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Sydney hub short oral presentations
100
A national survey to determine the process of conducting medication reviews by Australian consultant
pharmacists
Dr Lisa Kouladjian O'Donnell1, Assoc Prof Amy Page2,3, Dr Amanda Cross4, Ms Deborah Hawthorne3,5,
Dr Kenneth Lee2,3
1Kolling Institute, Royal North Shore Hospital and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia, 2Division
of Pharmacy, University of Western Australia, Crawley, Australia, 3Western Australia Centre for Health and Ageing, University of Western
Australia, Crawley, Australia, 4Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University,
Parkville, Australia, 5South Wangaratta Medical Centre, Wangaratta, Australia
Introduction. Home Medicines Reviews (HMRs) are an Australian government-funded medication review service conducted in the home by
consultant pharmacists (CPs – specially trained pharmacists who have received post-registration certification in medication review). Limited
data are available to understand how pharmacists conduct HMR services during the various stages of service provision.
Aims. To explore the information gathering and report writing processes of CPs conducting HMR services in Australia.
Methods. A national cross-sectional online survey was used to explore and describe the information gathering activities of CPs during the
various stages of a HMR (pre-interview, interview, post-interview, report writing). The survey was developed by the research team and
included 5-point Likert-type scales and multiple-choice questions. After face validation and piloting by pharmacists with varied academic and
professional expertise, the online survey was advertised through professional organisations to Australian registered CPs who had completed
at least one HMR service within the past 12 months.
Results. A total of 269 consented to participate in the survey, which represented 11% of the approximate total 2400 CPs registered in
Australia. Most participants were female (n=133, 76.0%) and received their specialised certification through the Australian Association of
Consultant Pharmacy (n= 169, 97.1%). Participants reported that medication lists (97.4%) and past medical history (88.1%) of HMR patients
are commonly provided in referral letters, but medication lists (100%) and social history (57.8%) is often reported back to referrers in their
written reports. The most common evidence-based tools used by participants during report writing included medication adherence scales
(22%) and anticholinergic medication burden scales (18.2%).
Discussion. This study explored the extent of information collected by CPs during the different stages of the HMR service provision and
identified that CPs provide evidence-based and patient-centred written reports to referrers.
101
A survey on knowledge, attitude and practice of household medicine storage and disposal in three cities
of Indonesia
Mr Antonius Nugraha Widhi Pratama1,2, Prof Henny Lucida3, Dr Christofori Maria Ratna Rini Nastiti4,
Mr Heribertus Rinto Wibowo5
1Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 2Faculty of Pharmacy, Universitas
Jember, Jember, Indonesia, 3Faculty of Pharmacy, Universitas Andalas, Padang, Indonesia, 4Faculty of Pharmacy, Universitas Sanata Dharma,
Sleman, Indonesia, 5Tulodo Indonesia, South Jakarta, Indonesia
Introduction. Pharmacy campaigns about medicine use have been run in Indonesia by several organisations at national level. Finding the
remaining gaps of proper storage and disposal of household medicines will be beneficial to improve the existing campaigns.
Aims. This research aimed to capture knowledge, attitude and practice related to storage and disposal of household medicines among people
in Jember, Yogyakarta and Padang.
Methods. A mini cross-sectional survey with quota sampling was done in three Indonesian cities during June-July 2021. A face-to-face data
collection was done by three surveyors per city and data were stored online using mWater.
Results. 89 of 90 participants (98.8%) agreed to participate. Most participants (62, 69.7%) failed to correctly interpret the labels of expiry
date and 38 (42.7%) participants did not understand damaging the primary packaging of medicines should be done prior to disposal. Most
participants (81, 91.0%) agreed to not share their medicines for others who have similar complaints. Various responses were emerged about
the practice of storing syrups in a refrigerator, the disposal of liquid dosage forms through the drainage and the habit of dating the first
opening of the packaging of a liquid dosage form.
Discussion. Our study revealed several topics that could strengthen the on-going campaigns, including the correct interpretation of expiry
date and the need to damage medicine packaging before disposal. Surprisingly, sharing someone’s medicine to close social circles was
commonly disagreed by our participants. However, this attitude may not be translated into practice1. The disposal of household medicines
in Indonesia is problematic as a medication return program that can be found in other country2 remains limited. Such program was just
recently piloted in 15 major cities of Indonesia in 2019. Further works are needed to improve the practice.
1. Bayene K, Aspden T, Sheridan J. Prescription medicine sharing: exploring patients’ beliefs and experiences. J. Pharm. Policy Pract.
2016;9:23.
2. Yang SL, Tan SL, Goh QL, Liau SY. Utilization of Ministry of Health medication return programme, Knowledge and disposal practice of
unused medication in Malaysia. JPPCM.2018;4(1):7-11.
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102
An exploration of resilience with early career pharmacists: a qualitative study
Ms Syafiqah Nadiah Halimi1, Dr Karen Luetsch1, Assoc Prof Karen Whitfield1, Prof Debra Rowett2
1School of Pharmacy, The University of Queensland, Brisbane, Australia, 2Clinical and Health Sciences, University of South Australia, Adelaide,
Australia
Introduction. Resilience assists healthcare professionals to overcome or bounce back from challenges, remain positive in the face of
adversity, and allow them to deal with challenging work situations and environments. Little is known about how healthcare professionals,
especially early career pharmacists, understand resilience.
Aims. To explore early career pharmacists’ understanding of resilience, their strategies to enhance and maintain resilience as healthcare
professionals and to identify resilience-fostering programmes they perceive could be implemented during pharmacy studies.
Methods. Three focus groups and twelve semi-structured interviews with a total of fifteen hospital pharmacists and ten community
pharmacists (less than three years post-registration) were conducted. Audio recordings were transcribed verbatim and analysed using
NVivo®. An inductive thematic analysis was performed to identify the main themes.
Results. The main themes identified were 1) Pharmacists understood resilience as the ‘capability to adapt to and learn from challenges and
setbacks’ 2) Resilience in the workplace was challenged by ‘the transition from intern to registered pharmacist’, ‘workload pressures’ and
‘working during the COVID-19 pandemic’ 3) Professional resilience was supported by ‘strong support from workplace management and senior
pharmacists’, ‘social networks within workplaces and private lives’ and ‘keeping professional boundaries’ 4) Pharmacists perceived
‘mentorship’, ‘early exposure to pharmacy placements’ and ‘constructive role play’ as potentially beneficial in building resilience during
undergraduates studies and internship.
Discussion. Pharmacists defined resilience constructively and identified challenges testing but also strategies supporting their resilience in
the workplace. Workplaces can support pharmacists by monitoring workload increases over extended periods, creating opportunities for
peer and mentor support and by allowing pharmacists to implement their personal, individualised resilience maintaining strategies.
Universities may consider role play of challenging situations during undergraduate studies and mentorship during internships as resilience
enhancing strategies and preparation for potentially challenging careers, as suggested by early career pharmacists.
103
Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of
general practitioners in Australia
Mr Eyob Alemayehu Gebreyohannes1, Dr Sandra Salter1, Dr Leanne Chalmers2, Ass Prof Jan Radford3, Dr Kenneth Lee1
1Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia, 2Curtin Medical School, Curtin University,
Perth, Australia, 3Tasmanian School of Medicine, University of Tasmania, Hobart, Australia
Introduction. Clinical guidelines produced by cardiology societies
(henceforth referred to simply as ‘clinical guidelines’) recommend
thromboprophylaxis with oral anticoagulants (OACs) in patients with
atrial fibrillation (AF) who have moderate-to-high stroke risk. However,
deviations from these recommendations are observed, especially in the
primary healthcare setting.
Aims. To evaluate the self-reported use of AF clinical guidelines and risk
stratification tools among Australian general practitioners (GPs), and
their perceptions regarding the available resources.
Methods. We conducted an online survey of Australian GPs. Descriptive
statistics were used to summarise the findings.
Results. Responses from 115 GPs were included for analysis.
Respondents reported various ways of accessing thromboprophylaxis-
related information (n=113), including clinical guidelines (13.3%),
‘Therapeutic Guidelines©’ (37.2%) and Royal Australian College of
General Practitioners websites (16.8%). Of those who reported reasons
against accessing information from clinical guidelines (n=97), the most frequent issues were: too many AF guidelines to choose from (34.0%;
33/97), different guidelines for different diseases (32.0%; 31/97), time-consuming to read guidelines (21.6%; 21/97), disagreements between
different guideline recommendations (20.0%; 19/97), conflict with criteria for government subsidy (17.5%; 17/97), and GPs' busy schedules
(15.5%; 15/97). When assessing patients' risk of stroke (n=112) and bleeding (n=111), the majority of the respondents reported primarily
relying on a formal stroke risk (67.0%) and bleeding risk (55.0%) assessment tools, respectively. Respondents reported using formal stroke
and bleeding risk assessment tools mainly when newly initiating patients on therapy (72.4%; 76/105 and 65.3%; 65/101, respectively).
Discussion. Among our small sample of Australian GPs, most did not access thromboprophylaxis-related information directly from AF-specific
clinical guidelines developed by cardiology societies. Although the majority reported using formal stroke and bleeding assessment tools,
these were typically used on OAC initiation only. More focus is needed on formal risk reassessment as clinically indicated and at regular
review.
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104
Clinical yarning with Aboriginal and/or Torres Strait Islander peoples: – A systematic review of its use
and impacts
Mr Alexander Burke1, Ms Susan Welch1, Dr Tamara Power1, Dr Cherie Lucas2, Assoc Prof Rebekah Moles1
1University of Sydney, Sydney, Australia, 2University of Technology Sydney, Sydney, Australia
Objectives. To explore the use and impact of clinical yarning on Aboriginal and/or Torres Strait Islander Peoples health.
Methods. A one-word search term “yarning” was applied in Scopus, EMBASE, CINHAL, Medline, International Pharmaceutical Abstracts,
Australian Public Affairs Information Service-Health and the Aboriginal and/or Torres Strait Islander Health Bibliography databases.
Databases were searched from inception to May 20, 2020. We included all studies where clinical yarning had been used as a health
intervention. Inclusion and exclusion criteria were developed and applied according to PRISMA systematic review reporting methods.
Results. A total of 375 manuscripts were found from the initial data search. After removal of duplicates and removal of manuscripts based
on abstract review, a total of 61 studies underwent full text review. Of these, only five met the inclusion criteria of utilising yarning as a
clinical intervention. Four of these studies described consumer self-reported health outcomes, with only one study looking at
improvements in objective physiological health outcomes.
Discussion. There is a lack of evidence that clinical yarning has any impact on health outcomes. However, this is not a reason to prevent it
being implemented, as any intervention to improve the provision of services for Aboriginal and/or Torres Strait Islander people and make
them feel culturally safe within the healthcare setting should be explored. It should be noted that clinical yarning is only one aspect of
providing culturally safe care and holistic approaches may be warranted.
Conclusions. Whilst clinical yarning may be a culturally appropriate intervention in healthcare, there are limited studies that have
measured the impact of this intervention. Further research may be needed to ascertain the true benefits of this intervention.
105
Community pharmacists administering a blood product: A case study of routine Prophylactic Anti-D in
pregnancy in South Auckland, New Zealand
Dr Natalie Gauld1,2, Amanda Hinks2, Rachel Donegan2, Talalelei Teu2, Dr Dhana Gounder3, Graeme Sykes2, Yvonne Choy2, Manpreet Gill2
1The University of Auckland, Auckland, New Zealand, 2Counties Manukau District Health Board, Auckland, New Zealand, 3New Zealand
Blood Service, Auckland, New Zealand
Introduction. Haemolytic disease of the foetus and newborn is a dangerous complication of sensitisation of a rhesus negative woman. A new
recommendation to administer routine antenatal anti-D prophylaxis (RAADP) IM in late pregnancy to reduce sensitisation risk was
implemented.
Aim. To describe the development of a model to administer RAADP and support best practice prescribing and appropriate timing of blood
tests.
Methods. Those developing and implementing the model prepared this case study.
Results. Administration in community pharmacy was chosen to maximise women’s access, safety and correct storage and administration of
the medicine, ensure best practice prescribing, and minimise midwife and blood bank workload and distribution costs. Twelve pharmacies
were used to maximise experience and knowledge in each pharmacy and limit distribution costs and blood bank workload. A multi-
disciplinary team (midwifery, pharmacy, blood bank, transfusion medicine, and nursing) developed the model and prepared materials and
training.
Table 1 Concerns and Management
Concern
Management
Blood test < 48 hours before the
first dose of RAADP
Pharmacists to question the woman and manage excursions.
Most pharmacies close to laboratory collection centres
Accessibility
Geographical location, adequate parking and extended hours considered in selecting pharmacies.
Need for high quality stock
management, administration and
reporting.
As a new service, pharmacists
needed to support best practice
prescribing and blood tests.
Provision of extended services (including vaccination) considered in selecting pharmacies.
Training for pharmacists and midwives. Pharmacy fridge records checked before stock
distributed.
A prescribing/administration guideline, pharmacy standard operating procedure and blood bank
standard operating procedure were developed, requiring significant input from all disciplines. The
team managed queries and checked pharmacy reporting to support implementation.
Blood bank staff personally provided the first delivery with further education.
Conclusion. The multi-disciplinary team was key in developing the service using pharmacists for RAADP administration and ensuring
appropriate prescribing and blood tests.
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106
Towards assessment of pharmacy preceptors: a qualitative study of preceptor and preceptee
perspectives
Mr Andrew Bartlett1, Dr Carl Schneider1, Dr Irene Um1
1The University of Sydney, Camperdown, Australia
Introduction. The role of the preceptor is to model professional behaviour and provide feedback on preceptee performance and competence.
Preceptor competencies have been identified in the literature, yet the scope and nature of preceptor competency assessment has yet to be
established.
Aims. To explore pharmacists’ and preceptees’ experience of preceptorship and views on assessment of preceptor competencies to inform
the development of a best practice model of preceptorship.
Methods. A qualitative study design comprising focus groups and interviews with pharmacists, current pharmacy students and pharmacy
interns in New South Wales, Australia was employed. Participants were recruited using a maximum variation sampling strategy. Focus groups
and interviews were conducted by trained facilitators using a semi-structured interview guide between July 2018 and January 2020 until data
saturation was reached. Data were digitally recorded, transcribed verbatim, coded, and iteratively analysed via inductive thematic analysis
to identify emergent themes.
Results. Fourteen focus groups and two interviews were conducted with 50 participants, across rural, regional and urban areas. Emergent
themes included the nature of the experiential environment, the influence of the preceptor-preceptee relationship, the value of
preceptorship and preceptor evaluation, attitudes to preceptorship and preceptor assessment. The willingness of the pharmacist preceptor
to be assessed or rated was related to the motivation for having a preceptee and formal recognition. In metropolitan areas where there is
greater availability of preceptees, preceptors preferred to be assessed through student evaluation. In contrast, rural preceptors were willing
to be further assessed through peer observation.
Discussion. An assessment framework comprising multi-modal assessment measures and accompanying minimum performance criteria
requires development and validation to assure quality of pharmacy preceptorship. Appropriate recognition or accreditation may increase
preceptor acceptance of assessment.
107
Conscientious objection (CO) and refusing supply – Australian pharmacists’ perspectives
Dr Sami Isaac1, Prof Andrew McLachlan1, Assoc Prof Betty Chaar1
1The University of Sydney Faculty of Medicine and Health, School of Pharmacy, Camperdown, Australia
Introduction. Conscientious objection (CO) is :“[A] practitioner’s refusal to engage or provide a service primarily because the action would
violate their deeply held moral or ethical value about what is right and wrong” In modern medicine CO is apparent in – a multitude of
healthcare situations such as circumcision, termination of pregnancy, contraception, and voluntary-assisted-dying.(1) CO is a highly
controversial issue perceived as a freedom of conscience by some (2), or an issue of professionalism/duty of care by others (3).
Aims. This study aimed to investigate pharmacists’ decision-making in complex bioethical scenarios around their right to conscientious
objection and explore reasons for their choices.
Methods. A mixed-methods analysis of an online, vignette-based questionnaire of Australian registered pharmacists (n=223), about scenarios
related to the supply of medication for medical termination, emergency contraception, IVF surrogacy for same-sex couples and voluntary
assisted dying.
Results. Approximately half (48%) the respondents believed that pharmacists have the right to CO, while the other half either
disagreed/strongly disagreed (40%) or were neutral. (12%). Majority of participants agreed to supply the prescriptions across all four
vignettes (78%, 70%, 93% and 72%, respectively). Those who chose not to supply (9% n=20) believed it ethically justifiable to conscientiously
object even at the risk of the patient failing to access treatment. Regarding continuity of care, most pharmacists agreed (97% n=217) that
continuity of care is necessary for equity of care. Strong self-reported religiosity had a statistically significant relationship with pharmacists’
decision making, for medical termination (p<0.001), IVF surrogacy (p<0.001) and VAD (p<0.001).
Discussion. This study revealed views from Australian pharmacists, including workplace challenges and lack of guidance around conscientious
objection in pharmacy. Findings highlighted an absence of clear, specific professional frameworks to guide pharmacists who choose to
exercise conscientious objection, articulating the decision-making procedures needed to ensure patient safety, equity of access and
continuity of care.
3. Lawrence RE, Curlin FA. Physicians' beliefs about conscience in medicine: a national survey. Academic Medicine Journal 2009;84(9):1276-
82.
4. Smith VP. Conscientious objection in medicine: Doctors' freedom of conscience. British Journal of Medicine. 2006;332(7538):425.
5. Cantor JD. Conscientious objection gone awry--restoring selfless professionalism in medicine. New England Journal of Medicine (NEJM).
2009;360(15):1484-5.
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108
Developing and testing a novel method to explore implicit bias in community pharmacy
Dr Jack Collins1, Prof Megan MacKenzie2, Dr Carl Schneider1, Assoc Prof Betty Chaar1, Assoc Prof Rebekah Moles1
1The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 2School for
International Studies, Simon Fraser University, Vancouver, Canada
Introduction. Implicit bias is bias shown without conscience. This bias may occur due to factors such as age, race, or gender. Implicit bias has
been identified in a variety of health care professionals using Implicit Association Tests, however literature has not examined the use of
covert simulated patients or explored implicit bias in practising pharmacists.
Aims. To develop and pilot a novel mixed-method to explore implicit racial bias by community pharmacists.
Methods. Four female actors of different racial and ethnic backgrounds (East Asian, Middle Eastern, South Asian, Caucasian Australian)
completed 32 simulated patient visits at eight community pharmacies in Sydney, Australia between February-March 2019. Actors provided
scripted requests for assistance with symptoms or products relating to women’s health ailments (dysmenorrhea, cystitis, emergency
contraception, vaginal thrush) at a rate of one visit per pharmacy per week. Visits were audio-recorded. Brief, semi-structured interviews
were conducted with actors immediately post-visit to capture the ‘consumer’ experience. Transcriptions of visits and interviews were
transcribed verbatim and analysed through discourse analysis, using frames of ‘caring’, ‘neutral’, or ‘abrupt’.
Results. Analysis of 32 pharmacy encounters revealed that consultation length, number of products sold, and number of questions asked did
not significantly differ between visits. Discourse analysis enabled identification of potential differences between pharmacists when
responding to actors of different racial and ethnic backgrounds.
Discussion. This novel method proved feasible. Future work could adapt this method to a variety of practice settings and practitioners. Future
studies could also explore other types of implicit bias, such as age, gender, or weight. Through the identification of the presence of implicit
bias and how it manifests in practice, interventions and curricula can be developed to address the role of implicit bias in health care
disparities. Further work is warranted to generate valid and representative results.
