Impacts of Pharmacy Intervention on Appropriateness of Antibiotics Use in Pneumonia Patients

AIM: This study analyzed the impact of pharmacy intervention on appropriateness of antibiotics use in the treatment of inpatients with pneumonia admitted to Universitas Sumatera Utara (USU) Hospital, Medan, Indonesia. METHODS: This cohort study analyzed appropriateness of antibiotic use in the treatment of in-patients with pneumonia without interventions or baseline group (n = 33) admitted to USU Hospital year 2018 and 3-month period admission with pharmacy intervention (n = 42) year 2019. Characteristics of the patients and antibiotics provided to both groups were descriptively analyzed. The appropriateness of antibiotics use in both groups was analyzed based on their medical conditions, culture and sensitivity tests, and trustable literatures, and then categorized applying Gyssens method regarding dose, intervals, routes, length of provision, effectivity, and costs. The significant difference in inappropriate use of antibiotics between groups with and without interventions was analyzed applying unpaired t-test (p < 0.05 was considered statistically significant). RESULTS: Most of the pneumonia patients in both groups were male. Mean age of the patients (years) in group: without intervention, 60.20 ± 15.48; with intervention, 60.48 ± 14.76. The three most widely provided antibiotics were ceftriaxone, meropenem, and ciprofloxacin. Incidence of inappropriate use of antibiotics per patient in group: without intervention, 0.66; with intervention, 0.33. The inappropriate use of antibiotics reduced significantly in group with intervention, p = 0.049. CONCLUSIONS: Pharmacy intervention is crucial to reduce the inappropriate use of antibiotics in the treatment of pneumonia.

Predicting inpatient pharmacy order interventions using provider action data

Objective The widespread deployment of electronic health records (EHRs) has introduced new sources of error and inefficiencies to the process of ordering medications in the hospital setting. Existing work identifies orders that require pharmacy intervention by comparing them to a patient’s medical records. In this work, we develop a machine learning model for identifying medication orders requiring intervention using only provider behavior and other contextual features that may reflect these new sources of inefficiencies. Materials and Methods Data on providers’ actions in the EHR system and pharmacy orders were collected over a 2-week period in a major metropolitan hospital system. A classification model was then built to identify orders requiring pharmacist intervention. We tune the model to the context in which it would be deployed and evaluate global and local feature importance. Results The resultant model had an area under the receiver-operator characteristic curve of 0.91 and an area under the precision-recall curve of 0.44. Conclusions Providers’ actions can serve as useful predictors in identifying medication orders that require pharmacy intervention. Careful model tuning for the clinical context in which the model is deployed can help to create an effective tool for improving health outcomes without using sensitive patient data.

Impact of pharmacy intervention on influenza vaccination acceptance: a systematic literature review and meta-analysis

Background Vaccination plays an important role in the prevention of influenza. Channels that improve vaccination adherence can play a vital part in improving patient care. This study seeks to inform the design and implementation of pharmacy interventions at scale on improving influenza vaccination rates. Aim of the review The aim of this study was to identify key success factors for effective pharmacy intervention design and implementation to improve vaccination acceptance rates in influenza. Methods A systematic search of MEDLINE, Embase, and Cochrane CENTRAL was performed to find literature on influenza vaccinations delivered at pharmacies, pharmacist-delivered influenza vaccinations, or influenza vaccination campaigns originating in the pharmacy setting. A meta-analysis using a random effects model estimated the impact of pharmacy intervention on vaccination rates (assessed as relative risk [RR] and 95% confidence intervals [95% CI]). Results A total of 1221 studies were found that met the search criteria, of which 12 were selected for the literature review following eligibility screening. A meta-analysis of studies that contained binary total population and vaccination rate data was conducted on 6 studies, including 3182 participants, the vaccination rate was 24% higher in those who used the pharmacy-based intervention compared with those who used standard care [RR (95% CI) 1.24 (1.05, 1.47)]. Two separate sensitivity analyses were run for the vaccination rate. In participants aged ≥ 65 years, the vaccination rate was 3% higher in those who received the pharmacy-based intervention compared with those who received standard care; however, this change was not significant [RR (95% CI) 1.03 (0.86, 1.24)]. Additionally, a qualitative review showed that more successful pharmacy-based interventions were those with the more active involvement of pharmacists in routine care. This included regular checkup of vaccine status, proactive conversations and recommendations about vaccination, and pharmacy-based immunization programs, with specific vaccination days. In-pharmacy communication rather than passive information, such as through leaflets and posters was also more effective. Conclusion Pharmacists can play a significant role to improve patient treatment, adherence, and outcomes associated with influenza vaccines. Once pharmacy-based immunization is established, proactive involvement of is key to ensure successful program implementation and results. Expanding access for pharmacists and pharmacy intervention to provide vaccinations may increase vaccination acceptance and could be a valuable intervention in patient care. Additional studies should consider high-risk populations to inform optimal design and implementation strategies.

