ORCID Profile
0000-0002-2084-8469
Current Organisations
KU Leuven
,
University of Western Australia
,
Monash University
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Publisher: Springer Science and Business Media LLC
Date: 03-12-2021
DOI: 10.1186/S12916-021-02180-5
Abstract: Although randomized controlled trials (RCTs) have suggested a non-significant increased risk of stroke among proton pump inhibitor (PPI) users, the association has not been confirmed. We evaluated the association between regular use of PPIs and incident stroke and identified population groups at high net risk. This is a prospective analysis of 492,479 participants free of stroke from the UK biobank. Incident stroke was identified through linkage to hospital admission and death registries using the International Classification of Diseases (ICD)-10 codes (I60, I61, I63, and I64). We evaluated hazard ratios (HRs) adjusting for demographic factors, lifestyle habits, prevalent comorbidities, concomitant use of medications, and indications of PPIs. We assessed the risk differences (RDs) according to the baseline Framingham Stroke Risk Score. In the meta-analysis, we searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (from 1988 to 1 June 2020) for randomized trials comparing PPIs with other interventions, placebo, or no treatment on stroke risk. Results were combined using a fix-effect meta-analysis (Mantel-Haenszel method). We documented 5182 incident strokes over 3,935,030 person-years of follow-up. Regular PPI users had a 16% higher risk of stroke than non-users (HR 1.16, 95% CI 1.06 to 1.27). The estimated effect was similar to our meta-analysis of nine RCTs (case articipants 371/26,642 RR 1.22, 95% CI 1.00 to 1.50 quality of evidence: moderate). The absolute effect of PPI use on stroke increased with the baseline Framingham Stroke Risk Score, with an RD of 1.34‰, 3.32‰, 4.83‰, and 6.28‰ over 5 years for the lowest, quartile 2, quartile 3, and the highest quartile, respectively. Regular use of PPIs was associated with an increased risk of stroke, with a higher absolute risk observed in in iduals with high baseline stroke risk. Physicians should therefore exercise caution when prescribing PPIs. An assessment of the underlying stoke risk is recommended for in idualized use of PPIs.
Publisher: Wiley
Date: 10-2020
DOI: 10.1002/JPPR.1695
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-025345
Abstract: Managing medication regimens is one of the most complex and burdensome tasks performed by older people, and can be prone to errors. People living with dementia may require medication administration assistance from formal and informal caregivers. Simplified medication regimens maintain the same therapeutic intent, but have less complex instructions and administration schedules. This protocol paper outlines a study to determine the feasibility of a multicomponent intervention to simplify medication regimens for people receiving community-based home care services. This is a non-randomised pilot and feasibility study. Research nurses will recruit 50 people receiving community-based home care services. All participants will receive the intervention from a clinical pharmacist, who will undertake medication reconciliation, assess each participant’s capacity to self-manage their medication regimen and apply a structured tool to identify opportunities for medication simplification. The pharmacist will communicate recommendations regarding medication simplification to registered nurses at the community-based home care provider organisation. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include the change in number of medication administration times per day, medication adherence, quality of life, participant satisfaction, medication incidents, falls and healthcare utilisation at 4 months. Ethical approval was obtained from the Monash University Human Research Ethics Committee and the community-based home care provider organisation’s ethical review panel. Research findings will be disseminated to consumers and caregivers, health professionals, researchers and healthcare providers through the National Health and Medical Research Council Cognitive Decline Partnership Centre and through conference presentations, lay summaries and peer-reviewed publications. This study will enable an improved understanding of medication management and administration among people receiving community-based home care services. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention. ACTRN12618001130257 Pre-results.
Publisher: Wiley
Date: 09-2015
DOI: 10.1002/JPPR.1136
Publisher: Wiley
Date: 12-2020
DOI: 10.1002/JPPR.1699
Publisher: Frontiers Media SA
Date: 04-2021
DOI: 10.3389/FMARS.2021.581901
Abstract: Ammonium is a fundamental nutrient for phytoplankton growth in seawater and is a key component of the microbial loop. Ammonium measured in parallel with other nutrients is crucial in understanding the small temporal scale changes in oceanographic ecology. Despite the importance of measuring ammonium at sea, owing to its lability, there is no consensus on the best method. The lack of availability of certified reference materials for ammonium in seawater also makes it difficult to assess the accuracy and reproducibility of ammonium measurements. In this study we present a modified segmented flow analysis method using ortho-phthaldialdehyde (OPA) with fluorescence detection to measure ammonium at sea together with four other macro-nutrients (nitrate, nitrite, silicate and phosphate) in near real time. An in-house ammonium quality control (QC) material was produced to improve the accuracy and repeatability of the measurement at sea. The QC was prepared following two different methods and stored in two types of containers. The suitability of the in-house QC’s as a reference material were assessed onboard the RV Investigator in 2018 during two oceanographic voyages, including one on the repeat SR03 CLIVAR transect. This paper describes the production and assessment of the in-house QC for ammonium in seawater, providing groundwork for creating a short-term stable ammonium reference material for sea going voyages. The uncertainty of this method of ammonium measurement was found to be 0.10 μmol/L at ammonium concentration of 1.0 μmol/L. Results show that preparation of the QC inside a laminar flow cabinet and directly into 10 mL polypropylene s le tubes just prior to the commencement of the voyage improved its stability.
Publisher: BMJ
Date: 08-2015
Publisher: Wiley
Date: 31-05-2017
DOI: 10.1002/PRP2.321
Publisher: SAGE Publications
Date: 27-12-2016
Abstract: Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel ‘BEGIN’ algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.
Publisher: Therapeutic Guidelines Limited
Date: 12-2020
Publisher: Public Library of Science (PLoS)
Date: 26-01-2022
DOI: 10.1371/JOURNAL.PONE.0262919
Abstract: Caregivers often use the internet to access information related to stroke care to improve preparedness, thereby reducing uncertainty and enhancing the quality of care. Social media communities used by caregivers of people affected by stroke were identified using popular keywords searched for using Google. Communities were filtered based on their ability to provide support to caregivers. Data from the included communities were extracted and analysed to determine the content and level of interaction. There was a significant rise in the use of social media by caregivers of people affected by stroke. The most popular social media communities were charitable and governmental organizations with the highest user interaction–this was for topics related to stroke prevention, signs and symptoms, and caregiver self-care delivered through video-based resources. Findings show the ability of social media to support stroke caregiver needs and practices that should be considered to increase their interaction and support.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2023
DOI: 10.1007/S11096-023-01561-5
Abstract: Comprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. Australian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis. Seventy-two de-identified reports from eight consultant pharmacists located in five of the eight Australian States and Territories were included for analysis. From the evaluated reports, four major categories of information were identified: (1) patient details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%) (2) pharmacist assessment including assessment of the patient (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%) (3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%) and (4) patient-centred experiences such as perspectives on medicines (n = 56, 78%). Reporting of patient-centred experiences appeared most variably in the included reports, including patient concerns (n = 38, 53%), willingness for change (n = 27, 38%), patient preferences (n = 13, 18%), and patient goals (n = 7, 10%). Pharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the patients they care for. However, variability across reports has the potential to impact consistent service delivery.