109
Compliance of community pharmacists with COVID-19 health protocols
Mr Fathul Muin1, Dr Anna Wahyuni Widayanti2, Yayi Suryo Prabandari3
1Magister Management Pharmacy Program, Faculty of Pharmacy, Universitas Gadjah Mada, 2Department of Pharmaceutics, Faculty of
Pharmacy, Universitas Gadjah Mada, 3Department of Public Health, Faculty of Medicine, Universitas Gadjah
Introduction. Pharmacists as health workers in community pharmacies have a high risk of transmitting the COVID-19 virus. During the COVID-
19 pandemic, the number of infections among pharmacists increased due to direct contact with the public and COVID-19 patients who visited
pharmacies.
Aims. This study aimed to determine the compliance level of pharmacists with the COVID-19 health protocols and its correlations to the level
of knowledge, organizational environment, and self-efficacy.
Methods. The study was designed as mixed-method research with a sequential explanatory strategy among pharmacists working in
community pharmacies in the Special Region of Yogyakarta, Indonesia. The participants were selected with simple random sampling in
quantitative research with questionnaire data collections and purposive sampling in qualitative research with interviews. The quantitative
data were analysed statistically to identify factors that correlate to the level of compliance, while the qualitative data were used to explain
the results obtained in quantitative research.
Results. A total of 262 pharmacists participated in this study. Most of them were in a medium level of compliance (65.66%), followed by the
high level (19.1%) and the low level (15.3%). Statistical analysis on organizational environment factors and self-efficacy showed a significance
value (p<0.05) with a Pearson Correlation value of 0.463 and 0.409, respectively. The level of knowledge showed no significance correlation
to the level of compliance (p>0.05). Meanwhile, the interview with 9 respondents showed that the implementation of COVID-19 health
protocols in community pharmacies was quite good but required more consistent efforts and supporting facilities from the pharmacy owners.
Discussion. These findings showed a correlation between organizational environmental factors and self-efficacy with the compliance level of
pharmacists to the COVID-19 health protocols. Improving environment factors and self-efficacy may increase the level of pharmacist’s
compliance with the health protocols.
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110
Connecting the dots of care: Linking Aboriginal and Torres Strait Islander people with diabetes care in
hospital using hospital pharmacists
Ms Susan Welch1,2, Assoc Prof Alexander Viardot3, Assoc Prof Kylie Lee2, Mr Scott Daley4, Ms Pauline Deweerd1, Assoc Prof Rebekah Moles2
1St Vincent's Hospital Sydney, Darlinghurst, Sydney, Australia, 2University of Sydney, Camperdown, Sydney, Australia, 3Garvan Institute,
Darlinghurst, Sydney, Australia, 4St Vincent's Health Australia, Sydney, Australia
Introduction. Diabetes is a common diagnosis for Aboriginal and/or Torres Strait Islander peoples.
Aims. To identify how an urban hospital pharmacist can detect if Aboriginal and/or Torres Strait Islander peoples admitted into hospital have
diabetes or have a higher chance of getting diabetes.
Methods. Aboriginal and/or Torres Strait Islander peoples admitted to hospital, between July – September 2021 were identified. A hospital
pharmacist visited consenting patients, checking random blood glucose and glycosylated haemoglobin (HbA1c). Patients with HbA1c > 6.5%
(not known diabetes) or 7% (known diabetes) were referred for endocrinology review during admission. Results and diabetes plans were
shared with their GP. Two days after discharge, the pharmacist telephoned each participant to gauge their views on diabetes care provided
during their hospital stay.
Results. Seventy-two patients were eligible for inclusion, 67/72 (93%) consented to take part (female 27, male 40; aged 21-87 years). Sixty-
one (91%) patients had HbA1c < 6.5. Of these, 4/67 (6%) had an HbA1c between 6 to 6.4. They were contacted and/or their general
practitioner to suggest a yarn about how diabetes could be prevented. Six of the 67 (9%) qualified for endocrine review, 5 had known
diabetes, one was newly diagnosed. None were previously known to endocrinology. All patients telephoned were satisfied with their diabetes
care.
Discussion. We have developed, implemented and pilot tested a pharmacist led screening service. Hospital pharmacists can help detect
diabetes in Aboriginal and/or Torres Strait Islander peoples, ensuring linkage to endocrinology review and improved care during admission.
111
Evaluating informal caregivers’ needs in managing medicines for people receiving cancer treatment in
Australia
Dr Ramesh Walpola1, Dr Amary Mey2, A/Prof Reema Harrison3, Dr Sohil Khan2, Dr Ronald Castelino4, Dr Natasa Gisev5
1School of Population Health, UNSW Sydney, Kensington, Australia, 2School of Pharmacy and Medical Sciences, Griffith University, Southport,
Australia, 3Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia, 4School of Pharmacy, The University of
Sydney, Camperdown, Australia, 5National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, Australia
Introduction. Informal caregivers are family members, relatives or friends who support the care and overall wellbeing of loved ones in need.
In the context of cancer treatment, informal carers often assume this role instantaneously and may not necessarily have the capacity or
capability to manage these responsibilities. Medicine management responsibilities have been linked to negative impacts on the mental and
physical health of cancer caregivers. However, the nature of the activities that carers undertake, and their support needs, are poorly
understood.
Aims. To evaluate informal caregivers’ support needs in medicine management for people receiving cancer treatment.
Methods. An online national survey was conducted between November 2020 and June 2021. Participants were recruited through targeted
social media advertising on Facebook, Twitter and LinkedIn inviting them to complete a 21-item survey. The survey ascertained their
responsibilities as a caregiver, their capabilities in medicine management, and their specific health service needs to better manage the
medicines of their loved ones.
Results. A total of 192 participants completed all items in the survey. Almost all respondents (93%) felt confident in their capability to manage
their loved one’s medicines, 85% of respondents reported they can recognise side effects, with 79% reporting they can manage the side
effects appropriately. Despite these positive results, 51% of participants feel they need extra support with managing medicines: 20% require
more support in collecting prescriptions or medicines, 42% require more support to recognise side effects, and 45% with medicines
information provision. In terms of preference of who caregivers would like to receive this support, medical specialists were the highest
ranked, followed by pharmacists and general practitioners.
Discussion. This study has shed light on the key medicine management roles informal carers play in supporting their loved ones who are
receiving treatment for cancer. Given the workload of medical specialists, there is a need for future research to explore how pharmacists can
better support cancer caregivers in their medicine management roles.
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112
Development of a performance-based pharmacy payment framework for Australia
Mr John Jackson1
1Pharmaceutical Society of Australia, Australia
Introduction. Rising healthcare costs have led healthcare payers to seek improved performance and better value. Pharmacists in Australia
are funded for dispensing on a fee-for-service basis. To date, neither their performance or the outcomes of their dispensing have been
assessed in determining their level of remuneration.
Aims. This work sought to assess the impact on pharmacists’ practice of the current dispensing payment model and determine whether a
performance-based pharmacy payment model (PBPPM) may be an appropriate alternative.
Methods. Using an adaptation framework, interviews were conducted with individuals from five strata of the socio-ecological environment
of community pharmacy in Australia to evaluated the current PBS model, determined the fit of key components of PBPPM in an Australian
context, and assessed the feasibility of using a PBPPM for PBS dispensing. Thematic analysis of the results was used to determine the benefit
of changing the current funding model and to assess the potential application of a PBPPM. Based on the outcome, inductive reasoning was
applied to develop an alternate quality-focused PBS funding framework.
Results. The current model is perverse. It encourages pharmacists to dispense quickly rather than commit time and apply expertise to
improve outcomes in accordance with each patient’s requirements. Pharmacists’ payments for dispensing should be time-based and risk-
related, based on patient and medication factors. A preferred model would separate payment for commercial and technical aspects of
dispensing from professional aspects. Supplementary payment should support pharmacists to incorporate processes recognised to enhance
the quality use of medicines.
Discussion. The current fee-for-service model is not appropriate for either patients or the profession. A PBS funding framework that supports
greater delivery of services focused on quality is proposed. Payment adjustments linked to performance outcomes should not be included
until patient outcome measures with strong specificity and correlation to pharmacists’ services are developed.
1. Jackson J, Urick B. Performance-based pharmacy payment models: the case for change. Aust Health Review, doi 10.1071/AH1820
113
Effect of promotion and Covid lockdowns on uptake of funded maternal Pertussis vaccination in
pharmacies
Dr Natalie Gauld1, Cath Knapton2, Dr Anna Howe1, Associate Professor Helen Petousis-Harris1, Professor Cameron Grant1
1The University of Auckland, Auckland, New Zealand, 2Midlands Community Pharmacy Group, Hamilton, New Zealand
Introduction. Maternal pertussis vaccination (MPV) prevents pertussis
in infants. From late 2016, one New Zealand district extended funding
of MPV to community pharmacy. Promotion from April to October 2018
included emails to pharmacies and midwives, two phone calls to each
pharmacy suggesting how to increase MPV uptake, social media
targeting pregnant women, distributions to pharmacies of posters, key
points documents, t-shirts, and quizzes for staff with prizes.
Aim. To explore the uptake of funded pertussis vaccination in pharmacy
over time including effects of promotion and COVID-19 lockdowns.
Methods. Five years of pharmacy claims data for MPVs were analysed
and twelve pharmacists, 18 women eligible/recently eligible for MPV and 11 midwives were interviewed.
Results. Of 82 pharmacies in the district, 38 (47%) provided vaccinations. Provision of pertussis vaccination expanded during and after a six-
month promotion campaign.
Pharmacists valued phone calls from the research group with information about MPV and recommendations for increasing uptake. Prompted
by these calls, some pharmacists contacted midwives to inform them of funded MPV availability in the pharmacy (appreciated by midwives)
and recommended MPVs to women getting folic acid or iodine prescriptions during pregnancy. Having pharmacy staff informed about MPVs
and posters displayed reminded staff to recommend it. Two pharmacists in non-vaccinating pharmacies lacked MPV knowledge and used no
MPV materials.
Women seemed to be more influenced by health care professionals’ conversations about MPV than other promotion including social media.
MPV uptake in pharmacy was 31% greater March to May 2020 (before and during the first COVID-19 lockdown) compared with the same
time the previous year. No substantial increase was seen in later lockdowns.
Conclusion. Promotion appeared to have a sustained effect on uptake of MPV beyond that of the promotion period with indications of
behaviour change. Verbal discussions were important for women and health care professionals.
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114
Identification of key medicine safety interventions for Australian pharmacists
Mr John Jackson1
1Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
Introduction. With the declaration of Medicine Safety as a national health priority in Australia in 2019, the pharmacy profession requires a
strategy to tackle medicine-related harm and empower pharmacists to improve medicine safety.
Aims. To identify priority areas in medicine safety relevant to pharmacists and determine a key intervention by pharmacists in each priority
area.
Methods. An expert advisory group identified 20 domains within the themes of professional functions, consumer / patient factors, life
stages, medicines, and resources, in which pharmacists could potentially improve medicine safety. A subsequent workshop of pharmacists
evaluated each domain using prevalence, risk and level of pharmacist engagement. A poll identified five priority domains which were
allocated to sub-groups within the workshop to scope potential interventions within pharmacists’ scope of practice relevant to their
allocated domain. Each group selected a preferred intervention based on the effort required to implement and the likely impact of each
intervention. The preferred interventions were described using a common 9-point instrument.
Results. In descending priority, the selected domains are polypharmacy, health literacy, geriatrics, high risk medicines and potentially
inappropriate medicine use. The preferred interventions in the respective domains are; primary care embedded pharmacists, improved
counselling, medication review with follow-up, pharmacist workforce capacity building to increase confidence, and pharmacists’ engagement
in on-going medication management. Factors common to the implementation of these interventions include workforce capability and
capacity, regulatory changes, enhanced communication, access to patient records, and remuneration.
Discussion. All five interventions are enhancements of current practise and the implementation factors align with prior work that identified
macro-environmental changes required to adopt enhanced roles. (1)
1. Jackson J, Hussainy S, Kirkpatrcik C. [2016] The identification of major factors in Australian primary care pharmacists’ practice
environment which have a bearing on the implementation of professional models of practice. Aust Health Review,
http://dx.doi.orf/10.1071/AH16080reference.
116
Evaluation of impact of educational intervention on knowledge, attitude and practices of ambulatory
patients regarding antibiotic use
Dr Shobha Rani Hiremath1, Dr Shankar Prasad R2, Ms Bindu V1
1Director, Professor and Head, Bangalore, India, 2Medical Director, Bangalore, India, 3Research Scholar, Bangalore, India
Introduction. Inappropriate use of antibiotics leads to the Antibiotic Resistance (AMR) which is a global health challenge. The lack of
Knowledge regarding antibiotic usage, preconceived ideas they may have towards it (Attitude) and wrong practices are all the contributors
to AMR.
Aims. To assess the Knowledge, Attitude and Practice regarding antibiotic use using a standard questionnaire before and after patient
education and evaluate the impact of educational intervention.
Methods. The study was carried out at the outpatient department of the Tertiary care hospital. KAP questionnaires were administered to
the enrolled patients and the data was collected at baseline as well as after patient education. The difference in the KAP before and after the
intervention was evaluated using student paired t-test.
Results. The results showed that majority of the patients had poor Knowledge, Attitude and Practice regarding antibiotic use. Nearly 80% of
the patients did not have the knowledge about what antibiotics are and about AMR. 72% preferred to take antibiotics to prevent viral
infections like cold and flu. 86% of the patients believed that they can stop the medicine once they felt little better, 82% purchased antibiotics
without prescription, 81% of patients did not take the antibiotics as prescribed and did not finish the course, and 95% of patients self-
medicated. The differences in KAP after the intervention were highly significant (p<0.001).
Discussion. Educational intervention helps in creating awareness about appropriate antibiotic use, AMR and consequences of AMR. Clinical
pharmacy students and professionals can play a key role in promoting the Rational Use of antibiotics in the hospital as well as community.
This contributes to global capacity building.
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Development of a reflective practice toolkit designed to support student learning and capacity to work
respectfully with Aboriginal communities
Dr Cherie Lucas1, Prof Megan Williams2, Ms Sally Fitzpatrick3, Ms Mariyam Aly1, Dr Tamara Power4
1University of Technology Sydney, Graduate School of Health (Pharmacy), Sydney, Australia, 2University of Technology Sydney, Graduate
School of Health (Indigenous Health), Sydney, Australia, 3Western Sydney University, Sydney, Australia, 4The University of Sydney (Faculty of
Medicine and Health), Sydney, Australia
Introduction. Students training to be healthcare professionals come from diverse, heterogeneous backgrounds with regards to their
understanding, experiences and perceptions of Aboriginal people. To enhance student practice and professional development, they may
benefit from training to promote cultural learning to engage, communicate and work respectfully with Aboriginal people.
Aims. To develop a Toolkit designed to support pharmacy student learning and capacity to work respectfully with Aboriginal communities.
Methods. To inform the inclusions of the Toolkit, a three-phase project was completed. Phase 1 and 2 included pre-test and post-test student
surveys and student and clinical partners’ focus groups (n=2); (i) student perceptions (n= 12); (ii) clinical partners (n=7). This provided the
basis for the pharmacy students’ and external clinical partners’ perceptions of experiences and views of possible Toolkit inclusions. Phase 3
included a Stakeholder consultation group including Aboriginal elders from the university and community (n=8).
Results. Three phases of the project generated views from different perspectives (students, clinical partners and Aboriginal elders) of what
should be included as resources for the development of the Toolkit. Toolkit inclusions: (i) Counselling videos related to ‘Closing the Gap’
processes; (ii) Reflective practice prompts before, during and after placement; (iii) Map of Aboriginal countries on the Australian continent;
(iv) Student workbook for preparation of placement (such as research into significant sites, historical walks, understanding Aboriginal
colloquial terminology); (v) Clinical placement manual; (vi) Reflective practice models and resources.
Discussion. Ensuring students are aptly prepared using practical learning tools such as the reflective practice Toolkit may enhance the
development of culturally safe future pharmacy workforce and facilitate improvements in health inequalities. Furthermore, the Toolkit has
the potential to be adapted for other health professional education.
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Pharmacist and pharmacy staff knowledge, attitude and practice of wound care in the community
setting: A cross-sectional survey
Daisy H K Cheung1, Dr Carl R Schneider1, Dr Irene S Um1
1The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia
Introduction. Community pharmacy is uniquely positioned as a first port of call for wound care. There is limited evidence detailing wound
care management in Australian community pharmacies.
Aims. To assess wound care knowledge, attitude and practices of pharmacists and pharmacy staff in the Australian community setting.
Methods. A national online cross-sectional survey targeting community pharmacists and pharmacy staff in Australia was performed. The
attitude and practice behaviour section comprised 9 and 14 Likert-type items respectively. The knowledge section comprised 36 items with
a combination of open-ended, true/false, and multiple choice questions and three case vignettes.
Results. Preliminary results indicate 58 completed records out of 95 respondents. Most participants (91.4%) agreed/strongly agreed that
wound care is an important aspect of community pharmacy. Despite a majority of participants (62.1%) agreeing that they have the confidence
in providing wound care advice, perceived skills in the assessment (75.9%) and management (70.7%) of wounds in the pharmacy, they also
perceived the need (82.8%) and would partake (82.8%) in further wound care education. The majority of participants assessed wounds
(67.2%) and provided wound care products (81%) in the pharmacy on at least a weekly basis, yet 65.5% of participants rarely or never
physically performed wound management. The knowledge section reflected overall poor performance, only 12.1% of participants correctly
identified all dressing types and its use in the relevant section.
Discussion. Australian pharmacists and pharmacy staff play a frequent and active role in wound care in the community setting. However,
reported behaviour reflects that survey participants are not practicing to the full extent of their scope of practice. There is a clear and present
need for further education to build capacity of the pharmacy workforce in the field of wound care.
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119
Perinatal women’s acceptability of community pharmacist-led perinatal depression screening: a
qualitative study
Ms Lily Pham1, Assoc Prof Rebekah Moles1, Dr Claire O'Reilly1, Dr Stephen Carter1, Prof Camille Raynes-Greenow1, Prof Timothy Chen1, Dr
Corina Raduescu1, Dr Andrea Murphy2, Prof David Gardner2, Dr Sarira El-Den1
1University of Sydney, Camperdown, Australia, 2Dalhousie University, Halifax, Canada
Introduction. In Australia, 1 in 5 women are affected by perinatal depression (PND) and yet approximately 20% of perinatal women are not
mental health screened in the perinatal period (1). Despite being accessible and trusted primary care providers that are increasingly mental
health first aid trained, pharmacists are not formally recognised as PND screening providers.
Aims. This study aims to explore perinatal women’s acceptability of community pharmacist-led PND screening.
Methods. The research team designed the semi-structured interview guide based on outcomes from a systematic review on the acceptability
of PND screening (2) as well as the development and psychometric evaluation of a questionnaire exploring attitudes towards PND screening
(3). Interviews were conducted with Australian perinatal women until data saturation was reached. Data was inductively and thematically
analysed against the Consolidated Framework for Implementation Research.
Results. Perinatal women (n=41) were accepting of pharmacist-led PND screening, acknowledging that improving visibility of the
pharmacists’, particularly regarding their role in mental health would facilitate service acceptability. Perceived barriers to pharmacist-led
service acceptability and accessibility included a pharmacies’ perceived lack of privacy, time constraints and potential out-of-pocket costs.
