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International Telepharmacy Education: Another Venue to Improve Cancer Care in the Developing World

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Abstract and Figures

In developed countries, pharmacists play a crucial role in designing and implementing cancer treatments as part of a multidisciplinary oncology team. However, developing countries have a shortage of pharmacists, and their role is generally limited to dispensing and selling drugs. The aim of this study was to investigate the feasibility of providing clinical pharmacy educational activities via international teleconferencing to improve cancer care in developing countries. Meticulous preparation and intense promotion of the workshop were done in Egypt before the telepharmacy conferences began. Multiple connectivity tests were performed to resolve technical problems. Nine telepharmacy conferences were delivered during 3-h sessions that were held on three consecutive days. Talks were subsequently made available via Web streaming. Attendees were requested to complete a survey to measure their satisfaction with the sessions. The teleconference was attended by a total of 345 persons, and it was subsequently reviewed online via 456 log-in sessions from 10 countries. Technical issues (e.g., poor auditory quality) were resolved on the first day of the event. The rate of attendees' responses on the survey was 30.1%, and satisfaction with the event was generally good. Telecommunication is a relatively inexpensive approach that may improve pharmacy practices, especially those used to treat patients with cancer in developing countries. Special attention to patient-based telepharmacy education, including the use of cost-effective technology, should be considered.
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Brief Communication
International Telepharmacy Education: Another Venue
to Improve Cancer Care in the Developing World
Ahmad S. AlFaar, M.B.B.Ch.,
Sherif Kamal, Pharm.D.,
Sherif AbouElnaga, M.D.,
William L. Greene, Pharm.D.,
Yuri Quintana, Ph.D.,
Raul C. Ribeiro, M.D.,
and Ibrahim A. Qaddoumi, M.D., M.S.
Departments of
Pharmaceutical Services,
Academic Affairs Research and Outreach,
Children’s Cancer Hospital, Cairo, Egypt.
Departments of
Pharmaceutical Sciences,
Oncology and
International Outreach Program,
St. Jude Children’s Research Hospital, Memphis, Tennessee.
Objective: In developed countries, pharmacists play a crucial role
in designing and implementing cancer treatments as part of a
multidisciplinary oncology team. However, developing countries
have a shortage of pharmacists, and their role is generally
limited to dispensing and selling drugs. The aim of this study
was to investigate the feasibility of providing clinical pharmacy
educational activities via international teleconferencing to im-
prove cancer care in developing countries. Materials and Meth-
ods: Meticulous preparation and intense promotion of the workshop
were done in Egypt before the telepharmacy conferences began.
Multiple connectivity tests were performed to resolve technical
problems. Nine telepharmacy conferences were delivered during 3-h
sessions that were held on three consecutive days. Talks were sub-
sequently made available via Web streaming. Attendees were re-
quested to complete a survey to measure their satisfaction with the
sessions. Results: The teleconference was attended by a total of 345
persons, and it was subsequently reviewed online via 456 log-in
sessions from 10 countries. Technical issues (e.g., poor auditory
quality) were resolved on the first day of the event. The rate of
attendees’ responses on the survey was 30.1%, and satisfaction with
the event was generally good. Conclusions: Telecommunication is a
relatively inexpensive approach that may improve pharmacy prac-
tices, especially those used to treat patients with cancer in devel-
oping countries. Special attention to patient-based telepharmacy
education, including the use of cost-effective technology, should be
Key words: pharmacy, distance learning, telemedicine
Pharmacists play a major role in improving healthcare and
patient safety while reducing cost, especially for oncology
The role of pharmacists as part of the treating
team is well established in the developed world.
there is a general shortage of pharmacists in developed countries that
is the most critical in rural areas.
This shortage has prompted New
Zealand to explore compulsory externships in which all pharmacy
students would be required to complete part of their training in rural
In the United States, Wisconsin has created new laws that
allow the use of telepharmacy for practice as a solution to the
pharmacist shortage in that state.
In the developing world, the
shortage of clinical pharmacists is even worse, partially because their
role is marginalized and their activities are predominantly those of
medication dispensers or entrepreneurs.
Oncology is a multidisciplinary field in which pharmacists play an
integral role in treatment design and implementation, side effect
management, patient safety, supportive care, and patient educa-
In addition, the cost of antineoplastic and supportive care
drugs is rising. Pharmacists can be gatekeepers and help control that
cost while improving efficiency.
This is most important in developing
countries, where drug costs constitute 25–66% of healthcare expenses;
drugs constitute only 10% of healthcare in developed countries.
The Children’s Cancer Hospital 57357 Egypt (CCHE), which opened
its doors in Cairo in July 2007, is considered one of the largest pe-
diatric cancer centers in the world; 950 new cases are accepted each
year. The CCHE Pharmacy is dedicated to improving care, promoting
research, and cutting cost. The International Outreach Program and
Pharmaceutical Services at St. Jude Children’s Research Hospital
(Memphis, TN) agreed to facilitate telepharmacy educational activi-
ties to CCHE via videoconferencing. Here we report our experience
with emphasis on the quality of the telepharmacy sessions, the per-
ception of the participants, and the savings in cost and time that this
event allowed.
