Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

Interpretation of Pharmaceutical Pictograms by Pharmacy and Non-Pharmacy University Students

Background: The present study was undertaken to evaluate the correct interpretation by university students of internationally available pictograms and to assess the ability of the pictograms to convey the intended messages. Aim: To compare the ability of pharmacy and non-pharmacy students to comprehend pharmaceutical pictograms. Method: Twenty eight internationally available (United States Pharmacopoeial Convention Inc. USP) pictograms were used throughout this study, which was conducted with 300 pharmacy and non-pharmacy students. Questionnaires included relevant questions, and participants were instructed to study the pictograms and write their interpretations. The American National Standards Institute requirement of 85% correctness criterion was used for correct interpretation. Differences between responses of the two groups were calculated using SPSS version 18 and p < 0.05 was considered significant. Results: The majority of pharmacy (98%) and non-pharmacy (86%) students stated that pictograms should be included in medicine leaflet and they were helpful for all patients. Out of the 28 pictograms 7 (25%) and 2 (7.1%) of them achieved the ANSI requirement of 85% correctness criterion by pharmacy and non-pharmacy students respectively. Conclusion: Interventions to increase public awareness of the usefulness of pharmaceutical pictograms are needed.

Possibility of Drug-Drug Interaction in Prescription Dispensed by Community and Hospital Pharmacy

Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4-85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). Result and Discussion: The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug;spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. Conclusion: It is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.

Return on Investment after Implementation of a Centralized Automated Storage System in a Hospital Pharmacy

An ADS （automated dispensing system） was implemented in our hospital pharmacy in 2008 to optimize and secure the medication process. The main objective of this study was to compare the projected and the real ROI （return on investment）, after seven years of use. ROI was calculated annually （from 2008 to 2015）, by deducting the cost of investment （ADS buying and implementation, maintenance, repairs and ADS upgrade） from the cost saving （drugs stock reduction and decrease of pharmacy staff dedicated to global dispensing）. In 2015, total costs saving （＋$1,141,987） were divided between decreasing drug stock value and reduction of pharmacy staff. Total costs of investment （-$978,656） were acquisition, maintenance, repairs and an unplanned upgrade costs. Finally, the real ROI was ＋$163,331 after seven years of use. In 2008, projected ROI was ＋$410,786. The real payback period has been increased by approximately two years （six years of use, instead of four years as expected）. Despite their cost, ADSs are a worthwhile investment, leading to a ROI within a few years. These economic considerations should be put into perspective with optimization of drugs stock management, greater efficiency of the global dispensing process, securitization of medication process and redeployment of pharmacy staff.

The Managerial Role of Pharmacist at Community Pharmacy Setting in Saudi Arabia

In Saudi Arabia community pharmacies by law, be owned and managed by pharmacists. Although these two functions seemed to be the same but in reality, they are not. Some studies showed that in community pharmacy managerial functions account for more than 50% of total routine and critical activity for all managerial position surveyed while other study showed that only 13.6% of the pharmacist’s time spent in administrative activities. This article addressed the role of the pharmacist as manager and the way in which he/she manages the pharmacy to ensure optimum productivity. The main part of this review discussed the managerial role of pharmacist in management of human resources, financial resources, marketing, inventory, information resources and space management of the pharmacy. Additionally, the management process, professional skills of managers, development of managerial skills, problems in management process and their resolution were also discussed. In addition to management functions which also include planning, organizing, leading, and controlling processes. The author concluded that the skills of pharmacy managers may vary because of the lack of formalized management training programs. To bridges a gap in management education, interested pharmacists should be encouraged to shift their career goals from professional to pharmacy administration. In addition, expansion of curricula in pharmacy management to include management training of highest possible caliber in managerial skills is highly demanded. Formalized management training programs for those involved in community pharmacy practice are also warranted.

Pharmacy residency system in Gunma University Hospital

Recently,undergraduate and postgraduate pharmaceutical education systems have been changing greatly in Japan.In 2006,undergraduate pharmacist program was changed from 4 years course to 6 years course to train higher-quality pharmacists who can deal with the changes in the progression of medical technology and meet social demands for medication safety[1].As a postgraduate training system,pharmacy residency system was started in several hospital in 2002,and around 35 hospitals have pharmacy residency system at 2015[2].