Discussion. Current healthcare infrastructure is unable to meet the growing demand for PND care. Perinatal women are accepting of
community pharmacist-led PND screening, highlighting an opportunity for pharmacists to support existing PND screening providers in
supporting perinatal women.
1. Australian Institute of Health and Welfare (2012) Perinatal depression Data from the 2010 Australian National Infant Feeding Survey.
Available at: https://www.aihw.gov.au/getmedia/80df038a-4a03-4214-beca-cfd4b0ac6a43/14496.pdf.aspx?inline=true.
2. El-Den S, O'Reilly CL and Chen TF (2015) A systematic review on the acceptability of perinatal depression screening. J Affect Disord 188:
284-303.
3. El-Den S, O'Reilly CL and Chen TF (2019a) Development and Psychometric Evaluation of a Questionnaire to Measure Attitudes Toward
Perinatal Depression and Acceptability of Screening: The PND Attitudes and Screening Acceptability Questionnaire (PASAQ). Eval Health
Prof 42(4): 498-522.
120
Implementation of pharmacist-led opioid stewardship in a general practice: an effectiveness-
implementation study
Ms Margaret Jordan1,2, Prof Judy Mullan3, Dr Adele Stewart2, Prof Timothy Chen1
1University of Sydney, Sydney, Australia, 2Woonona Medical Practice, Woonona, Australia, 3University of Wollongong, Wollongong, Australia
Introduction. Embedding a general practice pharmacist (GPP) into the interdisciplinary team and implementing stewardship activities are
two potential innovative approaches to improving the use of opioids in primary care.
Aims. To describe the strategies employed in implementing pharmacist-led opioid stewardship in a general practice and to determine its
effectiveness
Methods. A mixed-method hybrid effectiveness-implementation study was conducted. The innovation was opioid stewardship
implementation facilitated by the embedded GPP. Strategies comprised instigation of a practice-wide opioid policy, iteratively developed by
the GPP and endorsed by GPs, and development and use of localised patient resources (e.g., opioid handouts, patient-GP agreements,
individualised tapering plans), to guide conversations, review, and tapering of opioids, if appropriate. Patient-GPP consultations incorporated
medication reconciliation, non-opioid and non-pharmacological advice, and initiation of management plans. Effectiveness was evaluated
through pre-post, quantitative analysis of opioid doses [standardised to oral morphine equivalent daily dose (oMEDD)] at baseline, six- and
nine-months review and opioid prescribing for the cohort at the study end. Enabling strategies were determined from qualitative analysis of
semi-structured interviews with GPs (10) and practice personnel (3), patient records and study field notes.
Results. The GPP had consultations with 100 patients, with data from 92 contributing to final analysis. The cohort baseline median oMEDD,
44.5mg (IQR 30-90mg), was significantly reduced at six and nine months to 13.5mg (IQR 0-40mg) and 7mg (IQR 0–30 mg) at 9-months
(p<0.0001). The mean overall oMEDD reduction at the study end was 66%, with 42% no longer prescribed regular opioids. GPP factors
facilitating weaning included providing patient-centred care, applying pharmaceutical knowledge, and investigating modifiable reasons for
opioid use. Stewardship principles (localised organisational policy, collaboration, promotion of leadership and culture change, advancement
of clinical expertise and practice, patient engagement, monitoring performance data and feedback) enabled implementation.
Discussion. This study contributes to growing research investigating optimum methods for reviewing and deprescribing opioids to doses that
pose lower risks of harm. The innovation utilised systems-based strategies to embed GPP-led change and a patient-centred approach, which
is generalisable to other primary care settings.
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Influencing the pharmacy profession by building the capacity of pharmacist education providers
Ms Glenys Wilkinson1, Prof Debra Rowett2, Ms Bronwyn Clark1, Ms Kate Spencer1, Dr Josephine Maundu1
1Australian Pharmacy Council, Canberra, Australia, 2University of South Australia, Adelaide, Australia
Introduction. A key objective of the Australian National Regulation and Accreditation Scheme (NRAS) is to enable the continuous
development of a flexible, responsive, and sustainable health workforce and to enable innovation in the education of, and service delivery
by, health practitioners. The Australian Pharmacy Council (APC), as the appointed accreditation authority for pharmacy, is responsible for
ensuring pharmacy programs are compliant with Standards designed to address this objective. APC uses evidence-based strategies to
develop future-focused accreditation standards which build the capacity of pharmacist education providers and enables innovation.
Aims. To outline how APC influences and impacts the pharmacy profession through accreditation.
Methods. APC works closely with stakeholders to review and update accreditation standards for Australian pharmacy degree and intern
training programs. Strategies have included best practice literature reviews, expert input, and stakeholder consultation.
Results. A ground-breaking set of Accreditation Standards was implemented in 2014, focusing on outcomes rather than inputs and enabling
degree providers to adopt greater flexibility and innovation in curriculum design and provide relevant evidence demonstrating the quality
and compliance of their programs. In 2020, the focus was extended to include both outcomes and processes and was for the first time
underpinned by the principle of social accountability which acknowledges the importance of public good in addition to avoidance of harm. A
suite of documents was developed to highlight performance as the key outcome of pharmacist education, and emphasis was placed on
producing pharmacists equipped to adapt to as-yet-unimagined roles in the health care system of the future.
Discussion. Education programs are influenced and shaped by the accreditation standards that they must meet. Accreditation authorities
play a significant role in influencing the current and future practice of health professionals by having an impact on their education and
training.
1. International Pharmaceutical Federation – FIP (2014). Quality Assurance of Pharmacy Education: the FIP Global Framework. The Hague,
The Netherlands: International Pharmaceutical Federation. Used with permission.
122
Quality of medicines in Sri Lanka: a retrospective review of safety alerts
Mrs Tharmalinga Sharma Jegath Janani1, Madumai Ketharam2, Kaumada Binoli Herath3, Senathiraja Sherley Shobia2
1Univerity of Sri Jayawardenapura, Nugegoda, Sri Lanka, 2National Medicine Regulatory Authority, Sri Lanka, 3Institute for Research and
Development in Health & Social Care, Sri Lanka
Aims. This study aims at investigating the extent of quality and safety of medicines in Sri Lanka.
Methods. A retrospective review was done for medicine recalls and withdrawal on documents conveying issues relating to defective (ie.,
substandard and falsified) medicines in the National Medicines Regulatory Authority (NMRA) website between 2019 and 2021.
Results. There were 166 defective medicines of which 104 were recalled and 62 were withheld. The three most frequently reported types of
defects were contamination (66 incidents), stability issues (37 incidents) and active ingredient defects (27 incidents). All the foreign medicines
recalled, were distributed across several authorized importers, market authorization holders and manufacturers, however, some of these
were found to be repetitive in the same groups over
others. Over 75% of the medicines recalled are of Indian
origin and India does account for a large share of the
total imported medicines in Sri Lanka. There were no
marketing authorization holders for 16 medicines that
were shown defects.
Discussion. The reporting of substandard medicines in
Sri Lanka is on the rise. The launch and improvement of
the NMRA’s website created an important
communication tool with health care professionals and
the public. It is concerning that stability failure and active
ingredient defects have the potential to affect the
bioavailability of the active ingredients in the systemic
circulation, and in turn, may lead to therapeutic failure
eventually a threat to patient safety. Importers, market
authorization holders and manufacturers should be held
accountable for ensuring the accurate quality of
medicine through increased awareness, education, and
sanctions.
1. 1. Almuzaini T, Sammons H, Choonara I. Substandard and falsified medicines in the UK: a retrospective review of drug alerts (2001–
2011). BMJ Open 2013;3: e002924.
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Psychometric (Rasch) testing of a professional identity scale for pharmacy students
Dr Joy Spark1, Mrs Anna Barwick1
1University of New England, Armidale, Australia
Introduction. The Macleod Clark Professional Identity Scale (MCPIS-9) is a tool
to assess Professional identity (PI) in pharmacy students.1 Despite validation,
a recent review found it had undergone limited psychometric testing.2
Aims. To examine the construct validity of the MCPIS-9 using Rasch analysis.
Methods. Undergraduate pharmacy students across all year levels completed
an adjusted MCPIS-9 with a seven point strongly disagree/ strongly agree
response scale and specific referral to the pharmacy profession. The fit of the
MCPIS-9 to the polytomous Rasch model was evaluated using RUMM2030.
Results. The MCPIS-9 was completed by 109 pharmacy students. PI scores
were positively skewed, ranging from 27 to the maximum of 54 (mean: 43±6.8). Initial assessment of the MCPIS-9 fit to the Rasch model
identified severe miss-targeting and disorder thresholds; these were not improved by collapsing response categories. Consequently the mid-
point was removed and response categories collapsed into 4. There was evidence of response dependence for the negatively worded
questions. The two questions relating specifically to students were most redundant and removed. Unidimensionality of the 7-item scale was
explored using principle components analysis of the residuals. Investigation of the 2 highly positive items and 3 highly negative items using
a t-test showed the number of responses that differed by more than 5% was 6.5% (95CI 2.5% to 11.4%) of responses indicating
unidimensionality. The resulting scale showed good fit to the Rasch model with a non-significant item-trait interaction total 2=10.3 (df=14,
p=0.74) and PSI=0.74. Targeting is reasonable except for one threshold on an item that had no disagree responses.
Discussion. The high Cronbach’s reported for the MCPIS-92 is artificially inflated by the response dependence between 3 of the items.
There is a large positive skew to responses that can be controlled by removing the mid-point and collapsing categories. In future,
consideration should be given to using a 7-item tool with an even number of response categories that may also be tested in health
professionals as well as students.
1. 1. Adams K, Hean S, Sturgis P, Clark JM Investigating the factors influencing professional identity of first-year health and social care
students. Learn Health Soc Care. 2006;5(2):55-68.
2. 2. Matthews J, Bialocerkowski A, Molineux M Professional identity measures for student health professionals - A systematic review of
psychometric properties. BMC Med Educ. 2019;19(1).
124
Prevalence and predictors of opioid use before orthopaedic surgery in an Australian setting: a
multicentre, cross-sectional, observational study
Ms Shania Liu1, Dr Jennifer Stevens3,4, Dr Ashleigh Collins3, Prof Jed Duff5, Dr Joanna Sutherland6, Dr Morgan Oddie7, Assoc Prof Justine
Naylor8,9, Prof Asad Patanwala1, Ms Benita Suckling10,11, Dr Jonathan Penm1,2
1The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Australia, 2Department of Pharmacy, Prince
of Wales Hospital, Randwick, Australia, 3School of Medicine, Notre Dame University, Sydney, Australia, 4Vincent’s Clinical School, The
University of New South Wales, Kensington, Australia, 5Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane
City, Australia, 6Rural Clinical School Coffs Harbour Campus, The University of New South Wales, Coffs Harbour, Australia, 7St George
Hospital, Kogarah, Sydney, Australia, 8Whitlam Orthopaedic Research Centre, Ingham Institute, Liverpool, Australia, 9South Western Sydney
Clinical School, The University of New South Wales, Sydney, Australia, 10Clinical Pharmacology Department, Royal Brisbane and Women’s
Hospital, Herston, Australia, 11Department of Pharmacy, Redcliffe Hospital, Redcliffe, Australia
Introduction. Opioid analgesics are commonly used by patients awaiting orthopaedic surgery and preoperative opioid use is associated with
a greater burden of postoperative pain, suboptimal surgical outcomes and higher healthcare costs.
Aims. This study aimed to examine the prevalence of total opioid use before elective orthopaedic surgery with a focus on regional and rural
hospitals in New South Wales, Australia.
Methods. This was a cross-sectional, observational study of patients undergoing orthopaedic surgery conducted between April 2017 and
November 2019 across five hospitals that included a mix of metropolitan, regional, rural, private and public settings. Preoperative patient
demographics, pain scores and analgesic use were collected during pre-admission clinic visits, held between two and six weeks before
surgery.
Results. Of the 430 patients included, 229 (53.3%) were women and the mean age was 67.5 years (standard deviation 10.1 years). The overall
prevalence of total preoperative opioid use was 37.7% (162/430). Rates of preoperative opioid use ranged from 20.6% (13/63) at a
metropolitan hospital to 48.8% (21/43) at an inner regional hospital. Multivariable logistic regression showed that the inner regional setting
was a significant predictor of opioid use before orthopaedic surgery (adjusted odds ratio, 2.6; 95% confidence interval, 1.0 – 6.7) after
adjusting for covariates.
Discussion. Opioid use prior to orthopaedic surgery is common and appears to vary by geographic location. Given its use is associated with
worse postoperative outcomes, rigorous efficacy studies involving different geographic locations are required to determine whether opioid
tapering prior to surgery can reduce harm.
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Student-led medication histories in hospital: Analysis of student and preceptor feedback
Miss Linda Do1,4,7, Dr Carl Schneider1, Dr Jonathan Penm1, Prof Asad Patanwala1,2, Ms Rosemary Burke2,3,4,5, Mr Russell Levy2,5, Mr Garry Soo3,
Mrs Jocelyn Ong4, Ms Amy Murray6, Dr Rebekah Moles1
1The University of Sydney, Camperdown/Darlington, Australia, 2Royal Prince Alfred Hospital, Camperdown, Australia, 3Concord Repatriation
General Hospital, Concord, Australia, 4The Canterbury Hospital, Campsie, Australia, 5Balmain Hospital, Balmain, Australia, 6Blacktown
Hospital, Blacktown, Australia, 7Liverpool Hospital, Liverpool, Australia
Introduction. Roles of Australian pharmacy students within hospital placements is often limited; under-utilising the knowledge and skills
obtained during tertiary studies. Taking a medication history is an Entrustable Professional Activity (EPA) students can perform as part of the
Medication Reconciliation (MedRec) process.
Aims. To evaluate a student-led MedRec program from the perspective of students and pharmacist preceptors.
Methods. In 2019, 70 students volunteered to take medication histories across 6 participating hospitals; one full-day shift per week over 10
weeks. Students submitted reflective portfolios and focus groups/interviews were held with students and preceptors independently and data
gathered were analysed for emergent themes.
Results. In total, 49/70 students gave consent for their reflective portfolios to be reviewed; 32 students participated in 5 focus groups, and
23 pharmacists participated in a further 6 focus groups/interviews. Emergent themes included: 1. Student preparedness to perform tasks; 2.
Real-life complexities; and 3. Preceptors overwhelmed by added clinical load. Students felt prepared for the task and gathered confidence
over time. These data were validated by preceptors although many preceptors believed students could only be trusted with the task after 4-
6 weeks of experience. Students reported that they struggled with the dynamic and “real” environment of the hospital including difficulties
conversing with all patients or not having the clinical pharmacist with them all the time. Preceptors believe reviewing students’ medication
histories were time-consuming often compromising their usual workflows.
Discussion. Refinement of the program over time may allow universities to modify on-campus learning to better prepare students for the
complex environment which may allow preceptors to gather trust in students’ abilities earlier. Preceptors and students may require more
structured approach to setting realistic goals together throughout the MedRec program so that preceptors can better control their workload
whilst maintaining the ongoing support for students’ professional training and development.
126
Pharmacists’ acceptability of perinatal depression screening in community pharmacies: A content
analysis
Miss Clara Strowel1, Camille Raynes-Greenow1, Stephen Carter2, Katharine Birkness6, Lily Pham2, Rebekah Moles2, Claire O’Reilly2, Timothy
Chen2, Corina Raduescu3, Andrea Murphy4, David Gardner5, Sarira El-den2
1The University of Sydney, Sydney School of Public Health, Sydney, Australia, 2The University of Sydney School of Pharmacy, Faculty of Medicine
and Health, Sydney, Australia, 3The University of Sydney Business School, The University of Sydney, Sydney, Australia, 4College of Pharmacy,
Faculty of Health, Dalhousie University, Canada, 5Department of Psychiatry, Faculty of Medicine, Dalhousie University, Canada, 6Dalhousie
University, Canada
Introduction. Perinatal depression (PND) screening facilitates the early detection of people at risk of PND. There have been calls to
incorporate screening in primary care settings, which can include community pharmacies.
Aim. The aim of this study was to examine pharmacists’ perspectives regarding community pharmacist-led PND screening, with a specific
focus on their acceptability of PND screening and training needs.
Methods. An online questionnaire was advertised to pharmacists in Australia who are registered with National, and/or state-based
pharmacy organisations. The questionnaire was based on previous work (1) and explored pharmacists’ acceptability of PND screening in
community pharmacy and their training and resource needs. Using content analysis, questionnaire responses were coded and categories
and/or themes were developed. Codes and themes were then mapped to the seven constructs within the theoretical framework of
acceptability (2).
Results. There were 149 pharmacist participants, of those (n=135, 90.6%) perceived PND screening in pharmacies as acceptable and
beneficial. However, there were concerns about limited knowledge of PND screening processes and the time required to deliver PND
screening in community pharmacy. Four themes relevant to acceptability were identified: the benefit of PND screening, accessibility,
resources, and system and policy changes. Participants highlighted that pharmacist-specific training should include topics such as
communication, perinatal mental illness and PND screening tools (including interpretation and explanation of scores). Furthermore,
community pharmacists require a range of resources including training material, reimbursement, referral options and support networks to
assist pharmacy-led PND screening.
Discussion. This study provides information on the benefits and limitations of community pharmacy-led PND screening, from pharmacists’
perspectives. Findings can be used to guide the development of pharmacists training, as well as the delivery and evaluation of community
pharmacist-led PND screening.
1. El-Den S, O'Reilly CL, Chen TF. A systematic review on the acceptability of perinatal depression screening. Journal of affective disorders.
2015;188:284-303.
2. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical
framework. BMC health services research. 2017;17(1):1-13.
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Simulation-based education in the therapy of serious infections
Dr Petra Czarniak1, Dr Leanne Chalmers1, Dr Ya Ping Lee1, Ms Kiran Parsons1, Dr Alina Miranda1
1Curtin University, Perth, Australia
Introduction. Simulation-based education (SBE) provides safe and effective learning opportunities for health professional students by
utilising goal-based role-play with a simulated patient to replicate the clinical setting but with no risk to a real patient.
Aims. To develop two authentic video simulations requiring appropriate antibiotic selection in response to diagnosis, available therapeutic
evidence and patient-specific factors and to evaluate their impact on student learning.
Methods. Two scenarios (tuberculosis and polymicrobial infection) were developed with expert input and filmed using professional actors
and a small film crew. All students enrolled in a second year pharmacy program (n=123) were invited to attend SBE tutorials utilising the
videoed scenarios. Evaluation was via validated pre- and post-tutorial questionnaires.
Results. Of 123 students invited to participate, pre- and post-tutorial questionnaires were completed by 97 (78.9%) students for tuberculosis
and 75 (61.0%) for polymicrobial infection; 74 (60.2%) completed the tuberculosis evaluation and 53 (43.1%) completed the polymicrobial
infection evaluation. A statistically significant difference between pre- and post-tutorial questionnaire scores (p < 0.001, Wilcoxon signed-
rank test) was noted. A majority reported the tuberculosis (63/74; 85.1%) and polymicrobial infection SBE activities (50/53; 94.3%) were
outstanding or excellent. Most (71/74; 95.9% tuberculosis and 50/53; 94.3% polymicrobial infection) agreed that the tutorial learning
activities helped them to acquire critical thinking skills (logical thought processes to help make clinical decisions and formulate a solution)
and that the SBE session was useful to help them learn better (73/74; 98.6% tuberculosis and 51/53; 96.2%). Almost all participants (92.0-
96.2%) agreed that they would like more SBE activities in the future.