Publisher: Oxford University Press (OUP)
Date: 05-2023
Abstract: potentially harmful polypharmacy is very common in older people living in aged care facilities. To date, there have been no double-blind randomised controlled studies of deprescribing multiple medications. three-arm (open intervention, blinded intervention and blinded control) randomised controlled trial enrolling people aged over 65 years (n = 303, noting pre-specified recruitment target of n = 954) living in residential aged care facilities. The blinded groups had medications targeted for deprescribing encapsulated while the medicines were deprescribed (blind intervention) or continued (blind control). A third open intervention arm had unblinded deprescribing of targeted medications. participants were 76% female with mean age 85.0 ± 7.5 years. Deprescribing was associated with a significant reduction in the total number of medicines used per participant over 12 months in both intervention groups (blind intervention group −2.7 medicines, 95% CI −3.5, −1.9, and open intervention group −2.3 medicines 95% CI −3.1, −1.4) compared with the control group (−0.3, 95% CI −1.0, 0.4, P = 0.053). Deprescribing regular medicines was not associated with any significant increase in the number of ‘when required’ medicines administered. There were no significant differences in mortality in the blind intervention group (HR 0.93, 95% CI 0.50, 1.73, P = 0.83) or the open intervention group (HR 1.47, 95% CI 0.83, 2.61, P = 0.19) compared to the control group. deprescribing of two to three medicines per person was achieved with protocol-based deprescribing during this study. Pre-specified recruitment targets were not met, so the impact of deprescribing on survival and other clinical outcomes remains uncertain.
Publisher: Public Library of Science (PLoS)
Date: 04-03-2016
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 29-06-2016
DOI: 10.1111/AJR.12199
Abstract: Undergraduates who undertake rural placements often choose a rural career. Reluctance from universities to send students to rural settings limits placement numbers. The Western Australian Centre for Rural Health (WACRH) invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities to an Academic Bush C . Based on situated learning theory, this c modelled student programs through experiential learning and structured workshops. It aimed to build relationships and showcase innovative rural learning opportunities. To build relationships and showcase innovative rural learning opportunities. An evaluation of a residential c based on situated learning theory. The c stated and finished in Geraldton, WA and was centered in Mt Magnet, WA a remote town 600 kilometres northeast of Perth. WACRH invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities. This c modelled student programs through experiential learning and structured workshops. Online pre- and post-c questionnaires included open-ended questions and questions on a 5-point Likert scale. Responses were analysed in SPSS 22 using descriptive statistics and Wilcoxon signed-rank test. Follow-up phone interviews six months later assessed longer-term reflections and changes in student placement practice. The main outcome measure was whether the c met participants' expectations, and their knowledge about and interest in WACRH's programs. Twelve academics from five WA universities and seven health disciplines attended. Nine had previously lived or worked rurally. The c met participants' expectations and all would recommend the opportunity to a colleague. Many valued the interaction with community and clinical placement partners and would have preferred more of this. The c increased awareness of WACRH's programs and benefits of longer rural placements and a service-learning environment. Six months later, participants' familiarity with WACRH's placement model, supports and staff had led to an enhanced willingness to place students. Rural academics can influence rural placement intentions by demonstrating the infrastructure, learning and academic support available. A c experience increases metropolitan academics' awareness of rural placement programs and willingness to encourage student participation. Participants with rural backgrounds appeared more receptive to rural learning possibilities.
Publisher: Oxford University Press (OUP)
Date: 25-08-2020
DOI: 10.1111/IJPP.12668
Abstract: To compare the frequency and type of inpatient Parkinson’s medication errors reported through an incident report system versus those identified through retrospective case note review in a tertiary teaching hospital. A search of inpatient medication-related incident reports identified those pertaining to Parkinson’s medication. A discharge diagnoses search identified admissions for patients with Parkinson’s disease over the same time period. A retrospective case note and incident report review were performed to describe and quantify medication-related events. Substantially, more medication-related problems were identified via case note review (n = 805) versus incident reporting system (n = 19). A significantly different pattern of error types was identified utilising case note review versus incident reporting, with case note review more likely to identify delayed dosing, and incident reports more likely to identify wrong dose or formulation administered errors. Retrospective incident report and case note review can be used to characterise medication administration errors encountered in an inpatient setting. Incident report review alone is insufficient in estimating error rates, and dual data collection methods should be used.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.SAPHARM.2015.08.011
Abstract: Deprescribing may reduce harmful polypharmacy in older people and is an accepted clinical practice however, data to guide deprescribing decisions are scarce. This study aimed to determine if physicians and pharmacists agree on medicines to deprescribe. Two physicians and two pharmacists independently applied a deprescribing decision-making aid to clinical and medicines data collected during a deprescribing trial of frail older people in four residential aged care facilities. The consensus list of medicines selected for deprescribing by the physicians was compared with the consensus list selected by the pharmacists. Lin's concordance correlation coefficient (CCC) was used to assess agreement in the number of medicines, and agreement on each specific medicine was assessed using the level 2 intra-cluster correlation (ICC) for medicine within patient. Physicians and pharmacists had substantial agreement on the number of medicines to deprescribe (CCC = 0.70 95% CI: 0.58, 0.82), with a difference of 1.8 ± 2.0 total targeted medicines. For specific medicines, the agreement was moderate (ICC = 0.45, 95% CI: 0.32, 0.58). When considering only orally administered medicines, physicians and pharmacists had substantial agreement (CCC = 0.73 95% CI: 0.61, 0.84) in the number of medicines, but only moderate agreement for the specific medicines (ICC = 0.44, 95% CI: 0.30, 0.59). Physicians and pharmacists had substantial agreement in the number of medicines they targeted to deprescribe and to continue, but physicians targeted a greater number of medicines for deprescribing than pharmacists. However, they had only moderate agreement in the specific medicines to deprescribe. This suggests that the deprescribing decision-making aid is a useful tool for health professionals to use when considering medicines to deprescribe.
