhibitors: a cross-sectional study Abstract Background Although TNF inhibitors are well established in ankylosing spondylitis treatment, the majority of studies on TNF inhibitors safety have been performed in rheumatoid arthritis patients. Meanwhile, it seems that TNF inhibitors in ankylosing spondylitis may present a better safety profile than we thought. Objective The aim of our study was to retrospectively investigate the occurrence of adverse events in ankylosing spondylitis patients treated with TNF inhibitors. Setting A single referral center in Poland. Methods Detailed medical history of ankylosing spondylitis patients was obtained during the interview with the patient and by reviewing electronic medical records. Patients treated with TNF inhibitors and patients without TNF inhibitors treatment were compared. Main outcome measure The incidence of adverse events during the 3 months period before the interview. Results A total of 150 patients, 103 in the treatment group and 47 in the control group, were included in the study. There were no differences in the incidence of adverse events, serious adverse events, infections and opportunistic infections between both groups. However, in the treatment group, noninfectious adverse events were significantly less frequent than in control group (RR 0.39, 95% CI 0.23–0.66), with abdominal pain as the most common noninfectious adverse event (RR 0.20, 95% CI 0.07–0.63). The differences in incidence rates of specific infections were not significant, except acute infectious diarrhea which also was less frequent in patients treated with TNF inhibitors (RR 0.17, 95% CI 0.03–0.85). The female gender was significantly associated with any adverse event occurrence (OR 2.36, 95% CI 1.15–4.83). Conclusion TNF inhibitors show a good safety profile in ankylosing spondylitis patients.

Pharmacy-supported interventions at transitions of care: an umbrella review Abstract Background Medication discrepancies arising at care transitions are prevalent and are linked with adverse drug events and increased healthcare utilization. Evidence is lacking about which pharmacy-supported interventions at care transitions are most effective for both the patient and the healthcare system. Aim of the review To invesitigate the content and effect of pharmacy-supported interventions at transitions of care. Method The PubMed, Ovid/Medline and Cochrane Database of Systematic Reviews databases were used. The search was limited to systematic reviews and meta-analyses published in English up to May 2018. Included reviews investigated any intervention related to medication therapy performed by pharmacists or multiple healthcare professionals, including a pharmacist, at transition points in any healthcare setting. Reviews were excluded if interventions were not clearly defined or were not performed at care transitions or were not related to medications. A quality assessment was performed using the PRISMA guidelines. The data extracted included general characteristics, methodology, point of transition, pharmacy-supported interventions and outcomes. For systematic reviews, narrative conclusions were extracted. For meta analyses, reported relative risks or odds ratios were extracted along with the 95% confidence intervals. Results Nine systematic reviews and 5 meta-analyses reporting 162 studies were included. The interventions analysed included medication reconciliation (7 reviews) and composite interventions (7 reviews). Six studies reviewed interventions performed by pharmacists alone, while 8 studies explored interventions by different healthcare professionals, including a pharmacist. A positive effect on either medication discrepancies or (potential) ADEs was observed in all reviews. Mixed effects were observed for hospitalizations rates (9 reviews) and costs (4 reviews), regardless of the intervention applied. Mixed effects were also observed for both medication reconciliation and composite interventions on the number of emergency department visit. Interventions showed no significant effect on mortality (4 reviews). The quality of the reviews showed significant variability. Conclusion Pharmacy-supported interventions at transitions of care are heterogeneous and potentially improve medication safety, but show no significant effect on mortality. The effect on healthcare utilization and costs is inconclusive.

The appropriateness of psychotropic medicines: an interview study of service users attending a substance misuse service in England Abstract Background Mental health problems are common in people with substance misuse problems. However, there is a paucity of evidence regarding prescribing of psychotropic medications for people with comorbid mental health and substance misuse problems. Objective To explore the views of service users attending an addiction service on the appropriateness of psychotropic medications prescribed for their co-existing mental health problems. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with twelve service users. Data were analysed using thematic framework analysis. Main outcome measure Service users’ views concerning the appropriateness of their prescribed psychotropic medications. Results The following themes captured service users’ views on the appropriateness of their medications: benefits from medicines, entitlement to medicines, and assessment and review. Service users mostly described benefits from their medications (including those prescribed outside guideline recommendations) and there was also an awareness of the adverse effects they experienced from them. It appears that people with substance misuse problems have a particularly strong sense of their own needs and seek to influence prescribing decisions. Service users further described varied practices regarding assessment and review of their medications with evidence of regular reviews while others identified suboptimal or inadequate practices. Conclusion Most service users described improved functioning as a result of their prescribed psychotropic medications. Prescriptions that are inappropriate in terms of their usual indications may well be justified if they assist in stabilising service users and moving them on to recovery.