Discussion. SBE activities are a novel method to enhance students’ learning experience. They encourage students to consolidate their
knowledge about antimicrobial agents and engage them in selecting appropriate antibiotics to treat infectious diseases.
128
Simulated schizophrenia role-plays for pharmacy students: Co-design and content validation by mental
health stakeholders
Mrs Tina Ung1, Assoc Prof Rebekah Moles1, Dr Claire O'Reilly1, Dr Sarira El-Den1
1The University of Sydney, Camperdown, Australia
Introduction. Simulated patient role-plays are effective for assessment of Mental Health First Aid skills, among pharmacy students. Mental
health consumers are involved in mental health education delivery, however consumer involvement in curriculum co-design is lacking, as is
research describing the development of educational material specifically relating to caring for people living with schizophrenia and their
carers.
Aims. This project aimed to co-design, content validate, pilot test and face validate simulated schizophrenia role-plays with mental health
stakeholders, for use in pharmacy curricula.
Methods. Three simulated schizophrenia role-play cases and marking rubrics were co-designed by mental health consumers and the research
team. Then, mental health stakeholders engaged in a two-round process to content validate the educational material. The first round
involved completing a survey to calculate the item content validity index (I-CVI) scores for relevance and clarity, content validity ratio (CVR)
scores for item essentiality and overall scale content validity index (S-CVI/Ave and S-CVI/UA) scores for each role-play case and rubric.
Analyses of scores and feedback comments informed item revisions and discussions at the second-round content validation panel meeting.
The finalised educational material was pilot-tested and face validated with Master of Pharmacy (MPharm) students.
Results. Two mental health consumers participated in co-design. Nine mental health stakeholders participated in content validation. Each
item in all three role-play cases showed excellent content validity for relevance and clarity, and eleven items were revised for essentiality.
Item revisions were discussed and re-rated at the content validation panel meeting, until consensus was reached. MPharm students (n=15)
participated in the simulated schizophrenia role-plays, which were positively received for relevance to future practice.
Discussion. Partnering with mental health stakeholders has enabled the co-development of authentic, content and face valid educational
material to meet the needs of pharmacy students and people living with schizophrenia and their carers.
1. El-Den S, Moles RJ, Zhang R, O’Reilly CL. Simulated patient role-plays with consumers with lived experience of mental illness post-mental
health first aid training: Interrater and test re-test reliability of an observed behavioral assessment rubric. Pharmacy. 2021;9:28-44.
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Simulated mental health first aid assessments involving role-plays with mental health consumers:
Evaluating pharmacists’ performance and experiences
Miss Ricki Ng1, Dr Claire O'Reilly1, Dr Jack Collins1, Ms Helena Roennfeldt2,3, Dr Sara McMillan4, Prof Amanda Wheeler2,5, Dr Sarira El-Den1
1The University of Sydney, Camperdown, Australia, 2Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 3Centre for
Psychiatric Nursing, The University of Melbourne, Melbourne, Australia, 4Health Systems Menzies Health Institute Queensland, School of
Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia, 5Faculty of Medical and Health Sciences, The University of Auckland,
Auckland, New Zealand
Introduction. Healthcare professionals, including pharmacists, can recognise and assist people experiencing mental health crises. Despite
this, little is known about how pharmacists assist and engage with people presenting with signs of mental health crises.
Aims. To examine the language used during suicidal assessments in simulated patient role-plays (SPRPs) by pharmacists trained in Mental
Health First Aid (MHFA) and explore their experiences of the challenges of providing support to people living with mental illness or
experiencing a mental health crisis.
Methods. As part of a training program designed to upskill pharmacists to support people living with severe and persistent mental illness, 55
MHFA-trained community pharmacists participated in audio recorded SPRPs of three crisis (suicide and mania) scenarios enacted by mental
health consumers. Pharmacists were assessed on the language used during suicidal assessments. Post-SPRP, reflective debrief discussions
with mental health consumers, peers and a facilitator, were analysed using inductive thematic analysis.
Results. The majority of pharmacists asked about suicidal ideation using appropriate, direct terminology. Qualitative analyses yielded three
inter-related themes: (i) Relationship with the consumer was seen as a facilitator, which if supported by (ii) Appropriate verbal and non-
verbal communication, could help with the (iii) Challenges with crisis assessment. Challenges included difficulties associated with initiating
conversations about suicide and mania as well as anticipating how consumers may respond to direct questioning.
Discussion. While pharmacists demonstrated the correct use of language in asking about suicide post MHFA training, pharmacists felt
uncomfortable initiating conversations around suicide, lacked confidence during crisis assessments and reflected on the difficulty in using
non-stigmatising language. Future training, opportunities to practice and support for pharmacists should involve co-design and co-delivery
with mental health consumers to ensure realistic, authentic learning and practice experiences.
Funding/Registration. This activity received grant funding from the Australian Government Department of Health. Registration:
ACTRN12620000577910.
130
A community pharmacy implementation logic model for opioid optimisation service development and
implementation in Pakistan
Miss Ayesha Iqbal1, Prof Claire Anderson1, Dr Roger David Knaggs1, Dr Li Shean Toh1
1Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom
Introduction. Self-medication and unsafe use of medications are major public health concerns in developing countries including Pakistan (1).
Community pharmacists (CPs) play a large role in medicine optimisation and disease management in developed countries but extended
patient-oriented services in community pharmacies are still in nascent stages in Pakistan.
Aims. This study aimed to identify barriers and facilitators and develop strategies towards developing and implementing role of CPs in the
optimisation of opioids to ensure patient safety in the management of CNMP.
Methods. In-depth semi-structured interviews of purposively sampled pharmacy policymakers (n=11) and people with CNMP (n=14) and
focus groups with doctors (n=31) and CPs (n=36) were done in Pakistan in 2020. Data were inductively analysed using reflexive thematic
analysis (2) using N-Vivo 12. Case study observations were carried out in 6 community pharmacies between September-November 2020 and
analysed using a cross case synthesis method using explanation building technique. The data were mapped to an adapted implementation
science framework (3) and realist inspired analytical techniques were used to understand mechanistic changes of strategies leading to
improved implementation of services and improved safety of opioids. Ethical approval was obtained from University of Nottingham, UK and
Hamdard University Islamabad, Pakistan.
Results. Numerous barriers and facilitators were identified across a range of social ecological levels. A community pharmacy implementation
logic model for opioid optimisation service development was created. The model Identifies strategies for developing and implementing role
of CPs included designing compatible intervention within existing systems, CP remuneration models, improving regulatory systems,
favourable laws and policies, support and advocacy of policy makers, pharmacist representation on government policy making level,
initiatives to improve public awareness and improved CP knowledge, skills and motivation.
Discussion. The implementation logic model targets current multi-level pharmacy practice barriers and provides a clear pathway for policy
makers, towards effectively developing and implementing extended pharmacy services in Pakistan.
1. Mohammad Majid Aziz, Masood I, Yousaf M, Saleem H, Ye D, Fang Y. Pattern of medication selling and self-medication practices: A study
from Punjab, Pakistan. PloS one. 2018;13:3:e0194240.
2. Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Qual Quant. 2021.
3. Arianna Rubin Means, Kemp CG, Gwayi-Chore MC, Gimbel S, Soi C, Sherr K. Evaluating and optimizing the consolidated framework for
implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implement. Sci. 2020;15:17.
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131
Survey of Australian hospital pharmacy departments – how are we caring for Aboriginal and/or Torres
Strait Islander inpatients
Ms Susan Welch1,2, Assoc Prof Bhavini Patel3,4, Ms Aleena Williams5, Assoc Prof Rebekah Moles2
1St Vincent's Hospital Sydney, Darlinghurst, Australia, 2University of Sydney, Camperdown, Australia, 3Northern Territory Department of
Health, Charles Darwin University, Darwin, Australia, 4Medicines Management Top End Health Service, Darwin, Australia, 5Public Health
Directorate, Department of Health, Darwin, Australia
Introduction. There are limited data describing the role of hospital pharmacists caring for Aboriginal and/or Torres Strait Islander inpatients.
Aims. To determine roles and initiatives provided by Australian Hospital Pharmacy Departments in providing medicine management services
to Aboriginal and/or Torres Strait Islander people admitted to Australian hospitals.
Methods. Mixed method (online survey + telephone semi-structured interviews). The survey was emailed to Directors listed in the Society
of Hospital Pharmacists of Australia Directory (January 2019). Follow-up telephone conversations were digitally recorded and continued until
theme saturation. Recordings were transcribed verbatim and thematically analysed.
Results. 69 responses were received from 313 pharmacy departments (Response Rate = 22%), Of these, 20 (29%) pharmacists agreed to a
semi-structured interview. All hospital categories, states and territories were represented: Metropolitan (33,48%); regional (22, 32%); rural
(12, 17%) and remote (2, 3%). Over half surveyed (64%) had specific processes for Aboriginal and/or Torres Strait Islander inpatients. Program
outcome measurement was low (10, 14%). Survey results and qualitative interviews revealed work is being done under the broad themes:
culturally safe care; provision of culturally appropriate medicines information; chronic disease management; continuum of care; managing
funding models. Potential outcome measures and future plans were proposed.
Discussion. Several sites have pharmacy initiatives. Results have identified the pharmacist’s role in providing services for Aboriginal and/or
Torres Strait Islander people, not included in the literature however, outcomes of these services were not routinely assessed. Wider
knowledge, evaluation and measurement of the impact of these services on health outcomes and equity is needed and would allow hospital
pharmacy teams to better tailor initiatives to meet the needs of Aboriginal and/or Torres Strait Islander people.
132
Student-led medication histories in hospitals during the COVID-19 pandemic: Analysis of student and
preceptor feedback
Miss Linda Do1,4, Dr Carl Schneider1, Dr Jonathan Penm1, Prof Asad Patanwala1,2, Ms Rosemary Burke2,3,4,5,6, Mr Russell Levy2,5, Mr Garry
Soo3,6, Mrs Jocelyn Ong4, Dr Rebekah Moles1
1The University of Sydney, Camperdown/Darlington, Australia, 2Royal Prince Alfred Hospital, Camperdown, Australia, 3Concord Repatriation
General Hospital, Concord, Australia, 4Canterbury Hospital, Campsie, Australia, 5Balmain Hospital, Balmain, Australia, 6Concord Centre for
Mental Health, Concord, Australia
Introduction. Taking a medication history is an Entrustable Professional Activity (EPA) pharmacy students can perform as part of the
Medication Reconciliation (MedRec) process. Since 2018, an annual student-led MedRec program was initiated across various metropolitan
hospitals. However, the COVID-19 pandemic in 2020-2021 impacted pharmacy workflows forcing changes to the program.
Aim. To evaluate the feasibility of the MedRec program during the COVID-19 pandemic from the perspective of pharmacy students and their
pharmacist preceptors.
Methods. In 2020-2021, 34 students volunteered to take medication histories across 5 participating hospitals. Focus groups/interviews were
held with students and preceptors independently and data gathered were analysed for emergent themes.
Results. The 34 students recorded medication histories for approximately 400 patients. A total of 9 focus groups (n=27 students, n=14
pharmacists) and 14 individual interviews (n=3 students, n=11 pharmacists) were conducted. Emergent themes included: student
preparedness; real-life complexities; and overwhelming clinical load for preceptors. Students felt prepared and gathered confidence over
time. Preceptors believed that some students took longer than previous years for the entrustment process, with communication skills sighted
as the main barrier. Some perceived this may be due to the online learning environment, where students had less practice at in-person
classroom simulation. Adhering to pandemic restrictions such as wearing masks and social distancing were considered minimally burdensome
to students.
Discussion. Despite the pandemic, pharmacy students were able to provide a clinical service to hospital inpatients. However, the pandemic
did impact on the number of students experiencing these placements (e.g. 2018, n=91) and disruption to classroom learning may have
impacted student skill development. Further, preceptors were also under pressure during this time with other priorities such as vaccinations.
Future pandemics are inevitable, and universities and hospitals will need to continue working together to prepare students for EPA’s and to
set realistic expectations.
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133
Reasons for non-adherence to atrial fibrillation thromboprophylaxis prescribing guidelines in Western
Australia: A qualitative descriptive study of general practitioners’ views
Mr Eyob Alemayehu Gebreyohannes1, Dr Sandra Salter1, Dr Leanne Chalmers2, Prof Luke Bereznicki3, Dr Kenneth Lee1
1Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia, 2Curtin Medical School, Curtin University,
Perth, Australia, 3School of Pharmacy and Pharmacology, Hobart, Australia
Introduction. A significant proportion of the atrial fibrillation (AF) population attending
Australian primary care is not receiving guideline-adherent oral anticoagulant (OAC)
treatment.
Aims. To explore reasons for non-adherence to thromboprophylaxis guidelines in AF
from the perspectives of general practitioners (GPs) and to map these reasons to the
Capability, Opportunity, Motivation-Behaviour (COM-B) model to identify potential
opportunities to support practice change.
Methods. An exploratory qualitative descriptive study among GPs practising in Western
Australia was conducted using semi-structured interviews, from November 2020 to
February 2021. The Framework Method was employed to facilitate thematic analysis,
using NVivo software. Interview responses were also mapped to the COM-B model.
Results. Nine of the 10 GPs initially consented participated in the semi-structured
interview (Male = 56%, median age = 52 years, data saturation reached with 6 participants). Two themes emerged from analysis of the
interview transcripts: (1) GPs’ decision-making process and (2) Patient refusal to take OACs. The COM-B model mapping identified
behavioural factors that could impact adherence: capability (GPs’ knowledge and understanding of guideline recommendations, difficulty
balancing risk-benefit), opportunity (bulk and presentation of the guidelines, focus of the guidelines on only single disease conditions, time
for reading multiple guidelines, difficulty accessing specialists, patients’ refusal to take OACs), and motivation (GPs’ perceptions on the role
of guidelines, subjective assessment of patients’ risk of bleeding, GP’s emphasis on risk of bleeding than risk of stroke, perception on the
safety and efficacy of aspirin).
Discussion. GPs identified various reasons contributing to non-adherence to thromboprophylaxis guidelines in patients with AF. Multifaceted
interventions should consider behavioural opportunities to improve adherence, including education and training, electronic decision support,
clinical audits by allied health professionals, partnership between general practices and local hospitals, and cardiologist-led interventions to
support GPs. Further studies are needed to capture patients’ reasons for refusing OACs. (Published recently:
https://doi.org/10.1016/j.thromres.2021.10.025).
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Status of Aboriginal and Torres Strait Islander people’s cultural safety/competence education in
Australian pharmacy schools
Mr Alexander Burke1, Ms Josephine Maundu2, Ms Bronwyn Clark2, Ms Glenys Wilkinson2, Prof Bandana Saini1, Assoc Prof Rebekah Moles1
1University of Sydney, Sydney, Australia, 2Australian Pharmacy Council, Canberra, Australia
Objective. The aim of this study was to explore academics views on Aboriginal and/or Torres Strait Islander Health and Cultural
Competence teaching in pharmacy schools to inform recommendations for future curricula.
Methods. 18 pharmacy schools in Australia were contacted, and interviews conducted with Heads of school or their delegate/s. The
interviews covered what the school was doing regarding the new APC accreditation standards, what they had taught in the past and how
they were implementing new content and further ideas for improvement. Audio recordings of interviews were transcribed verbatim via an
online transcription service. Transcripts were thematically analysed and coded according to the framework approach and the Aboriginal
and Torres Strait Islander Health Curriculum Framework. Coding was facilitated using NVivo software
Results. Thoughts and ideas from interviewees were coded under eight principles of the health curriculum framework and each sub coded
into four frames: - Contextual, Diagnostic, Evaluative and Strategic. Many Interviewees expressed that the current content throughout
Aboriginal health and cultural safety/competence was lacking and cited many barriers that have led to the lack of development. They
expressed multiple ideas for how new curricula could embed cultural safety/competence and ideas for sustainable change moving forward.
Discussion. Whilst the Aboriginal and Torres Strait Islander Health Curriculum Framework was introduced in 2014, its dissemination to
individuals teaching pharmacy curricula appears to be poor. Despite this, the Australia Pharmacy Council guidelines are well known to most
educators. It is apparent that pharmacy schools are at different stages in their development of Aboriginal and Torres Strait Islander Health
curriculum design and implementation and future resources should be developed and made available.
Conclusion. Whilst cultural safety/competency was taught in the pharmacy schools, disparities in teaching were identified and ideas for
future improvements were uncovered.
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Top 10 unanswered questions about quality use of medicines in people living with dementia
Dr Edwin Tan1, Dr Emily Reeve2,3, Dr Nagham Ailabouni2, Prof Lynn Chenoweth4, Dr Mouna Sawan1,5, Dr Tuan Anh Nguyen2,6, Dr Lisa Kalisch
Ellett2, Dr Julia Gilmartin-Thomas7,8, Dr Janet Sluggett5,9, Lyntara Quirke10, Prof Sarah Hilmer11
1School of Pharmacy, University of Sydney, , Australia, 2Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health
Sciences, University of South Australia, , Australia, 3Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie
University and Nova Scotia Health Authority, Canada, 4Centre for Healthy Brain Ageing, University of New South Wales, , Australia, 5Centre
for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Australia, 6National Ageing Research Institute, , Australia,
7College of Health and Biomedicine & Institute for Health and Sport, Victoria University, , Australia, 8School of Public Health and Preventive
Medicine, Monash University, , Australia, 9UniSA Allied Health and Human Performance, University of South Australia, Australia,
10Consumer representative, 11Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of
Sydney and Royal North Shore Hospital, St Leonards, Australia
Introduction. People living with dementia often have multiple co-morbidities which lead to polypharmacy and medicine-related problems.
Achieving quality use of medicines (QUM) in people living with dementia is a global patient safety challenge. In the past, research questions
about medicines for people living with dementia have been led by drug companies or researchers, with little involvement of consumers and
clinicians.
Aims. To identify the Top 10 unanswered quality use of medicines questions for people living with dementia, as determined by consumers
(people living with dementia, carers, family/friends) and healthcare professionals (clinicians).
Methods. The James Lind Alliance Priority Setting Partnership method was used. A national qualitative survey and interviews with
stakeholders asked consumers and clinicians what questions they have had about medicine use in people living with dementia. Responses
were used to generate summary questions which were then cross-checked with the published literature to determine if they have already
been answered. A second survey followed by an online workshop with consumers and healthcare professionals was conducted to prioritise
the unanswered questions, resulting in a Top 10 list.
Results. In our first survey, we received 545 questions from 151 consumers and 77 clinicians. These were summarised into 68 unique
summary questions, and, after evidence checking, 67 unanswered questions. Our second survey (171 consumers and 67 clinicians) identified
the top 16 questions and finally, 17 consumers and clinicians identified and ranked the Top 10. The highest priority questions were around
shared decision making, healthcare professional knowledge and skills, and transitions of care.
Discussion. Targeting future research efforts towards these identified consumer- and healthcare professional-priorities will ensure that
clinically relevant research is being undertaken and funds are being directed to the most urgent areas of need.
136
The implementation of an osteoporosis medication management intervention in community pharmacy:
A pilot study
Mr Jonathan Phuong1, Ms Sunny Manon1, Assoc Prof Rebekah Moles1, Dr Stephen Carter1
1University of Sydney, Camperdown, Australia
Introduction. Osteoporosis in Australia is undertreated despite effective pharmacotherapy due to poor patient adherence and limited
medication management services.