Publisher: Oxford University Press (OUP)
Date: 18-03-2023
DOI: 10.1093/IJPP/RIAD012
Abstract: Pharmacists’ response to practice change tends to range from apprehension to excitement. It is unknown if these varying responses are related to differing personality traits. This study aimed to describe the personality traits of Australian pharmacists, pharmacist interns and pharmacy students and any potential associations with their career satisfaction and/or outlook. Australian pharmacy students, pre-registration and registered pharmacists were eligible to participate in the cross-sectional online survey that consisted of participant demographics, personality traits (using a reliable validated instrument, the Big Five Inventory) and career outlook statements (three optimistic and three pessimistic statements). Data were analysed descriptively and using linear regression. The 546 respondents scored highly for agreeableness (4.0 ± 0.6) and conscientiousness (4.0 ± 0.6) and lowest in neuroticism (2.8 ± 0.8)). Pessimistic career outlook statements were predominantly neutral or disagreement, in contrast to the responses to the optimistic outlook statements that were predominantly neutral or agreement. Just over half (198 out of 368, 53%) of the registered pharmacists stated that they intended to practice in the profession for more than 10 years. For pharmacists, age had significant positive associations with the three optimistic career outlook statements and significant inverse relationships with three pessimistic career outlook statements. Neuroticism had significant inverse associations with optimistic statements and positive relationships with pessimistic statements. All demographics tested was overall optimistic about the pharmacy profession with pharmacists scoring highly in agreeableness, conscientiousness and openness.
Publisher: MDPI AG
Date: 13-10-2023
Publisher: Elsevier BV
Date: 09-2023
Publisher: Oxford University Press (OUP)
Date: 22-01-2021
DOI: 10.1093/IJPP/RIAA022
Abstract: An adequate workforce is necessary for health care delivery. The last official analysis of the Australian pharmacist workforce was in 2014 and the results of recent studies are contradictory. The objective of this work was to determine current demographic details and recent trends of the pharmacy workforce and assess the impact of changes in student numbers and migration policy. Longitudinal and descriptive analysis was undertaken of National Health Workforce Datasets and registrant data available from the Australian Health Practitioner Regulation Agency and the Pharmacy Board of Australia from 2013 to 2018. There was an increase in females and a trend towards hospital practice but no change in the geographic distribution of pharmacists over the period. However, the pharmacist workforce grew more slowly than comparable health professions and while the youngest pharmacist cohort (20–34 years) remains the largest, the next oldest cohort increased at a greater rate. The youngest cohort reported a decrease in intention to remain working in pharmacy. A fall in student numbers and changes to immigration policy have contributed to a low growth rate and ageing of the pharmacist workforce compared with other professions. Whether these factors along with the intentions of young pharmacists will result in a shortage is dependent on developments in demand for pharmacists and a workforce strategy is required to monitor these developments.
Publisher: Wiley
Date: 04-07-2018
DOI: 10.1111/JGS.15419
Abstract: To determine the incidence, severity, and preventability of and risk factors for medication-related harm (MRH) in community-dwelling older adults after hospital discharge. Systematic review. A search of Medline, EMBASE, CINAHL, and the Cochrane Library was undertaken without time restrictions. Older adults (average age ≥65) participating in observational studies investigating postdischarge adverse drug reactions (ADRs) or adverse drug events (ADEs) within a defined follow-up period. One author screened abstracts of all articles to exclude obviously irrelevant articles. Two authors independently screened the remaining articles for inclusion. Two authors independently extracted data, including study characteristics, MRH incidence, and risk factors a third reviewer critically appraised and verified the data. Disagreements were resolved through discussion. From 584 potentially relevant articles, 8 studies met our inclusion criteria: 5 North American and 3 European. Most of the included studies were of moderate quality. There was a wide range in MRH incidence, from 0.4% to 51.2% of participants, and 35% to 59% of MRH was preventable. MRH incidence within 30 days after discharge ranged from 167 to 500 events per 1,000 in iduals discharged (17-51% of in iduals). There is substantial methodological heterogeneity across multiple domains of the studies, including ADR and ADE definitions, characteristics of recruited populations, follow-up duration after discharge, and data collection. MRH is common after hospital discharge in older adults, but methodological inconsistencies between studies and a paucity of data on risk factors limits clear understanding of the epidemiology. There is a need for international consensus on conducting and reporting MRH studies. Data from large, multicenter studies examining a range of biopsychosocial risk factors could provide insight into this important area of safety.
Publisher: Wiley
Date: 08-07-2018
DOI: 10.1002/JPPR.1403
Publisher: Routledge
Date: 14-09-2017
Publisher: Wiley
Date: 18-02-2021
DOI: 10.1111/AJAG.12913
Abstract: Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not require diagnosis, and others stating that it is a genuine clinical syndrome. Many people with MCI will improve, and most will not progress to dementia. Managing co‐morbidities and exercising are likely to be the best treatment options. With limited evidence for effective interventions and uncertainty as to the prognostic value of the condition, the benefit of diagnosing MCI remains unclear.
Publisher: AMPCo
Date: 20-06-2019
DOI: 10.5694/MJA2.50244
Abstract: To estimate the prevalence of polypharmacy among Australians aged 70 years or more, 2006-2017. Analysis of a random 10% s le of Pharmaceutical Benefits Scheme (PBS) data for people aged 70 or more who were dispensed PBS-listed medicines between 1 January 2006 and 31 December 2017. Prevalence of continuous polypharmacy (five or more unique medicines dispensed during both 1 April - 30 June and 1 October - 31 December in a calendar year) among older Australians, and the estimated number of people affected in 2017 changes in prevalence of continuous polypharmacy among older concessional beneficiaries, 2006-2017. In 2017, 36.1% of older Australians were affected by continuous polypharmacy, or an estimated 935 240 people. Rates of polypharmacy were higher among women than men (36.6% v 35.4%) and were highest among those aged 80-84 years (43.9%) or 85-89 years (46.0%). The prevalence of polypharmacy among PBS concessional beneficiaries aged 70 or more increased by 9% during 2006-2017 (from 33.2% to 36.2%), but the number of people affected increased by 52% (from 543 950 to 828 950). The prevalence of polypharmacy among older Australians is relatively high, affecting almost one million older people, and the number is increasing as the population ages. Our estimates are probably low, as we could not take over-the-counter or complementary medicines or private prescriptions into account. Polypharmacy can be appropriate, but there is substantial evidence for its potential harm and the importance of rationalising unnecessary medicines, particularly in older people.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Wiley
Date: 07-03-2018
DOI: 10.1002/JPPR.1362
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 07-03-2018
DOI: 10.1002/JPPR.1361
Publisher: The Royal Australian College of General Practitioners
Date: 04-2023
Publisher: Mark Allen Group
Date: 02-01-2020
Abstract: Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. Deprescribing is an approach to managing polypharmacy and reducing adverse outcomes. Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.