The Impact of a Community Pharmacy-Based Coaching Program on Patient Confidence and Lifestyle

Objective: Like their urban counterparts, rural populations are experiencing increased health risks due to chronic disease. However, disease management is more problematic due to isolation, increased difficulty in getting to medical appointments, and reduced numbers of medical personnel. We undertook a pilot study to investigate the feasibility and utility of health coaching for rural residents with type 2 diabetes mellitus (DM2) from a local pharmacy. Methods: Using the pharmacy database to identify qualified individuals, a nursing student recruited four individuals aged 40 - 79, with a history of DM2 of 3 - 15 years, to participate in the pilot project. Individual in-person interviews were conducted to identify specific goals to effectively self-manage their condition and to rate their confidence in their ability to fulfill these goals. Three monthly sessions were held to review and update goals, and to record blood pressure, waist circumference and weight measurements. Results: At the end of the study, all four achieved success in reaching and maintaining their personal dietary and physical activity goals. Significantly, all participants expressed increased confidence in their ability to self-manage their diabetes after health coaching. Conclusion: The provision of health coaching services from local pharmacies has potential to support rural clients in chronic disease management in medically under-serviced rural areas.

Education Outreach: Raising Awareness of Diabetes and Pharmacy Careers

Objectives: 1) To demonstrate that education outreach in public schools by students in pharmacy education programs is effective at increasing knowledge of important health topics;2) To assess subject attitude towards pharmacy careers after education outreach. Study: A lecture was constructed providing participants with information about careers in pharmacy, diabetes, and information about health literacy. A multiple choice paper-based quiz covering the presented content both preceded and followed each delivery of the lecture. Increases in post-lecture scores of content-knowledge questions were seen in 10 of 11 questions, which indicated an overall increased knowledge from baseline. An additional question, which gauged student interest in pharmacy careers, showed a 10% increase in those who indicated they considered pharmacy as a career. Conclusions: The lectures, delivered by a student pharmacist, were effective in increasing awareness and knowledge of pharmacy as a career, diabetes as an important health issue, and health literacy as a problem pharmacists and other healthcare providers encounter on a daily basis.

Teaching Physical Assessment and Disease Screening to Students in the Health Professions: A Focus in Pharmacy Education

Background: As pharmacists continue to transition into the provision of public health care, physical assessment and disease screening will become part of their everyday practice, in a similar manner that it has been for doctors and nurses. Objective: The aim was to describe the health assessment of undergraduate curricula across three disciplines involved in public health care and to explore the students’ perceived training in a variety of health assessments. Method: Instructors of courses related to health assessment in medicine, nursing, and pharmacy colleges in Qatar were invited to participate in the curriculum review process. Students’ perceived training in a variety of health assessments was assessed using a self-administered survey. Both descriptive and inferential statistics were used to analyze the survey responses. Results: A narrative description for the similarities and differences in the health assessment curricula across the three colleges was provided. Blood pressure, heart rate, and heart sounds were the health assessments that almost all students received training on, although there were differences in where the training was delivered. The health assessments that the students perceived having received least training on were measuring bone mineral density, blood cholesterol and international normalized ratio reported by only 37%, 41% and 44% of students, respectively. Conclusion: The study identified a close alignment between each of the health discipline’s scope of practice and the health assessment content taught in each individual program. It also identified possible curricular gaps towards learning the skills of patient assessment that may need to be addressed.

Polypharmacy in Primary Care Practices among Chronic Elderly Patients in Gaza Strip

Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug;and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.

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.

Reducing Readmission Rates in Heart Failure and Acute Myocardial Infarction by Pharmacy Intervention

Background： Hospital readmissions are common, costly and largely preventable. Objectives： To evaluate the impact of a pharmacy-led medication discharge and post discharge counseling program on 30 day readmission rates for HF （heart failure） and AMI （acute myocardial infarction）. Methods： Three month prospective, quality improvement, pilot study with I-IF and AMI patients who received pre-discharge and post-discharge medication counseling from December 2013 to February 2014 whose 30 day readmission rates were compared to readmission rates from the previous fiscal year.Results： Fifty-one patients were included in the study. Primary endpoint of30-day readmission rates showed a 33.9% decrease for AMI and a 50.1% decrease for HF in readmission rates compared to the previous fiscal year, with a potential annual savings of $458,800. The study also identified 25.5% of patients having at least one medication error that was identified through medication reconciliation. Conclusions： Pharmacy provided medication reconciliation and medication discharge counseling reduced readmission rates as well as decreased medication errors. There is also a potential for significant health cost savings.