Materials and Methods
Before the teleconference, issues such as scheduling, duration of
the sessions, and topics were negotiated between the teams at CCHE
and St. Jude. Because of the 8-h time difference between Memphis
and Cairo, three daily 3-h sessions were more practical than a single
9-h workshop. The agreed-upon time was 5:00 to 8:00 p.m. (Cairo
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DOI: 10.1089/tmj.2011.0182 ªMARY ANN LIEBERT, INC. VOL. 18 NO. 6 JULY/AUGUST 2012 TELEMEDICINE and e-HEALTH 1
time), which was 9:00 a.m. to 12:00 p.m. ( Memphis time). Topics to be
discussed were suggested by the CCHE team with some minor mod-
ifications suggested by the St. Jude team. The learning objectives for
each topic were determined by the respective speakers (
T1 Table 1).
Finally, permission was obtained from speakers to film their lecture
for Web streaming.
Connectivity and other technical issues were tested prior to the
conference. The first test with high bandwidth was performed 9 days
before the conference. After addressing some of the recognized
technical problems, we performed another test 2 days before the
conference. A final test was done 30 min before the first tele-
pharmacy session started. The conference was publicized in Egypt
and around the world via personal communications (e.g., e-mails),
printed material, and online. Talks were available via synchronous
and recorded Web streaming.
The connection used at CCHE was a symmetric digital subscriber
line with 25 megabits per second (Mbps). The videoconference unit
used was a Tandberg (now part of Cisco) MXP 6400. The CCHE au-
ditorium has a capacity of 208 attendees and is covered by two
cameras, in addition to a unit-attached camera that was used for
preparing the connections before the sessions started. Images from
the auditorium cameras were collected and mixed by a video mixer.
The video mixer chooses the source and destination screen of the
video. Then the mixer provides the videoconference unit with the
video source. An audio mixer provided the audio to the videocon-
ference unit. Questions from the local conference attendees were
collected using wireless microphones.
Output from the videoconference unit was transferred to the dig-
ital versatile disc recorder (DVR) with an internal hard disc drive. The
DVR recorded and bypassed the audio/video signals to the previously
mentioned video mixer, which transferred the audio and video feeds
from the videoconference unit to conference displays, which con-
sisted of two 42-inch plasma screens and one auditorium projector.
Another projector was secured to avoid any main projector failures.
Video/audio was provided to the streamer/broadcaster (VBrick
Systems, Wallingford, CT) through the video mixer, and sessions
Table 1. Telepharmacy Topics, Learning Objectives, and Attendance
1 Research List two examples of pharmacokinetic or pharmacodynamic objectives that may be studied
in a clinical trial
Give an example of a drug with a known relationship between genetic variation and toxicity
Pharmacy dashboard Review the rationale for and process used to assemble a ‘‘living’’ data dashboard for use by health system
pharmacy leaders at St. Jude
Safety List key milestones in medication safety
Describe the features of a high-reliability organization
Discuss methods for applying these principles in practice
2 Order evaluation Review the many elements of proper pharmacy processing of an order for chemotherapy
Emphasize the important safety steps that should be adhered to for optimal handling of these orders
Hyperglycemia Evaluate the literature on hyperglycemia in the hospital setting
Discuss the sequelae associated with transient hyperglycemia in oncology patients
Identify patients at risk for transient hyperglycemia
Review insulin preparations and activity profile
Status epilepticus in neutropenia Describe the adequate drug selection in status epilepticus
Describe the challenges of home management of status epilepticus in neutropenic patients
Discuss the use of buccal midazolam for seizure control
3 Fever and neutropenia guidelines Provide an overview on practice guidelines currently published in the United States
Review key points of drug therapy related to preventing and treating infection in the neutropenic patient
with cancer
Zygomycosis treatment Review the current treatment of zygomycosis and the spectrum of activity and pharmacokinetic properties
of posaconazole
Describe the application of this treatment approach to a patient case
Voriconazole Review the basic principles of TDM
Review published data on the use of TDM for voriconazole for efficacy
Discuss the importance of TDM in the prevention of voriconazole-induced toxicities
Discuss the results of a pharmacokinetic review of voriconazole in pediatric patients
TDM, therapeutic drug monitoring.
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were broadcast directly over the conference Web site and recorded on
the streamer’s hard disk drive.
RCA cables were used. Videoconference units at both sides were
connected at a speed of 4,200 kilobits per second to accommodate the
available bandwidth. The connection was interrupted twice on Day 1,
once on Day 2, and twice on Day 3. Interruptions did not exceed 15 s
in duration. Connection was resumed each time without any conse-
quences or changes in the configuration. During discussions, the
picture-in-picture view was used, with the presenting side shown in
the maximized view.
A questionnaire was developed based on modified online surveys
from the Web site,
and other questions were added
based on previous telemedicine experiences
and eLearningGuild
.com synchronous learning evaluation surveys. The online survey
was implemented using the open-source survey management ap-
plication Lime Survey (, after its style was
modified for the hospital’s corporate identity. The survey was hosted
on a Web site prepared for the event. On Day 1, answering all of the
survey questions was not mandatory, so some questions were left
unanswered. On Day 2, all questions, except the responder’s name,
were programmed to be obligatory to answer for an attendee to be
able to complete the survey. However, it was not mandatory for
attendees to take the survey. Browser cookies and Internet protocol
(IP) addresses were used to track the respondents. Because the Lime
Survey system provides an IP-tracking module, each respondent’s IP
was tracked to ensure that attendees answered for themselves and
that all duplicate responses from anonymous users were removed.