Study protocol for a feasibility trial in community pharmacy of a personalised behaviour change intervention to reduce reliever reliance and overuse in individuals with asthma.

BackgroundIn patients with asthma, over-reliance and overuse of short-acting beta2 agonist (SABA) is common and associated with increased morbidity and mortality. Patient beliefs are a key driver of inappropriate reliever use. A recently developed, brief, online intervention has been shown to identify and shift patient beliefs that drive inappropriate reliever use. Whether this intervention works to shift beliefs in individuals with asthma when delivered by community pharmacists is unknown. ObjectiveTo investigate the feasibility and acceptability of a brief community pharmacist-delivered behavior change intervention, and its effect on beliefs about SABA and SABA use in patients with asthma. MethodsThis is a non-randomised, before- and after- study of 120 individuals aged 18 years and older, prescribed a SABA for their asthma symptoms, presenting to one of two enrolled community pharmacies in Auckland, New Zealand. At enrolment, all participants will complete the SABA Reliance Questionnaire (SRQ), Asthma Control Test and 5-item Medication Adherence Report Scale via an online survey platform. Control participants will receive usual asthma care from their community pharmacy. Intervention participants will receive the intervention to shift any misplaced beliefs about SABA, comprising the SRQ to identify individual beliefs about SABA, then personalized information and discussion between pharmacist and patient based on the specific responses to the questionnaires. Those on SABA monotherapy and/or are at risk of SABA overuse will be referred to the general practitioner. Effect on beliefs about SABA and actual SABA use will be assessed by the SRQ and dispensing records, respectively. Feasibility will be evaluated through participant recruitment and retention rates, intervention fidelity, appropriateness and procedures of outcome measures pre- and post-intervention, and acceptability by obtaining feedback from participants (both patients and pharmacists) on the intervention.

Reaching mEthadone users Attending Community pHarmacies with HCV: an international cluster randomised controlled trial protocol (REACH HCV)

IntroductionHepatitis C virus (HCV) is a global public health threat, and novel models of care are required to treat those currently or previously at highest risk of infection, particularly persons who inject drugs (PWID; ever injected), as conventional healthcare models do not have the reach to deliver cure of HCV to disadvantaged, disproportionately affected communities. In Western Europe and Australasia, it is estimated that HCV affects between 0.4% and 1.0% of the regions’ populations, accordingly, it affects between 0.4% and 0.7% of the populations of countries in this study (Scotland, Wales and Australia). Reaching mEthadone users Attending Community pHarmacies with HCV (REACH HCV) will evaluate community pharmacy-based diagnostic outreach and HCV treatment against conventional HCV testing and treatment pathways for clients receiving opioid substitution therapy (OST) in community pharmacies.Methods and analysisREACH HCV is an international multicentre cluster randomised controlled trial with sites in Scotland, Wales and Australia. The sites are community pharmacies which are randomised equally to one of two pathways: the pharmacy intervention pathway or the education-only (control) pathway. Participants are recruited from OST clients in these pharmacies.In the pharmacy intervention pathway, participants receive a rapid point-of-care HCV PCR test in their pharmacy by a study outreach nurse. If positive, direct-acting antivirals (DAAs) are delivered to participants via their pharmacist in line with their OST schedule.In the education-only pathway, pharmacists counsel OST clients on HCV and refer them to the nearest nurse-led clinic or general practitioner offering HCV testing according to standard care protocols. If positive, DAAs are delivered as in the intervention pathway.The primary endpoint for both pathways is sustained viral response at 12 weeks post-treatment . Secondary outcomes are: cost-efficacy by pathway; participants tested by pathway; adherence to therapy by pathway and impact of blood test results on treatment decisions.A statistical analysis plan will be finalised prior to data lock. Analysis will be by intention to treat (ITT) to show superiority. Modified ITT analysis will also be undertaken to explore the steps in the pathways.Ethics and disseminationThe trial received ethical favourable opinion from the East of Scotland Research Ethics Committee 2 (19/ES/0025) for UK sites and approval from the Alfred Hospital Ethics Committee (148/19) for Australian sites and complies with principles of Good Clinical Practice. Final results will be presented in peer-reviewed journals and at relevant conferences.Trial registration numberClinicalTrials.gov Registry NCT03935906.Protocol versionV.4.0—19 March 2020.