Aims. To evaluate the acceptability of a medication management intervention for osteoporosis in community pharmacy, to inform a future
larger-scale study.
Methods. Australian community pharmacists were trained to delivery an osteoporosis medication management intervention. The
intervention was delivered to patients with diagnosed osteoporosis, and after 4 weeks, the patient was followed up by the research team.
Outcomes measured were pharmacists’ competency in service delivery, pharmacists’ and patients’ perceptions of service, changes in
patients’ self-reported adherence and beliefs about their osteoporosis medications
Results. Five community pharmacies completed a total of 24 interventions over a 6-week trial period. Patients rated perceived service quality
at a median score of 6.33/7 for both face-to-face (n=12) and telepharmacy (n=12) interventions. Pharmacists reported that providing the
intervention is worthwhile for patients and provides professional satisfaction. The main barriers to service delivery were time and workload,
particularly relating to the COVID-19 pandemic. There were no significant changes in patients’ self-reported adherence and beliefs about
their osteoporosis medicines.
Discussion. An osteoporosis medication management intervention in community pharmacies can be feasible and acceptable for both patients
and pharmacists. The proceeding study should consider greater remuneration for service delivery, mandatory training of all pharmacists,
inclusion of non-English speaking participants, and a longer follow up period of 12-24 months.
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137
The impact of COVID-19 on clinical research at Australian and New Zealand universities: a qualitative
study
Ms Renu Bhutkar1, Dr Sarira El-den1, Dr Jack Collins1, Dr Claire O'Reilly1
1The University of Sydney, Sydney, Australia
Introduction. The COVID-19 pandemic has resulted in the implementation of social distancing measures, travel restrictions and infection
control measures which have introduced a myriad of challenges when conducting clinical research.
Aims. To explore the impact of the COVID-19 pandemic on clinical research, specifically across accredited medicine, nursing, and pharmacy
program providers in Australian and New Zealand universities.
Methods. An exploratory qualitative study was conducted with a purposive sample of participants, whereby representatives from all
providers of accredited medicine, nursing and pharmacy programs across Australian and New Zealand universities were invited to participate
in semi-structured interviews. An interview guide was developed based on the findings of a systematic review exploring guidance on the
conduct of clinical research during the COVID-19 pandemic. Interviews were transcribed verbatim and underwent inductive thematic content
analysis.
Results. Interviews were conducted between August-October 2021, with 16 participants from 17 program providers (n=4 medicine, n=7
nursing, n=6 pharmacy) across Australia and New Zealand. Major themes of (1) immediate and (2) broader research impact encapsulated six
subthemes regarding clinical research: (1.1) Essentiality of Research; (1.2) Modifications to Research; (1.3) Funding and Changes to Research
Focus; (2.1) Collaboration; (2.2) Research Workforce; (2.3) Differences in impact depending on context.
Discussion. The impact of the pandemic on clinical research conducted within medicine, nursing and pharmacy program providers at
Australian and New Zealand universities included consequences such as a decreased quality of research, lack of collaboration, basic disease
research neglect and a loss of the research workforce. However, positive impacts of the pandemic on research were also identified, including
increased accessibility to research through removed paywalls and a sense of solidarity within the scientific research community. Implications
of the experiences identified in these interviews should be considered, to enhance and ensure long-term sustainability of crucial clinical
research.
138
The effectiveness of computerised clinical decision support systems on deprescribing inappropriate
medications in older people: A systematic review protocol
Dr Leila Shafiee Hanjani1, Ms Aili Langford2, Prof Sarah Hilmer3, Dr Lisa Kouladjian O'Donnell3
1Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia, 2School of Pharmacy, The
University of Sydney, Sydney, Australia, 3Clinical Pharmacology and Ageing, Kolling Institute, Royal North Shore Hospital and the Faculty of
Medicine and Health, The University of Sydney, St Leonards, Australia
Introduction. Older people worldwide are increasingly exposed to inappropriate polypharmacy. Recent studies have investigated
implementing computerised clinical decision support systems (CCDSS) as part of an intervention in multiple settings, including pharmacist-
led medication review, to deprescribe inappropriate medications.
Aims. This systematic review of studies that investigate the effectiveness of CCDSS interventions in deprescribing inappropriate medications
in older people aims to understand the quality of evidence, effects on prescribing and clinical outcomes, and factors associated with
effectiveness.
Methods. A systematic search from inception to January 2022 will be conducted in PubMed, Embase, CINAHL, International Pharmaceutical
Abstracts, Cochrane Library, IEEE Xplore and Web of Science to identify relevant studies. Eligibility criteria includes studies of any design and
in any setting, that report the evaluation of a CCDSS intervention which aimed to facilitate deprescribing or medication review, or improve
appropriateness of prescribing for people aged 65 or more. Deprescribing will be defined as discontinuation and/or dose reduction of regular,
short term and as needed (PRN) medications. Any clinical outcomes and process markers reported by the studies will also be recorded.
Relevant tools will be used to assess quality and risk of bias of included studies, depending on the design of the study: the Cochrane
Collaboration’s Tool for assessing risk of bias in randomised trials for randomised controlled trials; the ROBINS-I (Risk Of Bias In Non-
randomised Studies - of Interventions) for nonrandomised controlled studies; the National Institutes of Health’s Quality Assessment Tool for
Before-After (Pre-Post) Studies With No Control Group for quasi-experimental before and after studies; and the Newcastle–Ottawa Scale
(NOS) for assessing observational studies.
Results. This review has currently identified 5802 records after removing duplicates, with 234 studies found to be suitable for full-text review
(as reviewed by three authors). Preliminary analyses have identified different variations of CCDSS implemented into multifaceted
interventions, and differing therapeutics targets.
Discussion. Further work will synthesise the available evidence around the potential role of CCDSS in deprescribing inappropriate medications
and improving prescribing and clinical outcomes.
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139
The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital
discharge (CATCH) tool: A national cross-sectional survey
Dr Mouna Sawan1, Prof Christine Bond2, Prof Y Jeon3, Prof Sarah Hilmer4, Prof Timothy Chen1, Assoc Prof Danijela Gnjidic1
1Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 2Institute of Applied Health Sciences,
Univ. of Aberdeen, Aberdeen, United Kingdom, 3Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney,
Camperdown, Australia, 4Clinical Pharmacology and Aged care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards,
Australia
Introduction. Medication management for people with dementia is often complex and a major contributing factor to adverse events after
discharge from the hospital. Carers play an important role in overseeing medication activities for the person with dementia, therefore there
is a need to understand the overall medication management guidance provided to carers at discharge.
Aims. To develop and distribute a tool to evaluate medication management guidance provided to carers of people with dementia at hospital
discharge.
Methods. The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital discharge (CATCH) tool was
developed using mixed methods conducted over two stages. Stage one was conducted using item generation and content validation involving
experts and consumers. Stage two involved pre-testing using cognitive interviews with carers of people with dementia. The CATCH tool will
be disseminated nationally. Briefly, a cross-sectional design will be adopted, using a survey comprising of the CATCH tool and open-end
questions. Electronic and hardcopy distribution of the survey will occur Australia wide through advertisement through organisations, such as
StepUP for Dementia Research and Dementia Australia. Inclusion criteria will be carers responsible for managing the medications of the
person with dementia, and the person living with dementia has had at least one discharge from the hospital to either their home or a
residential aged care facility.
Results. The CATCH tool consisted of 30 questions capturing information on all aspects of medication management guidance conveyed at
hospital discharge for carers of people with dementia. The preliminary findings from survey will be presented.
Discussion. The survey findings will identify targets for improvements and inform the design of interventions to improve the delivery of
medication management guidance at discharge and beyond.
140
Utilization of traditional healers and health-seeking behavior on low socio-economic status community
in Gunungkidul, Indonesia
Mr Ahmad Naufal1, Dr Anna Wahyuni Widayanti1, Dr Andayana Puspitasari Gani1
1Faculty of Pharmacy, Universitas Gadjah Mada, Sleman, Indonesia
Introduction. The availability of various types of treatment besides biomedical health services indicates that the community has its unique
health system constructed by socio-cultural conditions. Even though access to biomedical health services is easy through national health
coverage, low-income communities still choose traditional health services.
Aims. The study aims to explore the health system and health-seeking behavior of a low-income community in Gunungkidul and investigate
the factors influencing the community to use traditional health services.
Methods. This study used qualitative methods with a phenomenology approach. Semi-structured in-depth interviews were conducted on
seven residents, four traditional healers, and three community leaders in a poor community in Gunungkidul regency, Indonesia. Data analysis
was carried out through data reduction with thematic content analysis.
Results. The health system in the environment determines the community’s health-seeking behavior pattern. The health system is shaped
by geographic, demographic, economic, and socio-cultural conditions. Individuals with their profiles will interpret health and illness based
on the health system they believe. Factors that encourage individuals with low socio-economic profiles to choose traditional health services
include accessibility, cost, perceived effectiveness, service quality, influence of others, socio-cultural and religious reasoning.
Discussion. Utilization of traditional health services in people with low socio-economic status is an effort to try all healing methods to achieve
health amid financial limitations. Policymakers need to be aware of increasing the accessibility of biomedical healthcare facilities and
increasing collaboration with traditional health services. In contrast, health professionals need to be understood that the community has its
health system, and there are obstacles for people from low socio-economic status communities to seek treatment
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141
Community pharmacists’ acceptability of screening for depression among older adults: A qualitative
study
Miss Duha Gide1, Dr Sarira El-Den1, Yee Lam Elim Lee1, Dr Natasa Gisev2, Kevin Ou3, Dr Claire O'Reilly1
1Sydney Pharmacy School, The University of Sydney, Sydney, Australia, 2National Drug and Alcohol Research Centre, The University of New
South Wales, Sydney, Australia, 3Pharmaceutical Society of Australia, Sydney, Australia
Introduction. Approximately 10%-15% of older adults (≥65 years) experience late-life depression (LLD). LLD is often diagnosed late, impacting
the quality of life of older adults with depression. Pharmacists are well-placed to recognise consumers potentially at risk of LLD, thereby
supporting the timely identification and treatment of LLD.
Aim. To explore community pharmacists’ acceptability of pharmacist-led depression screening for older adults.
Methods. Pharmacists were recruited through promotional emails from the Pharmaceutical Society of Australia (national professional
pharmacists’ organisation) and social media platforms. An interview guide was developed to gauge pharmacists’ perspectives on the early
intervention of depression. Semi-structured interviews explored pharmacists’ attitudes towards potential roles in providing depression
screening services, previous experience using depression screening tools, and knowledge and awareness of recommended guidelines.
Inductive analysis was used to identify common themes, which were then divided into subthemes. Each subtheme was catergorised as either
a barrier or facilitator and mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model, which suggests that behaviour
change is influenced by these three factors.
Results. Fifteen pharmacists were interviewed, 12 of which were female and 11 of which practiced in a metropolitan area. Four key themes
were identified, including Training Needs, Environmental Factors, Pharmacists’ Roles, and Organisational Support, which were further divided
into 16 subthemes. Five subthemes were mapped to Capability, eight to Opportunity and three to Motivation. Barriers included lack of time
and privacy, and lack of remuneration, while facilitators included training, pharmacists’ accessibility, and rapport with consumers.
Discussion. The findings of this study may facilitate the development of pharmacist-led depression screening services and may ultimately
increase the early identification and treatment of LLD. However, appropriate referral and remuneration pathways are needed. Future studies
may explore the development of standardised guidelines and a funding scheme to provide remuneration for pharmacists delivering screening
services.
142
Using cluster analysis to describe burnout characteristics of pharmacists during COVID-19
Ms Karlee Johnston1
1Australian National University, Canberra, Australia
Introduction. COVID-19 has seen pharmacists reporting a high level of burnout and
work-related stress. Cluster analysis is a statistical method used to determine the
interaction of variables on a particular outcome.
Aims. To use cluster analysis to determine which variables are associated with burnout
in pharmacists, and describe various profiles to better understand pharmacists at risk of
burnout.
Methods. An online survey was sent to Australian pharmacists in 2020 measuring
burnout and possible related factors. A two-step cluster analysis was performed on the
results.
Results. A total of 647 responses were analysed using cluster analysis that resulted in
the formation of two distinct clusters, with 10 distinct variables being important
predictors of the cluster formation (Figure 1). The first cluster- ‘The affected pharmacist’
represented a community pharmacist with high burnout scores, experiencing incivility
and rudeness, increased workload and working overtime. The second cluster ‘The
business-as-usual pharmacist’ represented a profile of a hospital pharmacist without an
increase in workload, not experiencing incivility, and reporting sufficient precautionary
measures in their workplace.
Discussion. The distinct profiles of the affected community pharmacists who were busy, burnout and uncertain and the less affected,
business-as-usual hospital pharmacists that have been discovered through the use of cluster analysis are a reflection of the lived-experience
of the pharmacist community working through COVID-19. Whilst there are other ways to report the factors associated with burnout in
pharmacists, no other forms of multivariate analysis have the advantage of considering the whole person experience rather than just the
numbers. These profiles help to illustrate the factors that have affected pharmacists and their burnout during COVID-19 and will help
pharmacists who might identify with one or another of the profiles to consider their own experience and risk profile.
Figure 1: Variables by predictor importance
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143
Bridging the gap between physical and mental illness in community pharmacy (PharMIbridge):
Implementation of a cluster-RCT during the COVID-19 pandemic
Jie Hu3, Ricki Ng1, Dr Claire O'Reilly1, Helena Roennfeldt3, 5, Victoria Stewart2, 3, Sarira El-Den1, Dr Sara McMillan2, 3, Jack Collins1, Amanda
Wheeler3, 4
1The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 2School of
Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia, 3Menzies Health Institute Queensland, Griffith University, Brisbane,
Australia, 4Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 5Centre for Psychiatric Nursing, University
of Melbourne, Australia
Introduction. Physical comorbidities contribute to the significant life expectancy gap between consumers living with severe and persistent
mental illness (SPMI) and the general population. As medications are a major treatment modality for many mental and physical illnesses,
pharmacists are well-positioned to provide mental and physical healthcare services.
Aims. To describe the implementation of a Cluster Randomised Controlled Trial (C-RCT) testing the effectiveness of an individualised,
pharmacist-led support service for people living with SPMI focusing on medication adherence and the management of physical comorbidities
(PharMIbridge), compared to usual care (medication management service; MedsCheck).
Methods. Community pharmacies in four Australian regions were randomised to the PharMIbridge Intervention Group (IG) or Comparator
Group (CG). Participating pharmacy staff received Blended-Mental Health First Aid training. While IG pharmacists received training on
adherence, goal setting, motivational interviewing, managing physical health concerns and complex issues relating to psychotropic
medication, CG pharmacists received no additional training. IG pharmacies were supported by consumer and pharmacist mentors. The
COVID-19 pandemic necessitated various adaptations to be able to continue the C-RCT implementation.
Results. Fifty-nine community pharmacies were randomised to IG (n=28) or CG (n=31), across four trial regions. Consumer participant
recruitment and service delivery ran from September 2020-December 2021. In total, 169 (IG) and 163 (CG) consumers completed baseline
data collection. COVID-19 impacts included changes to trial regions, switching to online training for mentors, filming of expert trainers
remotely, the inability to conduct site visits supporting implementation, and delays in data collection.
Discussion. The COVID-19 pandemic presented significant challenges to implementing the PharMIbridge C-RCT. However, by being flexible
and adapting as required, the research team and partners were able to implement the C-RCT in line with the study protocol.1 PharMIbridge
pharmacists were able to provide crucial support to people living with SPMI during the challenging COVID-19 pandemic.
Funding/Registration. This activity received grant funding from the Australian Government Department of Health. Registration:
ACTRN12620000577910.
1. *Wheeler AJ, *O'Reilly CL, El-Den S, Byrnes J, Ware RS, McMillan SS. Bridging the gap between physical and mental illness in community
pharmacy (PharMIbridge): protocol for an Australian cluster randomised controlled trial. BMJ Open. 2020;10(7):e039983. *joint first
authors.
144
Australian pharmacist’s anti-doping knowledge and skills in assisting athletes avoid unintentional
ingestion of prohibited substances
Miss Deborah Greenbaum1, Assoc Prof Betty Chaar1, Prof Andrew McLachlan1, Dr Rebecca Roubin1, Assoc Prof Rebekah Moles1
1The University of Sydney, Camperdown, Australia
Introduction. The World Antidoping Agency (WADA) prohibited list places strict limitations on which medicines (and substances) an athlete
may consume in and out of competition in an effort to control doping/cheating and for athlete safety reasons. Yet, breaches of the WADA
code still occur. The International Pharmacy Federation in 2014 declared that pharmacists have an important role in assisting athletes.
Surveys of pharmacists have indicated varying levels of knowledge as well as recognition of pharmacists’ responsibility in assisting athletes’
informed decision-making.
Aim. To examine the knowledge and skills of Australian pharmacists about counselling and advice-giving in relation to the use of prohibited
medications in sport.
Method. Using a pseudo-patient study design the researcher/athlete contacted 100 pharmacies by telephone requesting advice about taking
salbutamol inhaler (WADA prohibited, with conditional requirements) for exercise-induced asthma, following a set interview protocol.
Results. Findings indicated majority of pharmacists had limited knowledge of whether a substance was prohibited for use by elite athletes.
Less than 25% of the pharmacists were able to provide comprehensive anti-doping advice to the athlete, with another 46% providing only
minimal advice. 47% referred the caller to a suitable resource to seek antidoping information. Significantly, 32% of pharmacists not only gave
incorrect or no anti-doping advice, but also could not identify credible sources of antidoping information.
Discussion. Pharmacists, by training, can play a role in providing accurate medication-related information to athletes which can assist in
avoiding unintentional ingestion of prohibited substances. There appears to be however, a knowledge gap preventing pharmacists from
undertaking this new scope of practice. Specific inclusion of sport pharmacy in education and national standards of professional practice will
ensure ongoing competence. Formally expanding scope of practice to incorporate sport-based pharmacy advice will clarify willingness and
ability to engage in this relatively new and important healthcare service by pharmacists.
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Chicago hub short oral presentations
200
Māori and medicines adherence – Indigenous voices and the pharmacists’ role in achieving medicines
access equity in Aotearoa New Zealand
Dr Joanna Hikaka1, Ms Nora Parore1, Mr Robert Haua1, Ms Mariana Hudson1, Mr Kevin Pewhairangi1, Dr Anneka Anderson2, Dr Rachel
Brown2, Mr Brendon McIntosh1
1Ngā Kaitiaki o Te Puna Rongoā o Aotearoa - The Māori Pharmacists' Association, Taupō, New Zealand, 2The National Hauora Coalition,
Auckland, New Zealand
Introduction. Māori experience inequities in medicines access compared to non-Māori. Little evidence exists regarding Māori and medicines
adherence. Pharmacist effectiveness in improving medicines adherence is known1 yet pharmacists’ role in adherence support and achieving
medicines access equity for Māori is understudied.
Aims. To explore Māori experiences of medicine adherence and non-adherence, and pharmacists’ role in supporting adherence.
Methods. Eligible participants (Māori, 18 years plus, accessed medicines from pharmacy in last three years) took part in online or in-person
focus groups (included short presentation, facilitated discussion, questionnaire). Participants could contribute in English and Māori. Data was
thematically analysed using a general inductive approach, informed by kaupapa Māori theory2 and situated in social, cultural, political and
historical Māori contexts.