Publisher: MDPI AG
Date: 06-03-2023
Abstract: Prescription request applications (apps) have changed the way consumers can obtain prescription-only medications. However, there is a lack of research surrounding such apps and their potential risks to consumers. We conducted an Australian study to (1) identify and characterise prescription request apps available in Australia and (2) assess whether prescription request apps in Australia adhere to guidelines for safe prescribing. Three online platforms (iOS App Store, Google Play store and Google search engine) were searched using 14 different search terms. Prescription request apps were identified based on pre-defined inclusion criteria. To determine whether the prescription request apps adhere to a safe prescribing framework, five medications were selected, and their corresponding consultation questionnaires were assessed against the Australian National Prescribing Service MedicineWise 12 core competencies for safe prescribing. A total of seven prescription request apps were identified. Assessment of the prescription request apps revealed that none of the apps provided prescribers with sufficient information to meet all the competencies required for safe prescribing rather, they inconsistently adhered to the safe prescribing framework. Thus, consumers and healthcare professionals should consider the implications and safety concerns of obtaining medications via prescription request apps.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 22-03-2022
DOI: 10.1002/JPPR.1804
Abstract: The aim of this narrative literature review was to describe the existing evidence for a post‐graduate experiential learning program, such as a foundational pharmacy residency, to support the competency development for early‐career pharmacists in conducting education, leadership and supporting innovation. We identified publications that addressed research in skills development within foundational pharmacy residency programs. Articles were identified using the databases Scopus and Embase. It was found that foundational residency programs have supported competency development in delivering education, leadership and management, and support of innovation and quality improvement. Residency programs have fostered these skills development through the use of courses, assessments and activities, but to varying degrees. Many of these skills are attained as a benefit of inclusion and mentorship in non‐clinical tasks. Residency programs can serve as a strong platform for the development of non‐clinical skills in education, leadership and innovation. A mix of activities and course‐specific skills building courses have demonstrated levels of success in developing skills in education, leadership and innovation when implemented.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2021
DOI: 10.1186/S12909-021-02664-1
Abstract: Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions. We conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models. There were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription p 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5–7) key gaps were noted in antimicrobials’ anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3–5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes p ≤ 0.01. Gaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.
Publisher: MDPI AG
Date: 30-05-2022
Abstract: A unique approach was introduced to integrate pharmacy students into a multicentre patient-centred research project predicting medication related harm (MRH) post-discharge. A training framework was developed to prepare students for research participation and integration. The framework aligned research project tasks with the pharmacists’ national competency standards framework. The framework was piloted on four research placement students from two local universities during three hospital placements, from October 2020 to August 2021. Following their initial orientation and training, students collected data from 38 patients and were involved in patient screening processes, interviewing, data collection and analysis. Patients’ MRH risk scores correlated with re-admission rates with 16/38 (42%) of patients re-admitted within eight weeks following discharge. Their participation in the research enabled students to obtain skills in (1) literature searching, (2) maintaining patient confidentiality, (3) interviewing patients, (4) obtaining data from medical records, (5) communicating with patients and clinicians, and (6) the use of clinical information to predict MRH risk.
Publisher: Wiley
Date: 19-03-2022
DOI: 10.1002/JPPR.1802
Abstract: To investigate physical health outcomes associated with medications prescribed to manage chronic physical conditions in people living with dementia and determine whether a dementia diagnosis altered drug utilisation patterns for physical health conditions. Medline, Embase, Central and Scopus were searched 01/2011 to 12/2020. Experimental and observational studies, where participants with dementia using medications prescribed by doctors to prevent or treat one or more chronic comorbid physical condition, were compared to no intervention, usual care, or a non‐dementia comparison group. The outcomes of interest were clinically meaningful physical outcomes, and medication utilisation patterns. Ten studies met the inclusion criteria. All were of medium to high quality relative to their study design. Mixed findings were reported for ischemic stroke ( n = 3), all‐cause mortality ( n = 3) and bleeding‐related outcomes ( n = 2). This is likely due to the heterogeneity in exposures reported. One study found that people with dementia, receiving antidiabetic management, had a higher rate of severe hypoglycaemia compared to people without dementia. Medication utilisation pattern outcomes included oral anticoagulant use before stroke‐related hospitalisation ( n = 1), antithrombotic medication use before stroke‐related hospitalisation ( n = 1), cardiovascular medication use for secondary prevention of ischemic heart disease ( n = 1), antidepressant medication discontinuation ( n = 1), osteoporosis treatment ( n = 1), diabetic medication use ( n = 2), and antihypertensive medication discontinuation ( n = 1). This systematic review showed there is currently insufficient evidence to conclude that medication management in people with dementia should differ substantially to people without dementia. Comprehensive and high‐quality evidence is needed to improve confidence that medication prescribing achieves optimum clinical outcomes, quality of life, and benefit‐to‐risk determination in this vulnerable population.
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-070265
Abstract: Clearly understanding and describing professional behaviours of pharmacists allows the profession, researchers and policy-makers to observe and monitor the professionalism of pharmacists, and design interventions to improve it where needed. The primary objective of this review was to identify which behaviours are discussed to contribute to professionalism in registered pharmacists in peer-reviewed literature. The secondary objective was to review the identified behaviours using a behavioural specification framework to understand how they are expressed. A scoping literature review was conducted. An electronic database search of Scopus, Embase, PsycINFO, PsychArticles, Emcare and Medline limited to articles published in English from 1 January 2000 to 21 October 2022 was conducted. Eligible articles contributed behaviourally relevant content with reference to registered pharmacists’ professionalism. Extracted behaviourally relevant content was subject to researcher’s familiarisation, then deductive coding to one of two overarching definitions of technical or non-technical behaviour. Data were then inductively coded through assignment of a descriptive code to identify categories of professional behaviour within these two overarching types of behaviour. Seven articles were identified and included in the final analysis. From the extracted behaviourally relevant content, 18 categories of behaviours were identified. All articles identified behaviours in categories titled ‘establishes effective relationships’ and ‘complies with regulations codes and operating procedures’. Identified behaviours were often broadly described and merged with descriptions of influences on them and broader outcomes that they contribute to. Behaviours described to contribute to pharmacists’ professionalism in the literature are broad and non-specific.
