No pharmacist ... is not an option

 

Pharmacy practice has significantly changed over the last decades. Pharmacists do not only receive and validate drug prescriptions; they initiate therapy, adjust and prescribe drugs. While pharmacists still buy, dispense and sell drugs, they also monitor drug therapy and take care of patients. Even though a lot of pharmacists work in community pharmacies, they are also found near the patient’s bedside, at home and more than ever in the society.  To us, having pharmacist a must!

The platform Impact Pharmacie presents the best available published data about the role and the impact of the pharmacist in the healthcare system. Although the financial resources are limited, pharmacists are essential due to their contribution to maximize health outcomes for patients. Because of their education, their knowledge, their skills and abilities, pharmacists allow for the optimal use of drug therapy. While the absence of evidences does not necessarily imply the absence of an intervention impact, this platform describes the contribution of pharmacist in a large number of diseases, patient care programs and pharmaceutical activities. It highlights the outcomes but also the descriptive results that can inspire to better pharmacy practices.

Impact Pharmacie is a platform of the Research Unit in Pharmaceutical Practice (URPP) of CHU Sainte-Justine. Initially developed with the support of the Ministry of Health and Social Services (MSSS) in 2012, the platform is updated periodically by a team of research assistants. Each summary sheet published on the platform includes a structured summary written according to a standard operating procedure. The structured abstract includes the summary published in its original language (English, French), several structured fields, a quality score URPP (A - very good quality article, B - good quality article with some limitations, C - article containing many limitations) and a link to the PubMed summary (when applicable).

The articles on the platform are categorized into three categories according to themes: pharmaceutical activities (eg patient counseling, peer education, prescribing), conditions (eg cancer, diabetes, hypertension) and programs care (eg cardiology / dyslipidemia, nephrology, intensive care). For each theme, a summary page contains eight sections containing important information: selection of articles, selection of articles, overview of data, interventions, indicators, guidelines, what to remember...

  • The platform contains over 2700 articles
  • The articles come mainly from the United States, Canada, France, United Kingdom, Australia and Spain
  • The studies include markers related to morbidity (23%), errors (11%), satisfaction (7%), adherence (6%), costs (5%), adverse events (4%). ), mortality (1%) or other types (42%)
  • Of the 13,000 parameters evaluated in the studies, 44% evaluate the impact of the pharmaceutical activity
  • When assessed, pharmaceutical activities are associated with a positive impact in 62% of cases 

The Impact Pharmacie platform is based on a census of the best published and available data on the pharmacist's role and impact. The site is periodically updated according to a structured and reproducible method. The following elements should be noted regarding to the data:

  • Articles selected were found on PubMed; as of 2015, included articles were also selected from Embase and non-indexed professional journals at some point in time (eg Can J Hosp Pharm, Pharmactuel, Canadian Pharmaceutical Journal / Canadian Pharmacists Journal, Hospital Pharmacist and Clinician).
  • All original articles published in scientific journals belong, in most cases, to the editor of the journal and the authors surrendered their rights by agreeing to be published in these journals; therefore, we are prohibited from distributing a copy of most of these publications.
  • To promote an optimal sharing of information, the platform includes a database for which each article selected is analysed and published in a summary sheet; from the page ‘Consult the data’, you can take a look at all the articles categorized under 6 sections: conditions, pharmaceutical activities, care programs, location (eg. country where the studies were conducted), the practice setting (eg. the place in which the studies were conducted: hospital, outpatient clinic, pharmacy, mixed or other) and the assigned URPP quality score (see below for more details).
  • When selecting one of the previous section, you get a list of themes in alphabetical order (the relative size of each theme is proportional to the number of articles included)
  • Each articles selected has a summary sheet associated; the link ‘Consult data’ is updated   
  • Each summary sheet (per article) is written by theme; the tab "Consult data" is updated as a priority because summary records may not include all the articles listed
  • Each summary sheet, there is:
    • A definition of the theme
    • The inclusion criteria for the articles
    • A map of the selected articles  
    • An overview of the data
    • The interventions
    • The indicators
    • The guidelines
    • Other references
    • Key points to remember about the theme
    • Collaborators who participated to the summary sheet
  • When clicking on the PMID of an article, the summary sheet opens up. By clicking on ‘See on PUBMED’, a new window opens directing the user to the PubMed article.  

The URPP score classifies articles according to their relevance and quality. It is defined according to the following criteria:

Score A:

• Systematic reviews

• Meta-analyzes

• Randomized Controlled Studies

Score B:

• Good quality literature reviews

• Good quality cohort studies

• Good quality "before-after" studies

• Studies with/without good quality control group (i.e. explicit inclusion/exclusion criteria, well described intervention, informed discussion, justified conclusion)

Score C:

• Observational, qualitative, case-control, cross-sectional, case series

• Lower quality "before-after" studies

• Cohort studies of lower quality

• Literature reviews of lower quality

• Studies with/without control group of lower quality (ie methodological deviations, little/not described interventions, unconvincing discussion, questionable conclusion)

The Impact Pharmacie platform has been initialed funded by the Ministère de la Santé et des Services Sociaux in 2012 and the URPP in the context of research project realized in hospitals.  URPP offers the financial and the scientifical support for the update of the website and its blog.