Balancing traditional activities and cognitive pharmaceutical services by community pharmacists: a work sampling study Abstract Background Community pharmacy is undergoing a transition, shifting focus from traditional roles to the provision of cognitive pharmaceutical services. However, traditional activities performed by community pharmacists reduce the amount of available time for implementing and providing such services. Therefore, hampering the community pharmacist in the transition. Objective The aim of this study was to identify characteristics of community pharmacists that spend a higher proportion of their time on cognitive pharmacy services and to identify activities that compete with time spent on such activities by community pharmacists. Setting Daily community pharmacy practice. Method Self-reporting work sampling using smartphone technology was used to register the activities of community pharmacists. Participating pharmacists recorded their current activity five times per working day for 6 weeks and also completed an online survey about baseline characteristics. Main outcome measure Time utilization. Results Ninety-one Dutch community pharmacists provided work-sampling data. The results showed that Dutch community pharmacists are predominantly spending less time on managerial activities when spending more time on cognitive services (from 25.7% to 14.5%, p = 0.016). Pharmacists who are spending more time on such services, want to spend even more time on direct patient contact compared to pharmacists who spend less time on it (p = 0.030). Conclusion This study shows that community pharmacists that spend more time on cognitive pharmacy services are devoting less time on managerial activities, logistics and other activities. Pharmacists spending more time on cognitive pharmaceutical services are mostly locum pharmacists or work at a pharmacy located in a residential area with largely older inhabitants.

Engaging patients to access the community pharmacy medicine review service after discharge from hospital: a cross-sectional study in England Abstract Background The post-discharge Medicines-Use-Review (dMUR) is a commissioned service in England and Wales whereby community pharmacists facilitate patients’ understanding of their medicines and resolve any medicine-related problems. This service is poorly utilised. Objective To explore the impact of raising hospital patients’ awareness of dMURs on their uptake. Setting Hospital in South East England. Method Patients on medical wards with at least one change (medicine, or dose regimen) to their admission medicines were provided with standardized written and verbal information about the service. Participants were responsible for their own medicines and anticipated that they would be discharged home. Structured telephone interviews conducted 4 weeks after discharge explored any medicine-related issues experienced, and reasons for engaging, or not, with the dMUR service. Responses to closed questions were analysed using descriptive statistics. Responses to open questions were analysed thematically. Ethics approval was obtained. Main outcome measure Proportion of patients who received a dMUR and their motivations or barriers to accessing the service. Results Hundred patients were recruited and 84 interviewed. Their mean (SD) age was 73 (11) years. They were taking a median (range) of 9 (2–19) medicines. 67% (56/84) remembered receiving information about dMURs. Nine (11%) had attempted to make an appointment although four had not received the service because the pharmacist was unavailable. Most (88%) were not planning to access the service. The most common reason given was poor morbidity or mobility (13/31, 42%). Conclusion The use of written and verbal information to encourage patients to use the dMUR service had minimal impact.

Pharmacists’ perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study Abstract Background Medication reviews by pharmacists have been shown to identify and reduce drug-related problems in long-term care residents. Objective To explore pharmacist perspectives of the Australian Government funded pharmacist-conducted residential medication management review and its role improving the quality and safety of prescribing in long-term care, in particular for those living with advanced dementia. Setting Australian Long-term care pharmacists. Method A qualitative research methodology approach using semi-structured interviews was used, with participants pharmacists with Residential Medication Management Review experience. Interviews were recorded, transcribed and coded utilising a meta-model of Physician-Community Pharmacy Collaboration in medication review. Main outcome measure Pharmacists’ perspectives on the Residential Medication Management Review and how to improve the quality of reviews for residents with advanced dementia. Results Fifteen accredited pharmacists participated. The majority believed that the Residential Medication Management Review had the potential to improve the quality and safety of medicines but highlighted systemic issues that worked against collaborative practice. Participants emphasised the importance of three-way collaboration between general practitioners, pharmacists and nursing staff and highlighted key strategies for its optimisation. Conclusion Incorporating avenues for greater communication between team members can improve collaboration between health professionals and ultimately the quality of medication reviews.