The Experts below are selected from a list of 13158 Experts worldwide ranked by ideXlab platform

Donald R J Singer - One of the best experts on this subject based on the ideXlab platform.

  • the impact of interventions by Pharmacists in Community pharmacies on control of hypertension a systematic review and meta analysis of randomized controlled trials
    British Journal of Clinical Pharmacology, 2014
    Co-Authors: Ejaz Cheema, Paul Sutcliffe, Donald R J Singer
    Abstract:

    AIMS: To undertake a systematic review and meta-analysis of randomized controlled trials concerned with the impact of Community Pharmacist-led interventions on blood pressure control in patients with hypertension. METHODS: Eight electronic databases were searched up to 30 November 2013, with no start date (Web of Science, Embase, The Cochrane Library, Medline Ovid, Biomed Central, Biosis Citation Index, CINAHL, PsycINFO). All studies included were randomized controlled trials involving patients with hypertension, with or without cardiovascular-related co-morbidities, with difference in blood pressure as an outcome. Data collected included the study design, baseline characteristics of study populations, types of interventions and outcomes. The Cochrane tool was used to assess risk of bias. RESULTS: From 340 articles identified on initial searching, 16 randomized controlled trials (3032 patients) were included. Pharmacist-led interventions were patient education on hypertension, management of prescribing and safety problems associated with medication, and advice on lifestyle. These interventions were associated with significant reductions in systolic [11 studies (2240 patients); -6.1 mmHg (95% confidence interval, -3.8 to -8.4 mmHg); P < 0.00001] and diastolic blood pressure [11 studies (2246 patients); -2.5 mmHg (95% confidence interval, -1.5 to -3.4 mmHg); P < 0.00001]. CONCLUSIONS: Community Pharmacist-led interventions can significantly reduce systolic and diastolic blood pressure. These interventions could be useful for improving clinical management of hypertension.

Mina Tadrous - One of the best experts on this subject based on the ideXlab platform.

  • fitting in the Pharmacist a qualitative analysis of the perceived relationship between Community Pharmacists and older adults with complex care needs
    International Journal of Pharmacy Practice, 2021
    Co-Authors: Larkin Davenport Huyer, Laura Desveaux, Nardine Nakhla, Colleen J Maxwell, Mina Tadrous
    Abstract:

    OBJECTIVES To explore the current perceived relationship between older adults with varying levels of frailty and healthcare needs and Community Pharmacists. METHODS This qualitative study conducted a thematic analysis of focus groups with older adults and older adult caregivers and Community Pharmacist participants. Participants were recruited following a maximum variation sampling technique. Verbatim transcripts were inductively coded using NVivo to develop key findings. KEY FINDINGS Four major themes emerged: (i) Pharmacy Landscape, (ii) Prescription and Non-Prescription Drug Safety, (iii) Patient-Pharmacist Relationship and (iv) Recommendations for Pharmacy Practice. Themes demonstrate three key findings: (1) older adults approach drug information with a key focus on safety and cost of both prescription and non-prescription drugs, (2) there is a demonstrated opportunity, recognized by older adults and practitioners, for Community Pharmacists to expand their role in the care of older adults, (3) Community Pharmacists are able, interested and/or have already incorporated frailty assessments into their practice to better support their care of the older adult population with varying levels of frailty. CONCLUSIONS The results demonstrate a reason for the Community Pharmacist role to shift. The unique knowledge and skills of Community Pharmacists, coupled with their accessibility and strong patient-clinician relationship, have the potential to better support older adults with varying levels of frailty.

Jeff Harrison - One of the best experts on this subject based on the ideXlab platform.

  • Community Pharmacist led interventions and their impact on patients medication adherence and other health outcomes a systematic review
    International Journal of Pharmacy Practice, 2018
    Co-Authors: Aleksandra Milosavljevic, Trudi Aspden, Jeff Harrison
    Abstract:

    Introduction Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution Community Pharmacist-led interventions can have on improving patients' adherence and health outcomes. Objectives To provide an overview of the published literature on Community Pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes. Methods A search strategy was developed, aiming to retrieve published reports of Community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken. Key findings Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community Pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. Conclusion Community Pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.

