Description
Write a review of related literature. At least 20 references. Include foreign literature, foreign studies, local lit, and local studies. Follow the format attached with the CORRECT headings or variables in the study entitled:Assessment in the Community Internship Performance of the MCNP – BS Pharmacy Students: Its Relation to the Level of Satisfaction of the Pharmacist to the Interns. MCNP means Medical Colleges of Northern Philippines, a tertiary institution in Cagayan Valley, Philippines.
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CHAPTER II
REVIEW OF RELATED LITERATURE
This
chapter
literature
contribution
and
to
extensively
studies
reviews
relevant
medication
to
review
both
foreign
community
and
patient
and
local
pharmacists’
education.
Information from this literature review section aims to provide a
solid foundation for understanding the factors influencing the
critical roles of community pharmacists in enhancing healthcare
outcomes.
2.1 Foreign Literature
2.1.1 Medication Review Practices
In the pursuit of improving healthcare outcomes for older
adults, community pharmacists have emerged as crucial players,
actively involved in medication review interventions (Kallio et
al., 2016). Kallio and colleagues conducted a systematic review to
delve into the impact of these interventions, spanning the period
from January 2000 to February 2016. Their thorough investigation
spanned various databases, including International Pharmaceutical
Abstracts, Cochrane Library, Cinahl, MEDLINE (Ovid), and Scopus,
aiming to pinpoint relevant articles (Kallio et al., 2016).
The outcome of their review brought forth sixteen articles,
collectively
detailing
twelve
distinctive
medication
review
interventions (Kallio et al., 2016). These interventions fell into
categories such as prescription, clinical medication, compliance,
and concordance reviews following a predefined typology (Kallio et
al.,
2016).
Community
pharmacists’
contributions
ranged
from
sharing dispensing records with other healthcare staff to ensuring
more comprehensive participation in managing the entire medication
spectrum (Kallio et al., 2016).
Key
outcomes
interventions,
were
shedding
essential
light
on
to
evaluating
their
these
effectiveness.
Of
particular significance was the observed impact on medication
changes,
specifically
those
resulting
in
a
reduction
of
established or possible drug-related problems (Kallio et al.,
2016).
This
outcome
was
a
recurring
theme
across
twelve
interventions. That shows the vital role of community pharmacists
in addressing issues tied to medication regimens for older adults.
Notably, the results indicated a consistent reduction in drugrelated
problems
(n
=
12)
and
a
noteworthy
improvement
in
medication adherence (n = 5) resulting from these interventions
(Kallio et al., 2016).
These results have important implications because they show
that medication review interventions always have positive results,
no matter how involved community pharmacists are (Kallio et al.,
2016). The tangible benefits of reduced drug-related problems and
enhanced medication adherence stand out prominently. However, the
authors advocate for a more robust research approach. There is a
need for rigorous studies utilizing sensitivity and specificity
1
outcome
measures
(Kallio
et
al.,
2016).
This
call
for
methodological refinement aims to provide a better mastery of the
nuanced
effects
medication
of
community
pharmacists’
contributions
reviews,
ultimately
contributing
to
the
to
ongoing
discourse on enhancing the health of older adults.
In a study conducted among pharmacists in the United States
by Chisholm-Burns et al. (2010), the conclusion is that recognizing
and utilizing pharmacists’ expertise within healthcare teams could
be a pivotal solution to tackling challenges in the U.S. healthcare
system and moving towards more comprehensive and patient-centered
care. The researchers went on a deep dive, searching through
databases like NLM PubMed and Ovid/MEDLINE, among others, from the
beginning until January 2009 (Chisholm-Burns et al., 2010). They
looked for studies that talked about pharmacist-provided care,
compared it with other services, and shared outcomes related to
patients. After sifting through 298 studies, a team of experts
carefully extracted the data. The findings painted a positive
picture regarding therapeutic and safety aspects. According to the
meta-analyses, there were significant improvements in crucial
health indicators like LDL cholesterol, adverse drug events, blood
pressure, and hemoglobin A1c (Chisholm-Burns et al., 2010). This
suggests that when it comes to influencing these key factors,
having pharmacists directly involved in patient care outshines
other
services,
showing
their
potential
to
enhance
treatment
2
effectiveness and patient safety. Humanistic outcomes showed some
variability.
