International Journal of Clinical Pharmacy 

About: International Journal of Clinical Pharmacy is an academic journal published by Springer Science+Business Media. The journal publishes majorly in the area(s): Pharmacy & Pharmacist. It has an ISSN identifier of 2210-7703. Over the lifetime, 2102 publications have been published receiving 29132 citations. The journal is also known as: Pharmacy World & Science & Int. J. Clin. Pharm..

How to use the nominal group and Delphi techniques.

Abstract: Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how 'consensus' is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of 'experts.' Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.

Assessing medication adherence: options to consider

Abstract: Background Adherence to chronic therapy is a key determinant of patient health outcomes in chronic disease. However, only about 50 % of patients adhere to chronic therapy. One of the challenges in promoting adherence is having an accurate understanding of adherence rates and the factors that contribute to non-adherence. There are many measures available to assess patient medication adherence. Aim of the review This review aims to present the commonly used indirect methods available for measuring medication adherence in routine healthcare and research studies. Method A literature review on medication adherence measures in patient populations with chronic conditions taking chronic medications was conducted through Medline (2003–2013). A complementary manual search of references cited in the retrieved studies was performed in order to identify any additional studies. Results Of the 238 initial Medline search results, 57 full texts were retrieved. Forty-seven articles were included as a result of the manual search. Adherence measures identified were: self-report (reported in 50 publications), electronic measures (33), pharmacy refills and claims data (26) and pill counts (25). Patient self-report, electronic measures, pharmacy refill and claims data were the most commonly used measures of adherence in research, routine practice, epidemiological and intervention studies. These methods, and their strengths and limitations have been described in this paper. Conclusion A multitude of indirect measures of adherence exist in the literature, however, there is no “gold” standard for measuring adherence to medications. Triangulation of methods increases the validity and reliability of the adherence data collected. To strengthen the adherence data collected and allow for comparison of data, future research and practice interventions should use an internationally accepted, operational standardized definition of medication adherence and clearly describe the medication adherence methods used.

Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes.

Abstract: Background Most of interventions that have attempted to improve medication adherence in type 2 diabetes have been educational; on the assumption that knowledge regarding diabetes might affect patients’ adherence to their treatment regimen. Objectives The purpose of the study was to investigate any association of knowledge and medication adherence with glycemic control in patients with type 2 diabetes mellitus. Setting The study was conducted at the Diabetes Outpatients Clinic, Hospital Pulau Penang. Methods A cross-sectional study was conducted with a convenience sample of 540 adult patients with type 2 diabetes attending the clinic. A questionnaire including previously validated Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used and the patients’ medical records were reviewed for haemoglobin A1C (HbA1C) levels and other disease-related information. A total of 35 (6.48%) patients were excluded after data collection due to lack of HbA1C results. Results Five hundred and five patients were included in the final analysis, with a mean age of 58.15 years (SD = 9.16), 50.7% males and median HbA1C of 7.6 (IQR was 6.7–8.9). The median total knowledge score was 7.0 (IQR was 5.0–10.0) while the median adherence score was 6.5 (IQR was 4.75–7.75). Significant correlations were found between the three variables (HbA1C, knowledge and adherence). A significantly higher score for knowledge and adherence (P < 0.05) was found in those patients with lower HbA1C. Higher diabetes knowledge, higher medication adherence and using mono-therapy were significant predictors of good glycemic control in the multivariate analysis. Conclusion Patients’ knowledge about diabetes is associated with better medication adherence and better glycemic control. In addition to other factors affecting medication adherence and glycemic control, healthcare providers should pay attention to knowledge about diabetes that the patients carry towards medication adherence.

Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy.

Abstract: The use of qualitative research methodology is well established for data generation within healthcare research generally and clinical pharmacy research specifically. In the past, qualitative research methodology has been criticized for lacking rigour, transparency, justification of data collection and analysis methods being used, and hence the integrity of findings. Demonstrating rigour in qualitative studies is essential so that the research findings have the “integrity” to make an impact on practice, policy or both. Unlike other healthcare disciplines, the issue of “quality” of qualitative research has not been discussed much in the clinical pharmacy discipline. The aim of this paper is to highlight the importance of rigour in qualitative research, present different philosophical standpoints on the issue of quality in qualitative research and to discuss briefly strategies to ensure rigour in qualitative research. Finally, a mini review of recent research is presented to illustrate the strategies reported by clinical pharmacy researchers to ensure rigour in their qualitative research studies.

The impact of computerized physician order entry on medication error prevention.

Abstract: With interest we have read the article by Villamanan et al. [1]. They stated that medication errors (MEs) occur commonly in hospitals, and emphasized that while most such MEs have little potential for harm, they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events (ADE). It is written that ADEs ‘‘have a major impact on the healthcare system. Several studies over the last few years have shown that they are largely due to failures during the ordering stage of the medication process. About one-third of serious MEs occur in this phase’’ [1]. It is then argued that MEs have resulted in patient deaths each year, and can also cause adverse reactions that range from the minor occasions to major disabilities. Computerized Physician Order Entry (CPOE) is established to ensure that patients do not receive medication that is wrong or dangerous for them. MEs occur in the process of ordering, dispensing, or administering a medication at the wrong time or not at all, regardless of whether an injury occurred or whether the potential for injury was present. Two years ago, a survey was conducted by Kazemi et al. [2] that showed most of the MEs happen at the prescribing stage, and the most common type is dose error. ADEs occur three times more often in newborns than in adults. Result of this Iranian study show that ‘‘Drug dose related errors are usually the most frequent when clinicians prescribe treatments manually’’ [2]. They argue that ‘‘Research in Iran showed dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of MEs, and curtailed-interval was the least’’ [2]. It is concluded that the neonatal ward CPOE without decision support functionality neither reduces non-intercepted dose, nor frequency of MEs for antibiotics and for anticonvulsants. However, when paired with a dose decision support system, CPOE is capable of reducing these errors. The effects of CPOE on medication errors are also demonstrated in this research, and this is done according to different specialties. However, the new study fails to show the effect of CPOE according to either types of hospitals (public, private, non-profit) or where they are located (metropolis, urban or rural). It therefore could be concluded that use of CPOE minimizes the occurrence of MEs, however, they still occur. Most errors are associated with the CPOE technology. The health industry therefore faces a new challenge in the prevention of ME that require a change in strategy for patient safety. Processing a prescription drug order through a CPOE system decreases the likelihood of errors [3]. Systems such as these have the potential to both fix and cause problems, and require evaluation. As one of us coauthored elsewhere [4] on this matter, the reductions occurred because order entry both structured orders and facilitated the checking of them. Further reductions should be possible with additional decision support. Such refined systems should therefore be used more widely.