Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

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TL;DR

This supplement contains abstracts from the 13th PCNE Working Conference, focusing on new roles for pharmacies in pharmaceutical care. Key findings include that problematic prescribing cascades are common and often significant, elderly patients are generally willing to have pharmacists involved in deprescribing, and a reminder device significantly improved adherence to direct oral anticoagulants in stroke patients. The clinical significance lies in demonstrating that community pharmacists can play a crucial role in medication safety, deprescribing, and adherence, bridging gaps between research and practice.

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**Background** This document is a supplement containing abstracts from the 13th PCNE (Pharmaceutical Care Network Europe) Working Conference, themed “Pharmacies' new roles in pharmaceutical care: bridging research and practice.” The conference covers a wide range of topics related to the expanding role of pharmacists, including prescribing cascades, deprescribing, medication reviews, adherence interventions, and the implementation of pharmaceutical care services across different countries and settings.

**Methods** The supplement includes both oral and poster presentations, each employing diverse methodologies. For example, abstract 583 (Mohammad et al.) used a mixed-methods approach, starting with a literature review and expert assessment to identify problematic prescribing cascades, followed by a Prescription Sequence Symmetry Analysis (PSSA) to quantify their occurrence using Dutch dispensing data from 2015-2020. Abstract 581 (Bužančić et al.) was a cross-sectional study using a questionnaire (rPATD) administered by community pharmacists to elderly patients in three regions of Croatia. Abstract 614 (Dietrich et al.) was a randomised cross-over trial (MAAESTRO; NCT03344146) investigating the effect of an intake aid with a reminder function on adherence to direct oral anticoagulants (DOACs) in stroke patients, using an electronic device for measurement. Abstract 608 (Pflieger and Ravera) used a web-based survey distributed to National Focal Points in South-eastern Europe Health Network (SEEHN) member states to map the implementation of pharmaceutical care. Abstract 624 (Amador-Fernández et al.) used semi-structured interviews based on the Consolidated Framework of Implementation Research (CFIR) and a questionnaire to identify barriers and facilitators for pharmacist prescribing in Switzerland.

**Key Results** - **Prescribing Cascades (Abstract 583):** Of 85 prescribing cascades assessed by 16 experts, 67 were deemed problematic. A significant adjusted sequence ratio (aSR) was found for 43 (64%) of these problematic cascades, involving more than 60,000 out of 423,000 incident users (mean age 68 years). The highest aSR was 5.12 [95% CI 54.41–5.83] for lithium inducing parkinsonism. ACE-inhibitors inducing urinary infection showed the most incident users (33,563). - **Deprescribing (Abstract 581):** Among 194 elderly patients (median age 76, median 5 medicines), 87.11% were willing to stop one or more medicines. 70.10% believed their pharmacist has enough knowledge to suggest deprescribing, and 70.60% would feel comfortable with pharmacist involvement. Patients from rural Slavonia were more willing to stop medicines than those from urban Zagreb or coastal Dalmatia (59.46%, 31.09%, and 23.68% respectively, p=0.007). - **DOAC Adherence (Abstract 614):** In 84 stroke patients (mean age 76.5 years), reminder use significantly improved adherence. The probability of achieving 90%-timing adherence was 2.7-fold higher with a reminder (6% vs 18%; OR 2.65; 95% CI 1.05–6.69; p=0.039). Overall timing adherence increased from 92% [IQR 81–97] without reminder to 96% [IQR 85–98] with reminder. - **Pharmaceutical Care Implementation (Abstract 608):** In SEEHN member states, the concept of pharmaceutical care is familiar to 62.5% of respondents. Electronic Health Information Exchange is more common in hospital pharmacies (75%) than community pharmacies (25%). Major barriers include absence of regulations, lack of data on proven benefit, and lack of access to patient medical records. - **Pharmacist Prescribing (Abstract 624):** Main barriers to implementation in Switzerland were non-reimbursement, irrelevance of drugs included, negative perception by GPs, and lack of time. Facilitators included availability of information, being part of a pharmacy group, and proximity/accessibility. - **Medication Review Interventions (Abstract 635):** Preliminary results from a controlled clinical trial showed significant differences between intervention and control groups in the mean number of medications (3.9 points) and potentially inappropriate medications (3.6 points), but no significant differences in hospital admissions or deaths. - **Drug-Related Problems (Abstract 579):** In 460 patients undergoing elective surgery, age and the calculated Charlson Comorbidity Index (CCI) were associated with a higher risk of drug-related problems. - **Pediatric DILI (Abstract 584):** In Taiwan, 484 suspected DILI cases were identified from 17,248 reports. Oxacillin (ROR 5.33; CI 3.14–8.78), isoniazid (ROR 23.77; CI 8.83–67.92), and rifampicin (ROR 13.97; CI 5.71–33.48) were significantly associated with DILI. Valproic acid was the only anticonvulsant with a significant ROR (3.23; CI 1.39–7.02). - **Retinoid Risk Awareness (Abstracts 586, 588):** Awareness of teratogenic risks was high among patients, pharmacists, and physicians (83-100%). However, adherence to pregnancy prevention measures varied considerably, with measures requiring patient signatures being least used. - **Medication Discrepancies (Abstract 619):** In 9 patients with multiple long-term conditions, all had at least one medication discrepancy after hospital discharge, with a median of 4 discrepancies (range 1-9). - **CMM in CVD (Abstract 627):** A comprehensive medication management intervention significantly improved systolic blood pressure (p=0.038), diastolic blood pressure (p=0.001), total cholesterol (p=0.014), LDL cholesterol (p=0.005), and HbA1c (p=0.045). Hospital admissions and unplanned GP visits were 3.35 and 2.34 times higher in the control group, respectively.

**Clinical Implications** The findings collectively underscore the expanding and vital role of community pharmacists in various aspects of patient care. The high prevalence of problematic prescribing cascades and drug-related problems highlights the need for pharmacist-led medication reviews and interventions to improve medication safety. The positive patient attitudes towards pharmacist involvement in deprescribing and the demonstrated effectiveness of adherence-enhancing interventions (like reminder devices) support the integration of these services into routine practice. However, significant barriers to implementation, including lack of reimbursement, time constraints, and insufficient interprofessional collaboration, need to be addressed through policy changes, education, and the development of supportive frameworks. The studies also emphasize the need for targeted interventions for vulnerable populations, such as the elderly, those with polypharmacy, and patients with communication difficulties.