Pharmaceutical Care:An Additional and Personalized Service in Health Care

The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.

The Introduction of Pharmaceutical Care in Psychiatric Outpatients in Community Pharmacy of the Northeast Region of Argentina

The purpose of this paper is to implement a pharmaceutical care program in psychiatric outpatients in a community pharmacy. Outpatients （536） with psychiatric treatment requiring the dispensing of medication prescribed by a psychiatrist were followed up in a community pharmacy, where different medicines were prescribed as PS （pharmaceutical specialties）, PC （pharmaceutical compounding） or both PS and PC. Each prescription was registered with details on a patient level. Also, three reporting sheets were designed： patients profile, patients monitoring and patients counseling. The total study population in the community pharmacy consisted of 536 outpatients： 357 （66.6%） females and 179 （33.4%） males. Most of the outpatients （78.5%） have health insurance, 50% correspond to public and 28.5% to private institution. The other patients （21.5%） do not have medical insurance. We also observed that the education level of these patients was： primary school 19.1%; high school 45.9%; college 15.3% and university 20.7%. Many patients had more than one psychiatric diagnosis, to whom were prescribed different medicines. All the medication studies on the charts were screened for prescriptions with antidepressants and other psychotropic drugs, starting on the date of first diagnosis made by a psychiatrist. The counseling to the patients was also registered. The possibility of the follow-up of these outpatients in the community pharmacy promoted the development of the psychiatric pharmacy and all advances in care for patients with mental health needs, working in closer collaboration with psychiatrists.

Pharmaceutical Care in Homeopathic Treatment

Homeopathy is a therapy based on the principle of similarity. This therapy was proposed by the father of medicine, Hippocrates for almost 3000 years, thus developing the principle ＂Similia similibus curantur＂. Therapy with homeopathic medicines is widely used in therapeutics, but the patient often has difficulty in understanding how the treatment should be conducted. The Pharmaceutical Care, one pact relationship between patient and pharmacist, presents itself as an appropriate tool to assist in obtaining positive results in homeopathic therapy. Objectives： to demonstrate how the pharmacotherapeutic follow--AFT assists in detecting and solving problems related to homeopathic medicine and promotes improvements in response to treatment. Methodology： we performed literature review of the portals： SCIELO, MEDLINE and Google academics. Patients were interviewed by pharmacotherapeutic monitoring that was conducted--AFT employing the Dader method adapted to pharmaceutical care in homeopathic medicines in a pharmacy, this place was located in Rio de Janeiro, from November-December 2010 and January 2011. The research was previously approved by the Research Ethics Committee of the Unigranrio （CAAE： 4531.0.000.317-10）. Results： the first of three interviews were identified DRM （drug related problem）, having been required to apply IF--pharmaceutical intervention to adjust the behavior of the patient regarding the treatment and improvement of the results. Conclusions： the pharmacotherapeutic follow--AFT--introduced himself as appropriate methodology for managing patients on therapy with homeopathic medicines, and an improvement factor in the outcome of treatment of the patients.

A Study of Attitudes toward Pharmaceutical Care during COVID-19 Pandemic in Tbilisi(Georgia)