The survey consisted of 19 questions that addressed the following
topics: session quality (topic, presenter, audiovisual, equipment, and
technical support), impact on practice, general satisfaction, request
for general suggestions, and miscellaneous (e.g., session name, per-
sonal name, and whether the person would recommend or participate
in such activities again in the future). The survey was done elec-
tronically and was available for 2 weeks after the last session.
In total, 106 surveys were completed. Of these, two were excluded
because no information was provided, so 104 surveys were evalu-
able. We also documented a total of 456 online log-ins from 10
countries to review the sessions. Most of the responses (84 [80.8%])
were completed within 3 days of the last session, and the rest (20
[19.2%]) were completed within the following 11 days. It should be
noted that the percentages were calculated for each day separately
T2 Table 2).
The majority of attendee responses indicated that the sessions will
influence their practice (n=93), will improve their patient care
(n=82), will improve treatment outcomes (n=91), met their educa-
tional needs (n=78), reinforced their current practice (n=87), and
met the stated objectives (n=85). Most attendees indicated no evident
commercial bias and/or influence (n=59), but some were uncertain
(n=29). When asked about their commitment to making changes in
their practices, many were committed to implementing these changes
(n=74). Some reported a desire to change for their practice but
cannot because of various limitations, including administrative is-
sues (n=26), practice issues (n=30), lack of resource issues (n=10),
policy issues (n=3), or financial reasons (n=15).
Most attendees were satisfied with the presenters’ knowledge of
the subject (n=95), meeting the stated learning objectives (n=91),
and method of presenting information (n=88). There were many
attendees who had never participated in telepharmacy sessions
(n=87). Many indicated satisfaction with the presenter who led the
discussion (n=85) and with their opportunity to ask questions
Most attendees were satisfied with the information they received
prior the videoconference (n=90), the video quality (n=85), and the
audio quality (n=64). Some attendees were not satisfied with the
audio quality (n=17), while some were not sure (n=22). Satisfaction
with equipment was good (n=82), as well as that with the room
(n=94) and technical support (n=95). Nearly a third (28.9%) of the
attendees reported dissatisfaction with the background noise that
occurred on Day 1 (discussed below).
Some attendees suggested allowing more time for questions
(n=21), showing more visual examples (n=19), and allowing more
interaction between the presenter and attendees (n=19).
When asked how they learned about the teleconference, the
attendees responded as follows: word of mouth (n=28), printed
material (n=22), e-mail (n=14), and Internet search (n=13).
Table 2. Attendance and Survey Response Rates
1 140 126 38 (27.1)
2 105 203 36 (34.3)
3 100 127 30 (30.0)
Total 345 456 104 (30.1)
Surveys were completed by local attendees only, and 80.8% were completed
within 3 days of the last telepharmacy session.
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Two weeks prior to the workshop, we identified interference with
Internet functions requiring bandwidth caused by e-mails, broad-
casting, and regular Internet browsing. To overcome this interfer-
ence, the Internet bandwidth at CCHE was increased from 10 to
25 Mbps. Another problem faced during the testing was that any
changes in the St. Jude real IP of the videoconference machine
or gateway required that CCHE register the new IP addresses at
their firewall to accept the connection and route it to their video-
conference unit.
On Day 1, the level of background noise was very high. Different
methods of noise reduction were attempted using an auditorium-
equalizer facility with little improvement, and the problem persisted
throughout the session. On Day 2, we discovered that the source of
the background noise was the echo-reduction option on the CCHE
videoconference unit. When this option was turned off, the audio
became very clear. However, the microphone at CCHE had to be
turned off during the presentation to avoid the echo. Thus, when an
attendee at CCHE posed a question, that microphone was switched on,
and the microphone at St. Jude had to be turned off. Attendees’
satisfaction with the audio quality was preserved throughout the rest
of the workshop.
Knowledge sharing using advanced telecommunication strategies
has been successful in accomplishing diverse educational and eco-
nomic activities, including adult and pediatric oncology. Applied to
oncology, it has improved cancer care in the developing world. To
date, most of these teleinteractions have involved diagnostic and
therapeutic procedures but not pharmacy practices.
To our
knowledge, this is the first reported experience of an international
telepharmacy educational symposium in pediatric oncology. Most
cancer burden in the future will be in developing countries
; thus,
integrating pharmacy activities into oncology practices will improve
care and decrease cost.
This goal is crucial in developing countries
because drugs constitute a significant portion of the healthcare cost
Telemedicine has the potential of saving money and time by de-
creasing the need to travel.
The airfare for one speaker to travel
from Memphis to Cairo during the period of the teleconference was
approximately $3,000 (U.S.), and the cost of hotel accommodation in
Cairo for 3 nights would have been about $570 (U.S.). By using
videoconferencing, CCHE saved nearly $25,000 (U.S.). This amount
does not include the honorarium usually paid to speakers by the
hosting institute or the number of working days saved by St. Jude.
