Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis

This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions’ clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative–hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, p < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, p = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, p = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.

Student Pharmacists’ Perceptions of Amazon Pharmacy

Amazon recently launched their online pharmacy in the United States (US). However, no studies have explored student pharmacists’ perceptions of the potential impact of Amazon Pharmacy. This qualitative study used individual semi-structured interviews to examine third- and fourth-year student pharmacists’ perceptions of how Amazon Pharmacy will affect economic, clinical, and humanistic outcomes; the pharmacy experience; and the job market. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed by two independent reviewers until saturation was reached, with differences resolved through discussion with a third researcher. Seventeen students participated in the study. Five themes were identified: perceived economic outcomes for patients, perceived clinical outcomes for patients, perceived humanistic outcomes for patients, perceived impact of the pharmacy experience for patients, and perceived influence of Amazon Pharmacy on the pharmacy market. The majority suggested Amazon Pharmacy would offer lower costs for patients (71%), improved medication adherence (76%), and improved quality of life (65%). There was a consensus that the Amazon Pharmacy experience would be different, with various opinions highlighting potential positive or negative aspects of the service. There were mixed opinions about job opportunities and impact on existing pharmacies. Future studies should evaluate economic, clinical, and humanistic outcomes for patients utilizing Amazon Pharmacy.

ECHOs of Medication Non-Adherence in Hypertensive Patients: A Systematic Review

Globally, hypertension has been one of the most common diseases. Although there has been improvement in the blood pressure control with the use of antihypertensive drugs, poor adherence to medications is still a problem. This has caused economic, clinical and humanistic outcomes (ECHOs) resulting in severe health crisis. This includes worsening of present disease condition, increase in co morbid diseases, increase in health care costs and ultimately death. This systematic review has broadened the scope of knowledge by providing valuable input into the development of clinical, economic and humanistic framework to standardize the consequences of medication non-adherence with the ECHOs. Literature documents the multiple adverse clinical consequences of medication non-adherence. It is also associated with a greater risk of cardiovascular events including vascular stiffness, left ventricular hypertrophy, micro albuminuria, acute coronary syndromes, stroke and transient ischemic attack and chronic heart failure ultimately leading to death. Humanistic outcomes were evaluated by measuring the symptomatic and functional status and quality of life. Economic outcomes were mainly affected by hospital related costs, productivity costs, social welfare costs, personal costs, cost to the family and friends and other associated costs. Keywords: Hypertension, Medication non-adherence, Clinical outcomes, Economic outcomes, Humanistic outcomes.

Physicians' Experience in Blood Supply Shortages and the Top Factors That Impact the Clinical, Economic, and Humanistic Outcomes of Myelodysplastic Syndrome (MDS) Patients in 5 European Countries