Background:After the outbreak of COVID-19 in Georgia,the number of patients visiting pharmacies has increased.It became relevant to research the importance of Pharmaceutical Care inprevention of COVID-19.The aim of the study was to understand the attitudes of patients and physicians regarding the involvement of pharmacists in prevention of COVID-19,after the spring and autumn waves of pandemic;also,what role can pharmacists take in the future and whether they can transfer Good Pharmaceutical Practice(GPP)to Georgia.Study also tried to capture overall attitudes towards involving pharmacists in healthcare projects such as population rapid testing and vaccinations.Methods:522 patients,1289 pharmacists,and 200 physicians were surveyed regarding their attitudes toward pharmaceutical care during COVID-19 pandemic.Results:The study found that 82.2%of surveyed patients who visited pharmacy during pandemic bought medication and COVID-19 preventive items(face mask,disinfectants,etc.).Out of the surveyed participants,66.9%of patients and 77.1%of pharmacists believe that recommendations given by pharmacists play an important role in the prevention of COVID-19.Study also revealed that 76.6%of pharmacists and 79.3%of patients agree with the statement,the pharmacist should be able to decide whether to choose over-the-counter medications for a patient or refer the patient to a physician.91.8%of patients and 78.3%of pharmacists believe that during a pandemic pharmacist should provide patients who visit pharmacies with complaints of flu,cold,and fever with Pharmaceutical Care;which is agreed by 41.7%of physicians.63.1%of patients,52%of pharmacists,and 45%of physicians have a positive attitude towards administering rapid testing of COVID-19 by pharmacists.The desire for pharmacists to be involved in vaccination was expressed most in patients(43.6%),followed by pharmacists(38.7%),and physicians(36.7%).Conclusions:The study showed similar attitudes of patients and pharmacists-Pharmaceutical Care plays an important role in pandemic prevention.The attitude of patients and pharmacists is positive regarding administering Pharmaceutical Care for patients who come in pharmacies with symptoms of flu and cold.Physicians had more cautious attitude towards the issue,indicating that they may see risks of spreading the virus and aggravating patients’conditions.Most patients who participated in the study believe that pharmacists should be involved in pandemic prevention activities-COVID-19 tests and vaccinations.It is recommended that Georgian healthcare system develops projects that support collaboration of medical professionals and bring us closer to Good Pharmacy Practice(GPP).Training of pharmacists along with physicians in scope of pandemic prevention projects should be planned.

The Guiding Role of Pharmaceutical Care in the Rational Drug Use of Bronchial Asthma

Objective:To investigate the guiding role of pharmaceutical care in the treatment of bronchial asthma.Methods:Eighty patients with bronchial disease admitted to our hospital from November 2008 to December 1818 were enrolled in this research.The computer program was used to generate random numbers.The method was divided into two groups:control group and observation group,40 cases respectively.40 patients in the control group were treated with normal medication according to the doctor’s advice;40 patients in the observation group were enrolled in the pharmacological care on the basis of the control group,and the rational drug use was compared between the two groups.Results:The incidence of adverse reactions in the observation group and the control group were 5.00%and 17.50%,respectively,and the difference was statistically significant(P<0.05);the incidence of medication error events in the observation group was 7.50%,which was significantly lower than that of the control group,which was 25.00%,and the difference was statistically significant(P<0.05).The medication errors mainly include improper administration,incorrect dosage,and unscientific administration.Conclusion:The guiding role of pharmaceutical care in bronchial asthma rational drug use can reduce medication error events and ensure rational drug use,which is worthy of popularization in clinical practice.

Pharmaceutical care of a patient with antibiotic-associated encephalopathy

Objective:To provide reference of pharmaceutical care for the clinical treatment of a severe patient with antibiotic-associated encephalopathy.Methods:Clinical pharmacists participated in the clinical treatment of the patient with antibiotic-associated encephalopathy,provided pharmaceutical care for clinicians,including the evaluation of adverse drug events and the prevention of adverse drug interaction and development of anti-infection programs by using Pharmacokinetics/pharmacodynamics theory and therapeutic drug monitoring technique.Results:Through active clinical treatment and pharmaceutical care,the symptoms of patients with encephalopathy were relieved,and the infection was effectively controlled.Conclusion:Clinical pharmacists play a positive role in the treatment for the case with antibiotic associated encephalopathy.

Study on the Management Effect of Pharmaceutical Care on Adverse Reactions of Traditional Chinese Medicines in Joint Surgery and Neurology

Objective:In general hospitals,pharmaceutical care was carried out to reduce the incidence of adverse drug reactions(ADR),and this effect was significant.It can significantly reduce the incidence of adverse drug reactions and improve the safety of drug therapy.The Joint Surgery Department and the Department of Neurology of Changle County People's Hospital in Shandong province were investigated for the effect of pharmaceutical care on reducing adverse drug reactions.Methods:120 patients were selected from the Department of Joint Surgery and Neurology,Changle County People's Hospital,Shandong Province from May 2015 to May 2020.According to the random table method,the patients were divided into experimental group(60 cases)and control group(60 cases).Control group:routine drug therapy.Experimental group:pharmaceutical care treatment was carried out jointly,and the incidence of adverse reactions was compared between the two groups.Results:The incidence of adverse reactions in experimental group was lower than that in control group.Conclusion:In general hospitals,pharmaceutical care is effective in reducing adverse drug reactions,which can significantly reduce the incidence of adverse drug reactions.At the same time,this improves the safety of drug treatment,which is worthy of clinical promotion.

