A randomised controlled trial of the impact of structured written and verbal advice by community pharmacists on improving hypertension education and control in patients with high blood pressure

Purpose: This study was aimed to determine whether structured written and verbal education provided to patients by community pharmacists about high blood pressure (BP) and its treatment would be (a) better retained and (b) be associated with improved BP control as compared to patients receiving verbal advice only. Methods: The study was designed as a randomised controlled trial and was conducted in the West Midlands, UK, between January 2014 and June 2014. The primary outcome measures were differences in systolic and diastolic BP from baseline and retention of information about high BP assessed with a questionnaire at 2-, 4- and 26-week follow-up points. Results: A total of 64 adults were included in the study. At the week 26 follow-up, compared to participants in the control group, there was a significant improvement in the knowledge of intervention participants about the risks associated with high BP (p < 0.001) and awareness about potential adverse effects of the new BP medicine (p < 0.001). Similarly, there was a greater and more significant reduction in systolic BP in favour of the intervention group 8 mmHg (95% CI 2.1–13.3 p = 0.009) compared to 6 mmHg (95% CI 0.6–11.7 p = 0.02) in the control group at the week 4 follow-up. However, this greater effect of an intervention on BP was not sustained at the 26-week follow-up. For diastolic BP, there was no added effect of the intervention. Conclusion: This randomised controlled trial suggests that although written advice provided by community pharmacists in comparison to verbal advice was more effective in improving knowledge and understanding of patients about hypertension and its treatment, it did not lead to better blood pressure control

The role of pharmacists in the management of chronic disease and prevention of adverse drug reactions

Community pharmacists are increasingly expected to improve disease management both by aiming to improve the effective use of medicines and by reducing the occurrence and severity of preventable adverse drug reactions (ADRs). The current PhD research began by assessing the challenges to the medicines reconciliation from patients' perspectives. A questionnaire based audit identified two important risk factors for reporting ADRs: being unaware of why medicines were prescribed and not recalling prior warnings about possible ADRs. These findings led to the evaluation of pharmacists' engagement with patients within pharmacy services such as the New Medicine Service (NMS). A questionnaire-based service evaluation of the NMS provided support for this service as an opportunity to improve identification and management of ADRs. This evaluation also highlighted the poor contribution of pharmacists towards reporting of ADRs. The findings led to the evaluation of ADR reporting by community pharmacists. This audit-based study identified lack of time and uncertainty about the seriousness of ADRs as the main barriers towards spontaneous reporting. The reporting of ADRs linked to high blood pressure medicines in this study indicated the need to assess the role of community pharmacists in the management of high blood pressure. A systematic review and meta-analysis suggested that pharmacist-led interventions made a significant impact on the management of systolic and diastolic blood pressure. Learning from two audits, a service evaluation and a systematic review led to the development of a randomised controlled trial that assessed the impact of written pharmacistled education on patients with high blood pressure. Interventions by pharmacists working in community pharmacies were associated with improvements in the control of hypertension, however, the mean difference in blood pressure between the intervention and control group was not statistically significant. Compared to participants in the control group, there was a significant improvement in the knowledge about hypertension and its treatment in the intervention group. The participants in this study gave a positive response about the involvement of pharmacists in the management of long-term medical conditions such as hypertension. The UK government wants to see a central role for pharmacists in patient care. The evidence presented in this research suggests that pharmacists have the potential to play a bigger role in patient care. Patients also recognize this potential and appear to be willing to seek pharmacists' advice on health-related issues. Pharmacists would need to identify their specific learning needs to help them deliver a more patient-centred care. They would also require the support and recognition from other stakeholders in particular the GPs

Healthcare-related factors affecting the management of HIV infected patients:a systematic review of qualitative evidence

Human immunodeficiency virus (HIV) infection is a major health concern that is associated with high mortality and socioeconomic burden on both patients and healthcare authorities. This systematic review aimed to qualitatively explore the healthcare-related factors influencing the management of HIV in adult patients. Seven online databases (PubMed, Embase, Google Scholar, CINAHL, PsycInfo, PsycExtra, and International Pharmaceutical Abstract) were searched. Articles published in English language between September 2000 and September 2018 were eligible for inclusion. Quality assessment tool developed by the EPPI-Centre was used to assess the quality of the included studies. A cross-case thematic analysis was conducted using NVivo 10. A total of 30 studies were included in the review. The qualitative analysis identified four major themes influencing the management of HIV: awareness of healthcare professionals (HCPs), attitudes of HCPs, lack of healthcare infrastructure, and stigma associated with HIV. The findings of this review suggest that people living with HIV are at an increased risk of experiencing poor disease management due to various healthcare-related factors. HCPs and policy makers should acknowledge the presence of these factors with the aim of providing quality care to people living with HIV