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1002/JPPR.1809
Abstract: To benchmark annual research output from hospital pharmacy departments in Australian principal referral hospitals. Embase, Medline, and Scopus. All 29 principal referral hospitals listed by the Australian Institute of Health and Welfare were searched using the institution field from 2018–2020. Articles were included if an author was affiliated with a hospital pharmacy department. Conference abstracts, letters, narrative reviews, opinions, commentaries, or editorials were excluded. A total of 261 research articles were identified from 27 principal referral hospital pharmacy departments from 2018–2020. Median research output over 3 years was five (interquartile range, 3–9) articles. In terms of annual research, hospital pharmacy departments in the 50th and 90th percentile for total publication output published two and ten original research articles every year, respectively. Overall, 56% ( n = 145) of the published studies were observational, 35% (n = 90) had a first author with a pharmacy department affiliation, 97% ( n = 252) had at least one author with a university affiliation, and in 5% ( n = 12) of the articles there was more than one hospital pharmacy department affiliation. On average, hospital pharmacy departments in Australian principal referral hospitals publish two original research articles every year. Nearly all of these articles are published in collaborations with universities.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.MATURITAS.2017.11.001
Abstract: Multiple brands of the same active ingredient may be available for the same strength, administration route and dose form. Generic brands needs to demonstrate bioequivalence to the originator brand, but the appearance of the generic and originator brands are not required to match. This variation is possible because different brands may vary in the excipients used in the formulation. Excipients are inactive ingredients, and typically make up about 90% of the formulation of an in idual medication. In idual preferences or requirements may affect tolerance of particular excipients, such as the use of animal products. The different appearance of brands can affect medication management for some people. This review discusses the potential for excipients to alter the in idual response to or tolerance of a medication brand.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2022
DOI: 10.1186/S12913-021-07358-4
Abstract: Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated ex les were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20420986221100117
Abstract: In the context of an ageing population, the burden of disease and medicine use is also expected to increase. As such, medicine safety and preventing avoidable medicine-related harm are major public health concerns, requiring further research. Potentially suboptimal medicine regimens is an umbrella term that captures a range of indicators that may increase the risk of medicine-related harm, including polypharmacy, underprescribing and high-risk prescribing, such as prescribing potentially inappropriate medicines. This narrative review aims to provide a background and broad overview of the patterns and implications of potentially suboptimal medicine regimens among older adults. Original research published between 1990 and 2021 was searched for in MEDLINE, using key search terms including polypharmacy, inappropriate prescribing, potentially inappropriate medication lists, medication errors, drug interactions and drug prescriptions, along with manual checking of reference lists. The review summarizes the prevalence, risk factors and clinical outcomes of polypharmacy, underprescribing and potentially inappropriate medicines. A synthesis of the evidence regarding the longitudinal patterns of polypharmacy is also provided. With an overview of the existing literature, we highlight a number of key gaps in the literature. Directions for future research may include a longitudinal investigation into the risk factors and outcomes of extended polypharmacy, research focusing on the patterns and implications of underprescribing and studies that evaluate the applicability of tools measuring potentially inappropriate medicines to study settings. A review on potentially inappropriate medicine regimens Medicine use in older age is common. Older adults with more than one chronic condition are likely to use multiple medicines to manage their health. However, there are times when taking multiple medicines may be unsafe and the number of medicines, or the combination of medicines used, may increase the risk of poor health outcomes. The term medicine regimens is used to describe all the medicines an in idual takes. There are several ways to measure when a medicine regimen may be inappropriate and, therefore, potentially harmful. Much research has been published looking into potentially inappropriate medicine regimens. To bring together the current research, this review provides a background on the different measures of potentially inappropriate medicine regimens. It also summarizes how many people may experience potentially inappropriate medicine regimens, the impact it is having on their health and who may be at greater risk. In doing so, we found a number of gaps in the existing evidence, indicating that our understanding of potentially inappropriate medicine regimens is incomplete. This review highlights gaps in knowledge that can be addressed by future research. With an improved understanding of potentially inappropriate medicine regimens, we may be able to better identify those at greater risk to prevent or minimize the impact of poorer health outcomes related to unsafe medicine use.
Publisher: Springer Science and Business Media LLC
Date: 07-2019
Publisher: Wiley
Date: 21-06-2018
DOI: 10.1002/JPPR.1434
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.SMRV.2014.12.003
Abstract: Insomnia is a prevalent sleep disorder that can profoundly impact a person's health and wellbeing. Herbal medicine represents one of the most frequently used complementary and alternative treatments of insomnia. However, the safety and efficacy of herbal medicine for the treatment of this disorder is currently uncertain. In order to ascertain the evidence base for herbal medicine for insomnia, we systematically searched seventeen electronic databases and the reference lists of included studies for relevant randomised controlled trials (RCTs). Fourteen RCTs, involving a total of 1602 participants with insomnia, met the inclusion criteria. Four distinct orally administered herbal monopreparations were identified (i.e., valerian, chamomile, kava and wuling). There was no statistically significant difference between any herbal medicine and placebo, or any herbal medicine and active control, for any of the thirteen measures of clinical efficacy. As for safety, a similar or smaller number of adverse events per person were reported with kava, chamomile and wuling when compared with placebo. By contrast, a greater number of events per person were reported with valerian. While there is insufficient evidence to support the use of herbal medicine for insomnia, there is a clear need for further research in this area.
Publisher: Wiley
Date: 28-11-2020
DOI: 10.1002/JPPR.1674
Publisher: Intellect
Date: 04-2015
Abstract: This article is about resettled Afghan Hazaras in Australia, many of whom are currently undergoing a complex process of transition (from transience into a more stable position) for the first time in their lives. Despite their permanent residency status, we show how resettlement can be a challenging transitional experience. For these new migrants, we argue that developing a sense of belonging during the transition period is a critical rite of passage in the context of their political and cultural identity. A study of forced migrants such as these, moving out of one transient experience into another transitional period (albeit one that holds greater promise and permanence) poses a unique intellectual challenge. New understandings about the ongoing, unpredictable consequences of ‘transience’ for refugee communities is crucial as we discover what might be necessary, as social support structures, to facilitate the process of transition into a distinctly new environment. The article is based on a doctoral ethnographic study of 30 resettled Afghan Hazara living in the region of Dandenong in Melbourne, Australia. Here, we include four of these participants’ reflections of transition during different phases of their resettlement. These reflections were particularly revealing of the ways in which some migrants deal with change and acquire a sense of belonging to the community. Taking a historical view, and drawing on Bourdieu’s notion of symbolic social capital to highlight themes in in idual experiences of belonging, we show how some new migrants adjust and learn to ‘embody’ their place in the new country. Symbolic social capital illuminates how people access and use resources such as social networks as tools of empowerment, reflecting how Hazara post-arrival experiences are tied to complex power relations in their everyday social interactions and in their life trajectories as people in transition. We learned that such tools can facilitate the formation of Hazara migrant identities and are closely tied to their civic community participation, English language development, and orientation in, as well as comprehension of local cultural knowledge and place. This kind of theorization allows refugee, post-refugee and recent migrant narratives to be viewed not merely as static expressions of loss, trauma or damage, but rather as in idual experiences of survival, adaptation and upward mobility.