Community Pharmacy Experiences and Attitudes towards Diabetes Managment

To measure the experiences, knowledge and attitudes of community pharmacists in Jordan towards diabetes and its management. The validated diabetes knowledge survey tool obtained from Simpson et al, 2009 was modified to suit the Jordanian population of community pharmacists. It contains two sections related to the services that pharmacists provided to diabetics patients and attitude toward health care professionals. The random sampling selection method was used and oral interviews using modified questionnaires were administered to measure the attitudes of pharmacists in Jordan towards diabetes. Random selection was achieved via numbering lists of 1,000 community pharmacists with 500 being chosen randomly across the country. In a total of 422 completed survey （84.4%）, more than 60% of the pharmacists showed that they ＂sometimes＂ counsel diabetic patients. In addition, home blood glucose monitoring was promoted by around half of them. Only a small part of them showed that that they checked prescriptions for drug interactions. The most of them showed not to provide patients with information regarding insulin use and storage. The most of them showed that absence of time and lack of continuous education programs are the main barriers limiting community interaction with diabetic patients. Pharmacists should be provided with continuous diabetes education programs to increase and enhance their counseling skills. The community pharmacists should play a greater role toward the well being of diabetic patients.

Patient Perceptions and Effects of Single Community Pharmacy Systems： Key Elements for Transitions of Care

The primary objective of the study was to evaluate baseline patient perception on single versus multiple community pharmacy systems. The secondary objective was to determine effects of a pharmacist provided educational intervention on perception of using a single community pharmacy system. This was a prospective survey based study implemented in a single grocery store chain pharmacy and one location of a large retail pharmacy. An anonymous pre-survey was administered to eligible patients. The primary investigator then delivered a brief educational intervention followed by an anonymous post survey. This aimed to determine if there was a change in perception of components assessed in the pre-survey. Data analysis was performed using descriptive statistics. Subjects reported using approximately 1.5 pharmacies. Major reasons included cost, location, and immunizations. 63% of subjects answered that their pharmacist will not have an accurate medication list when using multiple pharmacies, however, 92% of subjects responded that the pharmacist should be aware of all medications they take. Education on multiple pharmacy use may help protect against its risks. Cognizance of medications filled at other pharmacies and close communication between patients and pharmacists may help foster pharmacist-patient relationships while reducing the risk of multiple pharmacy use.

Research progress of Sini decoction in pharmacy, pharmacology and clinical application

Sini decoction originated from Zhang Zhongjing's Treatise on Cold Pathogenic and Miscellaneous Diseases(200-210 C.E.)in the Eastern Han Dynasty.It is a traditional and famous prescription in China.Its preparations mainly include Sini decoction,Sini decoction drop pills and Sini decoction suppositories.The main chemical components are diterpenoid alkaloids,gingerol,volatile oil,coumarin,polysaccharide,triterpene saponins,flavonoids,amino acids,and alkaloids.This product has a cardiovascular function,anti-shock,anti-diabetes complications,anti-tumor,anti-atherosclerosis,and effects on the nervous system.Modern clinical practice is widely used in cardiovascular,respiratory,digestive,neurological and gynecological diseases.This paper reviews the pharmaceutical research,pharmacological effects,safety evaluation and clinical application of Sini decoction,including the source and composition of Sini decoction,the origin and resource status of authentic medicinal materials of Sini decoction,the research on preparation form reform,chemical composition and quality control,to provide a reference for further research and clinical promotion of Sini decoction.

The development of polycarbophil as a bioadhesive material in pharmacy

Polycarbophil(PCP),a kind of pharmaceutical polymers with superior bioadhesive properties has been widely used in the field of controlled drug delivery systems.It could be used as a highly efficient thickener,bioadhesive agent,suspending aid and emulsion stabilizer when dispersed in water or other polar solvents.These exceptional utilities of the polymers result from their hydrophilic nature.Hydrogen bonding plays an important role in most adhesion behaviours and becomes the main adhesion force.This paper reviews the applications of PCP in pharmacy over the past decades,and clarifies its unique advantages in the bioadhesive formulations.After an introduction discussing its structural characteristics and action mechanism,the focus turned to the description of its available applications in detail with particular emphasis on the ocular,nasal,vagina and oral drug delivery systems.The other less developed formulations are also described,including the buccal and the transdermal delivery systems.