Round-trip travel from Memphis to Cairo is approximately 42 h; thus,
the seven St. Jude speakers saved in total 294 h of travel time.
Our study provides evidence of the success of an international
experience of telepharmacy. This success is evident in the attendance
and number of times the programs were reviewed online. Such at-
tendance was made possible because of the dynamic marketing of the
telepharmacy workshop via different methods such as e-mails, online
announcements, printed material, and word of mouth. Except for
poor audio quality on the first day, the attendees were generally
satisfied with the content, preparation, and technical support. This
success was due to the meticulous preparation and multiple technical
tests done prior to the telepharmacy sessions. This technical success
would not have been possible without the human factor and local
institutional support that are crucial for any telemedicine activity to
Many CCHE pharmacy colleagues and those from other CCHE
departments, including two of the co-authors (S.K. and S.A.), have
visited St. Jude since the establishment of our International Outreach
Program partnership with their institution. Thus, to establish a sus-
tainable telepharmacy program, it is best to incorporate it as part of a
larger twinning/collaboration initiative.
We must note that the general satisfaction reported in the survey
could be overestimated because of the low response rate of around
30%. Attendees who had positive feedback to offer responded, and
those who were dissatisfied may have elected to not fill out a survey.
Many of the suggestions offered by attendees focused on allowing
more time for interaction with the speaker and more time for ques-
tions. These suggestions will be considered in the planning of future
telepharmacy activities to alleviate the anxiety of the attendees and
compensate for the lack of the speaker’s physical presence.
Finally, we must emphasize that we are not proposing that tele-
pharmacy is the solution for all pharmacy problems and deficits in
developing countries or underserved populations in the developed
world, but rather we suggest that it is a method to be explored in a
systemic approach. Providing seminars may not necessarily improve
patient care, but a patient-focused approach complements the
knowledge gained during the telepharmacy sessions and may benefit
patients in real time.
Also, other methods of telemedicine that are
less expensive than videoconferencing (e.g., or
Skype) should also be considered, if they can achieve the defined
To improve patient care, the pharmacy teams from CCHE and St.
Jude have started holding regularly scheduled online meetings
that are mainly dedicated to actual cases at CCHE. The teams are
conducting these meetings via the Cure4kids Web site (www The meetings may facilitate the application of
knowledge gained during these interactions into clinical practice.
Further follow-up work could include surveying the CCHE attendees
to learn whether they have implemented changes or improved their
practice based on the telepharmacy symposium and online follow-up
The authors would like to acknowledge the internet company
TEDATA in Egypt for upgrading the bandwidth speed at CCHE, the
Egyptian National Science and Technology Information Network for
donating the Tandberg MXP 6400 videoconference unit to CCHE,
Mdm. Ola Laurence for logistical support, and Cornelius Johnson for
technical support. We also thank the St. Jude speakers who partici-
pated in the telepharmacy sessions: William Greene, Cyrine Haidar,
TMJ-2011-0182-ver9-AlFaar_1P.3d 05/19/12 10:10am Page 4
Kristine Crews, James Hoffman, Sara Jane Faro, Rong Wang, and
Jennifer Pauley. Finally, the authors acknowledge Angela McArthur
for scientific editing of this manuscript. This work was supported, in
part, by the American Lebanese Syrian Associated Charities.
Disclosure Statement
A.S.A. is the owner of an e-learning company called Moriat for
eSolutions, e-Learning, which did not contribute to this work. S.K.,
S.A., W.L.G., Y.Q., R.C.R., and I.A.Q. declare no competing financial
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Address correspondence to:
Ibrahim A. Qaddoumi, M.D., M.S.
MS 260, St. Jude Children’s Research Hospital
262 Danny Thomas Place
Memphis, TN 38105-3678
Received: August 31, 2011
Revised: November 28, 2011
Accepted: November 29, 2011
TMJ-2011-0182-ver9-AlFaar_1P.3d 05/19/12 10:10am Page 5
... Fifteen of the twenty-five articles described an education initiative for physicians [17, 20, 23-25, 27, 29, 30, 33, 35-40]. Four articles described an initiative for nurses [19,21,28,31], and one article was aimed at pharmacists [26]. Five articles described initiatives for more than one member of the health care team: three initiatives were for physicians and nurses [18,22,32], one was for physicians, nurses and pharmacists [41] and one was for physicians, nurses and other non-health professionals [34]. ...
... Thirteen initiatives were conducted in the Middle East/Africa [17,19,20,25,26,29,32,34,35,[38][39][40][41], six in the Americas [18,23,24,27,28,31] and five in Asia/Pacific [21,30,33,36,37]. Project ECHO, a tele-mentoring programme for cervical cancer prevention was conducted in all three of these regions ( Figure 2) [22]. ...
... There were only two initiatives for medical students (undergraduate medical education (UME)) [23,33]. All four initiatives targeting nurses [19,21,28,31] and the one initiative for pharmacists [26] were CME. ...