However,
the
meta-analyses
indicated
significant
improvements in drug adherence, patient awareness, and quality of
health
(Chisholm-Burns
et
al.,
2010).
This
tells
us
that
pharmacists play a vital role in helping patients understand their
medications, stick to their treatment plans, and improve their
quality of life.
A study by Alorfi et al. (2023) focused on assessing community
pharmacists’ knowledge in Jeddah, Saudi Arabia, regarding drugdrug interactions (DDIs). Given the potential for DDIs to cause
serious
adverse
drug
events
and
significantly
impact
patient
outcomes, the objective of the investigation was to assess the
ability of community pharmacists to recognize and manage these
interactions. Employing a cross-sectional survey approach, 147
community pharmacists, predominantly male (89.1%, equivalent to
131 respondents), all possessing a bachelor’s degree in pharmacy,
participated in the study. Notably, the results highlighted a
noticeable deficiency in DDI knowledge, with the lowest correct
response
observed
for
the
combination
of
theophylline
and
omeprazole and the highest for amoxicillin and acetaminophen. Most
participants accurately identified only six out of 28 drug pairs.
The study underscored the importance of training and educational
programs for community pharmacy practitioners in Saudi Arabia to
enhance their understanding of DDIs to improve patient care and
3
safety. The measured DDI knowledge of 38.22 ± 22.0 shows the
urgency of addressing this knowledge gap to enhance pharmaceutical
practice in the region.
2.1.2 Evaluating Pharmacists’ Contributions
The main objective of Noormandi et al.’s (2019) systematic
review was to assess the clinical and financial effects of the
actions taken by clinical pharmacists in Iran. The study sought to
systematically collect and assess data regarding the impact of
these
interventions
on
medication
safety
and
expenses,
representing the first comprehensive review of interventions by
Iranian
community
involved
an
pharmacists.
extensive
search
The
data
across
acquisition
six
online
process
databases,
employing specific terms related to Iranian community pharmacists,
adverse drug effects, medication errors, drug interactions, drug
use evaluation, and costs (Noormandi et al., 2019). Adhering to
PRISMA guidelines, the study identified 39 studies meeting the
eligibility
criteria.
These
studies
covered
various
clinical
pharmacist interventions, including implementing pharmaceutical
care,
preventing
adverse
drug
reactions,
optimizing
drug
utilization patterns, and addressing medication errors. Notably,
most interventions focused on protocol development and enhancement
of drug utilization patterns. Most of the studies were conducted
in Tehran’s ambulatory care or inpatient settings. The review
4
concludes
that
patients’
clinical
pharmacists
pharmaceutical
care
are
pivotal
efficiency,
in
improving
safety,
and
effectiveness in Iran, underscoring their positive impact on the
healthcare system.
Additionally, Ahmed et al. (2021) conducted a systematic
review examining the impact of community pharmacist services on
patient
outcomes
in
Pakistan.
The
transformation
of
the
pharmacist’s role, shifting from merely dispensing medications to
providing bedside care, has proven beneficial for patient health
outcomes
in
developed
countries.
However,
the
extent
and
effectiveness of clinical pharmacist services in low- and middleincome countries (LMICs), such as Pakistan, remain uncertain. This
systematic review sought to evaluate the therapeutic, safety,
humanistic, and economic outcomes resulting from the clinical
responsibilities
of
pharmacists
in
Pakistan.
The
search
encompassed databases, including PubMed, Scopus, EMBASE, CINAHL,
and the Cochrane Library, identifying nine pertinent studies of
seven randomized controlled trials (RCTs) and two observational
studies. Clinical pharmacist interventions, such as teaching,
encouraging lifestyle changes, counseling patients on taking their
medications as prescribed, and conversing with doctors, showed
promise in lowering medication errors and improving therapeutic
and humanistic outcomes (Ahmed et al., 2021). The review shows
5
that most studies included had a high risk of bias. This shows
that more research with robust study designs is needed to fully
understand how clinical pharmacist services in Pakistan affect
people’s
lives,
especially
regarding
money.
The
study’s
conclusions underscore the vital role of clinical pharmacists in
improving patient health outcomes in Pakistan while advocating for
methodologically rigorous research to
strengthen the evidence
base.
