Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.

https://www.dovepress.com/getfile.php?fileID=57205

Medication Therapy Management: Current Challenges.

https://escholarship.org/content/qt5r67r2j7/qt5r67r2j7.pdf?t=qr2v6m

Medication Abortion With Pharmacist Dispensing of Mifepristone.

Background Over the last few years, pharmacy practice in the Arab regions of the Middle East has started to change and develop. There have been small but promising steps to recognize the importance of extending community pharmacists’ roles to meet the expanding public healthcare demands. Objectives This systematic review aims to identify, synthesize and assess the quality of the literature in the Middle East concerning public attitudes on community pharmacist role and services and in relation to public perceptions on strategies to improve pharmacy services and the image of community pharmacist. Methods A systematic search of 11 electronic databases was conducted to identify all published relevant studies from inception till January 2020. Data was extracted using a designed and tested tool. Studies were assessed for quality using Crowe Critical Appraisal Tool. Results The final study results included 36 studies of which 31 adopted a cross-sectional-survey-based design. Included studies were published between 2004 and 2019. Most studies were done in Saudi Arabia (n = 11) or the United Arab Emirates (UAE) (n = 10). We identified four overarching themes across included studies 1) Use of Community Pharmacies; 2) Attitudes towards Community Pharmacist role; 3) Attitudes towards Current Community Pharmacy Services and 4) Strategies to Improve Community Pharmacy Practice. The most common reason for visiting a community pharmacy was to purchase a prescription or over-the counter-medication. The most common factors that affected patients’ choice of a particular pharmacy included convenient pharmacy location, availability of a good range of products or medicines, friendliness of the pharmacy staff and convenient pharmacy opening hours. There was a general public perception of community pharmacist as a business oriented person. Expectations of pharmacist duties included treatment of minor health ailments, consultation on over-the-counter medications and parapharmaceutical products, and accuracy checking of dispensed medications. Overall satisfaction with community pharmacy varied between the studies and ranged from 33% to 67.1%. Most commonly reported recommendations to improve pharmacy practice were provision of diagnostic, screening and monitoring services, keeping patient records in the pharmacy, advice on minor illness and provision of a private area for consultation. Seven articles were considered of low quality and 13 articles were considered of high quality. Conclusions While the public in the Middle East has a good understanding of the basic duties of a community pharmacist, there is lack of awareness of advanced pharmaceutical services. Decision makers in Middle Eastern countries should set strategies to improve community pharmacist professional image and competence beyond medication dispensing.

Public attitudes towards community pharmacy in Arabic speaking Middle Eastern countries: A systematic review.

Objectives: To survey, analyze, and ascertain the preferences for specialty pharmacy services among patients requiring complex care and to provide evidence to support specialty pharmacy service decision-making in China. Methods: To identify essential service attributes and levels, a review of the literature, discussions with specialty pharmacy managers and a pilot questionnaire were conducted. A D-efficient fractional factorial design was used to generate the discrete-choice experiment (DCE) questionnaire. A face-to-face survey of patients with chronic illness and their families or friends was conducted at three specialty pharmacies in Chengdu and Qingdao, China. A mixed logit model was used for estimation. Results: Six relevant attributes were identified and incorporated into the DCE questionnaire. A total of 417 participants completed the survey (mean age 43 years, 45.1% males), and 32.1% had lung cancer. The conditional relative importance showed that the most critical attribute was "frequency of telephone follow-up to monitor adverse drug reactions (ADRs), "followed by "mode of drug delivery," "provider of medication guidance services," and "availability of medical insurance consultation"; the least important attribute was "business hours." A 1 min increase in time spent led to a 0.73% decrease in the probability that a service profile would be chosen. Negative preferences were noted for ADR monitoring by telephone follow-up once a year (β = -0.23, p < 0.001) and business hours [8:30-20:00 (Monday to Friday), 8:30-17:30 (weekend)] (β = -0.12, p < 0.001). Compared with women, men had a higher preference for service monitoring ADRs once every 3 months. Conclusions: Preference measurements showed that "frequency of telephone follow-up to monitor ADRs" had the most critical impact on decisions, followed by "mode of drug delivery." Specialty pharmacies in China need to take these findings into account to improve their design to increase uptake and patient loyalty.

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Patient Preferences For Specialty Pharmacy Services: A Stated Preference Discrete-Choice Experiment in China.

This study aimed to evaluate the current practice of community pharmacists from patients’ and pharmacists’ perspectives in Saudi Arabia. This paper presents the pharmacist’s perspective. A cross-sectional self-administered online survey was designed to collect responses from community pharmacists in Saudi Arabia from February to April 2021. The questionnaire consisted of several statements related to best practice in community pharmacy. Pharmacists’ responses to each statement were scored using a 5-point Likert scale. Higher scores represented a greater extent to which they adhered to best practice in the community pharmacy setting and vice versa. Data of 164 participants were included in the analysis. The minimum median score was related to the statement: Pharmacist explains the main side effects. The maximum median score was related to the statement: Pharmacist explains dosage regimen. Pharmacists aged 30 years or above and non-Saudi pharmacists had significantly higher median scores compared with pharmacists less than 30 years of age (p = 0.016) and Saudi pharmacists, respectively (p = 0.001). A gap between best practice and current practice of community pharmacists was observed. Policymakers can utilize these findings to provide targeted professional development opportunities for the practicing community pharmacists in order to improve the overall service and care for patients.

/pdf/evaluation-of-current-community-pharmacist-practice-in-saudi-16elq86k.pdf

Evaluation of Current Community Pharmacist Practice in Saudi Arabia—A Cross-Sectional Study from Pharmacists’ Perspective (Part II)

Objective Patient selection of community pharmacy is based on a multitude of factors. With increasing competition and rapidly changing face of pharmacy, identification of these factors is critical for patient satisfaction and financial success. This systematic review summarizes patient preferences for different attributes of community pharmacy. Data sources Systematic review of peer-reviewed studies conducted on U.S. population, published from 2005 to 2018 in EBSCO, PubMed, and EMBASE, was conducted to identify attributes of community pharmacy that determine patient patronage. Study selection Studies conducted between 2005 and 2018 on U.S. population that examined attributes in choosing a pharmacy were eligible for this systematic review. Data extraction Data were independently extracted, assessed, and evaluated by 2 reviewers. Any disagreements were resolved by the third reviewer. Data obtained included year, setting, number of patients, data collection and evaluation methods, and relevant results and outcomes. Results Of the 713 papers identified, 10 articles met the inclusion criteria and were included in this systematic review. Majority of the studies used surveys to examine key attributes that influence patients’ selection of a pharmacy. Pharmacist traits like friendly, helpful, trustworthy, professional, competent, caring, knowledgeable, responsive, and approachable are critical attributes that influence a patient’s selection of pharmacy. Convenience (i.e., location, hours of operation, wait time, stock availability) also influenced patients’ selection of pharmacy. Cost and contract with insurance were other important factors. Availability of auto-refills appeared consistently in the studies. Medication safety (detecting drug interactions) quality metrics also appeared high among patients’ preferences. Conclusion The results of this review found that a relationship with a respectful, friendly, competent pharmacist represents important pharmacist-related attributes in the process of pharmacy selection. Important pharmacy-related attributes include cost, convenience, and wait times. Availability of auto-refill service was also a frequently reported attribute in this review.

Djatomah A. Comoe

Papers

Determining patient preferences of community pharmacy attributes: A systematic review.