Results. Sixty-two participants (71% female, median age range 35-44, median number medicines=2.0) took part in 13 focus groups
(September 2021-February 2022). Four themes were identified: Māori wellbeing - medicines as a component of holistic wellbeing;
whanaungatanga (relationships); knowledge; and whānau (family and support network) advocacy and problem solving.
Discussion. Improving medicines adherence improves clinical outcomes and this study privileged Māori voices to better understand
adherence, and pharmacists’ role in supporting Māori to experience the best possible medicine-related outcomes. Adherence is particularly
relevant for Māori who experience inequities in access to quality health care across the spectrum of clinical contexts, and are likely to
experience earlier onset of chronic co-morbidity than non-Māori. Pharmacists can support medicines adherence by developing authentic
and caring relationships, providing good quality information, and supporting Māori to exercise autonomy through informed decision-making
regarding medicine treatment.
1. Milosavljevic A, Aspden T, Harrison J. The impact of a New Zealand community pharmacy service on patients’ medication adherence
and ambulatory sensitive hospitalizations. Res Soc Adm Pharm. 2020;16(7):904–13.
2. Smith LT. Decolonising methodologies: Research and indigenous peoples. 2nd ed. London: Zed Books; 2012.
201
Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to
administer injections in Ontario Canada
Dr Nancy Waite1, Dr Sherilyn Houle1, Mr Patrick Timony2, Dr Alain Gauthier2
1School of Pharmacy University of Waterloo, Waterloo, Canada, 2Centre for Rural and Northern Health Research (CRaNHR), Laurentian
University, Sudbury, Canada
Introduction. Allowing pharmacists to immunize has been associated with improved vaccination rates; however, little is known whether
areas with little to no access to this service (‘vaccination deserts’) exist.
Aims. To determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario, Canada.
Methods. Ontario College of Pharmacists’ registry data was used to identify patient care-providing pharmacists in community pharmacies
who had completed injection certification. Number of hours worked were converted into full-time equivalents (FTEs). Practice site(s) were
mapped by postal code and presented by Public Health Unit (PHU) area. Communities were further categorized as urban or rural, and
northern or southern, with ratios of FTEs/1000 population calculated for both injection-trained and non-injection-trained pharmacists.
Results. 74.6% of Ontario’s practicing community pharmacist are authorized to provide injections. Northern PHUs had slightly better access
to immunization pharmacists (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41
FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist
immunizers, while PHUs with greater land area were more likely to not have any immunization pharmacists present (p<0.05).
Discussion. As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-
based immunization and collaboration with public health and primary care providers to address these geographic vaccination deserts will be
required to ensure equitable access.
1. Houle SKD, Timony P, Waite NM, Gauthier A. Identifying vaccination deserts: The availability and distribution of pharmacists with
authorization to administer injections in Ontario. Can Pharm J (accepted)
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202
Community pharmacy provision in England during COVID-19: learning for future pandemic
preparedness
Miss Harriet Warr1, Mr Syed Hussain1, Mr Ankesh Gandhi1, Dr Daniel Greenwood
1School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
Introduction. The COVID-19 pandemic placed increased pressure on community pharmacy in England e.g. a 22% increase in dispensing
volume in March 2020 (1), and changed the scope of services with the emergence of new services such COVID-19 test distribution, vaccination
and extensive medicines delivery (2). These changes should be explored to learn how pharmacy could and should respond to any future
pandemic.
Aims. To explore community pharmacy service provision in England during the COVID-19 pandemic for future pandemic preparedness
Methods. Telephone interviews with 9 pharmacists (including 4 managers and 2 owners), 1 dispenser and 9 patients between April and
September 2021, from a mixture of rural, semi-rural or city settlements. Interview schedules (for providers/patients) were informed by
literature and piloted. Transcripts were analysed thematically. Results. Providers (pharmacists and dispenser) and patients contributed 8 and
6 themes respectively. Some examples, providers described changes in prescribing habits e.g. patients being given several inhalers for the
first time in years, with such changes considered a cause of medicines shortages. Although providers felt more trusted by General Practice
[GP] and vice versa, double standards were suggested: “we were being asked to take patient’s blood pressure... why couldn’t the surgery
[GP]?”. Patients also described service double standards “you couldn’t see a doctor, but you could see a nurse to have a blood test”. Regarding
medicines use, the only change described by patients was self-monitoring blood pressure at home and informing GP of readings.
Discussion. Differences in how different professionals provided care should be further explored to ensure an effective and equitable service
delivery in any future pandemic. To support appropriate medicines use and supply chains, protocols should be developed to guide pharmacy
services and healthcare more broadly.
1. The Pharmaceutical Journal. Items dispensed from electronic prescriptions increase by 22% in March 2020.
[Internet]. London: The Pharmaceutical Journal; [updated 2022 Jun 02; cited 2022 Mar 21]. Available from: https://pharmaceutical-
journal.com/article/news/items-dispensed-from-electronic-prescriptions-increase-by-22-in-march-
2020#:~:text=By%20Carolyn%20Wickware&text=Of%20the%20items%20dispensed%20in,the%20EPS%20in%20February%202020.
2. Maidment I, Young E, MacPhee M, et al Rapid realist review of the role of community pharmacy in the public health response to COVID-
19 BMJ Open 2021;11:e050043. doi: 10.1136/bmjopen-2021-050043.
203
African-born persons living with HIV in Minnesota at the intersection of culture and US healthcare
system
Assist Prof Alina Cernasev1, Dr William Larson2, Assoc Prof Cynthia Peden-McAlpine3, Prof Paul Ranelli4, Assoc Prof Olihe Okoro4, Prof Jon
Schommer4
1The University of Tennessee Health Science Center, Nashville, United States of America, 2Allina Health Uptown Clinic, Minneapolis, United
States of America, 3University of Minnesota, School of Nursing, Minneapolis, United States of America, 4University of Minnesota, College of
Pharmacy, United States of America
Introduction. African-born people have been disproportionately affected by HIV/AIDS in Minnesota. Previous studies have demonstrated
pharmacist's roles in adherence to the Antiretroviral (ART) regimen. Little is known about pharmacist’s role in adherence and non-
pharmacological interventions of African-born persons living with HIV[PLWH] when interacting with the U.S. healthcare system.
Aims. To uncover the experiences of African-born PLWH who receive ART medications and their interactions with the U.S. healthcare system.
Methods. Narrative Interviews were used as a qualitative approach for this study. Conceptual frameworks were used in designing the
interview guide. Recruitment via fliers for in-person interviews with African-born PLWH in Minnesota continued until saturation was
achieved. Conventional content analysis was used to analyse the data. Dedoose, a qualitative software program facilitated the data analysis.
Codes were inductively derived, and similar codes were grouped into categories.
Results. Fourteen participants were from seven different African countries. Eight of the participants were diagnosed and started treatment
for HIV in the U.S., while the remaining did so in their country of origin. The findings revealed two major themes.
Theme 1: Lessons from interacting with the U.S. healthcare system. Participants are still learning how to use the US healthcare system. They
rely mostly on physicians for medical advice. Participants seemed unaware of the pharmacist role in their medication management.
Theme 2: Diagnosis secrecy. Participants faced the dilemma of revealing their secret to their loved ones and friends. The fear of disclosing
the secret with the healthcare professionals, including pharmacists, was expressed by the participants.
Discussion. Participants seemed willing to better understand and use the healthcare system for their own benefits. Participants are not using
the pharmacists as a key resource for medication information and might not seek pharmacist’s advice on ART or non-pharmacological
options. Pharmacists could use this opportunity to engage this population to maximize outcomes.
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204
Predicting confidence to manage symptoms and seek medical care in patients taking oral oncolytic
therapy
Dr Amna Rizvi-Toner1, Emily Mackler1, 2, Kelly Procailo1, 2, Vincent Marshall1, Karen Farris1, 2
1University of Michigan College of Pharmacy, United States, 2Michigan Oncology Quality Consortium, Ann Arbor, United States
Introduction. Oral oncolytics have transformed cancer care by allowing patients to self-administer cancer treatments. Although convenient,
these drugs cause side effects that require frequent monitoring. Importantly, patients must now recognize and assess their symptom severity
and comprehend and use symptom management strategies.
Aims. To assess the relationship between symptom severity and patients’ confidence to manage their most bothersome symptom and
patients’ confidence to seek medical care for any symptom.
Methods. The Michigan Oncology Quality Consortium (MOQC) created a 19-item patient reported outcome measure (PROM) survey to assess
symptom severity, confidence to manage symptoms, and adherence to therapy. Symptoms are rated from 0 (none) to 10 (worst possible),
and confidence is rated from 0 (not confident) to 10 (confident). MOQC-PROM surveys were completed across multiple sites in Michigan
from July 2016 to December 2018 by adult patients taking an oral oncolytic. Patients’ first completed PROM was analysed (n=653) using
simple linear regression.
Results. Patients that reported experiencing more severe symptoms of tiredness, shortness of breath, lack of appetite, tingling/numbness,
constipation, pain, drowsiness, depression, anxiety, nausea, and overall well-being had statistically significantly lower confidence to manage
their most bothersome symptom (p<0.05). The largest effect sizes were observed for depression (b1=-0.39) and anxiety (b1=-0.36); for each
one-point increase in depression symptom severity, confidence score decreases by 0.39. Confidence to seek medical care for any symptom
was significantly lower (p<0.05) in patients rating symptoms of pain, depression, anxiety, and mouth sores as more severe, and the largest
effect size was observed for mouth sores (b1=-0.27).
Discussion. A better understanding of symptoms that predict confidence to manage symptoms will allow clinicians to identify patients that
require more education and/or support during cancer treatment. Future research should explore ways to enhance confidence and how to
use a confidence measure in clinical settings to provide optimal treatment.
205
Pharmacists' views of their roles: Results from a national survey
Dr Marcia M Worley1, Dr Anandi Law2, Dr Eunhee Kim2, Dr Amanda Mercadante2, Ms Jammie Luong2
1The Ohio State University, Columbus, United States, 2Western University of Health Sciences, Pomona, United States
Introduction. Pharmacists’ roles have advanced but it remains to be seen if pharmacists’ perceptions of their roles have evolved alongside
these expanded opportunities.
Aim. Examine pharmacist role perceptions in the medication use process (MUP).
Methods. Cross-sectional survey design with a Qualtrics online pharmacist panel. A 15-item survey was developed using a role theory
framework to explore pharmacist role perceptions in the 5-step MUP: prescribing, transcribing, dispensing, administering, and monitoring,
and in direct patient care services and interprofessional collaboration. Data collected included pharmacist characteristics and perceptions
regarding effectiveness of and best choice for improving the MUP step (Likert-type responses) and open-ended questions explaining
rationale for responses. Descriptive and content analysis were performed.
Results. A panel of 205 pharmacists, representative of practicing U.S. pharmacists in terms of age, gender, and ethnicity, completed the
survey during October-November 2021. Half the sample (42.9-59.5%) believed that prescriptions are written error-free, patients use their
medications as directed most of the time and are monitored and followed-up as needed. Pharmacists believed that patients first connect
with them about health-related problems, and can best help patients with counselling, taking medications as directed, and medication-
related monitoring. Pharmacists selected staffing, working conditions/environment, and time to be the best choices to reduce medication
dispensing errors; open-ended comments additionally showed themes such as pharmacist burnout, competing demands, technology, and
insurance. Almost all respondents (97.7%) agreed that pharmacist-physician collaboration is important to improve patient care/outcomes;
pharmacists believed that lack of time and appropriate setup, as well as interprofessional communication challenges were barriers to
collaboration.
Discussion. Pharmacists believe their roles have evolved to align with changes in expanded opportunities. This study is part of a larger
project that examined physician and patient perceptions of pharmacist’s roles. Clarity in role expectations amongst these stakeholders is
critical to optimizing the pharmacist’s role on the healthcare team.
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206
Patient contributions to a multi-state virtual stakeholder engagement advisory group for PatientToc™
Ms Betty Chewning
1University of Wisconsin School of Pharmacy, Madison, United States
Introduction. Mixed stakeholder engagement has enriched research projects by including advice from both patients and providers. The
question is whether similar processes used for face-to-face interaction might be applicable for virtual stakeholder meetings, particularly
when mixed groups are composed of distant patients and providers. The PatientToc™ study provides a case study.
Aim. To describe the process and outcomes of a virtual advisory group composed of patients, pharmacists and pharmacy techs from three
states.
Methods. The process for the PatientTocTM virtual advisory meeting was informed by a toolkit1 designed to facilitate effective participation
of patient and provider advisors. Similar to in-person mixed groups, the PatientTocTM advisors began each meeting together in the same
virtual room. The PI (MS) shared her screen and offered an overview of the project’s status, progress, and meeting goals. Importantly, in
subsequent meetings she explained how the advisory group’s advice had been used by the project. After this orientation to promote open
discussion, patients and pharmacy staff were separated into two different virtual rooms along with at least one facilitator per room. Ground
rules for confidentiality, respectful listening, and sharing were adopted by each group. Facilitators posed questions designed to inform
PatientToc’s design and implementation. Questions with any IRB implications were excluded. After each group finished discussing questions,
they came back together in one room to summarize their recommendations.
Results. Patients offered useful advice about PatientToc’s pamphlets, items and instructions. For example, they wanted PatientToc to
facilitate discussing their health condition with a pharmacist, not just a single medication. Participants said they could use PatientToc online
at home, in a car, during a medication home delivery, or at a pharmacy.
Discussion. The same principles in the earlier toolkit for in-person mixed advisory groups worked well with the virtual groups across states.
They may have potential across countries.
1. Chewning B, Cox ED, Jacobsohn G. Sustaining Engagement of Blended Stakeholder Boards Across the Research Trajectory Toolkit.
Madison, WI: University of Wisconsin School of Medicine and Public Health’s Department of Pediatrics, Health Innovation Program;
October 2016. Available at: https://hipxchange.org/Sustaining Engagement.
207
Overcoming defensive responding in the estimation of prescription stimulant misuse
Dr Sujith Ramachandran1, Dr John Bentley1
1University of Mississippi School of Pharmacy, University, United States
Introduction. Extant literature indicates that the prevalence of non-medical use of prescription stimulants (NMUPS) has been increasing
among young-adult college students. Previous estimates of NMUPS may be biased due to reluctance to disclose sensitive and potentially
illegal behavior in self-report format. The crosswise randomized response technique (CRRT) helps estimate the true prevalence for sensitive
behaviors such as NMUPS by providing respondents increased anonymity.
Aims. (1) Estimate the prevalence of NMUPS in the college student population using the CRRT; and (2) estimate the difference in prevalence
of NMUPS measured using CRRT and direct self-report (DSR).
Methods. This study employed a cross-sectional, randomized experimental design conducted among undergraduate students using Qualtrics.
Eligible respondents randomized to the CRRT group were presented a non-sensitive question along with the NMUPS question and had to
indicate whether their responses were ‘same’ or ‘different’ to both questions. In the DSR group, the non-sensitive question, ‘being born in
the first 10 days of the birth month’, was asked directly along with a direct self-report question for NMUPS. Respondents were also asked a
series of questions that assess demographic and other characteristics that are expected to be risk factors for NMUPS. All respondents were
given a $5 gift card in return for their participation.
Results. Of the 1,326 respondents who completed the survey, 16.9% individuals self-reported having ADHD, 47.9% were underclassmen,
52.1% upperclassmen, along with 66.6% females and 78.1% White. The prevalence of NMUPS in the DSR group was 18.6%, while prevalence
in the CRRT group was 32.5% (estimated using an established algorithm). Difference between the two rates was found to be statistically
significant (p = 0.003).
Discussion. This study represents a significant advancement for prevalence estimation of sensitive behaviors such as NMUPS. Further
research is needed to evaluate prevalence in larger samples and to identify drivers of NMUPS.
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208
Usability testing of PatientToc™, an electronic patient reported outcomes tool: lessons learned
Mrs Bonyan Qudah1, Prof Betty Chewning, Ms Apoorva Reddy, Mrs Dale Wilson
1University of Wisconsin Madison, Madison, United States
Introduction. PatientToc™ is a tablet-based application that captures patients’ reported outcomes in community pharmacies. Patients
review their medication profile embedded in PatientToc, update it when necessary. and report medication adherence and concerns. Being
developed for older adults, special attention was made to be user friendly and time sensitive.
Aim. To ensure the acceptability and feasibility of PatientToc™ before beta testing in pharmacies, a lab-based usability study was
conducted with standardized patients at The School of Pharmacy at the University of Wisconsin-Madison.
Methods. To explore patients’ experiences using the app, a coding protocol was developed guided by the Framework for Usability and User
Experience. Usability sessions were conducted individually with 6 older standardized patients. Patients followed a scenario they were given
earlier and did a “think aloud” process while proceeding through PatientToc™. An instructor took notes using the coding protocol and
asked questions as patients viewed screens. The usability session was videorecorded for later analysis. After completing PatientToc™,
patients were debriefed for in-depth information. Rapid qualitative analysis was conducted based on the usability testing notes and patient
debriefs.
Results. Patients had positive views about PatientToc™. They perceived it as feasible and useful. Although each usability session lasted
around 45 minutes, patients reported they didn’t feel it was time intensive. Several issues were identified to improve user experience and
data quality which include visual clutter, inconsistency of alignment of questions and font size, inappropriate answer space for date of
birth, difficulty navigating droplists, and identifying questions with multiple answers. Skipping free-standing instructions and reluctance to
answer sensitive questions were also observed.
Discussion. The visual presentation of questionnaires administered through PatientToc™ is important as it can impact peoples’
engagement and quality of information they provide. Patients’ feedback was utilized to refine the visual design of PatientToc™ before its
launch to pharmacies.
209
The identification and management of drug-related problems in the emergency department: a narrative
review
Miss Tanisha Patel1, Dr Penny Lewis2, Dr Douglas Steinke2, Dr Daniel Greenwood1,2
1Anglia Ruskin University, Chelmsford, United Kingdom, 2University of Manchester, Manchester, United Kingdom
Introduction. Drug-related problems (DRPs) “actually or potentially interfere with desired health outcomes” (1) and include adverse drug
reactions and medication errors. Up to 28% of ED visits are due to DRPs (2), with up to 87.7% considered preventable (3). In the UK, the cost
of drug-related hospital admissions is an estimated £466million per annum. Despite their impact on health outcomes and substantial cost,
to date there has been no review of how DRPs are identified and managed in ED.
Aims. To investigate how DRPs are identified and managed in ED. Methods. Eight databases e.g. PubMed were systematically searched for
global literature about the identification and management of DRPs in ED. From abstract screening, 406/9,102 search results were potentially
relevant and 112 met the inclusion criteria e.g. concerned ED DRPs. Results. Only one tested intervention was found, where a pharmacist
reviewed 59 patients with heart failure/COPD in ED and identified and supported management of 82 potential DRPs. Negative outcomes due
to DRPs e.g. poor BP control, were significantly reduced per patient (0.95 versus 1.44; p=0.01). Other literature described opportunities to
identify and manage DRPs but were untested e.g. pharmacists advising clinicians on drug therapy and counselling patients, or education
interventions for clinicians. Challenges to DRP identification were also described, including how the clinical effect of DRPs is often non-specific
e.g. diarrhoea, and so can be mistaken for a symptom of disease.
Discussion. DRPs cause nearly a fifth of ED visits, yet only one specific intervention for their identification and management in ED has been
tested. Although in a limited patient cohort, an ED pharmacist did reduce negative outcomes of DRPs compared with routine practice (no ED
pharmacist). Further interventions should be developed and tested to identify and manage DRPs in ED, with the aim of improving health
outcomes and reducing costs.