Fred H P De Koning - One of the best experts on this subject based on the ideXlab platform.

  • Pharmacist based medication review reduces potential drug related problems in the elderly the smog controlled trial
    Drugs & Aging, 2009
    Co-Authors: Thijs H A M Vinks, Ton M De Lange, Toine C G Egberts, Fred H P De Koning
    Abstract:

    Background: The high prevalence of drug-related problems (DRPs) in the elderly, occurring as a result of multiple drug use combined with age-related changes in pharmacokinetics and pharmacodynamics, is a well known phenomenon. However, effective intervention strategies are uncommon. Objective: A pharmacy-based controlled trial (SMOG [Screening Medicatie Oudere Geneesmiddelgebruiker; Screening Medications in the Older Drug User]) was performed to investigate whether a Community Pharmacist-led intervention reduces the number of potential DRPs in patients aged ≥65 years using six or more drugs concomitantly. Methods: This intervention study was conducted from June 2002 until June 2003 in 16 Community pharmacies in the Netherlands. Medication assessment was undertaken in elderly patients aged ≥65 years using six or more drugs concomitantly on the date of inclusion. Ten types of potential DRPs were determined and grouped into the following three categories: (i) patient-related potential DRPs: non-compliance; (ii) prescriber-related potential DRPs: expired indication, therapeutic duplication, inappropriate dosage (over- and under-dosage), off-label use, undertreatment, inconvenience of use; and (iii) drug-related potential DRPs: contraindications, drug-drug interactions, drug treatment of adverse drug reactions. A list of recommended changes in medication was compiled by the Pharmacist for the patients in the intervention group. Recommendations for medication change were discussed with the general practitioner (GP). Four months after the date of inclusion, the medications of each patient were again reviewed and screened for potential DRPs. The primary outcome corresponded to the change in the number of potential DRPs; the secondary outcome was related to the change in number of used medications between the intervention group and the control group at baseline and 4 months later. Results: A total of 174 patients were analysed: 87 patients in the intervention arm and 87 patients in the usual care arm. After a 4-month period, we observed a significant reduction in the mean number of DRPs per patient (mean difference −16.3%; 95% CI −24.3, −8.3). The mean number of drugs per patient was not significantly reduced (mean difference −4.7%; 95% CI −9.6, 0.2). Conclusion: This study showed a positive influence of the Community Pharmacist in reducing potential DRPs in the elderly. Future interventions should also focus on actual outcomes, including quality of life, morbidity and mortality.

  • identification of potential drug related problems in the elderly the role of the Community Pharmacist
    Pharmacy World & Science, 2006
    Co-Authors: Thijs H A M Vinks, Fred H P De Koning, Ton M De Lange, Toine C G Egberts
    Abstract:

    Objective: The high prevalence of multiple drug use combined with age-related changes in pharmacokinetics and pharmacodynamics makes older adults more vulnerable to drug-related problems (DRPs). This pharmacy-based study was performed to identify potential DRPs from prescription records of the elderly and the role of the Pharmacist in this process. Method: The study was performed from June 2002 to February 2003 in 16 Community pharmacies in the Netherlands. Medication assessment of elderly patients aged 65 and over using six or more drugs concomitantly took place on the date of inclusion. Ten types of potential DRPs, grouped into three categories, were determined. The three groups were patient-related, prescriber-related or drug-related potential DRPs. We looked at the occurrence, nature and determinants of differential potential DRPs. Results: The mean number of prescriptions per patient was 8.7. In total 3.9 potential DRPs per elderly person were identified. The distribution of the potential DRPs over the three categories was: patient related 4.7%, prescriber related 55.7% and drug related 39.6%. Use of NSAIDs (OR 29.9; 95% CI 4.1–219) and digoxin (OR 15.7; 95% CI 4.9–50.5) were associated with the highest risk for potential DRPs. Conclusion: In this vulnerable group of elderly patients potential DRPs frequently occur. Community Pharmacists can play an important role in the identification, assessment and prevention of potential DRPs in the elderly. It is useful to investigate which part of potential DRPs can be avoided by the intervention of the Community Pharmacist in collaboration with the prescriber and the patient.