Full-text available
Background: The global cancer burden falls disproportionately on low and middle-income countries (LMICs). One significant barrier to adequate cancer control in these countries is the lack of an adequately trained oncology workforce. Oncology education and training initiatives are a critical component of building the workforce. We performed a scoping review of published training and education initiatives for health professionals in LMICs to understand the strategies used to train the global oncology workforce. Methods: We searched Ovid MEDLINE and Embase from database inception (1947) to 4 March 2020. Articles were eligible if they described an oncology medical education initiative (with a clear intervention and outcome) within an LMIC. Articles were classified based on the target population, the level of medical education, degree of collaboration with another institution and if there was an e-learning component to the intervention. Findings: Of the 806 articles screened, 25 met criteria and were eligible for analysis. The majority of initiatives were targeted towards physicians and focused on continuing medical education. Almost all the initiatives were done in partnership with a collaborating organisation from a high-income country. Only one article described the impact of the initiative on patient outcomes. Less than half of the initiatives involved e-learning. Conclusions: There is a paucity of oncology training and education initiatives in LMICs published in English. Initiatives for non-physicians, efforts to foster collaboration within and between LMICs, knowledge sharing initiatives and studies that measure the impact of these initiatives on developing an effective workforce are highly recommended.
... The main characteristics of papers (first author and country investigated, type of study, specific purposes and sample size, strengths and weakness) are summarized in a tabular format per each group of analysis (Tables 1-3). Alfaar 2012, Egypt-USA, [14] Original research Application of telepharmacy for staff training. 106 surveys. ...
... This centre was opened in July 2007 and the staff had to be trained. To increase the Egyptian staff's education, a team of pharmacists of the St. Jude Research Hospital, shared their know-how on paediatric oncology primarily via videoconferencing [14]. ...
Full-text available
Background and Objectives: The term "telepharmacy" indicates a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities. Telepharmacy has been adopted to provide pharmaceutical services to underserved areas and to address the problem of pharmacist shortage. This paper has reviewed the multi-faceted phenomenon of telepharmacy, summarizing different experiences in the area. Advantages and limitations of telepharmacy are discussed as well. Materials and Methods: A literature analysis was carried out on PubMed, using as entry term "telepharmacy" and including articles on the topic published between 2012 and 2018. Results: The studies reviewed were divided into three categories of pharmacy practice, namely (1) support to clinical services, (2) remote education and handling of "special pharmacies", and (3) prescription and reconciliation of drug therapies. In general, different telepharmacy services were effective and accompanied by a satisfaction of their targets. Conclusions: Nowadays, the shortage of health personnel, and in particular pharmacists, is a challenging issue that the health systems have to face. The use of a new technology such as telepharmacy can represent a possible option to solve these problems. However, there are unsolved limitations (e.g., legal implications) that make greater diffusion of telepharmacy difficult. Stronger data on the effectiveness of this area of pharmacy care, together with a critical evaluation of its limits, can make actors involved aware about the potentialities of it and could contribute to a larger diffusion of telepharmacy services in the interest of communities and citizens.
Full-text available
The introduction of Internet and ICT (information and communication technologies) in the health context has brought new challenges for health systems represented both by the availability of online medical medication, whose inaccuracy can be detrimental for public health, and the implementation of telehealth with the pharmaceutical context. As all other healthcare practitioners, the pharmacist has to became an active actor to foster a safe use of these innovations. My studies have focused on these two topic that are raising more and more interest among researchers with the aim to understand the implications that this breakthrough represents for the pharmacist. In both studies, I used Internet-based questionnaires to gather and analyse a consistent dataset. The first study has shown a high use of online medical information among Italian users and a variable awareness of threats connected to misinformation according mainly to age. In this respect, older users are those who are more prone to have a higher trust in online medical information and a lower perception of risks. The second one has pointed out a scarce implementation of telemedicine in Italian pharmacies mainly imputable to a low commitment of health authorities in supporting this integration process. Considering these findings, both academic and governmental interventions are strongly desirable to ensure the acquisition of those skills that the pharmacist requires to keep the pace with the evolving healthcare setting.
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Background: Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. Methods: Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. Results: A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. Conclusions: Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs.
Patients with uncontrolled diabetes living in rural and underserved communities experience many challenges, including lack of access to needed health and medication management services. Telepharmacy has been identified as a promising approach for addressing this gap. This article describes early insights into the implementation and effectiveness of a comprehensive medication management (CMM) telepharmacy service offered as part of primary care clinics in North Carolina and Arkansas. The CMM service involved pharmacists meeting remotely with patients in their homes to identify and resolve medication‐related problems (MTPs). The purpose of this article is to both describe early successes, challenges, and lessons learned, and summarize preliminary effectiveness results. This exploratory study made use of mixed methods data spanning the first three months of implementation. Successes, challenges, and lessons learned were captured through clinic interviews, open‐ended survey questions, and pharmacists' logs. Evidence of implementation progress and success was based on administrative data and implementation outcomes survey results. Medication therapy problems (MTPs) were used as a proxy to assess preliminary service effectiveness. Key insights centered on the perceived benefits of the service for patients and clinics, the importance of patient outreach and engagement, access to implementation support strategies, and the need for adaptability. Implementation success was rated highly by clinic stakeholders, with significant increases in service acceptability, appropriateness, and feasibility over time, and continued intent to maintain the service. The MTP resolution rate averaged 88% across pharmacists. These preliminary data are promising for supporting the value of a pharmacist‐led medication optimization service delivered remotely to complex patients with uncontrolled diabetes. Ultimately, this model has the potential to expand access to care and transform the delivery of pharmacy services, while creating an opportunity to evolve the role of the clinical pharmacist beyond the traditional boundaries.