1. Pharmaceutical Care Network Europe (PCNE). PCNE Working group on drug-related problems [Internet] 2020 [cited 2021 Apr 10].
Available from: https://www.pcne.org/working-groups/2/drug-related-problems.
2. Al-Arifi M, Abu-Hashem H, Al-Meziny M et al. Emergency department visits and admissions due to drug related problems at Riyadh
military hospital (RMH), Saudi Arabia. Saudi Pharmaceutical Journal. 2014;22(1):17-25.
3. Calvo-Salazar R, David M, Zapata-Mesa et al. Drug-related problems causing hospital admissions in the emergency rooms at of high
complexity hospital. Farmacia Hospitalaria. 2018;42(6):228–33.
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210
Medication use and self-management behavior in Muslim patients diagnosed with Type 2 Diabetes
Mellitus (work in progress)
Dr Asma Ali1, Dr Betty Chewning1
1UW-Madison, Madison, United States
Introduction. The Muslim population in the US constitutes 2.15 million adults. This group needs attention from researchers and medical
providers due to healthcare disparities and the lack of knowledge about factors that influence their health behavior. Diabetes mellitus (DM)
disproportionately affects people from minority and underserved populations.
Aims. 1. To establish stakeholder informed research with the Muslim community using a community-engaged research process. 2. To conduct
a qualitative study to explore factors related to type 2 diabetes (T2D) self-management behavior and medication use.
Methods. For the stakeholder engagement approach, we will conduct longitudinal, blended advisory group discussions with patients
diagnosed with T2D, clinicians, pharmacists, and refugees case coordinators. We will conduct 3 stakeholder meetings over one year, each
meeting will last for 90 minutes. To explore factors in the second aim, we will apply the social cognitive theory (SCT) to diabetes self-
management behaviors in Muslim patients including religious and sociocultural factors. We will conduct semi-structured one-on-one
interviews with 30 Muslim male and female patients diagnosed with T2D. Participants will be > 18 years, diagnosed with T2D for at least 6
months and use oral medications and/or insulin for diabetes treatment. We will use maximum variation sampling to recruit people who
speak different languages from diverse racial/ethnic backgrounds to capture the heterogeneity in this community. We will recruit 5
participants who speak Arabic, Rohingya, Pashto, English, Somali, or Urdu languages. Two trained researchers will independently conduct
directed content analysis to analyze the transcripts using NVivo software. The directed approach to content analysis will enable us to use SCT
to guide our analysis and to extend beyond this theoretical framework to include other possible factors that may arise.
Discussion. This is the first step in a stream of research to develop health interventions that foster behavioral changes to improve diabetes
management in this patient population.
211
An ethnographic exploration of the medicine use of community dwelling older adults with sensory
impairment in Scotland
Dr Peter Fuzesi, Dr Kirsten Broadfoot, Dr Marilyn Lennon, Dr Sabrina Anne Jacob, Dr Leah Macaden, Prof Annetta Smith, Dr Tomas Welsh,
Prof Margaret Watson
1University of Strathclyde, Glasgow, United Kingdom, 2Department of Nursing and Midwifery - University of the Highlands and Islands,
Inverness, United Kingdom, 3The RICE Centre, Royal United Hospital/University of Bath, Bath, United Kingdom
Introduction. The prevalence of sensory impairment (visual and/or hearing) increases with age. Older people with sensory impairment
(OPwSI) are at increased risk of suboptimal therapeutic benefits and medicine use-related harm.
Aims. To explore the challenges OPwSI experience and the strategies they employ to manage their medicines.
Methods. An ethnographic approach was developed to explore OPwSI’s medicine use practices. Due to COVID19 restrictions, participants
collected data about their own medicine management, using a range of media including videos, photographs, voice recordings and diary
notes. In addition, they participated in remote semi-structured interviews with a researcher to provide greater depth of information and to
facilitate data interpretation and analysis. Data were coded using comparative analysis to generate themes and sub-themes.
Results. In total, 13 individuals participated: visual impairment (4), hearing impairment (4), dual impairment (5); mean age: 75 years (range
65-89); and nine females. Participants used an average of 11 (range 5–22) medicines. Participants developed elaborate, individualised
strategies, customised to their home environment and personal medicine regimens. These involved bespoke storage systems, fixed routines
of medicine administration and other strategies. Whilst the use of high-tech assistive technologies was limited, many participants deployed
low tech tools e.g. medicine boxes, pill cutters and repurposed containers to facilitate medicine management. Despite familiarity with their
medicines and having developed personalised strategies, daily medicine use involved dealing with many uncertainties and ambiguities. None
of the participants reported substantial involvement with, or input from, their community pharmacists or other healthcare professionals.
Discussion. OPwSI are diverse in their abilities, skills and preferences and require different tools for their medicine management. It is
important that pharmacy personnel and other health and social care providers work in partnership with OPwSI and enable them to manage
their medicines, by offering accessible services, technological aids and addressing individual needs.
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Basel hub short oral presentations
300
Development and evaluation of an e-learning curriculum on drug-related problems for community
pharmacists
Dr Marina Weissenborn1, Viktoria S. Wurmbach1,2, Janina A. Bittmann1,2, Robert Moecker1,2, Dr Anette Lampert1,2, Emilia Maria Boček
Eknes1,2, Katharina Wien1,2, Patrick Schaefer3, Prof Walter E. Haefeli1,2, Prof Hanna M. Seidling1,2
1Heidelberg University Hospital, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany, 2Heidelberg University,
Cooperation Unit Clinical Pharmacy, Heidelberg, Germany, 3Chamber of Pharmacists Baden-Wuerttemberg, Stuttgart, Germany
Introduction. One in five patients in Germany experiences drug-related problems (DRPs) when receiving prescribed drugs, including drug
interactions or administration errors. Community pharmacists (CPs) are the last instance to verify home-dwelling patients’ ability to apply
their drugs correctly and they can prevent DRPs by providing solution-oriented counselling. Hence, continuous training on relevant DRPs is
essential.
Aims. To develop and evaluate a multicomponent e-learning curriculum for CPs to detect and prevent DRPs.
Methods. Relevant DRPs that occur frequently and can be prevented by CPs were identified via literature search and a Delphi-survey among
six healthcare professionals. For each selected DRP, an e-learning module was developed consisting of an educational video,
theoretical/practical exercises (e.g. documenting patient cases), and knowledge tests. After having pretested the first module, the curriculum
was piloted in 2018 including feedback for each module. A German Chamber of Pharmacists supported the project.
Results. A 10-module curriculum was developed addressing DRPs such as wrong eye drop administration or drug-food-interactions of
levodopa. Within 24h, 200 CPs registered, of whom 56% (n=112) successfully completed all modules. About one third (34%, n=60) dropped
out within the first module (one quarter even never accessed the homepage). Across all modules, participating CPs on average indicated to
highly appreciate the curriculum, i.e. 81% stated it is very well suited to quickly identify patients who might experience DRPs, 83% were able
to derive appropriate solutions for their patients, 87% felt more competent in patient counselling, and 81% could easily integrate the contents
into practice. About 95% of CPs would recommend participation to their colleagues, and almost all participants would continue to apply the
content learned in patient counselling.
Discussion. Due to positive feedback, the curriculum was established as an official training measure by the Chamber of Pharmacists.
Currently, analyses are conducted to determine how many DRPs were identified and resolved by CPs.
1. Nicolas A, Eickhoff C, Griese N, Schulz M. Drug-related problems in prescribed medicines in Germany at the time of dispensing. Int J Clin
Pharm 2013;35:476-82.
2. Lewinski D, Wind S, Belgardt C, Plate V, Behles C, Schweim HG. Prevalence and safety-relevance of drug-related problems in German
community pharmacies. Pharmacoepidemiol Drug Saf 2010;19:141-9
301
Community pharmacists' perception on the follow-up of frail patients using food supplements: new
avenues for multidisciplinary collaboration
Mrs Emilia Alves1, Mrs Patricia Tavares1, Dr João Gregório1
1CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal
Introduction. Malnutrition, a state resulting from the lack of uptake or intake of food/nutrients leading to impaired physical and mental
functions, affects particularly the elderly. Oral nutrition support, where the inclusion of oral nutritional supplements (ONS) for increase of
nutritional intake are included, has been shown to be an essential approach in early intervention for high-risk malnutrition.
Aims. This study aimed to characterize the experiences of community pharmacists, with the counselling and follow-up of patients using Oral
high protein and/or hypercaloric food supplements (FS).
Methods. A qualitative, observational, cross-sectional study was performed. To this end, an interview script was developed, and applied to
a convenience sample of community pharmacists obtained by the snowball sampling technique. As inclusion criteria, the pharmacists
contacted had to work in community pharmacy, in rural or urban settings, with a minimum of three years of professional experience. All
interviews were subject to audio recording for later transcription. The final sample was constituted by 19 pharmacists from 19 different
pharmacies.
Results. Three quarters of respondents stated that their pharmacy has Nutrition Consultations, provided by nutritionists. The counselling of
these FS occurred, in most cases, at least once a week. All respondents considered important to monitor the patient using FS. However, only
11% said they perform this monitoring proactively to assess the effectiveness of the FS. Barriers to the provision of follow-up, such as lack of
time and a lack of a tailored information system, were mentioned. When oncology patients seek FS, the majority of the interviewees
considered that they should immediately refer patients to a doctor, reflecting a feeling of insecurity in counselling these patients.
Discussion. The results of this study allow us to conclude that it is easier for the pharmacist to give advice on FS than to continue the follow-
up after that advice. Respondents believe that even if there were a consultation performed by a nutritionist, which may or may not be a
service provided by the pharmacy, it would be important to have a counselling consultation by pharmacists in order to facilitate and formalize
patient monitoring. New studies should focus on exploring the interaction between pharmacists and nutritionists, developing a set of
outcomes of interest to monitor these patients.
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302
Explorative research on health literacy and self-care behaviours among Malaysian type 2 diabetes
patients
Mrs Azrina Ely Ahmad Azhari1, Dr Jim Chai1, Prof Claire Anderson2
1University of Nottingham Malaysia, Semenyih, Malaysia, 2University of Nottingham, Nottingham, United Kingdom
Introduction. Type 2 diabetes (T2D) is a chronic metabolic condition which is associated with high blood sugar. In Malaysia, 1 in 5 adults are
diagnosed with diabetes. Limited health literacy among diabetes patients may result in poor self-care management and diabetes outcome.
Aims. This qualitative research explored the perception of pre-diabetes and newly diagnosed T2D patients (≤ 5 years) on disease knowledge
and management in empowering self-care behaviours to delay or prevent disease progression.
Methods. 18 T2D and 4 pre-diabetes patients were recruited through purposive sampling from online platforms and 2 public health clinics.
They were interviewed individually using semi-structured interview via Microsoft Teams or telephone call. All interviews were audio-
recorded, translated to English language and transcribed verbatim. The data obtained were coded and categorised into themes using reflexive
thematic analysis.
Results. Four major key themes were identified which are accessibility to reliable resources, mental health, self-awareness and overcoming
barriers to self-care.
Discussion. Most of the patients felt that having sufficient access to reliable information and services is important to ensure the information
gained is sufficient to practise self-care. Getting to see the same healthcare professionals (HCPs) is also important to stay consistent due to
the continuing care received. Being diagnosed with diabetes can affect a patient’s mental health due to the drastic changes that they need
to make, hence continuous support from family, peer and HCPs helps in empowering self-care behaviours. Patients who have a good
understanding about their diabetes, for example, the target blood glucose level to achieve, and fear of developing complications develop the
sense of self-awareness to practise self-care. Overcoming the barriers that patients faced to self-care for example, lack of support, difficulty
finding information and having the thought that self-care is hard also need to be addressed to improve their diabetes outcome.
1. Institute of Public Health Malaysia. (2019). Non-communicable Diseases Healthcare Demand. 21–22.
2. UCL Institute of Health Equity. (2015). Improving health literacy to reduce health inequalities. Public Health England.
303
Development of a new mHealth app for the monitoring of medication adherence
BSc Bettina Stalder1, Andreas Haenny1, Prof Samuel Allemann1, Dr Isabelle Arnet1
1University Of Basel, Switzerland
Introduction. With the democratization of smartphones and their permanent proximity to their users, mobile health (mHealth) applications
(app) allow new approaches to target medication use behaviour (adherence). In addition, an app can deliver appropriate adherence estimates
that could be shared with healthcare providers.
Aims. The aim is to develop an app with features rooted in literature that is not a medical device. The core elements should include the
recording of the medication intake, visualisation over time, calculation of appealing metrics and consumer-to-healthcare provider (C2B) data
export. Ultimately, data should be interpreted by pharmacists or other healthcare providers during an adherence consultation.
Methods. Google Play Store and Apple Store were searched for existing adherence apps. Their features were listed and compared.
Frameworks for app’s development and users’ experiences with apps were retrieved from literature through a pragmatic search on PubMed.
Results. Hundreds of apps exist already to support adherence in various diseases. The four key features include alerting (to take medicines);
tracking (medicine intakes); indicating (amount of medicine left)/reminding (to refill), and storing (medicine information). None allows data
export to healthcare providers in view of professional interpretation. According to Nebeker’s framework1, the key challenges in developing
an app are interoperability and integration; compliance and regulation; privacy and security, and usability, especially for elderly patients.
Patients’ experience highlight the need for visualizing the data in charts and a pragmatic execution of the tasks, among others. We have
developed a smartphone app whose central part is the current medication plan. The daily doses are grouped at predefined intake times.
Clicking an icon at the moment of the intake records a timestamp. Taking adherence and correct dosing days are calculated. Encrypted data
can be exported via email. Patient can modify all settings.
Discussion. We selected a robust development of our app to support its adoption by patients. The next step will be to evaluate the app with
polymedicated adult patients in primary care.
1. Nebeker C. Development of a decision-making checklist tool to support technology selection in digital health research. Transl Behav
Med 2020; 10(4): 1004-15.
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304
Development of quality indicators for community pharmacies; a qualitative study
Miss Ann Helen Jakobsen1, Dr Timothy Chen2, Dr Lars Småbrekke1, Dr Kjell Herman Halvorsen1
1Uit Arctic University of Norway, Tromsoe, Norway, 2The University of Sydney, Sydney, Australia
Introduction. New pharmacy services are constantly being designed and implemented in an increasing number of pharmacies in Norway.
Monitoring and evaluating these services is critical for continuous improvement. To measure quality and change in quality, different
stakeholders have developed quality indicators (QIs) for several areas in health care. However, in Norway, QIs are yet to be developed for
community and hospital pharmacies. Qualitative research is necessary to identify how different key stakeholders perceive good quality in
pharmacies and use this to create QIs.
Aims. To explore pharmacy professionals' and customers' experiences and perceptions about what constitutes good quality in community
pharmacies and potential means to measure this quality.
Methods. We applied a criterion-based sampling approach to recruit for five homogenous semi-structured focus groups. All interviews with
27 participants were conducted via Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive
approach was used. The study followed the Consolidated criteria for reporting qualitative research (COREQ) checklist.
Results. We identified four main themes from the analysis; good communication skills and relationships with the pharmacy professionals,
sufficient and substantively suitable information to cover individual needs, customer satisfaction with knowledgeable employees and
conveniently located pharmacies, and factors that affect the working environment the pharmacies. According to the informants, these
themes significantly impacted their perception of the quality of pharmacy services.
Discussion. This study has identified areas that pharmacy professionals and pharmacy customers consider as essential to define what
constitutes good quality in pharmacies. Several of these informants' perceptions can guide the development of QIs to be used in Norwegian
pharmacies.
305
Factorial survey methodology to inform pharmacy adherence interventions: comparison of two
international studies
Dr Paul Dillon1, Dr Elizabeth Unni2, Dr Jayoung Han3
1RCSI, Dublin, Ireland, 2Touro College of Pharmacy, SA, 3Fairleigh Dickinson University, School of Pharmacy and Health Sciences, USA
Introduction. Factorial surveys are becoming an increasingly used method to study how healthcare professionals make clinical decisions, and
have recently been applied to inform the design of pharmacy adherence interventions.
Aims. To describe the factorial survey design, and to compare the insights derived to inform a medication adherence intervention from two
international studies
Methods. Two separate factorial surveys were conducted on community pharmacists in the Republic of Ireland (2017) and New York, USA
(2020) to understand factors determining adherence monitoring within the clinical workflow. A factorial survey is a quasi-experimental design
defined by the presence of factorial vignettes, which allow the effect of contextual factors within the pharmacy, on clinical decisions, such as
adherence monitoring, be determined. The vignettes were designed with input from practising pharmacists and piloted before finalising. The
Theory of Planned Behaviour was employed as a conceptual model; pharmacists behavioural, normative and control beliefs were elicited
from validated standardised questionnaires such as the Medication Monitoring Attitude measure (MMAM) and from novel questionnaires,
and were also tested for influence on adherence monitoring.
Results. The surveys were administered online, and completed by 258 and 350 community pharmacists in Ireland and the USA, respectively.
Both studies identified contextual factors from the vignettes such as time-pressures within the community pharmacy and the number of days
late the patient collected their repeat prescription to influence adherence monitoring. Further, pharmacists with positive behavioural and
normative beliefs towards adherence monitoring, including highly positive attitudes to medication monitoring, were more likely to monitor
adherence. Conflicting findings were also observed, with control beliefs positively associated with adherence monitoring in the US study
only.
Discussion. Using the factorial survey methodology these studies highlighted that addressing both contextual factors as well as pharmacists
beliefs may improve the success of implementing novel adherence interventions in the community setting.
P a g e | 33
306
Exploring patient participation in an interprofessional medication management program in primary
care
Mr Robert Moecker1,2, Marina Weissenborn1,2, Anja Klingenberg3, Andreas Fuchs4, Christiane Eickhoff5, Uta Mueller5, Martin Schulz5,6, Petra
Kaufmann-Kolle3, ARMIN Study Group7, Walter E. Haefeli1,2, Hanna M. Seidling1,2
1Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany, 2Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Ho spital, H eidelberg, Germany,
3aQua Institute for A pplied Quality Improvement and Resea rch in Health Care, Göttingen, Ger many, 4AOK PLUS – Die Gesundheitskasse, Dresden , Germany, 5Department of Medicine, ABDA – Federal Union of
German Associations of Pharmacists, Berlin, Germany, 6Institute of Pharmacy, Freie Universität Berlin, Berlin, Ger many, 7ABDA – Federal Union of German Associations of Pharmacists: Christiane Eickhoff, Uta
Mueller, Martin Schulz; AOK PLUS: Andreas Fuchs, Dorit Braun, Ulf Maywald; Association of Statutory Health Insu rance Physic ians - Saxony: Catharina Doehler, Mike Maetzler; Association of Statutory Hea lth
Insurance Physicians - Thuringia: Anja Au erbach, Urs Dieter Kuhn, Anke Moeckel; State Association of Pharmacists - Saxony: Christine Honscha, Susanne Donner; State Ass ociation of Pharmacists - Thuri ngia:
Stefan Fink, Kathrin Wagner; Heidelberg University Hospital: Walter E. Haefeli, Andreas D. Meid, Robert Moecker, Carmen Ruff, Hanna M. Seidling, Felicitas Stoll, Marina Weissenborn, Lucas Wirbka; aQua-Institute
for Applied Quality Improvement and Research in Health Care: Petra Kaufmann-Kolle, Anja Klingenberg, Jona Frasch., , Germany
Introduction. Medication review and management programs (MMP) can improve medication-related, clinical, and patient-reported
outcomes [1,2]. Since 2016, approximately 4500 patients have participated in an interprofessional MMP in two German federal states.