COMMUNITY PHARMACIST-LED NEW MEDICINE SERVICE FOR PATIENTS WITH A LONG TERM MEDICAL CONDITION: A CROSS-SECTIONAL STUDY

Objective: This study assessed the impact of the new medicine service (NMS) on medication use in patients starting a new medication for a long-term medical condition in the United Kingdom (UK). Methods: A cross-sectional study was conducted in community pharmacies in the West Midlands area for three months from July to September 2012. The drug therapies/agents included in the study were antihypertensive, antidiabetics, anti-asthmatics and antiplatelet/anticoagulants.Results: 20 community pharmacists completed questionnaires related to 285 patients (160 female and 125 male). On the first NMS assessment, 82 patients reported drug-related problems including adverse effects and incorrect use of medications. Of these 82 patients, 58 received pharmacists' advice and 24 did not receive any advice. At the NMS follow up 39 (67%) of the 58 patients who received pharmacists' advice reported resolution of their drug-related problems while only four (17%) of the 24 patients who did not receive pharmacists' advice reported resolution of their problems (odds ratio 10.2, 95% CI 3.0-34.2 p&lt;0.0001). The improvement in the correct use of medications by patients reported in this study for example by improving the inhaler technique of asthmatic patients is expected to have important implications for improving the healthcare outcome of patients with long-term conditions.Conclusion: This study provides support for the NMS as an opportunity to improve detection of adverse effects and improve the incorrect use of medicines by patients. Further research is needed to address the policy implications of the NMS, including analyses of the clinical and cost-effectiveness of this service, and the sustainability of this form of pharmacist intervention in the long-term in clinical practice

Evaluation of preparedness of healthcare student volunteers against Middle East respiratory syndrome coronavirus (MERS-CoV) in Makkah, Saudi Arabia : a cross-sectional study

Aim: To assess the knowledge and attitude of senior medical, dental, nursing and pharmacy students toward Middle East respiratory syndrome-corona virus (MERS-CoV) in Saudi Arabia. Subjects and methods: A cross-sectional survey using a 21-item questionnaire was conducted for a 3-month period from November 2015–January 2016 in Makkah, Saudi Arabia. The questionnaire was designed to evaluate students’ understanding and perception of MERS-CoV. An ANOVA test was used to determine the association of study discipline and academic year with the student knowledge score on MERS. Results: A total of 364 students were assessed during the study. The majority (62%) of the participants were in the 20–22-year age group. More than half (53%) were pharmacy students followed by (22%) medical students. More than two thirds (71%) of the participants were aware that MERS is caused by the coronavirus. More than half (59%) of the participants believed that MERS can be transmitted through direct or indirect contact with infected camels. A statistically significant association was reported between the study discipline and mean knowledge score (p < 0.0001) with medical students achieving an overall better knowledge score compared with students from other study disciplines. Conclusion: Overall, students had good knowledge about MERS epidemiology, transmission and the recommended protective measures. However, students expressed their reluctance to work in healthcare facilities with inadequate MERS infection control isolation policies

Evaluating the role and integration of general practice pharmacists in England:a cross-sectional study

