Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

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.

Study on the Management of Chronic Diseases in American and British Community Pharmacy

Objective To provide a reference for promoting the construction of chronic disease management in community pharmacies in China.Methods Literature research and comparative research methods were used to analyze the management of chronic disease carried out by community pharmacies in the United States and the United Kingdom.Results and Conclusion The management of chronic diseases in American and British community pharmacies has formed retail health clinic and online chronic disease mode.It is recommended that Chinese government should issue measures and supporting guidelines for the management of chronic diseases in community pharmacies as soon as possible.Community pharmacies should be encouraged to carry out chronic disease management with the concept of prudent inclusion and gradual progression.Meanwhile,the concentration of drug retail industry should be improved to carry out the systematic construction of chronic disease management and build a standardized chronic disease service process.Besides,community pharmacies should make full use of new technologies such as the Internet,cloud computing and big data,smart wearable devices,and chronic disease management Apps to explore and carry out online professional chronic disease management mode.

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.

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.

The Problems and Countermeasures of Four Community Pharmacies on Drug Quality Management in Kangping County

Objective To study the drug quality management of four community pharmacies and provide countermeasures and suggestions for improving the drug management level in Kangping County.Methods Literature research and investigation research were adopted in this paper to analyze the current situation and problems of drug management in four community pharmacies in a town of Kangping County.Results and Conclusion The problems of four community pharmacies in a town of Kangping County are low level of drug quality management,insufficient quality and capability of the practitioners and physician’s illegal act such as some licensed pharmacists paid from the linked pharmacies.There are also problems in facilities and equipment,drug display and storage,and document management,which reflects the lack of local drug supervision.Based on the above problems,some countermeasures and suggestions are put forward to strengthen the drug quality management of four community pharmacies in Kangping County.

Availability of Antimalarial Medicines in Community Pharmacies of Lusaka District, Zambia: Implications on Compliance to Malaria Treatment Guidelines

Background: Malaria remains a major cause of morbidity and mortality in Zambia, affecting all levels of society, with children under the age of five and pregnant women being most at risk of serious illness. The availability of antimalarial medicines is one of the key interventions of malaria management. This study assessed the availability of antimalarial medicines in community pharmacies in Lusaka district, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 210 community pharmacies from September to November 2022 using a well-structured checklist in selected areas of Lusaka district. The availability was verified by a physical check of the product. The checklist contained the medicines listed both in the guidelines for diagnosis and treatment of malaria in Zambia as well as in the World Health Organization (WHO) malaria treatment guidelines. Results: This study found that all antimalarials listed in the local treatment guidelines for malaria were available in community pharmacies, though with the varying distribution. Of the 210 community pharmacies, 209 (99.5%) had artemether/lumefantrine in stock. The lowest available antimalarial was quinine/clindamycin, which was only available in 3 (1.4%) of the outlets. Conversely, 3 out of 16 (18.8%) antimalarials that were available in community pharmacies were not listed in the local treatment guidelines of malaria in Zambia, despite being listed in the WHO malaria treatment guidelines. This translated into a compliance level of 81.2% based on the local malaria treatment guidelines. Conclusion: This study concluded that antimalarials were available for all categories of malaria management in community pharmacies, though with a varying distribution. The presence of antimalarials not listed in the Zambian treatment guidelines is of public health concern which may have an impact on antimicrobial resistance in the future.

Methadone Maintenance Treatment Program in Portuguese Community Pharmacies

MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I.P. （Institute on Drugs and Drug Addiction）, the PPS （Portuguese Pharmaceutical Society）, and the ANF （National Association of Pharmacies）. In January 2004, the INFARMED （National Authority of Medicine and Health Products） became a partner of the program. The possibility of continuing the treatment at a community pharmacy was restricted to patients receiving a stabilized dose of methadone at IDT, I.P. treatment centers. Pharmacists joining the MMT were given mandatory training. Patients on the MMT program received daily doses of methadone solution under directly observed therapy, and were followed up by trained pharmacists. From January 1998 to January 2013, 3,090 patients underwent MMT in Portuguese community pharmacies. The delivery of MMT at community pharmacy level is feasible. This strategy improves access and adherence to methadone treatment, thus helping to reduce the use of illegal opioids. Community pharmacists fully demonstrated their ability to perform extended roles in public health and harm-reduction strategies. Interaction and close cooperation between the different health professionals and organizations involved were crucial to achieve adequate support to the patients.

Effects of Lifestyle Intervention Performed by Community Pharmacists on Glycemic Control in Patients with Type 2 Diabetes: The Community Pharmacists Assist (Compass) Project, a Pragmatic Cluster Randomized Trial

Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%;p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG;p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.

The Viewpoint of Community Pharmacists about Their Professional Role in Dispensing Beauty Products: A Study from Western Region of Saudi Arabia

Background: Community pharmacists play a significant role in dispensing and counseling about medications and pharmaceuticals including beauty and cosmetic products. Aims and Objectives: The current study was conducted to assess the viewpoint of community pharmacists in the Western region of Saudi Arabia about their professional role in dispensing beauty products. Methods: A cross-sectional study was conducted between September and December 2019 using an online questionnaire. Expert professors from college of pharmacy, Taif University validated the questionnaire. Results: Five hundred seventy-seven community pharmacists completed the questionnaire. Most of the participants were male (99%) and aged 23 - 34 years old (71.1%). Slightly less than half (45.58%) of community pharmacists have 6 - 10 years of experience. Most pharmacists (96.9%) communicate directly with customers/ patients and most of them (85.3%) ask and counsel patients about their product. Pharmacists strongly agreed that pharmacists must keep in developing their communication skills with customers/patients. Conclusion: Most of the community pharmacists surveyed in this study reported a good perceived knowledge and attitudes and demonstrated an acceptable level of practices regarding beauty products. Saudi FDA is encouraged to adopt Good Pharmacy Practice standards and guidelines to improve current practice of community pharmacists concerning Beauty Products.

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.

Pharmacist Opportunities to Improve Public Self-Medicating Practices in the UAE

Objective: Self-treatment is an important aspect of self-care and one of the vital issues under debate in health care. Self-medication patterns vary among different populations and are influenced by many factors. The objective was to investigate the nature of self-medication behavior among the general public in the UAE and to explore public attitudes, beliefs, and level of knowledge concerning self-medication. Methods: A purposive sample of individuals involved in self-medication who belong to different age, gender, income, education level and health-seeking behaviors. A qualitative approach through individual face-to-face interviews was utilized to investigate participants’ behaviors and attitudes towards self-medication;factors influencing decision to self medicate, sources of information on medications, types of conditions for which self-medication is sought and types of medications used. Participant recruitment continued until theme saturation using content analysis. Findings: Three themes emerged from the data: Reasons for self-medication such as costs associated with visiting a doctor, convenience in visiting a pharmacy and perception of simplicity of the condition;Sources of information: pharmacists as a main source in addition to medication leaflets, family role and previous use, and medicines and medicines’ use: medicines’ use in chronic disease, use of antibiotics, use of herbals and supplements and medicines’ use in children. Conclusion: Findings from this study indicate that self-medication behaviors are common among the population due to several reasons. Inappropriate self-medication practices are evident and may compromise patient care outcomes. Pharmacists play a vital role in intervening to optimize the use of medications and patient education regarding self-care.

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.