Aims. To investigate patients’ experiences of the MMP.
Methods. This was a cross-sectional self-administered postal survey among patients who participated in the MMP. The multi-part
questionnaire comprised questions about patients’ motivation for participation, perceived benefits, and suggestions for improvement,
among others. Single/multiple choice and Likert scale questions were used. Data collection took place between 12/2020 and 04/2021.
Descriptive statistics were applied.
Results. The response rate was 50.6% (n=2405/4757). 245 questionnaires were excluded due to >30% missing answers. Patients were 73
years old (median, IQR 66-81) and 52.4% female (n=2160). Patients’ top three reasons for participation in the MMP were (i) having received
general practitioner’s (GP) recommendation (70%), (ii) wanting community pharmacists and GPs to know their entire medication (40%), and
(iii) receiving a comprehensive medication review (34%). For 24% of the patients, GP’s recommendation was the only reason for participation.
Overall, 34% of the patients reported a benefit because of the MMP participation, 31% indicated to have no benefit but were already satisfied
before participation, and 15% reported they had no benefit. The majority of the patients would participate again (58%), primarily to have
their medication checked (66%), to receive additional care (56%), and to use their medication more safely (49%). However, 38% of the
patients would not participate again unless the benefits of the MMP were better explained (50%) and they perceived greater benefit (27%).
Discussion. Although the overall response was positive, many patients were not (fully) aware of the potential benefits of participating in the
MMP which in turn could explain their call for greater benefit. Potential MMP advantages should be better explained to patients.
1. Jokanovic N, Tan EC, Sudhakaran S, et al. Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm. 2017;13:661-685.
2. Al-Babtain B, Cheema E, Hadi MA. Impact of community-pharmacist-led medication review programmes on patient outcomes: A systematic review and meta -analysis of randomised controlled trials. Res
Social Adm Pharm. 2021;18:2559-2568.
307
Pharmacy student knowledge of online pharmacy use and the impact of education
Dr John Hertig1
1Butler University, Carmel, United States
Introduction. Currently, there is no set of standards for integrating the patient safety risks of online pharmacies into Doctor of Pharmacy
(DoP) degree curricula in the United States. As a result, many pharmacists are unable to recognize the differences between a legal and illegal
online pharmacy, or educate patients on the dangers of online pharmacies. Aims. The objective of this study was to assess gaps in student
pharmacist knowledge, and the practical impact of adding education on online pharmacies in a DoP program.
Methods. A pre and post survey design was developed. Data was collected through an electronic questionnaire distributed to pharmacy
students in their second professional year (P2) to evaluate student knowledge gaps at baseline and after their education on illegal online
pharmacies.
Results. A total of 102 students responded to the pre-survey, with 93 (91%) consenting to participate. Out of 100 respondents to the post-
survey, 84 (84%) students consented. Approximately 87% (81/93) indicated some awareness of prescription medications being purchased
online. Most students (89%, 77/86) stated that they do not believe the University has provided adequate curriculum on illegal online
pharmacies and counterfeit medications. After receiving education on the relevant topics, 64% (55/85) stated they now felt their education
was adequate.
Discussion. Although pharmacy students are aware of the existence of illegal online pharmacies, they were not aware of the significance of
this patient safety issue, or how to accurately identify suspicious websites. These topics are important in an internet-based economy, and
should supplement more traditional substandard/falsified medicine training. It is imperative that pharmacy programs around the world
incorporate formal education on the risks illegal online pharmacies pose to patient and medication safety in society today.
1. Fighting counterfeit pharmaceuticals: New defenses for an underestimated – and growing – menace. Strategy& (Part of the PwC network) website. https://www.strategyand.pwc.com/gx/en/insights/counterfeit-
pharmaceuticals.html. Accessed February 19, 2022.
2. Kennedy J. COVID-19 is driving consumers online and illicit pharmacies are waiting for them. Forbes website. https://www.forbes.com/sites/jaykennedy/2020/12/01/covid-19-is-driving-consumers-online-and-illicit-
pharmacies-are-waiting-for-them/?sh=bab993b798b2. Accessed February 19, 2022.
3. Rogue RX and Activity Report. National Association of Boards of Pharmacy website. May 2020. Accessed February 17, 2022. https://nabp.pharmacy/wp-content/uploads/2020/05/Rogue-Rx-Activity-Report-May-2020-
1.pdf.
4. Internet Pharmacy Warning Letters. U.S. Food & Drug Administration website. June 14, 2021. Accessed February 17, 2022. https://www.fda.gov/drugs/drug-supply-chain-integrity/internet-pharmacy-warning-letters.
5. Rogue RX and Activity Report. National Association of Boards of Pharmacy website. 2019. Accessed February 20, 2022. https://nabp.pharmacy/wp-content/uploads/2019/11/Rogue-Rx-Activity-Report-2019.pdf.
6. Substandard and falsified medical products. World Health Organization website. January 31, 2018. Accessed February 20, 2022. https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-
products.
7. Hertig JB, et al. Evaluation of pharmacists’ awareness of illegal online pharmacies and perceived impact on safe access to medicines. Med. Access Point Care. 2021;5:1-7.
8. Whitehead M, Hertig J. Proposing an Educational Framework for Healthcare Professionals on the Topic of Substandard or Falsified Medications and Illegal Online Pharmacies. Presented at: American Association of
Colleges of Pharmacy; July 2021; virtual meeting.
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308
Using machine learning methods to predict all-cause somatic hospital admissions and readmissions in
adults: A systematic review
Mr Mohsen Askar, Assoc Prof Kristian Svendsen, Prof Lars Småbrekke, Prof Lars Ailo Bongo, Assoc Prof Einar Holsbø
1The Arctic University of Norway, Tromsø, Norway
Introduction. Machine learning (ML) is currently extensively used for predicting hospital admission and readmission.
Aims. To summarize and evaluate ML methods used for predicting all-cause hospital admissions and readmissions and to suggest
recommendations for future work.
Methods. Four databases (PubMed, Embase, Web of Science, and CINAHL) were searched for literature from their inception dates to
November 2021. Four other databases (ProQuest, OpenGrey, WorldCat, and MedNar) were searched for grey literature.
Results. Of 6,388 citations reviewed, 96 (54 for predicting readmissions and 42 for admissions) citations were included. Most studies were
retrospective. Major groups of variables used were demographic, administrative, clinical, medical history, inpatient medication use,
clinicians’ notes, and utilization of health care services before admissions variables. Area Under the ROC curve (AUC) is the most used
evaluation metric. Bagging and boosting tree-based algorithms are frequently used and usually yield good discriminative performance. The
use of neural networks is gradually increasing. Nine studies used Natural language processing (NLP) of clinical notes for prediction. Generally,
reporting in these types of studies needs to improve especially in pre-processing steps, describing population characteristics, hyper-
parameter tuning, model calibration, and handling of imbalanced data and missing values.
Discussion. ML algorithms mostly outperformed regression and constantly outperformed risk prediction scores. Despite the rapid
development in the field, we are still far from the generalizability of ML models in clinical settings. Data privacy regulations, un-unified data
formats, external validity, the wide variety of data preparation steps are all obstacles in the way of generalization. The models must provide
patient-level interpretation to allow implementation into clinical practice. We recommend adopting institution-specific ML models in the
next coming years. To increase the quality of reporting in ML studies, an ML-specific reporting checklist is needed. We recommend the use
of longitudinal prescription databases to further improve these models.
309
The quality of over-the-counter medication counselling in Finnish pharmacies – A simulated patient
study
Dr Katri Hämeen-anttila1, Mrs Niina Alastalo2, Dr Johanna Jyrkkä1, Dr Piia Siitonen2
1Finnish Medicines Agency Fimea, Finland, 2University of Eastern Finland, Finland
Introduction. Use of OTC medicines is often associated with drug-
related problems. Safe self-medication requires quality counselling by
pharmacists.
Aims. To assess the quality of OTC medication counselling in Finnish
pharmacies
Methods. The simulated patient methodology was used with three
scenarios: the patient requesting specific brand name Burana® (ibuprofen, OTC-medicine), or Pronaxen® (naproxen, BTC-medicine), and
the patient requesting a nasal spray. A random sample of 150 pharmacies was selected from all Finnish community pharmacies. The
pharmacies were visited twice, and finally, altogether 292 visits were completed. A scoring criteria for the quality of medication counselling
were developed for each of the scenarios: poor (1-2 points), moderate (3-4 points), or high (5-6 points).
Results. Only a few pharmacies (n=29) performed high quality medication counselling. The quality of counselling was classified moderate or
high in 50% of the cases for Pronaxen® and Nasal spray -scenarios. In the Burana®-scenario, counselling quality was poor in all pharmacies
(n=18) or there was no counselling at all (n=65). Symptoms were often asked from those customers who requested a nasal spray (93%). In
the scenario with a direct product request of OTC -pain medicine, the most frequently asked questions were related to contraindications
and drug interactions (56%). The most often given instructions varied between the scenarios, being follow up in Burana® and Nasal spray -
scenarios (17% and 70%, respectively) and how to use the medicine in Pronaxen®-scenario (63%).
Discussion. OTC -medication counselling is rarely performed with high quality and there is variation in the quality of counselling depending
on the medication. There is room for improvement in medication counselling and in assessing the need for and suitability of t reatment,
especially when a patient requests the OTC medicine by a brand name.
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310
Pharmacy services tailored to patient's health needs - design of a tool to assist pharmacists in simple
medication review
Mrs Ligia Reis1, Dr João Gregório1
1CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal
Introduction. Medication reviews focuses on detecting drug-related problems and recommending interventions. A tool that assists the
pharmacist in processing data from the patient's electronic medication records and flags patients at risk or in need of pharmacy services can
improve the effectiveness of medication reviews and, consequently, the provision of tailored services.
Aims. To perform a simple medication review on patient’s medication records and identify clusters that enable the definition of an algorithm
to tailor pharmacy professional interventions.
Methods. Exploratory retrospective observational study performing a simple medication review to electronic patient records. A convenience
sample was used, extracted from the database of EMR of a community pharmacy located in the district of Lisbon, Portugal. The inclusion
criteria were: records of continuous therapy in 12 months (June 2017-July 2018); use of two or more chronic prescription medications.
Statistical analysis used a two-step cluster to identify common characteristics among patients.
Results. The medication review included 55 patients. 54.5% were female and 45.5% were male. The median of age was 68 years [IQR: 55.0
– 77.0]. The median number of drugs used per patient was 5.0 [IQR: 3.0 – 7.0]. The variables included in the model for the two-step cluster
analysis were severity degree of interactions, severity degree of contraindications, Beer’s criteria, number of drugs used and medical
condition with measurable biomarkers. Four clusters and one outlier patient were identified. Grouping patients into clusters, enabled their
prioritization and subsequent suggestion of pharmaceutical interventions according to their health needs.
Discussion. To provide more and better professional services, community pharmacists need tools that analyse information, processing data
easily, quickly, and continuously. This clustering will provide the foundation for the design of a criteria-based algorithm likely to be
automated, which will assist community pharmacists in providing better care for chronic patients
P a g e | 36
Author index
By surname with abstract reference number
A
Ahmad Azhari, Azrina Ely
302
Alves, Emilia
301
Ailabouni, Nagham
135
Aly, Mariyam
117
Ali, Asma
210
Anderson, Anneka
200
Allemann, Samuel
303
Anderson, Claire
130, 302
Arnet, Isabelle
303
Askar, Mohsen
308
B
Bartlett, Andrew
106
Boček Eknes, Emilia Maria
300
Barwick, Anna
123
Bond, Christine
139
Bentley, John
207
Bongo, Lars Ailo
308
Bereznicki, Luke
133
Broadfoot, Kirsten
211
Bhutkar, Renu
137
Brown, Rachel
200
Birkness, Katharine
126
Burke, Alexander
104, 134
Bittmann, Janina A.
300
Burke, Rosemary
125, 132
C
Carter, Stephen
126, 136
Chenoweth, Lynn
135
Carter, Stephen
119
Cheung, Daisy H K
118
Castelino, Ronald
111
Chewning, Betty
206, 208, 210
Cernasev, Alina
203
Choy, Yvonne
105
Chaar, Betty
107, 108, 144
Clark, Bronwyn
121, 134
Chai, Jim
302
Collins, Ashleigh
124
Chalmers, Leanne
103, 127, 133
Collins, Jack
108, 129, 137, 143
Chen, Timothy
119, 120, 126 139,
304
Cross, Amanda
100
Czarniak, Petra
127
D
Daley, Scott
110
Do, Linda
125, 132
Deweerd, Pauline
110
Donegan, Rachel
105
Dillon, Paul
305
Duff, Jed
124
E
Eickhoff, Christiane
306
El-den, Sarira
119, 126, 128, 129, 137, 141, 143
F
Farris, Karen
204
Fuchs, Andreas
306
Fitzpatrick, Sally
117
Fuzesi, Peter
211
G
Gandhi, Ankesh
202
Gilmartin-Thomas, Julia
135
Gani, Andayana Puspitasari
140
Gisev, Natasa
111, 141
Gardner, David
119, 126
Gnjidic, Danijela
139
Gauld, Natalie
105, 113
Gounder, Dhana
105
Gauthier, Alain
201
Grant, Cameron
113
Gebreyohannes, Eyob Alemayehu
103, 133
Greenbaum, Deborah
144
Gide, Duha
141
Greenwood, Daniel
202, 209
Gill, Manpreet
105
Gregório, João
301, 310
H
P a g e | 37
Haefeli, Walter E.
300, 306
Hikaka, Joanna
200
Haenny, Andreas
303
Hilmer, Sarah
135, 138, 139
Halimi, Syafiqah Nadiah
102
Hinks, Amanda
105
Halvorsen, Kjell Herman
304
Hiremath, Shobha Rani
116
Hämeen-anttila, Katri
309
Holsbø, Einar
308
Han, Jayoung
305
Houle, Sherilyn
201
Harrison, Reema
111
Howe, Anna
113
Haua, Robert
200
Hu, Jie
143
Hawthorne, Deborah
100
Hudson, Mariana
200
Herath, Kaumada Binoli
122
Hussain, Syed
202
Hertig, John
307
I
Iqbal, Ayesha
130
Isaac, Sami
107
J
Jackson, John
112, 114
Jeon, Y
139
Jacob, Sabrina Anne
211
Johnston, Karlee
142
Jakobsen, Ann Helen
304
Jordan, Margaret
120
Jegath Janani, Tharmalinga Sharma
122
Jyrkkä, Johanna
309
K
Kalisch Ellett, Lisa
135
Klingenberg, Anja
306
Kaufmann-Kolle, Petra
306
Knaggs, Roger David
130
Ketharam, Madumai
122
Knapton, Cath
113
Khan, Sohil
111
Kouladjian O'Donnell, Lisa
100, 138
Kim, Eunhee
205
L
Lampert, Anette
300
Lennon, Marilyn
211
Langford, Aili
138
Levy, Russell
125, 132
Larson, William
203
Lewis, Penny
209
Law, Anandi
205
Liu, Shania
124
Lee, Kenneth
100, 103, 133
Lucas, Cherie
104, 117
Lee, Kylie
110
Lucida, Henny
101
Lee, Ya Ping
127
Luetsch, Karen
102
Lee, Yee Lam Elim
141
Luong, Jammie
205
M
Macaden, Leah
211
Mey, Amary
111
MacKenzie, Megan
108
Miranda, Alina
127
Mackler, Emily
204
Moecker, Robert
300, 306
Manon, Sunny
136
Moles, Rebekah
104, 108, 110, 119, 125, 126, 128,
131, 132, 134, 136, 144
Marshall, Vincent
204
Mueller, Uta
306
Maundu, Josephine
121, 134
Muin, Fathul
109
McIntosh , Brendon
200
Mullan, Judy
120
McLachlan, Andrew
107, 144
Murphy, Andrea
119
McMillan, Sara
129, 143
Murphy, Andrea
126
Mercadante, Amanda
205
Murray, Amy
125
N
Nastiti, Christofori Maria Ratna Rini
101
Ng, Ricki
129, 143
Naufal, Ahmad
140
Nguyen, Tuan Anh
135
Naylor, Justine
124
P a g e | 38
O
O’Reilly, Claire
119, 126, 128, 129,
137, 141, 143
Oddie, Morgan
124
Ong, Jocelyn
125, 132
Okoro, Olihe
203
Ou, Kevin
141
P
Page, Amy
100
Pewhairangi, Kevin
200
Parore, Nora
200
Pham, Lily
119, 126
Parsons, Kiran
127
Phuong, Jonathan
136
Patanwala, Asad
124, 125, 132
Power, Tamara
104, 117
Patel, Bhavini
131
Prabandari, Yayi Suryo
109
Patel, Tanisha
209
Pratama, Antonius Nugraha Widhi
101
Peden-McAlpine, Cynthia
203
Procailo, Kelly
204
Penm, Jonathan
124, 125, 132
Petousis-Harris, Helen
113
Q
Qudah, Bonyan
208
Quirke, Lyntara
135
R
R, Shankar Prasad
116
Reddy, Apoorva
208
Radford, Jan
103
Reeve, Emily
135
Raduescu, Corina
119, 126
Reis, Ligia
310
Ramachandran, Sujith
207
Rizvi-Toner, Amna
204
Ranelli, Paul
203
Roennfeldt, Helena
129, 143
Raynes-Greenow, Camille
119, 126
Roubin, Rebecca
144
Rowett, Debra
102, 121
S
Saini, Bandana
134
Smith, Annetta
211
Salter, Sandra
103, 133
Soo, Garry
125, 132
Sawan, Mouna
135, 139
Spark, Joy
123
Schaefer, Patrick
300
Spencer, Kate
121
Schneider, Carl
106, 118, 108, 125,
132
Stalder, Bettina
303
Schommer, Jon
203
Steinke, Douglas
209
Schulz, Martin
306
Stevens, Jennifer
124
Seidling, Hanna M.
300, 306
Stewart, Adele
120
Shafiee Hanjani, Leila
138
Stewart, Victoria
143
Shobia, Senathiraja Sherley
122
Strowel, Clara
126
Siitonen, Piia
309
Study Group, ARMIN
306
Sluggett, Janet
135
Suckling, Benita
124
Småbrekke, Lars
304, 308
Sutherland, Joanna
124
Svendsen, Kristian
308
Sykes, Graeme
105
T
Tan, Edwin
135
Timony, Patrick
201
Tavares, Patricia
301
Toh, Li Shean
130
Teu, Talalelei
105
U
Um, Irene
106, 118
Ung, Tina
128
Unni, Elizabeth
305
V
V, Bindu
116
Viardot, Alexander
110
P a g e | 39
W
Waite, Nancy
201
Wibowo, Heribertus Rinto
101
Walpola, Ramesh
111
Widayanti, Anna Wahyuni
109, 140
Warr, Harriet
202
Wien, Katharina
300
Watson, Margaret
211
Wilkinson, Glenys
121, 134
Weissenborn, Marina
300, 306
Williams, Aleena
131
Welch, Susan
104, 110, 131
Williams, Megan
117
Welsh, Tomas
211
Wilson, Dale
208
Wheeler, Amanda
129, 143
Worley, Marcia M
205
Whitfield, Karen
102
Wurmbach, Viktoria S.
300