Introduction: Among patients with MDS, it is estimated that 17-82% (median 60%) are transfusion dependent (Harnan S, et al. Acta Haematol 2016;136:23-42) and require ≥ 1 unit of red blood cells (RBCs) every 8 weeks. Sufficient blood supply is essential for the administration of RBC transfusions in patients with MDS, as shortage of blood supply may create unnecessary burden, such as treatment delay, worsened quality of life, or increased healthcare utilization. To our knowledge, no studies have examined the physicians' experience associated with shortage of blood supply and RBC transfusion delays in this patient population. Physicians' perspectives on the factors that impact clinical, economic, and humanistic outcomes of patients with MDS are also not well understood. The current study investigated physicians' understanding of these topics. Methods: Prior to data collection, interviews were conducted with physicians (3 each in France, Germany, Italy, Spain, and the UK) to pre-test and revise the questionnaire, a 40-minute web-based physician survey via the M3 Global Research physician panel, for relevance and understanding. All physicians took the survey in their native language and had to have been in practice for 2-35 years, spend ≥ 75% of their time in direct patient care, and have managed ≥ 15 patients with MDS in the past 3 months. Physicians answered questions regarding adequacy of blood supply related specifically to RBC transfusions for patients with MDS. Physicians identified the top 10 factors (from a list of 32) impacting the clinical, economic, and humanistic outcomes of patients with MDS. These factors were then weighted accordingly (assigned point values summing up to 100). Results were described descriptively in proportions for categorical/ordinal data and mean (standard error [SE])/95% confidence intervals [CI]) for continuous data. Results: A total of 244 hematologist/oncologists, 124 hematologists, and 10 oncologists completed the survey in France, Germany, Italy, Spain, and the UK (n = 75 [approx.] in each country; Table). On average, physicians were in clinical practice for 14.70 years (SE 0.32), 41.3% were aged 45-54 years, and 64.3% were male. Physicians spent 88.7% (SE 0.36%) of their professional time in patient care, and had seen an average of 54.5 (SE 2.26) patients with MDS in the past 3 months. Over 65% of physicians (range 54.7 [France]-73.7% [UK]) reported that their patients with MDS encountered RBC transfusion delays due to blood supply shortage (Table). On average this impacted 9.0% (95% CI 7.6-10.4) of all patients with MDS. However, among physicians who reported delays (n = 248), 13.8% (95% CI 11.9-15.7) of patients were impacted, ranging from 11.0% (Spain) to 19.4% (Italy). Physicians (17.2%; range 9.3 [Spain]-31.6% [Italy]) reported ≥ 25% of their patients with MDS requiring transfusions experienced transfusion delay due to blood supply shortage. On average, patients experienced a 4.2-day (95% CI 3.6-4.8) delay in receiving a transfusion due to blood supply shortage, and 16.7% (95% CI 14.3-19.1) of patients required additional healthcare provider visits due to blood supply shortages. The top 10 factors reported that impact clinical, economic, and humanistic outcomes of patients with MDS included: Eastern Cooperative Oncology Group performance status (ECOG PS) (74.6%); age (66.7%); hemoglobin level (66.7%); infections (61.1%); percentage bone marrow blasts at diagnosis (60.1%); comorbidities (59.5%); platelets (56.3%); cardiovascular comorbidity (52.9%); genetic abnormalities (50.3%); and white blood cell count (48.4%). Factors that had the greatest mean impact scores were ECOG PS (8.9, 95% CI 8.1-9.8); percentage bone marrow blasts at diagnosis (8.3, 95% CI 7.3-9.2); age (7.2, 95% CI 6.5-8.0); hemoglobin level (6.8, 95% CI 6.1-7.4); and comorbidities (6.6, 95% CI 5.9-7.3). Conclusions: Two thirds of physicians reported that shortage of blood supply resulted in a delay in RBC transfusions for patients with MDS. Almost 20% reported ≥ 25% of their patients with MDS requiring transfusions experienced a transfusion delay due to blood supply issues. ECOG PS, hemoglobin level, and age were the top factors reported to impact outcomes of patients with MDS. New treatment options should be explored to help reduce the number of RBC transfusions, which may also help improve clinical, economic, and humanistic outcomes of patients with MDS. Disclosures Gupta: Bristol Myers Squibb: Consultancy, Research Funding; Kantar: Current Employment. Kulasekararaj:Alexion Pharmaceuticals Inc.: Honoraria, Membership on an entity's Board of Directors or advisory committees. Constantino:Kantar: Current Employment. Grisolano:Kantar: Current Employment; Bristol Myers Squibb: Consultancy. Tang:Bristol Myers Squibb: Current Employment; Asclepius Analytics: Current Employment. Jones:Bristol Myers Squibb: Current Employment. Tang:BMS: Current Employment, Current equity holder in publicly-traded company.

Clinical and Humanistic Outcomes of Tuberculosis Treatment in a Nigerian Directly Observed Treatment Short Course Centre

Background: Tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. The objective of the study was to evaluate the clinical and humanistic outcomes of tuberculosis treatment at the directly observed treatment short-course (DOTS) centre in Jos University Teaching Hospital. Methods: Data for clinical outcomes was collected retrospectively at the directly observed treatment shortcouse centre of Jos University Teaching Hospital from a cross-section of patients’ folders who had been treated for tuberculosis at the study site for at least 12months as at 1st April to 30th September 2018 while a validated questionnaire was administered prospectively to a census population of tuberculosis patients still undergoing treatment between 1st October 2018 and 31st March 2019 to determine the humanistic outcomes. A descriptive data analysis was done using SPSS version 23 and proportions were tested using chi squared statistics with significance level set at P<0.05. Results: The study revealed that tuberculosis treatment success in the centre was 76.33% which falls short of WHO standard of minimum of 85%. Patients taking tuberculosis treatment in the centre are satisfied with the services rendered to them and the improvement in their health conditions. Unfriendly attitude of some health care providers in the facility is an area for intervention. Conclusion: Clinical and humanistic outcomes of tuberculosis treatment was found to be satisfactory in the facility owing to the level of treatment success and patient reported satisfaction with facility services and improvement in their health conditions.