Introduction Telepharmacy has the potential to enhance pharmacy services in oncology care, especially in remote areas. This scoping review explored the range, critical benefits and barriers of using telepharmacy services in oncology care. Methods The scoping review followed the Arksey and O’Malley’s five-stage framework to identify available evidence. PubMed, CINAHL, Embase, PsycINFO, Ovid MEDLINE and Scopus databases were searched for original research published between 2010 and 2020. The five dimensions of the Alberta Quality Matrix for Health were used to analyse reported outcomes. Results Eligible articles ( n = 21) were analysed. Telepharmacy in oncology care was used for follow-up, monitoring and counselling, intravenous chemotherapy and sterile compounding, expanding availability of pharmacy services, and remote education. Telepharmacy obtained high acceptability among cancer patients ( n = 5) and healthcare professionals ( n = 5), and increased accessibility of pharmaceutical services to underserved cancer populations ( n = 2). Commonly cited effectiveness and safety outcomes were improved patient adherence ( n = 5), increased pharmacy services ( n = 3) and early identification of medication-related problems ( n = 5). Telepharmacy improved efficiency in staffing and workload ( n = 3), and increased cost savings ( n = 3). A shortage of resources ( n = 5), technical problems ( n = 4) and prolonged turnaround time ( n = 4), safety concerns ( n = 2) and patient willingness to pay ( n = 1) were identified barriers to implementing telepharmacy in oncology care. Discussion Despite evidence pointing to the advantages and opportunities for expanding oncology pharmacy services through telepharmacy, certain challenges remain. Further research is needed to investigate safety concerns and patient willingness to pay for telepharmacy services.
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Introduction Remote pharmacist interventions have achieved much more attention during the coronavirus disease 2019 (COVID-19) outbreak, since they reduce the risk of transmission and can potentially increase the access of vulnerable populations, such as patients with COVID-19, to pharmaceutical care. This study aimed to examine differences in rates and types of pharmacist interventions related to COVID-19 and medication dispensing errors (MDEs) across community pharmacies with and without telepharmacy services. Methods This was a prospective, disguised, observational study conducted over four months (from March 2020 to July 2020) in 52 community pharmacies (26 with and 26 without telepharmacy) across all seven states of the United Arab Emirates using proportionate random sampling. A standardised data-collection form was developed to include information about patient status, pharmacist interventions and MDEs. Results The test (telepharmacy) group pharmacies provided pharmaceutical care to 19,974 patients, of whom 6371 (31.90%) and 1213 (6.07%) were probable and confirmed cases of COVID-19, respectively. The control group pharmacies provided care to 9151 patients, of whom 1074 (11.74%) and 33 (0.36%) were probable and confirmed cases of COVID-19, respectively. Rates of MDEs and their subcategories, prescription-related errors and pharmacist counselling errors across pharmacies with telepharmacy versus those without remote services were 15.81% versus 19.43% ( p < 0.05), 5.38% versus 10.08% ( p < 0.05) and 10.42% versus 9.35% ( p > 0.05), respectively. Discussion This is one of the first studies to provide high-quality evidence of the impact of telepharmacy on COVID-19 patients’ access to pharmaceutical care and on medication dispensing safety.
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Background: Telepharmacy services are expected to have an important role in increasing access of patients to pharmaceutical care and reducing potential dispensing errors in community pharmacies. Objective: To assess the predictors for effective telepharmacy services on increasing access of patients to care and reducing dispensing errors in community pharmacies. Method: This is a prospective study carried out for 4 months in 52 community pharmacies across the United Arab Emirates (UAE) using disguised direct observation. Multivariable logistic regression was used as a tool to predict factors associated with effective telepharmacy services in improving dispensing safety and increasing access of patients to pharmaceutical care. Data were entered and analyzed using the Statistical Package for Social Science (SPSS) software version 26. Results: Pharmacist recommendations related to COVID-19 at pharmacies with telepharmacy (n = 63,714) versus those without remote services (n = 15,539) were significantly more likely to be (1) contact the nearest testing center (adjusted odds ratio [AOR] = 7.93), (2) maintain home quarantine (AOR = 5.64), and (3) take paracetamol for fever (AOR = 3.53), all were significant results (p < 0.05). Rates of medication dispensing errors (MDEs) and its subcategories, prescription-related errors, and pharmacist counseling errors across pharmacies with telepharmacy versus those without remote services were (15.81% vs. 19.43%, p < 0.05), (5.38% vs. 10.08%, p < 0.05), and (10.42% vs. 9.35%, p > 0.05), respectively. However, pharmacies with telepharmacy were more likely to include wrong patient errors (AOR = 5.38, p < 0.05). Conclusions: Telepharmacy can be used as a tool to reduce the burden on the health care system and improve drug dispensing safety in community pharmacies.
