Community Pharmacists' Attitudes and Practice in the Management of Minor Ailments

This study aimed to know the attitudes and practice of pharmacists regarding the management of minor ailments in Iraqi community pharmacies. A cross-sectional study for 320 community pharmacists was conducted during February 2020 using a newly developed and validated questionnaire. Only 4.4% of pharmacists prefer not to deal with minor ailment cases. Minority (15.6%) of participated pharmacists refer more than half of minor ailment cases they face to the physician. Regarding the assessment of minor ailments using WWHAM technique, what are the symptoms are the most commonly asked questions by pharmacists. Only 49.1% mentioned that they ask all WWHAM questions. On the other hand, most pharmacists (90%) educate their patients about the dosing regimen. Meanwhile, less than 10% of pharmacists provide their patients with all possible information about their medications. All demographic factors had no effect on the pharmacists' usage of WWHAM technique and in pharmacist's role in patient counseling or education. In conclusion minor ailment services that provided by community pharmacists' in Iraq was poor at which most pharmacists don't use WWHAM technique appropriately and also fail to provide their patients with the required medication counseling and education.

113. Improving Transitions-of-Care for Patients Discharged on High-Risk Antimicrobial Therapy

Background Providing effective transitions-of-care (TOC) services improves outcomes for patients discharged on high-risk medications. Literature has shown that successful TOC for certain antimicrobials reduces hospital readmissions, medication errors, and improves post-discharge follow-up and laboratory monitoring. Prior to this quality improvement (QI) initiative, there was no formal TOC process for patients discharged on high-risk antimicrobial therapy (HAT) at our institution. Without standardization, only 55.1% of patients discharged on HAT had successful TOC. The aim of this initiative was to develop and implement a TOC protocol in at least 90% of patients discharged on HAT. Methods This QI initiative utilized the Institute of Healthcare Improvement model for improvement. A workgroup of key stakeholders developed a protocol to identify and standardize TOC services provided to patients discharged on HAT. Successful protocol completion was achieved if the following process metrics were evaluated, obtained, and documented prior to discharge: baseline laboratory values, pharmacokinetic monitoring, appropriate intravenous access, drug-drug interactions, medication availability, discharge medication counseling, and formal pharmacist documentation in a discharge note. Outcome metrics included referral to outpatient infectious disease (ID) follow-up, 90-day readmissions, and successful TOC. Balancing metrics included pharmacist time and protocol initiation for patients not discharged on HAT. Results Between October 2020 and May 2021, 218 patients met protocol inclusion criteria. Of these, 203/218 (93.1%) were appropriately identified with the new TOC process. The protocol was successfully followed in 78.9% of patients identified. Readmission rates were 42.8%, which was unchanged from baseline. Inpatient ID involvement increased from 80.9% to 95.7% and referral to outpatient ID follow-up from 59% to 94.8%. Conclusion This newly developed TOC protocol successfully identifies patients discharged on HAT, improves provision of TOC services to these high-risk patients, and significantly improves the rate of infectious disease involvement while inpatient and after discharge. Disclosures All Authors: No reported disclosures

Impact of a Clinical Pharmacist in a Neurology Clinic Treating Patients with Myasthenia Gravis and Multiple Sclerosis

Background: Myasthenia gravis (MG) and multiple sclerosis (MS) are treated with complex pharmacological agents. Pharmacists play a vital role by optimizing care, providing medication counseling, and assisting with medication access. Currently, there are no published studies assessing the impact of a clinical pharmacist on MG management and limited studies evaluating impact in MS.Aim: The objective is to evaluate the impact of a clinical pharmacist in interdisciplinary MG and MS clinics by identifying pharmacist-led direct and indirect services. Methods: A retrospective chart review was conducted of MG or MS patients who had a clinical pharmacist visit between December 1, 2019 and August 31, 2020 to identify pharmacist interventions. Clinic-based pharmacist reports were used to identify indirect services provided by the pharmacist.Results: A total of 137 encounters were analyzed. For direct patient care, the most common intervention was evaluating monitoring parameters of the medications, which occurred at 129 encounters (94.2%). Within these encounters, an average of 2.79 parameters were evaluated. Other common interventions included evaluating laboratory findings (77.4%), identifying medication discrepancies (77.4%), and providing medication counseling (76.6%). Regarding indirect patient care, a total of 1280 services were identified. The most common service was telephone encounters, with a total of 598 encounters over 9 months.Conclusion: A clinical pharmacist improved the quality of care in the MS and MG management through direct and indirect services when integrated into a neurology clinic. This supports the role of pharmacists in specialty clinics by showing their impact on quality of care and medication management.