2.2 Foreign Studies
2.2.1 Patient Education in Community Pharmacies
Agomo et al. (2018) investigated to explore the worldwide
evidence supporting the involvement of clinical pharmacists in
public health. While community pharmacies in the UK are more
accessible than general practices, the study aimed to determine if
comparable
evidence
exists
globally
regarding
the
potential
expansion of community pharmacists’ roles in disease prevention
and health enhancement. The research involves a thorough review
and synthesis of global evidence concerning the public health
responsibilities
undertaken
by
community
pharmacists.
It
identifies barriers and deliberates on potential strategies to
enhance
these
roles.
A
meticulous
exploration
of
electronic
databases uncovered a diverse range of literature, including two
meta-analyses,
seven
literature
reviews,
23
interventional
6
studies, and 41 descriptive studies, all published since January
1, 2000. The literature was systematically classified based on
health topics, encompassing smoking cessation, weight management,
antibiotic use, health promotion, disease screening, preventive
activities,
vaccination
and
immunization,
advice
on
alcohol
dependence and drug misuse, emergency hormonal contraception, and
sexual health services.
The
review
examines
the
effectiveness
of
public
health
interventions in community pharmacies, spanning various domains
such as smoking cessation, health promotion, disease screening,
preventive activities, emergency hormonal contraception provision,
and vaccination services. While the evidence on interventions for
weight management, alcohol dependence, and antibiotic use advice
are inconclusive, the perceived accessibility and convenience
contribute to the feasibility and acceptability of these services.
The study provides valuable insights into the global scenario of
community pharmacists’ contributions to public health, shedding
light
on
effective
interventions
and
potential
avenues
for
improvement.
Furthermore, in an inquiry into the involvement of community
pharmacists in public health activities within Nigeria, the study
aimed to categorize the types of activities, gauge the extent of
pharmacist participation and assess factors influencing their
engagement (Osemene & Erhun, 2018). This cross-sectional survey,
7
conducted
among
pharmacies,
130
randomly
employed
a
selected
pretested
registered
community
questionnaire
for
data
collection. The study revealed 31 types of public health activities
in which community pharmacists were involved, with the highest
engagement
observed
in
patient
counseling,
personal
hygiene,
maintenance of normal blood pressure, and techniques for using
vagina pessaries (Osemene & Erhun, 2018). Conversely, areas with
the
most
minor
participation
included
eliminating
smokeless
tobacco use, using seat belts while driving, and the importance of
residing in a safe neighborhood.
Barriers
affecting
participation
encompass
inadequate
training, a shortage of pharmacists’ time, insufficient personnel,
time constraints for patients, a lack of profitability, limited
space in the pharmacy, and insufficient patient information. The
study underscores that addressing these identified barriers could
amplify
community
pharmacists’
involvement
in
public
health
activities in Nigeria, fostering a more impactful role in promoting
public health awareness and education (Osemene & Erhun, 2018).
2.3 Local Literature
2.3.1 Community Pharmacy Practices in the Philippines
A recent study by Joseph Mari B. Querequincia and Erwin M.
Faller (2023) aimed to provide thorough insights into community
pharmacies’
operations
in
light
of
the
COVID-19
pandemic
in
particular Southeast Asian nations. This concise review aimed to
8
distill
pertinent
data
shedding
light
the
on
and
information
experiences
of
from
various
community
studies,
pharmacists
grappling with the challenges posed by the widespread transmission
of COVID-19 across nations. The pandemic presented distinctive
difficulties for healthcare professionals, particularly community
pharmacists, who were at the forefront of public health and
medication therapy. Their roles and contributions in managing
infectious
diseases
became
notably
significant
during
this
critical period.
The review examined the Southeast Asian region, including
countries such as Indonesia, Malaysia, the Philippines, Singapore,
Thailand,
and
encountered
by
Vietnam,
emphasizing
community
the
pharmacy
noteworthy
practices.
challenges
Despite
these
challenges, these practices served as the primary point of contact
in the healthcare systems of the mentioned countries. In response
to the pandemic, community pharmacists expanded their services
within healthcare establishments and through various communication
channels,
ensuring
the
uninterrupted
supply
of
medicines
to
communities.