Revolutionizing patient care:the latest advancements in clinical pharmacy practice

The world of healthcare is constantly evolving,and one area that has seen significant advancements in recent years is clinical pharmacy practice.1 In the past,pharmacists were mainly responsible for dispensing medications and ensuring that patients understood how to use them safely.However,the role of clinical pharmacists has expanded significantly in recent years,and they now play a critical role in optimizing medication regimens,providing personalized patient counselling,and collaborating with other healthcare professionals to improve patient outcomes.2-3 In the extension of the role of the clinical pharmacist,nowadays health economics is also added,which includes cost-benefit analysis,cost-effectiveness analysis,cost-utilization analysis and costminimization analysis,which will ultimately help the policy and decision makers to make the cost of the drugs affordable,so that all the patient population can avail the benefits.

Level of Stress, Predisposing Factors and Status of Mental Health among Pharmacy Students of a Private University of Dhaka, Bangladesh: A Cross Sectional Study

Stress during tertiary educational period has significant negative effect on the performance of a student. Mental distress is increasing among students and is one of the important public health concerns. This study was carried out to investigate the socio demographic characteristics of students, level of their stress feeling, and status of mental health and to find out the co-relation of different factors associated with the level of stress feelings. A cross sectional study was conducted among the students of the Department of Pharmacy of UAP. A total of 504 students (181 male students and 323 female students) participated in this study. Feeling of severe stress was almost equal to both sexes. But, moderate level of stress was more associated with female students (N = 253, F = 78.33%) and overall female students were more stressful than male. Thought towards future career ranked one among many reasons of stress in students (59.67% for male students and 37.46% for female students). In terms of academic achievements, feeling of stress was higher in female students compared to male students (34.98% for female students vs. 15.47% for male students). Other factors such as unrealistic expectations, family relationship and affairs, socio economic condition, being of too busy also significantly participate in the development of stress in young mind. Mental health status was estimated by considering some facts such as state of shock due to unwanted life events, lacking of expression of emotions, reduced feeling of pleasure, unusual thinking, fear of any specific objects, short term memory loss, self identity disorder and lack of self confidence. We co-related different risk factors like age, gender, socio-economic condition, unrealistic thought patter to different levels of stress feeling. Feelings of stress were most among the student of 21 - 25 years of age. Socio-economic condition is always a great factor of stress, middle class society has more stress compared to other socio-economic classes. Psychological counseling is required in educational institution to detect and prevent mental distress and stress among students.

Research Progress of Paederia scandens(Lour.)Merr in Modern Pharmacy

Paederia scandens(Lour.)Merr.is a traditional Chinese medicine,which mainly has the functions of analgesia,detoxification,anti-inflammatory and anticonvulsant.Modern studies show that the main chemical constituents of this plant are iridoids and volatile oil,which have biological activities such as analgesia,anti-inflammatory,hepatoprotection,renoprotection and antibacterial.This review highlights the chemical constituents and biological activities of P.scandens based on studies published in last decades and provides the references for the further development and utilization of this medicinal plant.

Physicochemical characterization, the Hirshfeld surface, and biological evaluation of two meloxicam compounding pharmacy samples

Meloxicam(MLX) is an anti-inflammatory drug susceptible to variations and crystalline transitions. In compounding pharmacies, the complete crystallographic evaluation of the raw material is not a routine procedure. We performed a complete crystallographic characterization of aleatory raw MLX samples from compounding pharmacies. X-ray diffraction indicated the presence of two crystalline forms in one sample. DSC experiments suggested that crystallization, or a crystal transition, occurred differently between samples. The FTIR and ~1H NMR spectra showed characteristic assignments.^(13)C solid-state NMR spectroscopy indicated the presence of more than one phase in a sample from pharmacy B. The Hirshfeld surface analysis, with electrostatic potential projection, allowed complete assignment of the UV spectra in ethanol solution. The polymorph I of meloxicam was more active than polymorph III in an experimental model of acute inflammation in mice. Our results highlighted the need for complete crystallographic characterization and the separation of freely used raw materials in compounding pharmacies,as a routine procedure, to ensure the desired dose/effect.