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Introduction: Low-and Middle-Income Countries (LMICs) in the Middle East and North Africa (MENA) region are facing increasing global health challenges with a reduced ability to manage them. Global Health Capacity Building (GHCB) initiatives have the potential to improve health workforce performance and health outcomes, however little is known about the GHCB topics and approaches implemented in this region. This is the first systematic review of GHCB initiatives among LMICs in the MENA region. Methods: An academic database search of Medline (OVID), PubMed, Scopus, , and Open Grey was conducted for articles published between January 2009 and September 2019 in English. Next, a grey literature search following a recommended search framework was conducted. Reviewed records addressed a global health topic, had a capacity building component, looked at specific learning outcomes, and reflected an LMIC in the MENA. Primary outcomes included country, topic, modality, pedagogy, and population. Results: Reports of GHCB initiatives were retrieved from grey sources (73.2%) and academic sources (26.8%). Most GHCB initiatives were mainly conducted face-to-face (94.4%) to professional personnel (57.5%) through a theoretical pedagogical approach (44.3%). Dominant global health themes were non-communicable diseases (29.2%), sexual and reproductive health (18.4%), and mental health (14.5%). When matched against the Global Burden of Disease data, important gaps were found regarding the topics of GHCB initiatives in relation to the region's health needs. There were limited reports of GHCB initiatives addressing conflict and emergency topics, and those addressing non-communicable disease topics were primarily reported from Egypt and Iran. Conclusion: Innovative and practicum-based approaches are needed for GHCB initiatives among LMICs in the MENA region, with a focus on training community workers. Regional and country-specific analyses of GHCB initiatives relative to their health needs are discussed in the manuscript based on the results of this review.
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Background: Globalization has attracted much attention to universities over the past decade. The aim of this study was to evaluate the effect of the United States-China international pharmacy education programs (IPEP) in China. Methods: Kirkpatrick's model of evaluation was used to evaluate IPEP from reaction and learning levels. In the reaction level, a questionnaire survey with a Likert scale was used. In the learning level, data from "Assessment Record of Advanced Clinical Pharmacy Practice of Peking University" were collected. Cronbach’ α coefficient of reliability was calculated, principal component analysis and independent t-test were conducted. Results: All of the students who attended IPEP (n=36) completed the questionnaire survey. The scores of benefits were increased in four categories, including “Clinical practice competency improvement" (mean ranking (MR)=3.11 points), "Understanding of doctor of Pharmacy (Pharm.D.) education mode" (MR=3.48 points), "English competency improvement" (MR=3.64 points) and "International collaboration" (MR=3.92 points). Meanwhile, the overall satisfaction was relatively high with the IPEP (MR=4.22 points). In the learning level, a total of 22 records was obtained. Students who attended (n=5) the IPEP achieved higher scores than those did not attend (n=17) in the assessment records, although no statistical significant differences were observed. Personal in-depth interviews further supported the overall benefit of IPEP. Conclusions: The Kirkpatrick's model of evaluation can be used for IPEP. The benefit and satisfaction of students attended the IPEP were high in the reaction level; even though no statistically significant difference was shown in the learning level, higher scores were still demonstrated.
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Recent position papers addressing the profession of clinical pharmacology have expressed concerns about the decline of interest in the field among clinicians and medical educators in the United Kingdom and other Western countries, whether clinical pharmacology is actually therapeutics, and whether the profession should be limited to physicians. The Dutch Society for Clinical Pharmacology and Biopharmacy offers answers to these questions and presents a new model for clinical pharmacology.Clinical Pharmacology & Therapeutics (2009); 85, 4, 366-368 doi:10.1038/clpt.2008.148
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During the past few years, the pharmacy profession has expanded significantly in terms of professional services delivery and now has been recognized as an important profession in the multidisciplinary provision of health care. In contrast to the situation in developed countries, pharmacists in developing countries are still underutilized and their role as health care professionals is not deemed important by either the community or other health care providers. The aim of this paper is to highlight the role of pharmacists in developing countries, particularly in Pakistan. The paper draws on the literature related to the socioeconomic and health status of Pakistan's population, along with background on the pharmacy profession in the country in the context of the current directions of health care. The paper highlights the current scenario and portrays the pharmacy profession in Pakistan. It concludes that although the pharmacy profession in Pakistan is continuously evolving, the health care system of Pakistan has yet to recognize the pharmacist's role. This lack of recognition is due to the limited interaction of pharmacists with the public. Pharmacists in Pakistan are concerned about their present professional role in the health care system. The main problem they are facing is the shortage of pharmacists in pharmacies. Moreover, their services are focused towards management more than towards customers. For these reasons, the pharmacist's role as a health care professional is not familiar to the public.
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To highlight the patient care activities performed by pharmacists during their ward rounds in medical oncology ward of a tertiary care hospital in western region of Nepal. The study was conducted for 3 months. Two pharmacists joined the clinicians and nurses in the ward rounds every morning as a member of healthcare team. The data used in this study was obtained from different documented files in hospital and were analyzed as per study objectives. During 3 months (May 20, 2008 to August 20, 2008), pharmacists provided answers to eight queries asked by clinicians and nurses for the patient care purpose. During the same period pharmacists detected four cases of medication errors and provided suggestions on them. A total of 30 adverse drug reaction (ADR) reports were reported to the regional pharmacovigilance center during the study time. Altogether there were 84 types of adverse drug reaction seen on those patients. Most of them were related to hematological system. The study evaluated the drug information provided by pharmacists, spontaneous reporting of ADRs by the pharmacists, and their intervention on treatment plan of patients during ward round. This suggests pharmacists can play a significant role on patient care when he or she joins round with other healthcare personnel in the oncology ward.