Ross T Tsuyuki - One of the best experts on this subject based on the ideXlab platform.

  • a cost analysis and cost utility analysis of a Community Pharmacist led intervention on reducing cardiovascular risk the alberta vascular risk reduction Community pharmacy project rxeach
    Value in Health, 2019
    Co-Authors: Helen Tamtham, Ross T Tsuyuki, Yazid Al N Hamarneh, Braden J Manns, Marcello Tonelli, Brenda R Hemmelgarn, Fiona Clement, Scott Klarenbach, Joanne Penko, Colin Weaver
    Abstract:

    Abstract Background A randomized trial (the Alberta Vascular Risk Reduction Community Pharmacy Project) showed that a Community Pharmacist-led intervention was efficacious for reducing cardiovascular (CV) risk. However, the cost of this strategy is unknown. Objectives We examined the short- and long-term cost of a Pharmacist-led intervention to reduce CV risk compared to usual care. Methods We conducted a trial-based cost analysis from the perspective of a publicly funded healthcare system. Over 3 and 12 months of follow-up, we examined specific intervention costs (pharmacy claims), related intervention costs (laboratory tests and medications), and ongoing healthcare costs (physician claims, emergency department visits, and hospital admissions). We also used the validated CV Disease Policy Model–Canada to estimate the long-term effects. Results A total of 684 participants (mean age 62, 57% male) were included. Overall, there were no significant differences in healthcare costs at 3 or 12 months between the usual care and intervention groups (P = .127). The CV disease-related healthcare cost of managing a patient over a lifetime was estimated to be Can$45 530 (95% uncertainty interval [UI], 45 460-45 580) and Can$40 750 (95% UI, 37 780-43 620) in usual care and intervention groups, respectively, an incremental cost savings of Can$4770 per patient (95% UI, 1900-7760). The intervention dominated usual care (better outcomes and lower costs) across 3-year, 5-year, 10-year, and lifetime horizons. Conclusion This economic analysis suggests that a clinical pathway-driven Pharmacist-led intervention (previously shown to reduce CV risk) was associated with similar measured healthcare costs over 1 year, and lower extrapolated healthcare costs over a patient lifetime. This strategy could be broadly implemented to realize its benefits.

  • patient family physician and Community Pharmacist perspectives on expanded pharmacy scope of practice a qualitative study
    CMAJ open, 2017
    Co-Authors: Maoliosa Donald, Ross T Tsuyuki, Kathryn Kingshier, Yazid Al N Hamarneh, Charlotte Jones, Braden J Manns, Marcello Tonelli, Wendy Tink, Nairne Scottdouglas, Brenda R Hemmelgarn
    Abstract:

    Background The RxEACH trial was a randomized trial to evaluate the efficacy of Community pharmacy-based case finding and intervention in patients at high risk for cardiovascular (CV) events. Community-dwelling patients with poorly controlled risk factors were identified and their CV risk reduced through patient education, prescribing and follow-up by their Pharmacist. Perspectives of patients, family physicians and Community Pharmacists were obtained regarding Pharmacists' identification and management of patients at high risk for CV events, to identify strategies to facilitate implementation of the Pharmacist's expanded role in routine patient care. Methods We used a qualitative methodology (individual semistructured interviews) with conventional qualitative content analysis to describe perceptions about Community Pharmacists' care of patients at high risk for CV events. Perceptions were categorized into macro (structure), meso (institution) and micro (practice) health system levels, based on a conceptual framework of care for optimizing scopes of practice. Results We interviewed 48 participants (14 patients, 13 family physicians and 21 Community Pharmacists). Patients were supportive of the expanded scope of practice of Pharmacists. All participant groups emphasized the importance of communication, ability to share patient information, trust and better understanding of the roles, responsibilities, accountabilities and liabilities of the Pharmacist within their expanded role. Interpretation Despite support from patients and changes to delivery of care in primary care settings, ongoing efforts are needed to understand how to best harmonize family physician and Community Pharmacist roles across the health system. This will require collaboration and input from professional associations, regulatory bodies, Pharmacists, family physicians and patients.