Pharmaceutical Care of the Patients Suffering from Depression

Depression is the most present mental disorders with a very expensive treatment costs. Due to the high prevalence of depression in Bosnia and Herzegovina and high work load of psychiatrists, patients that suffer from depression are often marginalised, stigmatised and inadequately treated. Therefore, a pharmacist can influence an adequate selection of a therapy through an interdisciplinary approach and pharmaceutical care and alos provide patient monitoring, counselling about side effects and interactions of the prescribed drugs, which will in the end improve the quality of life for patients that suffer from depression. The aim of this work was to establish the influence of pharmaceutical care on the outcome of the quality of life and the pharmacological treatment of patients suffering from depression. Results showed that the involvement of pharmacist in a multidisciplinary approach to the treatment of depression lead to improvement of the effect of therapy and increased quality of life.

Design of Pharmaceutical Care Process for Retail Pharmacies Based on Pareto Analysis

Objective To study the problems of pharmaceutical care in retail pharmacies and provide reference for the standardized development of pharmaceutical care in China.Methods Based on the literature of CNKI database,Pareto analysis was used to study the present situation of pharmaceutical care in retail pharmacies.Then the following problems in pharmaceutical care were found such as low personnel professional quality,inadequate attention,imperfect laws and regulations,and lack of standard service process.As to the first three problems,there were more research references.But there was less literature on the standard care process.Results and Conclusion Focusing on the customer demand,taking drug sales process as the basic framework of pharmaceutical care standardized process,and combining with the collaboration,the service process including prescription drugs review and OTC drugs purchase consultation is established.This process elaborates the division of staff services as well as the service standards in pre-sale,on-sale,and after-sale stages.Besides,it also puts forward some advice for the previous three problems,which will ensure the smooth implementation of pharmaceutical care in drugstores.

A study of the impact of pharmaceutical care on medication compliance in asthmatic children

The objective of the study is to study the impact of pharmaceutical care on medication compliance in asthmatic children. The results will be used to further develop the pharmaceutical care delivered by pharmacists for asthmatic children, and to promote children＇s asthma control in China. The study was conducted in outpatient department of Beijing Children＇s Hospital from Mar. to Sept., 2009. Asthmatic children （101） were randomly divided into two groups： the intervention group that received routine treatment and complete pharmaceutical care provided by pharmacists and the control group that received routine treatment only. Questionnaires were distributed to both groups and responses were analyzed statistically. Our results showed that the percentage of children using medication following doctor＇s instructions in the intervention group was significantly higher than that in the control group （66.67% and 36.00%, respectively）; the percentage of children correctly using inhaler devices in the intervention group was significantly higher than that in the control group （78.26% and 32.84%, respectively）; children and care givers of the intervention group had significantly more knowledge about medication compliance. In conclusion, the pharmaceutical care provided by pharmacists could improve medication compliance of asthmatic children, and it would be desirable to further develop the pharmaceutical care for asthmatic children across China.