Background Since 2015, NHS England has facilitated the recruitment of pharmacists in general practice (GP) to reduce workload of general practitioners. The role of pharmacists is therefore expected to become more clinical and patient oriented. However, little is known about the current roles performed and the integration of GP pharmacists. Objective To assess the role performed by GP pharmacists and their integration into practice exploring facilitators and barriers to integration. Setting A cross-sectional survey of GP pharmacists in England. Method This study used both online and paper-based questionnaires for a period of six months. Survey items included demographics, roles performed, integration including available support and practice environment. Quantitative data were analysed using descriptive statistics and 95% confidence intervals. Open comments were analysed thematically to identify pharmacists’ perceptions of barriers and facilitators to their integration into practice. Main outcome measure Current role and integration of pharmacists into GP. Results 195 participants completed the questionnaire. Three quarters of pharmacists (76%) had only been in GP since 2015. Most pharmacists (81%) were independent prescribers (PIPs). The most reported pharmacists’ roles were medicine reconciliation (95%), telephone support for patients (95%) and face-to-face medication review (91%). 82% (95% CI: 76% to 86.8%) were satisfied with their overall integration into practice. Half of pharmacists (45%) were working in a shared office or at a hot desk and 9% had no designated workspace. PIPs had more access to a convenient workplace (p = 0.016) compared to non-IPs. Conclusion Practice pharmacists are fulfilling a wide range of clinical and non-clinical roles in England. Findings highlight relatively a satisfactory level of pharmacists’ integration into practice and shed the light on their integration issues. These findings could be significant for the development of future roles of pharmacists in GP

Patients’ views and experiences of the first community pharmacy-based medication therapy management clinic in the Middle East and North Africa (MENA):A qualitative study

Objective: This qualitative study aimed to describe patients’ experiences of a community pharmacy (CP)–based medication therapy management program (MTM). Methods: Qualitative, semistructured, face-to-face interviews were conducted with a purposive sample of patients with uncontrolled diabetes who received care at a CP-based MTM clinic. Interviews were conducted in the MTM clinic of Health Kingdom CP in Riyadh City, Kingdom of Saudi Arabia by a research pharmacist using an interview guide. Data collection was continued until data saturation. All interviews were audiorecorded, transcribed verbatim, and analyzed thematically. Key findings: A total of 16 patients, of whom more than half were male, were interviewed between October 2021 and March 2022. The mean ± standard deviation age of the patients was 52.0 ± 8.9 years, whereas the mean number of years since the first diagnosis of diabetes was 11.2 ± 7.3 years. Three main themes emerged from the interviews: perceived benefits and outcomes of the program, factors driving positive patient experiences, and challenges and recommendations for enhancing MTM service. Generally, patients were satisfied with the quality of advanced care that they received at the clinic and recognized the importance of the pharmacist’s role. Furthermore, the program was perceived by patients as an opportunity to transition to a healthier lifestyle. Patients also highlighted a few barriers related to follow-up, such as accessibility, and issues with the service, such as long waiting times. Finally, there were some suggestions for patient improvement. These include expanding the clinic space, initiating educational and follow-up messages, and cooperating with other specialists as required. Conclusions: Patients received the MTM program very positively with noticeable health benefits. Barriers to effective follow-up and care should be addressed before implementing this service in wider community pharmacies in Saudi Arabia and beyond.</p

Translation, cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ) 2.0 into the Arabic language among people with diabetes

Background: Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated tool in the Arabic language to measure patient satisfaction with pharmacy services. Objective: To translate the English version of the PSPSQ 2.0 into Arabic language, culturally adapt, and verify its reliability and validity. Setting: A community pharmacy in Riyadh, Saudi Arabia. Method: A cross-sectional study was conducted between April 2021 and June 2022 among patients with diabetes attending a community pharmacy. The International Society for Pharmacoeconomics and Outcomes Research good practice guidelines for linguistic translation and cultural adaptation were used to translate and culturally adapt the English version of PSPSQ 2.0 into Arabic. The Arabic version of PSPSQ 2.0 was subjected to factor analysis using principal component analysis with varimax rotation to evaluate its validity and Cronbach’s alpha was used to assess the reliability of PSPSQ 2.0. Results: A total of 129 (68.2% male, and mean age 50 (SD: 11.9) years) patients with diabetes participated in the study. The analysis was undertaken for the items in each of the three domains of PSPSQ 2.0: quality of care, interprofessional relationship and overall care. Exploratory factor analysis revealed validity of 92.7%, 80.5% and 96.2%, respectively. The Arabic version of PSPSQ 2.0 had high internal consistency with Cronbach’s alpha scores 0.99, 0.95 and 0.98 for the three measured domains, respectively. The sample adequacy was 0.924. Conclusion: The PSPSQ 2.0 was successfully translated and culturally adapted into the Arabic language and had acceptable validity and reliability to measure patient satisfaction with services provided by pharmacists in community pharmacies