Delving into the subject matter, a comprehensive overview
authored by Faller in 2022 aimed to provide insights into the
pharmacy practices of ASEAN countries, specifically focusing on
Indonesia, Vietnam, Malaysia, India, and the Philippines. Central
to this exploration was the term “good pharmacy practice” (GPP),
9
which encompasses a spectrum of activities, including medication
supply,
provision
of
health
information,
patient
advice,
and
ultimately influencing patient health outcomes. As referenced, the
Federation Internationale Farmaceutique (FIP) guidelines defined
GPP as the pharmacy practice responding to the needs of individuals
seeking pharmacists’ services to provide optimal, evidence-based
care. The pharmacy practice in each country is regulated by
legislation,
which
serves
as
the
foundation
for
the
ongoing
development of the profession.
The primary objective of this review was to present databased articles elucidating the fundamental concepts, principles,
and activities of GPP in ASEAN countries, with a specific emphasis
on the context of professional practice, including the health care
system, pharmacy practice, and pharmacy education. The review
highlighted the FIP’s advocacy of GPP principles and activities
(Beating
Non-Communicable
Contribution
of
Diseases
Pharmacists,
2019),
in
the
Community:
emphasizing
the
need
The
for
national pharmaceutical associations in each country to adopt GPP
standards.
Examining the context of professional practice, the review
covered aspects such as the health care system, pharmacy practice,
and pharmacy education. Notably, the discussion included good
pharmacy practice settings featuring the Rational Use of Medicines
(RUM) and pharmaceutical care services, where pharmacists engage
10
and
function
by
their
mandates.
The
paper
underscored
the
importance for every pharmacist to acquire and adhere to GPP
standards, thereby making a substantial professional and personal
contribution to enhancing service quality and health promotion in
their respective areas within ASEAN countries (DAR et al., 2023).
2.3.2 Patient Perspectives on Pharmacy Services
A
recent
review
focused
on
pharmaceutical
care
services
during the COVID-19 pandemic in the Philippines aimed to shed light
on the critical role pharmacists played on the frontlines in
mitigating the detrimental impacts of the ongoing crisis (Mariano
& Faller, 2021). As a developing country, the Philippines faced
significant
challenges
due
to
the
pandemic,
and
pharmacists
highlighted their crucial contributions. The methodology involved
scrutinizing available published materials from diverse journal
databases.
The
pharmaceutical
review
care
identified
activities
and
undertaken
discussed
by
various
pharmacists
in
response to the COVID-19 pandemic in the Philippines. Noteworthy
services
included
teleconsultation,
the
provision
of
drug
information through telepharmacy to the public and healthcare
professionals
illnesses
in
(Lu
the
&
Marcelo,
community,
2021),
the
ensuring
management
patient
of
minor
access
to
prescription and maintenance medications, active involvement in
teaching
and
advocating
for
vaccination
and
even
receiving
training to administer COVID-19 vaccines as part of the country’s
11
vaccination programs. The review’s findings show pharmacists’
versatility
and
adaptability
in
addressing
the
multifaceted
challenges posed by the pandemic. It concluded by emphasizing that
the pandemic presented an opportunity to highlight pharmacists’
critical role in healthcare delivery, especially in a country where
their role is often perceived narrowly as that of sellers of
medicines. The review showcased the diverse and impactful ways
pharmacists
contributed
to
the
healthcare
system
during
the
challenging times of the COVID-19 pandemic in the Philippines
(Mariano & Faller, 2021).
2.4 Local Studies
2.4.1 Community Pharmacist Interventions
In a groundbreaking investigation spearheaded by Martinez
Faller et al. (2020), an exploration into the evolving roles of
community pharmacists in worldwide health unfolded as a crucial
contribution to public healthcare delivery, given the escalating
health needs globally. The study sought to discern pharmacists’
knowledge, perceptions, and competence in implementing global
health initiatives. Executed using the cross-sectional descriptive
study
method,
distributed
the
among
research
the
employed
398
validated
participants
questionnaires
enrolled
in
the
International Certificate Course in Global Health Pharmacy. The
research’s
outcomes
moderate-to-high
painted
level
a
compelling
knowledge
and
picture,
competence
revealing
among
ASEAN
12
pharmacists.
advancing
That
global
positioned
health.
