American Pharmacists Association

About: American Pharmacists Association is a other organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Pharmacist & Pharmacy. The organization has 2413 authors who have published 1969 publications receiving 30470 citations. The organization is also known as: APhA & American Pharmaceutical Association.

Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory

Abstract: Objectives: Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care. Design: This is a qualitative study informed by strong structuration theory. The analysis was thematic, using a template approach. An a priori set of thematic codes, based on strong structuration theory, was developed from the literature and applied to the transcripts. The coding template was then modified through successive readings of the data. Setting: Clinical commissioning group in the south of England. Participants: Four focus groups and five semi-structured interviews were conducted with 18 participants purposively sampled from a range of stakeholder groups (general practitioners, pharmacists, patients and commissioners). Results: Using the system could lead to improved medication safety, but use was determined by broad institutional contexts; by the perceptions, dispositions and skills of users; and by the structures embedded within the technology. These included perceptions of the system as new and requiring technical competence and skill; the adoption of the system for information gathering; and interactions and relationships that involved individual, shared or collective use. The dynamics between these external, internal and technological structures affected the adoption and implementation of the system. Conclusions: Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation.

The manipulation of drugs to obtain the required dose: systematic review.

Abstract: richey r.h., craig j.v., shah u.u., ford j.l., barker c.e., peak m., nunn a.j. & turner m.a. (2012) The manipulation of drugs to obtain the required dose: systematic review. Journal of Advanced Nursing68(9), 2103–2112. Abstract Aim. To describe the development of a systematic review protocol that maps the evidence relating to drug manipulations conducted to obtain the required dose. This process included defining a search strategy and methods to assess the quality and to synthesize the evidence retrieved. Background. Economic constraints mean that marketed formulations may not meet the needs of all patients. Consequently, it is sometimes necessary to manipulate marketed products with the aim of obtaining the required dose. Most clinical practice appears to be guided by ad hoc approaches and informal literature reviews. Methods. This systematic review protocol has been designed to identify the evidence available on drug manipulation. The review aims to identify what evidence is available and where the gaps appear in the current evidence. This report describes the challenges of developing a systematic review in an area that potentially involves many drugs and considers outcomes other than effectiveness. In particular, searches required the use of non-specific terms and the iterative development of a complex search strategy. The development of quality assessment criteria is also described. Funding commenced in April 2009. Discussion. The systematic review described here will capture a broad selection of research about drug manipulations and may also be of interest to those conducting reviews in broad remit subject areas that are not easy to define using accepted terminology.

Serotonin toxicity of serotonergic psychedelics.

Abstract: In recent years, psychedelic substances with serotonergic mechanisms have accumulated substantial evidence that they may provide therapeutic benefits for people suffering with psychiatric symptoms. Psychiatric disorders targeted by these psychedelic-assisted therapies are managed with serotonergic drugs like selective serotonin reuptake inhibitors (SSRIs) as the current standard of care, so it is important to evaluate the potential risks of drug-drug interactions and serotonin toxicity (ST) between these agents. A critical evaluation of the scientific literature is necessary to delineate the risks of ST when combining psychedelics with available serotonergic pharmacotherapy options. This review article describes signs and symptoms of ST, characterizes mechanisms of ST risk, summarizes what is known about serotonergic psychedelic drug interactions, and outlines potential management strategies. True ST typically occurs with a serotonergic drug overdose or in combinations in which a drug that can increase intrasynaptic serotonin is combined with a monoamine oxidase inhibitor (MAOI). Serotonergic psychotropics that do not contain MAOIs are low risk in combination with psychedelics that also do not contain MAOIs. Signs and symptoms warranting immediate medical attention include myoclonus, extreme and fluctuating vital signs, agitation or comatose mental state, muscle rigidity, pronounced hyperthermia (fever), and/or seizure activity. Serotonin-related adverse reactions exist along a spectrum with serotonin syndrome being the most severe manifestations of ST. Due to varying serotonergic mechanisms of psychedelics and psychotropics, with varying propensities to increase intrasynaptic serotonin, some combinations may present a significant risk for serotonin toxicity (ST) while others are likely benign.

The impact of an aged care pharmacist in a department of emergency medicine

Abstract: Rationale, aims and objectives Departments of Emergency Medicine (DEM) have experienced increased demand largely because of the aging population. This project aimed to assess the impact of a specialist aged care pharmacist (ACP) on the efficiency and effectiveness of care of older patients seeking emergency treatment. Method Eligible patients presenting to the DEM of Bundaberg Hospital (Australia), aged ≥65 years with a chronic condition, or ≥70 years without a chronic condition, and an Australian Triage Category score of ≥2, were alternately allocated to either the ACP (for medication reconciliation and medication review roles, along with patient education and referrals where warranted), or continued management by the DEM doctor (control group). Results A total of 199 patients were included (intervention, n = 101; control, n = 98), with no significant difference in mean age or gender distribution. While the ACP-managed group demonstrated a significantly greater length of stay than the control group, some confounding was likely. The ACP demonstrated greater vigilance than usual care in ensuring completeness and accuracy in charted medication orders. The ACP also provided timely clinical review for medication-related problems, with 81 issues identified for 73 admitted patients, and 24 issues among the 28 discharged patients. Qualitative data were strongly supportive, valuing and accepting of the ACP role. Conclusions This study provides evidence, on balance, supporting the integration of an ACP in the DEM assessing elderly patients. Further research of this role using longer sampling, in multiple sites and with economic analysis is recommended.

Development and validation of a Spanish language patient satisfaction questionnaire with drug dispensing

Abstract: Objective: To develop and validate a specific questionnaire about patient satisfaction with drug dispensing at Spanish community pharmacies. Method: A self-administered semi-structured questionnaire was designed centered on the perception of the patients with the dispensing service. To validate this questionnaire, it was administered at Spanish community pharmacies, which voluntarily agreed to participate in the study for a period of 2 months (March and April 2006). Patients or caregivers who were able to read and write were included in the study. Main outcome measure: Scores of the items related to satisfaction with the dispensing service. Results: The questionnaire consisted of: an introduction, 10 closed questions in an interval scale of five points, an open section to express comments, and finally demographic data of the patients. Twenty-seven community pharmacies participated in the validation, and 561 questionnaires were obtained with a response percentage of 56.5%. A Cronbach’s α coefficient of 0.91 was obtained. The Kaiser–Meyer–Olkin coefficient was 0.92, and the extraction of the principal components revealed a unique component explaining 55.2% of the total variance. About 15.5% of patients made additional comments that praised the quality of attention received and other aspects of the service such as the amiability and friendliness shown by pharmacy staff. Conclusion: The questionnaire developed shows evidence of validity and reliability for evaluating patient satisfaction with the dispensing service in community Pharmacies in Spain.