  • Community Pharmacist targeted screening for chronic kidney disease
    Canadian Pharmacists Journal, 2016
    Co-Authors: Yazid Al N Hamarneh, Charlotte Jones, Brenda R Hemmelgarn, Craig Curtis, Carlee Balint, Ross T Tsuyuki
    Abstract:

    More than 1 in 10 adults in Canada is living with chronic kidney disease (CKD),1 defined as a reduction in kidney function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) or markers of kidney damage (albuminuria ≥3 mg/mmol or abnormalities in urine sediment or renal imaging) for more than 3 months.2 Individuals with CKD require more intensive follow-up due to their reduced renal function, increased cardiovascular risk and multiple associated comorbidities.3 Early detection can help optimize the treatment, prevent or slow the progression of the disease and ultimately improve the quality of life of patients with CKD.4-6 Early stages of CKD are often asymptomatic, making preventive efforts difficult. Indeed, Mitra and Bradley7 identified that a large proportion of patients in the Community are underdiagnosed and undertreated for CKD. As such, the use of comprehensive evidence-based guidelines to aid in targeted screening, early detection and management of such patients has been recommended.1 The CKD Clinical Pathway was developed to provide guidance on these issues in this high-risk population.8 The CKD Clinical Pathway is an online tool modeled after the successful National Institute for Health and Care Excellence (NICE) clinical pathways. It was developed by a team of stakeholders that included nephrologists, Pharmacists, primary care physicians, nurses, other health care professionals, information technology specialists, web developers and designers to aid in the diagnosis, management and referral of adults with CKD in the Community. The content in the CKD Clinical Pathway is evidence based and combines a group of national and international guidelines.2,9-14 This ensures that the recommendations are relevant and harmonized across Canada. More information on the CKD Clinical Pathway is available at www.ckdpathway.ca. Pharmacists are frontline health care professionals who see patients with, and at risk of, CKD frequently and therefore could systematically identify these individuals and assist in their management. Moreover, Pharmacists’ scope of practice has expanded in Alberta, allowing them to order and view laboratory tests. As such, we undertook this study to evaluate Pharmacists’ application of the CKD Clinical Pathway in the screening and identification of patients with CKD, particularly those with previously unrecognized CKD.

  • predictors of bone mineral density testing in patients at high risk of osteoporosis secondary analyses from the osteopharm randomized trial
    Journal of Clinical Densitometry, 2012
    Co-Authors: Nese Yuksel, Ross T Tsuyuki, Sumit R Majumdar
    Abstract:

    Abstract In a randomized trial, we demonstrated that a Community Pharmacist osteoporosis screening intervention doubled the rates of bone mineral density (BMD) testing in high-risk patients. The purpose of this secondary analysis was to evaluate the potentially modifiable factors associated with BMD testing. From 2005 to 2007, 15 pharmacies randomized 262 patients to intervention (education, pamphlets, point-of-care quantitative heel ultrasound [QUS]) or usual care. The main outcome was BMD testing within 4mo. Multivariate regression was used to determine independent correlates of BMD testing. The median age of the cohort was 62yr, 65% were women, and 49% (n=129) were randomized to intervention. Compared with patients who were not tested, those with BMD were more likely to be women ( p =0.007) and have excellent or very good health ( p p =0.017), greater osteoporosis knowledge ( p =0.004), and osteoporosis-specific physician visits ( p

  • Community Pharmacist initiated screening program for osteoporosis randomized controlled trial
    Osteoporosis International, 2010
    Co-Authors: Nese Yuksel, Sumit R Majumdar, C Biggs, Ross T Tsuyuki
    Abstract:

    Summary This study evaluated the effect of a multifaceted intervention (screening and patient education) by Community Pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis.