Exploring the Contribution of Pharmacists in Addressing the Opioid Crisis through Naloxone Prescriptions and Pharmacist-Led Interventions

The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.

Roles of Community Pharmacists in Screening and Disseminating of Information about Non-Steroidal Anti-Inflammatory Drugs Risks: Implications for Drug Safety Assessment

Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.

Investigation of Patients’ Mood on Their Distance from the Pharmacist during Medication Instruction

Background: Pharmacists must adjust their distance from patients to facilitate communication during interviews and gain their trust. The distance between the patients and the pharmacists varies depending on many factors, such as gender, posture and the patients’ mood. Only a few of these papers have actually measured and validated distance with patients. In this study, we validated our method of assessing mood and measuring distance before beginning a survey with patients. Methods: We measured comfortable interpersonal distance among men and women using an ecological scenario, in which a pharmacist approaches the subject, and the subject is asked to stop the pharmacist at the distance he/she feel comfortable with. Five pharmacists and 33 subjects participated in the study. The Japanese version of the Brief Mood Questionnaire Checklists (BMC-J) was used to quantify the subject’s mood for the day, and then the distance from the pharmacist that the subjects considered comfortable was measured at the bedside. The relationship between the mood and distance obtained was examined. Results: The comfortable distance of subjects was influenced by gender, posture, and mood. The shortest distance was 94.7 ± 11.1 cm (mean ± SD), for the male subjects versus the female pharmacists in the sitting position. The distance of male subjects shorted when they had positive emotions and lengthened when they were worried. Female subjects maintained a long distance from both male and female pharmacists when they had positive emotions and a short distance when they were worried. Conclusion: Findings show that the distance changes depending on the subjects’ mood at the time of measurement. It was found that the present measurement method can be used to determine the psychological state of the patient and measure the comfort distance at that time, and can be used as a simple method to examine these relationships. Therefore, it is also considered a practical method for the next step, which is a clinical study on patients.

Clinical pharmacists’ involvement in carbapenem antibiotics management at Wenzhou Integrated Hospital

BACKGROUND Carbapenem antibiotics are a pivotal solution for severe infections,particularly in hospital settings.The emergence of carbapenem-resistant bacteria owing to the irrational and extensive use of carbapenems underscores the need for meticulous management and rational use.Clinical pharmacists,with their specialized training and extensive knowledge,play a substantial role in ensuring the judicious use of carbapenem.This study aimed to elucidate the patterns of carbapenem use and shed light on the integral role played by clinical pharmacists in managing and promoting the rational use of carbapenem antibiotics at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital.AIM To analyze carbapenem use patterns in our hospital and role of clinical pharmacists in managing and promoting their rational use.METHODS We performed a retrospective analysis of carbapenem use at our hospital between January 2019 and December 2021.Several key indicators,including the drug utilization index,defined daily doses(DDDs),proportion of antimicrobial drug costs to total hospitalization expenses,antibiotic utilization density,and utilization rates in different clinical departments were comprehensively analyzed.RESULTS Between 2019 and 2021,there was a consistent decline in the consumption and sales of imipenem-cilastatin sodium,meropenem(0.3 g),and meropenem(0.5 g).Conversely,the DDDs of imipenem-cilastatin sodium for injection increased in 2020 and 2021 vs 2019,with a B/A value of 0.67,indicating a relatively higher drug cost.The DDDs of meropenem for injection(0.3 g)exhibited an overall upward trend,indicating an increasing clinical preference.However,the B/A values for 2020 and 2021 were both>1,suggesting a relatively lower drug cost.The DDDs of meropenem for injection(0.5 g)demonstrated a progressive increase annually and consistently ranked first,indicating a high clinical preference with a B/A value of 1,signifying good alignment between economic and social benefits.CONCLUSION Carbapenem use in our hospital was generally reasonable with a downward trend in consumption and sales over time.Clinical pharmacists play a pivotal role in promoting appropriate use of carbapenems.

A Survey on Pharmacists’ Job Burnout and Satisfaction during the COVID-19 Era

Background: The COVID-19 outbreak negatively impacted pharmacists who provided basic medical services by inducing anxiety and depression, thus, leading to medical errors. Objective: This study aimed to investigate the job burnout and satisfaction levels among hospital pharmacists during the period when China downgraded COVID-19 from a Category A disease to a Category B disease. Method: We selected pharmacists from several medical institutions in Yunnan Province as the subjects by using the general information questionnaire survey, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the Work Environment Scale-10 (WES-10). Results: After analyzing 461 questionnaires, the results showed that the age and marital status of the pharmacists displayed significant effects on their emotional exhaustion and sense of achievement, with younger pharmacists getting higher and lower scores for their tests on emotional exhaustion and sense of achievement, respectively (p Conclusion: Hence, it was concluded that the job burnout of pharmacists was at a low level during the period when China downgraded COVID-19 as a Category B disease from Category A.

Comparison of Anticancer Drug Preparation Techniques between Chemotherapy Specialist Pharmacists and Non-Chemotherapy Pharmacists Using Eye-Tracking Techniques

Anticancer drug preparation by pharmacists is a critical task directly related to medical incidents. This study examined the factors influencing medical errors in chemotherapy, that is, errors by specialist pharmacists (CPh) and pharmacists in other departments (NCPh), by measuring their gaze during the preparation of anticancer drugs. The eye-tracking results showed that the gazing time of NCPh was significantly longer than that of CPh for items such as “preparation of a closed-system device” and “preparation of the syringe” and all preparation times (P < 0.05). The NCPh were not assigned to prepare drugs on a regular basis, indicating their lack of familiarity with the process. There was no significant difference in gaze ratio between CPh and NCPh. This outcome was suggested to be a result of the use of an anticancer drug preparation support system. The results for the pupil diameter variation rate showed that NCPh were significantly more mydriatic in the “mixing injections” category than CPh. However, CPh tended to be more mydriatic in the “checking” category. CPh exhibited a smooth workflow and focused on the important items to be checked. This study showed that the differences in procedure flow and concentration points may lead to errors. Furthermore, the results are of interest from the perspective of medical incident prevention. They will be useful in identifying potential human factors, such as where the pharmacist focuses their attention by measuring eye movements.

Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions

To quantify drug-drug-interactions (DDIs) encountered in patients prescribed hepatitis C virus (HCV) treatment, the interventions made, and the time spent in this process.METHODSAs standard of care, a clinical pharmacist screened for DDIs in patients prescribed direct acting antiviral (DAA) HCV treatment between November 2013 and July 2015 at the University of Colorado Hepatology Clinic. HCV regimens prescribed included ledipasvir/sofosbuvir (LDV/SOF), paritaprevir/ritonavir/ombitasvir/dasabuvir (OBV/PTV/r + DSV), simeprevir/sofosbuvir (SIM/SOF), and sofosbuvir/ribavirin (SOF/RBV). This retrospective analysis reviewed the work completed by the clinical pharmacist in order to measure the aims identified for the study. The number and type of DDIs identified were summarized with descriptive statistics.RESULTSSix hundred and sixty four patients (83.4% Caucasian, 57% male, average 56.7 years old) were identified; 369 for LDV/SOF, 48 for OBV/PTV/r + DSV, 114 for SIM/SOF, and 133 for SOF/RBV. Fifty-one point five per cent of patients were cirrhotic. Overall, 5217 medications were reviewed (7.86 medications per patient) and 781 interactions identified (1.18 interactions per patient). The number of interactions were fewest for SOF/RBV (0.17 interactions per patient) and highest for OBV/PTV/r + DSV (2.48 interactions per patient). LDV/SOF and SIM/SOF had similar number of interactions (1.28 and 1.48 interactions per patient, respectively). Gastric acid modifiers and vitamin/herbal supplements commonly caused interactions with LDV/SOF. Hypertensive agents, analgesics, and psychiatric medications frequently caused interactions with OBV/PTV/r + DSV and SIM/SOF. To manage these interactions, the pharmacists most often recommended discontinuing the medication (28.9%), increasing monitoring for toxicities (24.1%), or separating administration times (18.2%). The pharmacist chart review for each patient usually took approximately 30 min, with additional time for more complex patients.CONCLUSIONDDIs are common with HCV medications and management can require medication adjustments and increased monitoring. An interdisciplinary team including a clinical pharmacist can optimize patient care.

Perceptions of Generic Drugs in the Pharmacists of Public Hospitals:A Cross-sectional Survey in Hubei Province of China

Objective:Generic drugs provide an opportunity for savings in drug expenditure since they are available at a lower cost and do not affect patients’health.A better understanding of pharmacists’knowledge,attitudes,and perception can promote the quality use of generic drugs.The objective of this study was to investigate the knowledge,attitudes,and perception of pharmacists from tertiary hospitals in China regarding generic drugs.Methods:A cross-sectional survey using a postal questionnaire was conducted,which was sent to 200 hospital pharmacists randomly selected from tertiary hospitals in Hubei Province.A total of 125 questionnaires out of 200 were received.Of the respondents,80 were female and 45 were male.Results:The majority of respondents(87.2%)could clearly distinguish between original and generic drugs.Pharmacists agreed that generic drugs were less effective(52.8%)and produced more side effects(52%).Forty-nine respondents thought that generic drug products were not adequately tested.Approximately 78% and 60% of the pharmacists indicated that generic substitution was not feasible for drugs with narrow therapeutic windows and drugs for critical diseases,respectively.Most of them supported the recommendation of generic drugs based on professional judgment.Conclusion:Our study showed that a considerable portion of Chinese hospital pharmacists hold negative perceptions of generic drugs.Interventions to improve pharmacists'knowledge of generic drugs are needed.

Perception of Physicians to the Role of Clinical Pharmacists in United Arab Emirates (UAE)

The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.

It’s Not Just the Money: Why Consumers Do Not Purchase Pharmacist-Provided Services

The reimbursement model for pharmaceutical care remains a barrier to successful widespread implementation of pharmacist-provided services. In some instances, community pharmacists have been successful in obtaining direct compensation for services from patients;however, evidence suggests that lack of patient demand for pharmacist-services may ultimately undermine the campaign for widespread third-party payment. The purpose of this study is to conduct a secondary analysis of data indicating consumer/patients’ rationale for not purchasing pharmacist-provided disease management services when offered the opportunity to do so in community pharmacies. Our review of the data indicates that while financial concerns are clearly important in consumer demand for pharmacist-provided services, other considerations exist. The consumer/patient belief that pharmacist-provided services are duplicative or that these services are not needed are significant barriers to overcome. Intensive education and marketing campaigns are needed to sway consumer opinion on the value of pharmacist-provided services.

Licensed Pharmacists in Pharmaceutical Retail Enterprises in China: Problems and Countermeasures

Objective To analyze the status and problems of licensed pharmacists in pharmaceutical retail enterprises in China, and to put forward suggestions for improving licensed pharmacists’ abilities. Methods Literature review and questionnaire survey were used to analyze the basic status of licensed pharmacists in pharmaceutical retail enterprises and fishbone diagram was used to find out the problems. Results and Conclusion Pharmaceutical retail enterprises have the following problems when they employ pharmacists, such as lack of assessment system, too general incentive policies. The causes of problems lie in four aspects, including system, environment, pharmacy and pharmacists. As to the above problems, the government should make policies to encourage and regulate enterprises to explore remote prescription service through Internet. Furthermore, pharmaceutical retail enterprises can take the advantage of Internet to develop a comprehensive performance appraisal system for licensed pharmacists. The assessment information platform will reflect the true level of pharmacists and enhance their professional value.

Evaluation of retail pharmacists’’ perception on patient safety

Patient safety has become a focus of clinical care and research in recent years. However, the potential for medical care to cause harm has been appreciated throughout the history of medicine (1)The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.

A Web-Based Cardiovascular Risk Assessment via Pharmacists: A Feasibility and Validation Study

Background: Involving pharmacists in clinical care could improve the identification of subjects at risk for cardiovascular (CV) disease. Data on web-based approach involving pharmacists for CV disease risk assessment are very limited. Methods: We first developed a web-based CV risk assessment tool to be used by pharmacists that includes demographic, lifestyle, biological and anthropometric information. Biological and anthropometric data were collected in independent laboratories. We then assessed the feasibility and validity of this approach by inviting adults who previously (within 6 months) participated in a Swiss standardized population-based study to fill out the web-based platform. Attrition rates and correlations were used to assess the feasibility and validity, respectively. Proportions were expressed as percentages and continuous variables were expressed as means ± standard deviations (SD). Main Outcomes Measure: Proportions of participants who 1) agreed to participate;2) filled out the questionnaire and had their biological and anthropometric measures taken;3) only filled out the questionnaire;and 4) only had their biological and anthropometric measures taken. Correlations were used to compare continuous variables (body mass index [BMI], waist circumference, systolic blood pressure, fasting blood glucose, total plasma cholesterol, HDL plasma cholesterol, LDL plasma cholesterol, triglycerides) collected via both studies. Results: Overall, 218 (53.2% women) adults of the population-based study were eligible and were contacted to participate, from April to November 2013. Of these, 140 (64.2%) agreed to participate. The majority (67/140, 47.8%) both filled out the questionnaire and had their biological/anthropometric measures taken, whereas only 2.8% and 7.1% only filled out the questionnaire or only had their biological measures taken, respectively. Except for systolic blood pressure, fasting glucose, and triglycerides, the correlations between the measures obtained in the population-based study and the web-based approach were generally greater than 0.80, suggesting very good correlations. Conclusions: A web-based CV risk assessment via pharmacists is a feasible and valid approach. This web-based approach should be adapted to lower attrition, and its impact on CV risk factors should be further tested.

YAN Yong-qing(严永清)——A Prominent Integrative Pharmacist

YAN Yongqing,male,bornin July 1934 inShanghai,wasgraduated fromthe PharmaceuticsDepartment ofNortheast Pharmaceutical College(Shenyang Phar-maceutical Univer-

How the community pharmacist contributes to the multidisciplinary management of heart failure

Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharmacists of the Franche-Comte region (France) and patients of the Franche-Comté Heart Association. Method: Two questionnaires were drawn up and sent to pharmacists and patients. Results: The 118 pharmacists participating in this survey (36.9%) felt that they had a role to play in dispensing drugs (100.0%), educating patients about their treatment (83.1%), informing patients about the importance of observance (81.4%) and over- the-counter drugs (58.5%), distributing heart failure brochures (51.7%) and providing medical equipment (44.9%). On the other hand, only a third of them thought that they should inform patients about their illness and give advice by phone. On the whole, knowledge level is good for disease, drug therapy, contraindicated drugs, medical supervision and hygieno-dietetic management, but intermediate or poor for alert signs of decompensation, essential vaccinations and patient associations. University training in this area during formal pharmacy studies is considered either “insufficient” or “very insufficient” in 56.9% of cases. Although more than 99% of the pharmacists think that additional training is needed, only 33.1% had actually benefited from such training. Of the 96 patients (48.0%) who completed the questionnaire, 92.6% are faithful to their pharmacist. They contact him more about drug therapy than about their disease, or information related to treatments. Roles attributed to their pharmacist are mainly related to drug therapy explanation and information concerning over-the-counter drugs. Therapeutic education is known to 40.6% of interrogated patients. Among these patients, two-thirds depend on their pharmacist and feel that he is capable of providing the necessary education. Moreover, 46.2% of patients had received some form of therapeutic education from their pharmacist. Pharmacists believe that they are able to assume this role in 67.8% of cases. Conclusion: In spite of biases, this study allowed us to assess the expectations of heart failure patients with regard to the pharmaceutical management of their disease, thus clarifying the indispensable contribution that pharmacists make in the management of this disease.