Publisher: Wiley
Date: 19-09-2022
DOI: 10.1002/JPPR.1833
Publisher: Elsevier BV
Date: 04-2021
DOI: 10.1111/IDJ.12605
Publisher: Elsevier BV
Date: 2024
Publisher: Wiley
Date: 06-10-2022
DOI: 10.1002/JPPR.1832
Abstract: Medication‐related harm can occur during transitions of care. Revised Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) program rules were published in April 2020 which allowed provision for some hospital medical practitioners to refer at‐risk patients for medication review. In turn, the Society of Hospital Pharmacists of Australia's (SHPA's) Transitions of Care and Primary Care Leadership Committee developed a framework to support hospitals facilitating Hospital‐Initiated Medication Reviews (HIMRs) via three pathways: HMR, RMMR, and Hospital Outreach Medication Review. Following the compilation of draft barriers and enablers to implementation of the SHPA HIMR framework, refinement occurred after broad consultation with hospital‐ and primary care‐based pharmacists with transitions of care experience. The finalised list of barriers and enablers can inform broadscale implementation of the SHPA HIMR framework to reduce medication‐related harm when high‐risk patients transition from hospital to primary care and aged care.
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.ARCHGER.2022.104849
Abstract: To describe medicines regimens used by older people living in residential aged care facilities (RACFs). This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2023
Publisher: Wiley
Date: 13-01-2022
DOI: 10.1111/AJAG.13038
Abstract: To determine i) the similarity of potentially inappropriate medications specified in and between existing explicit lists and ii) the availability in Australia of medications included on existing lists to determine their applicability to the Australian context. This systematic review identified explicit potentially inappropriate medication lists that were published on EMBASE (1974 – April 2021), MEDLINE (1946 – April 2021) and Elsevier Scopus (2004 – April 2021). The reference lists of seven previously published systematic reviews were also manually reviewed. Lists were included if they were explicit, and the most recent version and the complete list were published in English. Lists based on existing lists were excluded if no new items were added. Potentially inappropriate medications identified on each list were extracted and compared to the medications available on the Australian Register of Therapeutic Goods and Australian Pharmaceutical Benefits Schemes. Thirty‐five explicit published lists were identified. A total of 645 unique potentially inappropriate medications were extracted, of which 416 (64%) were available in Australia and 262 (41%) were subsided by the general Pharmaceutical Benefits Scheme. Applicability of each explicit list ranged from 50–96% according to medications available in Australia and 25‐83% according to medications available under subsidy. Pooling data from different lists may help to identify potentially inappropriate medications that may be applicable to local settings. However, if selecting a list for use in the Australian context, consideration should also be given to the intended purpose and setting for application.
Publisher: Wiley
Date: 19-10-2022
DOI: 10.1111/ADJ.12878
Abstract: In Australia, because of inequity in dental service accessibility and affordability, patients can see general medical practitioners (GPs) for acute dental conditions. This cross‐sectional study consisted of surveys distributed to the board registered GPs practising in Australia. The main outcome measures included statistical analysis of GPs managing different dental emergency scenarios and their confidence and expectations in managing dental emergencies. A total of 425 GPs participated in the study. The s le primarily consisted of GPs practising in metropolitan clinics (n = 315). Most participants reported that they would refer to the dentist for mobilized tooth (n = 402). There was a negative correlation between GPs with 5–29 years of experience and traumatized tooth management ( P 0.05). GPs aged between 40 and 49 years were more inclined to treat patients with mobilized teeth [Multivariate (MV): 0.42(0.09–0.74)]. However, GPs with 0–5 years of experience were less likely to manage patients with dental abscess [MV: −0.52(−0.80 to −0.24)]. Most GPs referred dental emergencies to dentists. GP management of dental emergencies were predominantly palliative. Therefore, opportunities for collaborative practice models amongst GPs and dentists may be needed to bridge the gap in the regional and remote locations.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Public Library of Science (PLoS)
Date: 09-10-2018
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 13-06-2016
DOI: 10.1111/BCP.12975
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.MATURITAS.2019.02.010
Abstract: Health care focuses on controlling symptoms and managing risk factors to improve survival by avoiding future complications. Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. The diagnosis provides a tool for the health professional to conceptualise and classify a presentation, and thus manage the condition, and can provide the patient with an explanation or validation of their experience. Not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit. Promoting investigations and diagnoses can lead to overdiagnosis related to vested interests in increased services, use of devices or therapeutics. Multiple factors drive this issue, including broadening disease definitions and cultural factors that encourage tests and treatments, as well as medicolegal factors. While the traditional medicine review process typically involved cross-referencing medicines used with current diagnoses, a more sophisticated version of this process critically reviews the medicines and associated diagnosis, giving less emphasis to diagnoses that are no longer relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.
Publisher: Oxford University Press (OUP)
Date: 04-2021
DOI: 10.1093/IJPP/RIAA002
Abstract: Simulated patients are increasingly used to measure outcomes in health services but reporting is suboptimal. This study aims to create a checklist for the reporting of simulated patient (SP) methodology. This was a Delphi study. The authors of health service research studies using SP methodology were invited to participate. Round 1 questionnaire assessed the applicability of the TIDieR (Template for Intervention Description and Replication) reporting checklist for SP methodology and asked for rewording of/additional items. Responses were thematically analysed to generate Round 2 items in which participants rated each item for importance (seven-point Likert scale) and median, mode and IQR were calculated. In Round 3, participants were invited to rescore their Round 2 responses. Consensus was defined as an IQR ≤ 1 (Extremely important) and median ≤ 2 (Very important). All consensus items were considered for inclusion in the checklist. Similarly, worded items were rationalised and items not specific to SP methodology or other existing checklists were excluded. Twenty-nine authors participated in Round 1 and a further seven for Rounds 2 and 3. Twenty-six responses were analysed for Round 1, 30 for Round 2 and 28 for Round 3. There was consensus on 29 of 54 items in Round 2 and 45 of 63 items in Round 3. The final checklist comprised 28 items. A new reporting checklist to guide the reporting of studies, using simulated patients, complementary to CONSORT or STROBE, has been developed and will now be tested for usability.