Assessment of the quality of randomized controlled trials on pharmaceutical care for asthmatic patients in journals of China's Mainland

The objective of this study was to assess the quality of randomized controlled trials（RCTs） on pharmaceutical care for asthma tic patients conducted by pharmacists in China's Mainland, to identify the problems in current studies, and to provide some references for further studies. The China National Knowledge Infrastructure（CNKI）, Wanfang Database, and VIP Database were searched for randomized controlled trials on pharmaceutical care for asthma tic patients, and only those studies undertaken by pharmacists were included. Information about the study design and reporting of selected studies was extracted and collected to systematically analyze these studies. Meanwhile, the Cochrane Collaboration＇s tool for assessing risk of bias was used to assess potential biases related to these studies. Ultimately, 14 articles were included in this study. No study determined the sample size in a scientific way. No article reported a scientific and detailed method of random sequence generation or allocation concealment. Two（14.3%） studies claimed to have implemented a double-blinding and a single-blinding respectively, but neither of them reported any details about how they performed the blinding. No study employed a blinding of outcome assessment. Five（35.7%） studies either stated statistical methods incompletely or used them incorrectly. One（7.1%） study reported an attrition without employing an intention-to-treat analysis. All studies reported eligibility criteria for participants to some extent, and all these criteria involved diagnosis of asthma, but only four（28.6%） of them reported patients＇ ages and three（21.4%） described the severity and the stage of asthma. Nine（64.3%） reported baseline data in the text rather than in a table, and 13（92.9%） involved comparisons between groups with significance tests either explicitly or implicitly. No report made a distinction between primary and secondary outcomes. Two（14.3%） mentioned informed consent of subjects, while no article reported ethical approval. ＂Unclear risk＂ made up the highest percentage of the studies analyzed according to the risk of bias assessment by the Cochrane Collaboration＇s tool. Our study demonstrates that the quality of RCTs on pharmaceutical care for asthma tic patients conducted by Chinese pharmacists is suboptimal, especially with regards to study design and reporti ng.

A study of drug therapy problems in pharmaceutical care

We evaluated the frequency and category distribution of drug therapy problems in young and elderly patients. A retro- spective study of the medical conditions, drug therapies, and drug therapy problems identified in 102 patients was performed. The patients were divided into young patient group （〈65 years of age） and elderly patient group （〉~ 65 years of age） in a hospital pharmacy setting. Inclusion criteria： patients who were referred by the treating doctors and received evaluation by the clinical pharmacists. Exclusion criteria： patients who were unable to or refused to be evaluated by the clinical pharmacists. We found that 1） Patients in young and elderly groups had a mean of 3 and 5 medical conditions per person, respectively （P = 0.001）. 2） On the average, they took 4 and 7 drug therapies per person, respectively. The elderly patients took a significantly higher number of drug therapies （P = 0.001）. 3） Totally 85 drug therapy problems in 7 categories were identified within 102 patients. 4） 36.8% of young patients experienced 1 to 4 drug therapy problems whereas 61.8% of elderly patient experienced I to 5 drug therapy problems. Drug therapy problems were significantly more prevalent in elderly patients （P = 0.017）. 5） The drug therapy problem by category had similar distribution in young and elderly patients. The elderly patients in this study encountered more drug therapy problems than young patients. Accordingly, more attention should be paid to elderly patients in pharmaceutical care practice.

Importance of the Pharmaceutical Council in the Dispensation of Laxants and Probiotics

The goal of pharmaceutical care is to improve the patient’s quality of life, and it must do so by maximising its effectiveness and reducing the risks of the treatment. Therapeutic protocols are an important tool for encouraging the correct use of drugs. The aims of this work are： to analyse the type of patients who visit the pharmacies in the study; to determine the importance of pharmaceutical advice in dispensing; and to identify the most commonly used strains of probiotics and laxatives. A transversal descriptive and observational study was conducted with 500 patients in five pharmacies. The population taking part in the study is predominantly female, aged over 61, of Spanish nationality, actively employed and with middle or higher educational studies. Over 90% of the patients followed the advice of the pharmacist over the advice of their doctors. The most widely used probiotics were Lactobacillus acidophillus and Saccharomyces boulardii for gastrointestinal protection and treatment of diarrhoea. The most commonly used laxatives are bulk-forming and contact laxatives. The pharmacist’s opinion is increasingly important in the treatment of pathologies that may be considered as minor. Therapeutic protocols are an aid to correct dispensing.

