Chronotherapy in practice: the perspective of the community pharmacist
- 371 Downloads
Background Optimising the time of drug administration in alignment with circadian rhythms to enhance the clinical effect or minimise/avoid adverse effects is referred to as chronotherapy. Pharmacists have a key role in providing medicine related information, including counselling about the optimal time for medication administration. Where applicable, the principles of chronotherapy should underlie this aspect of medication counselling. Despite significant developments in the science of chronotherapy for specific pharmacological treatments, the perspective of pharmacists about their understanding and application of these principles in practice has not been explored. Objective To explore community pharmacist’s viewpoints about and experience with the application of chronotherapy principles in practice. Setting Community pharmacies within metropolitan Sydney in New South Wales, Australia. Methods Semi-structured, face to face interviews with a convenience sample of community pharmacists were conducted. All interviews were audio-recorded, transcribed verbatim and thematically analyzed using a ‘grounded theory’ approach, given the novelty of this area. Main outcome measure Community pharmacists’ awareness, current practice and future practice support requirements about the principles of chronotherapy. Results Twenty-five semi-structured interviews were conducted. Most participants reported encountering cases where clinical decision making about suggesting appropriate times of drug administration to patients was needed. Their approach was mainly pragmatic rather than based on theoretical principles of circadian variation in drug disposition or on current or emerging evidence; thus there was an evidence practice chasm in some cases. However, most participants believed they have an important role to play in counselling patients about optimal administration times and were willing to enact such roles or acquire skills/competence in this area. Conclusion Community pharmacists contribute to the safe and effective use of medications in providing the patients with information on optimal timing of drug administration during counselling. Further education, practical training and access to information may help pharmacists in translating principles of chronotherapy into the practice.
KeywordsAustralia Chronotherapy Circadian rhythms Community pharmacist Timing of drug administration
The authors wish to thank the community pharmacists who consented to take part in the interview. Gagandeep Kaur is the recipient of scholarships from the NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS). Yuh-Lin Gan is the recipient of Summer Scholarship by Faculty of Pharmacy at The University of Sydney.
Conflicts of interest
- 1.Ortiz M, Cecere R, Gallagher R. Impact of the Mirixa Program on patient compliance to therapy. Aust Pharm. 2011;30(3):244.Google Scholar
- 4.Smolensky MH, Siegel RA, Haus E, Hermida RC, Portaluppi F. Biological rhythms, drug delivery, and chronotherapeutics. In: Siepmann J, Siegel RA, Rathbone MJ, editors. Fundamentals and applications of controlled release drug delivery. Advances in delivery science and technology. New York: Springer; 2012. p. 359–443.CrossRefGoogle Scholar
- 6.Hermida RC, Calvo C, Ayala DE, Covelo M, Rodriguez M, Lopez JE. Administration time-dependent effects of nifedipine GITS on ambulatory blood pressure in patients with essential hypertension. Am J Hypertens. 2005;18(S4):63A.Google Scholar
- 18.Zhao P, Xu P, Wan C, Wang Z. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev. 2011(10):Cd004184. doi: 10.1002/14651858.CD004184.pub2.
- 31.Mental health care project—A framework for pharmacists as partners in mental health care [Internet]. Deakin West, ACT, Australia: Pharmaceutical Society of Australia; 2013 [cited 2015 Sept 10]. http://www.psa.org.au/policies/mental-health-care-framework.
- 32.Corbin J, Strauss A. Grounded theory methodology. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Beverly Hills: Sage; 1994. p. 273–85.Google Scholar
- 33.Expenditure and prescriptions twelve months to 30 June 2014 [Internet]. Canberra: Department of Health, Pharmaceutical Policy Branch; [updated 2015 Jan 26; cited 2015 Sept 10]. http://www.pbs.gov.au/info/statistics/expenditure-and-prescriptions-30-06-2014/.
- 34.TGA eBS—Product and Consumer Medicine Information [Internet]. Therapeutic Goods Administration; [updated 2015 Sept 16; cited 2015 Sept 16]. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&t=&q=Coversyl&r=/.
- 37.Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204.CrossRefPubMedGoogle Scholar
- 46.Lincoln YS, Guba EG. Naturalist inquiry. Beverly Hills: Sage; 1985.Google Scholar
- 48.Snowball recruitment—active and passive [Internet]. Sydney: University of Sydney; [updated 2014 Apr 17 cited 2015 Mar 21]. http://sydney.edu.au/research_support/ethics/human/guidelines/snowballing.shtml.
- 49.Lawrence J, Tar U. The use of grounded theory technique as a practical tool for qualitative data collection and analysis. Electron J Bus Res Methods. 2013;11(1):29–40.Google Scholar
- 50.Creswell JW. Qualitative inquiry and research design: choosing among five approaches. 3rd ed. London: Sage; 2013.Google Scholar
- 51.Cho JY, Lee E-H. Reducing confusion about grounded theory and qualitative content analysis: similarities and differences. Qual Rep. 2014;19(32):1–20.Google Scholar
- 52.Alsaikhan MAA-EF, Alsubaie M, Aldosari SA, Alhamaad A. Antihypertensive medications and chronopharmacology: role of Saudi pharmacists in patient education. Int J Dev Res. 2015;5(3):3831–5.Google Scholar
- 62.Touitou Y, Haus E, editors. Biologic rhythms in clinical and laboratory medicine. Berlin: Springer; 1992.Google Scholar