Evaluation of a patient self-medication program in allogeneic hematopoietic stem cell transplantation

Introduction Patients admitted for allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged with multiple new medications. At our institution, a new patient Self Medication Program (SMP) was implemented on the allo-HSCT units. An SMP allows patients to practice self-administration of medications in a controlled environment before discharge. We assessed the impact of the SMP on patient medication knowledge, self-efficacy, adherence, and safety. Patient and staff satisfaction with the SMP was also explored. Methods Participants in the SMP group received medication counseling by a pharmacist and self-managed their medications with nursing supervision until discharge. Participants in the pre-SMP group received medication counseling by a pharmacist at discharge. All participants completed a Medication Knowledge and Self-Efficacy Questionnaire before discharge and at follow-up. Safety endpoints were assessed for SMP participants. Results Twenty-six patients in the pre-SMP group and 25 patients in the SMP group completed both questionnaires. Median knowledge scores in the pre-SMP group versus the SMP group were 8.5/10 versus 10/10 at discharge ( p = 0.0023) and 9/10 versus 10/10 at follow-up ( p = 0.047). Median self-efficacy scores were 38/39 in the pre-SMP group versus 39/39 in the SMP group at both discharge and follow-up ( pdischarge = 0.11, pfollow-up = 0.10). The SMP was associated with at least 1 medication event in 7 participants, but no medication incidents. Patient and staff surveys showed a positive perceived value of the SMP. Conclusion Our results demonstrate that the SMP is associated with durable, improved medication knowledge, a trend towards improved self-efficacy, and largely positive perceptions among both staff and patient participants.

Pharmacy preparedness in handling COVID-19 pandemic: a sharing experience from a Malaysian tertiary hospital

This commentary shares the experience of a hospital pharmacy department in providing healthcare services during the COVID-19 outbreak in Malaysia. During this pandemic, the medication delivery system is redesigned to minimize contact among patients and the health care providers. Also, the remote medication monitoring system was implemented to deliver pharmaceutical care for inpatients. Communication technology was used to assist the pharmacist in medication counseling. QR codes to access videos demonstrating the use of devices were made available for patients. Pharmacists were also tasked with the procurement of personal protective equipment and medications needed requiring special approval from the Ministry of Health.

Assessing preparation for care transition among adolescents with rheumatologic disease: a single-center assessment with patient survey

Background Despite the risk for poor outcomes and gaps in care in the transfer from pediatric to adult care, most pediatric rheumatology centers lack formal transition pathways. As a first step in designing a pathway, we evaluated preparation for transition in a single-center cohort of adolescents and young adults (AYA) with rheumatologic conditions using the ADolescent Assessment of Preparation for Transition (ADAPT) survey. Findings AYA most frequently endorsed receiving counseling on taking charge of their health and remembering to take medications. Less than half reported receiving specific counseling about transferring to an adult provider. AYA with lower education attainment compared with those who had attended some college or higher had lower scores in self-management (1.51 vs 2.52, p = 0.0002), prescription medication counseling (1.96 vs 2.41, p = 0.029), and transfer planning (0.27 vs 1.62, p < 0.001). AYA with a diagnosis of MCTD, Sjögren’s or SLE had higher self-management scores than those with other diagnoses (2.6 vs 1.9; p = 0.048). Non-white youth indicated receiving more thorough medication counseling than white youth (2.71 vs 2.07, p = 0.027). When adjusting for age, educational attainment remained an independent predictor of transfer planning (p = 0.037). AYA with longer duration of seeing their physician had higher transition preparation scores (p = 0.021). Conclusion Few AYA endorsed receiving comprehensive transition counseling, including discussion of transfer planning. Those who were younger and with lower levels of education had lower preparation scores. A long-term relationship with providers was associated with higher scores. Further research, including longitudinal assessment of transition preparation, is needed to evaluate effective processes to assist vulnerable populations.