Publisher: Elsevier BV
Date: 08-2020
Publisher: American Medical Association (AMA)
Date: 05-2015
DOI: 10.1001/JAMAINTERNMED.2015.0324
Abstract: Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one (2) consider overall risk of drug-induced harm in in idual patients in determining the required intensity of deprescribing intervention (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S40545-021-00395-8
Abstract: Variations in practice are commonplace in healthcare where health professionals, such as pharmacists act as autonomous practitioners. This is evident in simulated patient studies, where pharmacists practice does not meet widely accepted standards for medicines supply or treatment of an ailment. To promote best pharmacy practice a myriad of guidance resources including practice guidelines, codes and standards are produced by professional organisations. These resources provide a framework for pharmacy practice and endeavour to facilitate consistency in provision of pharmacy-based services to consumers. Despite their role in specifying essential pharmacist behaviours, there is limited research exploring if and how these resources are used in practice. To characterise Australian pharmacists’ use of the Pharmaceutical Society of Australia’s Code of Ethics, Professional Practice Guidelines and Professional Practice Standards. A cross-sectional, self-administered, electronic survey of registered pharmacists, intern pharmacists and pharmacy students living in Australia was conducted in July 2020. Questions considered use of professional practice resources (by resource group) in the preceding 12 months. Data were analysed descriptively. Of 601 responses included in the analysis 462 (76.9%) of respondents were registered pharmacists, 88 (14.6%) pharmacy students and 51 (8.5%) intern pharmacists. Interns and students accessed overarching practice resources, such as the Professional Practice Standards, Code of Ethics and Dispensing Practice Guidelines more frequently than practising pharmacists. Pharmacists accessed professional practice guidelines, such as Practice Guidelines for the Provision of Immunisation Services Within Pharmacy, more often than students. More pharmacists than interns and students indicated that they would access guidelines to resolve practice and patient care issues. All resources except the Professional Practice Standards for Pharmacists (67.4%) were accessed by less than 50% of respondents in the preceding 12-month period. Reasons for not accessing resources varied between participant and resource groups, and generally were due to a lack of awareness of the resource or not considering them necessary for the in idual’s practice. Access and use patterns for professional practice guidance resources change with experience. Professional organisations responsible for developing resources should consider these patterns when designing and reviewing resources and related policies. To ensure resources are meeting the needs of the profession, students, interns, and pharmacists should be involved in the review of and design of further resources.
Publisher: Wiley
Date: 06-2021
DOI: 10.1002/JPPR.1741
Abstract: Practice‐based research is essential in enhancing medication knowledge, quality use of medicines, the scope of the pharmacy profession and improving patient outcomes. This systematic review aims to uncover the attitudes of hospital pharmacists towards practice‐based research and their perceptions of the barriers and facilitators to undertaking practice‐based research. A systematic search of MEDLINE, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature databases from 1 January 2000 to 11 March 2021 was conducted. Peer‐reviewed empirical studies exploring hospital pharmacists’ perceptions of – as well as barriers and facilitators to – practice‐based research were included and a descriptive synthesis used to identify common themes. Nine studies were included in this review. Barriers and facilitators across four broad themes were related to pharmacist capacity and capability, workplace environment, research resources, and research culture. Hospital pharmacists had a high interest in conducting research, but limited research experience. Common barriers identified were lack of time, workplace support, funding, research culture, and competing priorities. Having a post‐graduate qualification and a positive attitude towards research facilitated research participation. Departmental support, designated research time and creation of research networks and forums were seen as facilitators for practice‐based research. Hospital pharmacists recognise the importance of practice‐based research in improving knowledge, patient care and advancing pharmacy practice. However, large variation has been reported for their confidence and experience in practice‐based research. Building research capacity and capability by supporting post‐graduate research qualification, providing designated time and creating research networks may strengthen the research culture amongst hospital pharmacists.
Publisher: Wiley
Date: 06-2020
DOI: 10.1002/JPPR.1665
Publisher: Elsevier BV
Date: 10-2023
Publisher: Oxford University Press (OUP)
Date: 13-07-2023
DOI: 10.1093/IJPP/RIAD044
Abstract: Guidelines support best practice for healthcare practice. In Australia, some non-prescription medicines are only accessible after consultation with a pharmacist and are known as Pharmacist Only medicines. Guidelines for providing some Pharmacist Only medicines are available, however, it is currently unknown if and how these guidelines are used in practice. The objective was to characterise pharmacists’, intern pharmacists and pharmacy students’ use of guidelines for Pharmacist Only medicines. A cross-sectional electronic survey of Australian registered pharmacists, intern pharmacists and pharmacy students was administered in July 2020. Questions explored the participants’ use of Pharmacist Only medicine guidelines (available both in print and online available online only) in the preceding 12 months. Data were analysed descriptively (i.e. frequencies, percentages). In total, 574 eligible respondents completed the survey. Overall, 396 (69%) reported accessing the online and in-print guidelines in the previous 12 months with 185 (33%) accessing online-only guidelines. The guideline on emergency contraception was used the most out of all guidelines in the past 12 months (278, 48%). Overall, respondents reported accessing guidelines to update knowledge, check their practice reflected best practice and content familiarisation. Respondents’ reasons for not accessing guidelines were due to respondents stating they did not need the information or that they had previously accessed the guidelines more than 12 months ago. These reasons varied between respondent groups. Access and use of the Pharmacist Only medicines guidelines varied between pharmacists, interns and students. Further understanding of the influences of the use of these guidelines will help inform professional bodies on how best to develop guidelines to increase consistent use in practice and implement interventions to increase use.
Publisher: Wiley
Date: 10-2016
DOI: 10.1111/IMJ.13215
Publisher: Wiley
Date: 07-2019
DOI: 10.1111/IMJ.14187
Abstract: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for ex le, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care hospitals with even a minimal IBD service provided improved care.
Publisher: Wiley
Date: 12-06-2019
DOI: 10.5694/MJA2.50226
Abstract: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Cross-sectional study. Six remote communities and the town of Derby in the Kimberley, Western Australia. Aboriginal people aged 45 years or more with complete medication histories. Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.
Publisher: Springer Science and Business Media LLC
Date: 23-12-2022
DOI: 10.1186/S12903-022-02660-X
Abstract: Prescribing medicine is integral to clinical dentistry. Infective endocarditis may be rare but fatal if left untreated. As a result, judicious prescribing of antibiotics should be implemented due to potential. To our knowledge, no Australian study has examined dental students' knowledge and perceptions about antibiotic prophylaxis for dental procedures. Australian dental students were invited to undertake the survey comprising case vignettes to investigate their medication knowledge. A total of 117 responses were received. The questions were 12 clinically relevant questions and three perception-based questions. Results were analysed using descriptive statistics as well as the chi-squared test. The 117 respondents had a mean correct response of 7.34 ± 2.64 (range 3–12 out of 12). Out of 117 students, 89 (76%) answered more than half of the questions correctly. Only three students (3%) answered all the questions correctly. Nearly two-thirds felt that they knew about antibiotic prophylaxis used for dental procedures. Most respondents answered more than half, but not all, of the clinical questions correctly. It is crucial to highlight that dental student may never receive any more training on antimicrobial stewardship (AMS) at any point in their future careers. It may be ideal that this issue is addressed at the dental school. One way to target this is to potentially nationalised teaching delivery of dental AMS across Australia.