Effect on Patient Safety of Brief Interventions Performed by Pharmacists via Drug Profile Books: VISualization of Treatment Assist by pharmacists (VISTA) Project in Japan

In Japanese pharmacies, Drug Profile Books (DPBs), which are a type of Personal Health Record (PHR), are incorporated in order to prevent duplicate medication and drug interactions in outpatients (patients) through the uniform management of drug administration information. In this study, we tried to clarify the effect on patient safety of brief interventions via DPBs by pharmacists. The study design was a randomized controlled trial on pharmacies as clusters. 65 pharmacies agreed to participate in the study (intervention group (IG): 33;control group (CG): 32). The primary outcomes were: rate of inquiry occurrence, rate of prescription change, and rates of duplicate medications & drug interactions. 56 pharmacies (IG: 29;CG: 27) completed the study. There was a higher tendency for prescription changes in the IG compared to the CG (IG: 0.03%;CG: 0.02%;P = 0.08). In addition, the rate of duplicate medications & drug interactions accounting for the inquiries was significantly higher in the IG than in the CG (IG: 89.2%;CG: 71.9%;P = 0.01). This implied that brief interventions by pharmacists using DPBs had an effect in raising patient safety.

Study of Consistency of Needs and Attitudes of Pharmacists towards Consumers/Patients in Retail Pharmacies in Georgia

Background:The demand for the pharmaceutical services in retail pharmacies has increased over the last decade.The aim of the study is to study the requirements of patients/customers in a modern changing environment to ensure that appropriate pharmaceutical care is provided to increase customer loyalty while taking into account the concept of pharmaceutical care.The study also examined the competence and attitudes of pharmacists in pharmaceutical care to meet the patient’s requirements.Methods:The study was conducted in December 2020.526 patients/pharmacy customers and 1,309 pharmacists participated in the study,via the online questionnaire.Participants were presented with questions such as“I visit pharmacy to buy products”and used 3 or 5-point scale to indicate their response.Results:When choosing a pharmacy,the costumers/patients prioritize:the quality of pharmaceutical services,speed of service,assortment,competence of the pharmacist and the price of the products;while receiving pharmaceutical care,customers want pharmacists to be oriented on them,to be professional and communicate in an understandable language.In pharmaceutical care,the pharmacists’visions and attitudes are consistent and meet with costumers’requirements.Conclusions:In Georgia,the pharmacy is no longer perceived as just a place to buy a medication,but 50%of customers go to the pharmacy to purchase cosmetic and hygiene products.Modern patient/costumer expectations tend to increase the speed and quality of pharmaceutical services.Considering the risks of the patients,it is recommended to expand the modern approaches-new technologies and online services to improve/accelerate the processes in retail pharmacies.

A review on analytical methods for pharmaceutical and personal care products and their transformation products

Pharmaceutical and personal care products(PPCPs)and corresponding transformation products have caused widespread concern due to their persistent emissions and potential toxicity.They have wide octanol-water partition coefficients(K_(ow))and different ionization constants(pK_(a))resulting in a poor analysis accuracy and efficiency.A suitable analytical method is the first prerequisite for further research on their environmental behavior to prioritize the substances.This study reviewed a full-scale analytical protocol for environmental samples in the recent ten years:from sampling to instrumental methods.Passive sampling techniques were compared and recommended for long-term continuous and scientific observation.A quick and effective sample extraction and clean-up method are highly required.Chromatographic methods coupled to mass spectrometry for determining PPCPs with a wide range of logK_(ow)(-7.53 to 10.80)were summed up.High-resolution mass spectrometry was confirmed to be a promising strategy for screening unknown transformation products,which would provide a nanogram level of detection limits and more accurate mass resolution.Screening strategies and mass change principles were summarized in detail.The recovery rate was important in multiple contaminants analysis identification and factors affecting the recovery rate of PPCPs were also discussed in this review,including sample matrix,target compounds characteristics,extraction method and solid-phase adsorbent.This review provides useful information for the selection of appropriate analytical methods and future development directions.