The Pharmacists Attributes in Advising Patients in Independently Owned Maltese Pharmacies

Objectives: To determine the influence of pharmacists on customers who have to decide between Over the Counter products in independently owned Maltese pharmacies. Methods: 20 managing pharmacists in independently owned Maltese pharmacies were interviewed. The interviews were recorded, transcribed verbatim and the data were coded. The main categories and subcategories were extracted and interrelated by using the grounded theory of action approach. Key findings Pharmacists dedicate time to ensure the right OTC is received by their patients. Before recommending an OTC medication the pharmacists ask key questions, which help them determine if an OTC is appropriate for the patient. The Maltese pharmacists engage their patients in a discussion before recommending an OTC product. In order to ensure that the patients are following their advice, pharmacists use different techniques. Whenever the patient might want to purchase an OTC, which could interfere with their medication regimen or might not be appropriate from the age point of view, then pharmacist intervenes accordingly. Each pharmacist offered specific examples how they convince their patients to purchase the correct medication. The pharmacists provided specific examples how they decide to select a specific OTC medicine and what type of questions were asked before taking a decision. In order to ensure their patients have the best access to the health care, many pharmacists embraced other roles and services, such as measuring and monitoring the blood pressure and glucose levels, determining the correct weight management product. Conclusions: The analyzed data highlight that Maltese community pharmacists play an important role in counseling patients on their choice of OTC products. The analysis has also identified some useful counseling techniques, which has been used by pharmacists for prescription medications. However, the Maltese pharmacists use these counseling techniques on a larger scale. It seems likely that many pharmacists are embracing more additional roles to ensure their population receives the best clinical services. Before dispensing an OTC medication, pharmacists use their clinical knowledge.

Japanese Community Pharmacists’ Barriers to Conducting or Participating in Practice Research

Objectives: This study identified barriers to Japanese community pharmacists’ active conduct or participation in practice research. Methods: Community pharmacists (n = 478) who gave presentations at three major pharmacy-related conferences in 2012 and 2013 were questioned about their difficulties of giving presentations, support for better presentations, and barriers to conducting pharmacy practice research in their practical setting. A questionnaire was mailed to and returned by the pharmacists directly. Results: We obtained 230 responses (47.9%). Presentation difficulties included pharmacists’ time constraints and lack of experience organizing the report’s results or discussion. Many thought statistical analysis support was necessary. The barriers were in sufficient time, community pharmacies’ lack of research supervisors, and other community pharmacists’ lack of understanding practice research’s importance. These were comparable to pharmacists’ barriers in other countries, except for money and funds. Conclusions: Japanese community pharmacists should clarify that practice research in their professional roles improves patients’ outcomes. Barriers were similar to pharmacists in other countries. Publication of pharmacists’ practice research results is important to expand their roles. Collaboration between faculties and pharmacists is a challenge for practice research development in the Japanese community setting.

Pharmacist Role in Pharmaceutical Care during Ramadan

Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan;moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.

A Structural Equation Model (SEM) for Pharmacist Competencies in Improving Quality of Life of Cancer Patients: Effect of Missing Values on the SEM

Objective: With the goal of improving health-related quality of life (HRQOL) in cancer patients, we previously reported a structural equation model (SEM) of subjected QOL and qualifications of pharmacists, based on a series of questionnaires completed by patients and pharmacists. However, several patients and pharmacists were excluded from the previous study because it was not always possible to obtain all the data intended for collection. In order to reveal the effect of missing data on the SEM, we established SEMs of HRQOL and the competency of pharmacists, using correlation matrices derived by two different statistical methods for handling missing data. Method: Fifteen cancer patients hospitalized for cancer and were receiving opioid analgesics for pain control, and eight pharmacists were enrolled in this study. Each subject was asked four times weekly to answer questions presented in a questionnaire. SEMs were explored using two correlation matrices derived with pair-wise deletion (PD matrix) and list-wise deletion (LD matrix). The final models were statistically evaluated with certain goodness-of-fit criteria. Results: Data were intended to be collected four times weekly for each patient, but there were some missing values. The same SEMs for HRQOL were optimized using both the LD and PD matrices. Although the path diagrams of the SEMs were not identical in the “competency of pharmacists,” the two models suggested that a higher competency of a pharmacist lowered the “severity” of condition and increased the “comfort” of patients, resulting in an increase in the subjected QOL. Conclusion: In collecting data for clinical research, missing values are unavoidable. When the structure of the model was robust enough, the missing data had a minor effect on our SEM of QOL. In QOL research, the LD matrix as well as the PD matrix would be effective, provided the model is sufficiently robust.