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Pharmacy is the health profession that has the responsibility for ensuring the safe, effective and rational use of medicines. As such it plays a vital part in the delivery of health care world-wide. However, there remain wide variations in the practice of pharmacy, not only between countries but also within countries. Nevertheless, in recent years there has been significant convergence, driven by a number of key factors. These include World Health Organization declarations concerning the role of pharmacists, changes in the political climate of many countries, and the pursuit by pharmacists themselves of the goals of medicines management and pharmaceutical care. This paper considers the main activities undertaken by pharmacists, describes their education and regulation, and explores the current state of pharmacy around the world.
The Cure4Kids Website ( brings the latest medical knowledge and continuing education on the treatment of pediatric catastrophic diseases to thousands of health care providers worldwide. The website offers a digital library, on-demand seminars with slides and audio in several languages, and online meeting rooms for international collaborations. In this paper, we describe the design challenges of the Cure4Kids Website as an online learning and collaboration center, including the web interface design, content organization, and usability. The solutions to these design challenges may help other web designers facing similar issues in the design of international web-based projects.
Access to quality cancer care is often unavailable in low-income and middle-income countries, and also in rural or remote areas of high-income countries. Teleoncology-oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines-has the potential to enhance access to and quality of clinical cancer care, and to improve education and training. Implementation of teleoncology in the developing world requires an approach tailored to priorities, resources, and needs. Teleoncology can best achieve its proposed goals through consistent and long-term application. We review teleoncology initiatives that have the potential to decrease cancer-care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programmes in low-income and middle-income countries.
In September 2005 a telemedicine service was started to assist multidisciplinary teams in Wales to improve cancer services. In October 2006 and October 2007 users of videoconferencing equipment at one site completed questionnaires. During October 2006 a total of 18,000 km of car travel were avoided, equivalent to 1696 kg of CO(2) emission. During October 2007 a total of 20,800 km of car travel were avoided, equivalent to 2590 kg of CO(2) emission. We estimate that 48 trees would take a year to absorb that quantity of CO(2). The results of the surveys show that exploiting telemedicine makes better use of staff time, reduces the time spent travelling and assists in reducing climate change by limiting the emissions of CO(2).
Videoconferencing technologies can vastly expand the reach of healthcare practitioners by providing patients (particularly those in rural/remote areas) with unprecedented access to services. While this represents a fundamental shift in the way that healthcare professionals care for their patients, very little is known about the impact of these technologies on clinical workflow practices and interprofessional collaboration. In order to better understand this, we have conducted a focused literature review, with the aim of providing policymakers, administrators, and healthcare professionals with an evidence-based foundation for decision-making. A total of 397 articles focused on videoconferencing in clinical contexts were retrieved, with 225 used to produce this literature review. Literature in the fields of medicine (including general and family practitioners and specialists in neurology, dermatology, radiology, orthopedics, rheumatology, surgery, cardiology, pediatrics, pathology, renal care, genetics, and psychiatry), nursing (including hospital-based, community-based, nursing homes, and home-based care), pharmacy, the rehabilitation sciences (including occupational and physical therapy), social work, and speech pathology were included in the review. Full utilization of the capacity of videoconferencing tools in clinical contexts requires some basic necessary technical conditions to be in place (including basic technological infrastructure, site-to-site technological compatibility, and available technical support). The available literature also elucidates key strategies for organizational readiness and technology adoption (including the development of a change management and user training plan, understanding program cost and remuneration issues, development of organizational protocols for system use, and strategies to promote interprofessional collaboration).
To determine the rural distribution of primary care providers (primary care physicians, physician assistants, nurse practitioners, and nurse midwives) and pharmacists. Five-digit ZIP code mapping to study the availability of primary care providers and pharmacists, alone and in combinations, in rural areas and ZIP code-based health professional shortage areas (HPSAs). National averages for annual physician visits for hypertension, asthma, and diabetes were used to estimate the sufficiency of the rural physician supply. Rural areas of the United States. In rural areas, all providers were present in lower densities than national averages, particularly in HPSAs. The primary care physician supply was insufficient to meet national averages for office visits for hypertension, asthma, and diabetes. Among available providers, the most prevalent co-presence was primary care physician with pharmacist. HPSAs showed very low physician density (1 per 22,122), and the most prevalent providers were pharmacists. States varied widely in provider density. Despite longstanding efforts and the expansion of managed care, primary care providers remain in short supply in rural areas, especially ZIP code-based HPSAs. Making the best use of available providers should be encouraged. The continued shortfall of primary care providers in rural areas, particularly HPSAs, makes it logical to use other available providers and combinations to increase health care access. Pharmacists could increase care for patients with conditions treated with medications. Other available providers, based on skills and work site, could also offset shortages.