Facile in situ growth of highly dispersed palladium on phosphotungstic-acid-encapsulated MIL-IOO（Fe） for the degradation of pharmaceuticals and personal care products under visible light

A simple, facile in situ reduction approach is reported for the synthesis of Pd- nanoparticle-decorated phosphotungstic acid （PTA）-MIL-100（Fe） nanocomposites （Pd-H3PW12040-MIL-100（Fe）, denoted Pd-PTA-MIL-100（Fe））. During the in situ synthesis, PTA is encapsulated into the matrix of MIL-100（Fe） and serves as a UV-switchable reducing agent, resulting in highly dispersed Pd NPs. Using the photocatalytic degradation of pharmaceuticals and personal care products as model reactions, the ternary Pd-PTA-MIL-100（Fe） hybrids exhibited enhanced photocatalytic activity compared with their foundation matrices, the binary PTA-MIL-100（Fe） nanocomposite. Based on photoelectrochemical analyses, the improved photocatalytic performance can be attributed to the well-known electronic conductivity of the Pd NPs, the fast electron transport of PTA, the intense visible-light absorption of MIL-100（Fe）, and the matched energy levels of the three components： MIL-100（Fe）, PTA, and Pd NPs. Importantly, almost no Fe and W ions were leached from the samples during the reaction, demonstrating the photostability of the Pd-PTA-MIL-100（Fe） composite. In addition, possible photocatalytic reactions mechanisms have also been investigated.

Pharmaceuticals and personal care products (PPCPs) in the freshwater aquatic environment

Pharmaceuticals and personal care products(PPCPs)are a unique group of emerging environmental contaminants,due to their inherent ability to induce physiological effects in human at low doses.An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments,which raises concerns about the potential adverse effects to humans and wildlife.Therefore,this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment.The environmental risk posed by these contaminants is evaluated in light of the persistence,bioaccumulation and toxicity criteria.Available literature on the sources,transport and degradation of PPCPs in the aquatic environment are evaluated,followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment(water,sediment and biota)of the five continents.Finally,future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.

An efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care products in environmental waters

In this study,a hydrophilic resin named GCHM was fabricated based on poly(N-vinyl pyrrolidone-codivinylbenzene),characterized,and applied as a solid-phase extraction(SPE)material.Up to 44 pharmaceuticals and personal care products(PPCPs)belonging to 10 classes were recovered in environmental water samples.Different variables affecting extraction,such as adsorbent amount,sample pH,and loading speed,were optimized.Under optimal conditions,the average absolute recovgy of 44 PPCPs was 75.6%using GCHM,indicating a better performance than the commercial Oasis^HLB.SPE with home-made hydrophilic polymeric sorbent followed by ultra-performance liquid chromatography and tandem mass spectrometry was validated,and the method achieved good linearity(r2>0.991,for all analytes).In addition,the method detection limits of target compounds ranged from 0.03 to 0.6 ng/L.The developed method was applied to determine PPCPs in 10 environmental water samples taken from the Yangtze River,Huaihe River,and Taihu Lake,1 groundwater sample from Changzhou in Jiangsu Province,1 wastewater sample from Xiamen and 2 seawater samples from the Jiulong River in Fujian Province,China.In these samples,22 compounds were determined at levels ranging from 0.5 to 1590 ng/L.

Occurrence, sources and fate of pharmaceuticals and personal care products in the groundwater: A review

The presence of pharmaceuticals and personal care products(PPCPs)in the aquatic environment may pose potential threat to the ecosystem and human health,hence PPCPs have aroused much concern over the world.The contamination of PPCPs in the groundwater,the main source of drinking water supply in many countries and regions,has been extensively studied in the last decade.This paper reviews the occurrence of frequently detected PPCPs,including antibiotics,anti-inflammatories,lipid-regulators,carbamazepine,caffeine,and N,N-diethyl-m-toluamide in groundwater,with special concern to the progress made over the past three years.Possible emission sources for PPCPs in groundwater,such as wastewater and contaminated surface water,landfills,septic systems,livestock breeding and sewer leakage,are summarized.Besides,adsorption,migration and degradation,the dominant mechanisms in the subsurface transport and fate of PPCPs,are discussed,and the insights into the future study of PPCPs in the groundwater are provided.