Publisher: BMJ
Date: 08-2017
DOI: 10.1136/BMJOPEN-2017-017906
Abstract: The Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice. Participants came from both rural and metropolitan communities in two Australian states. Focus groups were held with consumers, general practitioners, nurses and pharmacists. Outcomes: data were analysed thematically. Nine focus groups were conducted. Fifty-five participants validated the content of MATCH-D, appraising them as providing patient-centred principles of care. Participants identified potential applications (including the use of MATCH-D as a discussion aid or educational tool for consumers about medicines) and suggested supporting resources. Participants provided insights into applying MATCH-D in practice and suggested resources to be included in an accompanying toolkit. These data provide external validation of MATCH-D and an empiric basis for their translation to practice. Following resource development, we plan to evaluate the feasibility and efficacy of implementation in practice.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.MATURITAS.2016.06.006
Abstract: Older people with chronic disease have great potential to benefit from their medications but are also at high risk of harm from their medications. The use of medications is particularly important for symptom control and disease progression in older people. Under-treatment means older people can miss out on the potential benefits of useful medications, while over-treatment (polypharmacy) puts them at increased risk of harm. Deprescribing attempts to balance the potential for benefit and harm by systematically withdrawing inappropriate medications with the goal of managing polypharmacy and improving outcomes. The evidence base for deprescribing in older people is growing. Studies to reduce polypharmacy have used a range of methods. Most evidence for deprescribing relates to the withdrawal of specific medications, and evidence supports attempts to deprescribe potentially inappropriate medicines (such as long-term benzodiazepines). There is also evidence that polypharmacy can be reduced by withdrawing specific medications using in idualised interventions. More work is needed to identify the sub-groups of older people who may most benefit from deprescribing and the best approaches to undertaking the deprescribing interventions.
Publisher: Therapeutic Guidelines Limited
Date: 03-08-2020
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.MATURITAS.2021.06.004
Abstract: Many medicines have anticholinergic properties, which have previously been correlated with a range of adverse effects, including cognitive impairment, hallucinations and delirium. These effects are potentially of concern for people with dementia. This systematic review investigated the effect of anticholinergic medicines on the health outcomes of people with pre-existing dementia. Embase, Medline and the Cochrane Library were searched from January 2000 to January 2021. Studies were included if they matched the following criteria: (1) the intervention involved anticholinergic medications (2) the study was conducted in people with pre-existing dementia (3) there was at least one comparator group and (4) the outcome of interest was clinically measurable. A total of 14 studies met the inclusion criteria. Most studies used an anticholinergic burden scale to measure anticholinergic exposure. Five high-quality studies consistently identified a strong association between anticholinergic medications and all-cause mortality. Anticholinergics were also found to be associated with longer hospital length of stay in three studies. Inconsistent findings were reported for cognitive function (in 4 studies) and neuropsychiatric functions (in 2 studies). In single studies, anticholinergic medications were associated with the composite outcome of stroke and mortality, pneumonia, delirium, poor physical performance, reduced health-related quality of life and treatment modifications due to reduced treatment response or symptom exacerbation. While the evidence suggests that anticholinergic medication use for people with dementia has a strong association with all-cause mortality, the association with cognitive and other clinical outcomes remains uncertain. Hence, further studies are needed to substantiate the evidence for other outcomes.
Publisher: Oxford University Press (OUP)
Date: 09-05-2022
DOI: 10.1093/IJPP/RIAC033
Abstract: Pharmacists are known as medicine experts. Dentists can independently prescribe and administer medications related to dental conditions such as antimicrobials, anti-inflammatories and analgesics. However, little is known about pharmacists’ knowledge and perceptions of medicines prescribed for dentistry. Therefore, this study aimed to assess community pharmacists’ ability to identify the indications for dental prescriptions using hypothetical vignettes. Australian community pharmacists were invited through email and social media to undertake a web-based questionnaire consisting of nine case vignettes of dental prescriptions and their indicated uses in dental settings and two perception-based questions. The results were provided as a percentage of the correct answers to the case vignettes. In addition, Pearson chi-square tests were performed to examine associations between categorical variables. Of the 202 pharmacists who completed the questionnaire, the mean number of correct responses was 5 ± 2 (out of 9). More than three-quarters (78.5%) of pharmacists believed that thorough knowledge of prescriptions for dental ailments was necessary for safe and effective community pharmacy practice. In addition, nearly two-thirds (64.1%) felt confident that they could dispense medicines indicated for dental conditions safely and effectively. The knowledge demonstrated by participants through correct identification of the indications for dental prescription was less than optimal. Professional development courses for pharmacists in dental ailments could prove beneficial.
Publisher: Oxford University Press (OUP)
Date: 15-07-2023
DOI: 10.1093/IJPP/RIAD047
Abstract: Reference texts assist pharmacists by addressing knowledge gaps and enabling evidence-based decisions when providing patient care. It is unknown whether reference text utilisation patterns differ between pharmacists, intern pharmacists and pharmacy students. To describe and compare the self-reported use and perceptions of a reference text, namely the national formulary, by pharmacists, intern pharmacists and pharmacy students. Registered pharmacists, intern pharmacists and pharmacy students living in Australia were surveyed in July 2020. The survey was electronic and self-administered. Questions considered self-reported use of a specific reference text in the preceding 12 months. There were 554 eligible responses out of 774 who commenced the survey: 430 (78%) pharmacists, 45 (8%) intern pharmacists and 79 (14%) pharmacy students. Most participants (529/554, 96%) reported historical use of the text, though pharmacists were significantly less likely than intern pharmacists and students to use it frequently (52/422, 12% versus 16/43, 37% versus 23/76, 30%, P & 0.001). Pharmacists (44%, 177/404) reported using the text as a tool to resolve a situation when providing a service or patient care (177/404, 44%) or as a teaching resource (150/404, 38%). In contrast, intern pharmacists and students most commonly use these to familiarise themselves with the contents (30/43, 70% 46/76, 61%) or update their knowledge (34/43, 79% 53/76, 70%). Access and use patterns varied significantly across career stages. A broader understanding of the use of reference texts may help develop interventions to optimise the content and usability. Varying usage patterns across the groups may inform the tailoring of texts for future use.
No related grants have been discovered for Amy Page.