The
them
for
findings
significant
showcased
roles
in
adeptness
in
addressing clinical care and quality improvement issues in diverse
pharmacy services, collaborative efforts with other healthcare
providers,
and
substantial
enhancements
in
pharmaceutical
services. The survey results state the need for pharmacists to
have
research
collaborations
with
various
institutions
and
healthcare providers. That transcends beyond the conventional
roles expected of the pharmacy profession. This imperative shift
aligns
to
improve
public
health
locally
and
internationally,
marking a transformative era for pharmacists in their evolving and
pivotal roles in global healthcare (Setia et al., 2018).
The goal of Gutierrez’s randomized controlled trial in Region
IV-A of the Philippines from May 2021 to January 2022 was to
determine how well a pharmacist-led expert system could improve
medication adherence and blood pressure control in adults with
hypertension. Given the low hypertension control rate in the
Philippines, standing at a mere 20% (Tang et al., 2020) and
attributed
to
supplement
existing
intervention.
participated,
low
Four
with
medication
adherence,
the
study
government
programs
with
an
innovative
hundred
seventeen
eligible
patients
control
and
203
in
the
group
aimed
214
in
to
the
intervention group. The results demonstrated a noteworthy impact
on medication adherence, with the intervention group displaying a
13
substantial 430.40% increase in adherence likelihood (OR = 5.30,
p = 0.0001). Factors such as medication adherence (OR = 2.53, p =
0.000), BMI (OR = 0.939, p = 0.016), and perceived knowledge (OR
= 1.2023, p = 0.000) emerged as significant predictors of blood
pressure
control.
The
study’s
conclusions
highlighted
the
significant improvement in patients’ medication adherence and
perceived knowledge, persisting for six months, though the impact
on blood pressure was indirect. The author advocates for policy
adjustments,
proposing
integrating
the
pharmacist-led
expert
system alongside PhilPEN as a complementary patient education
program.
This
innovative
approach
stands
poised
to
reshape
hypertension management strategies, offering a promising avenue
for enhancing patient outcomes in the Philippines (Gutierrez,
2021).
Synthesis
The
literature
review
thoroughly
examines
community
pharmacists’ roles in healthcare, emphasizing patient education,
prescription review, and overall contributions. The benefits of
medication
review
interventions
are
emphasized
in
foreign
literature, especially when it comes to treating drug-related
issues and enhancing older persons’ medication adherence. Studies
in
the
United
pharmacists’
States
knowledge
show
within
that
recognizing
healthcare
teams
and
utilizing
significantly
improves therapeutic and safety outcomes.
14
Research
from
Saudi
Arabia
emphasizes
the
necessity
for
training programs by pointing out a knowledge gap in drug-drug
interactions among community pharmacists. Assessments conducted in
Pakistan and Iran highlight clinical pharmacists’ critical role in
enhancing
patient
care’s
efficacy,
safety,
and
efficiency,
highlighting the need for methodologically sound research. Views
worldwide on patient education in community pharmacies highlight
various initiatives and the obstacles that prevent pharmacists
from participating in public health campaigns.
Local
research
in
the
Philippines
highlighted
the
difficulties encountered and the increased services pharmacists
offered during the COVID-19 pandemic. Novel approaches, such as
pharmacist-led expert systems, can potentially enhance patient
outcomes and drug adherence. These studies highlight the critical
role
that
community
pharmacists
play
locally
and
worldwide,
highlighting the necessity of ongoing professional development,
improved
research,
and
changed
policies
to
maximize
their
contributions to healthcare.
There are still gaps in the research about the roles and
interventions of community pharmacists. More rigorous studies with
a worldwide focus are needed, especially those using sensitivity
and
specificity
outcome
measures.
Additionally,
studies
are
limited geographically in that they concentrate on specific areas,
leaving
gaps
in
our
knowledge
of
the
larger
international
15
environment.
Furthermore,
interventions
are
the
emphasized,
benefits
but
of
medication
surprisingly,
few
review
studies
examine the complex consequences and cultural differences. There
is conflicting data regarding the efficacy of community pharmacist
treatments in areas like helping people manage their weight and
providing guidance on alcoholism and antibiotic use. Moreover,
thorough evaluations of community pharmacies’ long-term effects
and responses are lacking. Filling in these gaps will help create
evidence-based procedures and guidelines, guaranteeing a more
comprehensive knowledge of community pharmacists’ responsibilities
and how they affect patient outcomes.
List references here
At least 20 sources
16
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