Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: eHealth tools are becoming increasingly popular for helping patients self-manage chronic conditions. Little research has examined the effect of ehealth tools for patient self-reporting on medication management. This review aims to determine whether ehealth tools featuring patient self-reporting of symptoms, adverse effects and drug therapy problems are effective at prompting medication changes and improving patient outcomes. Objective: The primary objective is to determine how patient self-reporting of symptoms and adverse effects via ehealth tools influences medication use and changes made to medications. Secondary objectives are to investigate how patient use of ehealth tools influences identification of adverse events, patient self-management of disease and self-efficacy, medication use behaviour, medication reconciliation and recommendations for drug changes, changes in patient signs and symptoms, health services utilization, quality of life, and patient satisfaction with health care. Methods: MEDLINE, EMBASE and CINAHL were searched from Jan 1, 2000 through to January 4, 2016. References were also searched. Title, abstract and full text review, as well as data abstraction and risk of bias assessment were performed in duplicate. Due to high heterogeneity, results were not meta-analyzed, and instead presented as a narrative synthesis. Results: 13 studies, including 10 randomized controlled trials (RCTs) and 3 single-arm cohort studies were included, from which 10 unique ehealth tools were identified. Here six of seven RCTs found improvement in patient symptoms following ehealth tool use, especially in adolescent asthma patients. Four of six RCTs reported that ehealth tools may have potential to initiate changes to medications based on patient self-reports. Two of four RCTs showed that ehealth tools may improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of ehealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behaviour, health service utilization, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy. Conclusions: Initial evidence showing ehealth tools may improve patient symptoms and lead to medication changes is promising. Patients generally found ehealth tools useful in improving communication with health care providers. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how ehealth tools can be used to effectively manage use of medications to improve patient outcomes.

The movement to integrate pharmacists into a primary care team-based settings is growing in countries such as Canada, the United States, the United Kingdom, and Australia. In the province of Ontario in Canada, almost 200 pharmacists have positions within interdisciplinary primary care team settings, including Family Health Teams and Community Health Centers. This article provides a narrative review of the evolving roles of pharmacists working in primary care teams, with a focus on evidence from Ontario, as well as drawing from other jurisdictions around the world. Pharmacists within primary care teams are uniquely positioned to facilitate the expansion of the pharmacist’s scope of practice, through a collaborative care model that leverages, integrates, and transforms the medication expertise of pharmacists into a reliable asset and resource for physicians, as well as improves the health outcomes for patients and optimizes healthcare utilization.

Introduction: Closed-system transfer devices (CSTDs) were introduced into clinical practice to protect healthcare practitioners (HCPs) from exposure to hazardous drugs. However, ambiguous guidelines have led to confusion as to when CSTD use is required, as institutes are instructed to maintain their own hazardous drug lists and determine the appropriate level of personal protective equipment for their staff. This study seeks to understand the current use of CSTDs by Canadian oncology HCPs, the influence of various stakeholders on their use and the challenges faced by HCPs surrounding the use of these medical devices. Methods: The researchers compiled a set of questions to inform on the current use of CSTDs in clinical practice and administered an online survey to oncology HCPs across Canada. Results: The results indicate that though CSTD use is common in Canadian oncology practice settings, there is variation in the extent of the use of these devices across provinces and with which products these devices are used. The survey results also show that the top challenges with the use of CSTDs include cost, lack of information on the compatibility of a CSTD with a drug product, and CSTD impact on drug quality. Many respondents are aligned that regulatory bodies are more likely to influence the use of CSTDs with specific drug products than drug manufacturers. Conclusion: Guidelines for the application of CSTDs in clinical practice vary and are often ambiguous. Regulatory bodies are uniquely positioned to provide healthcare institutions with more clarity on when CSTD use is appropriate.

BACKGROUND Electronic health (eHealth) tools are becoming increasingly popular for helping patients’ self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use. OBJECTIVE The objective of this systematic review was to determine the impact of patients’ use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use. Related secondary outcomes were also evaluated. METHODS MEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April 25, 2018. Reference lists of relevant systematic reviews and included articles from the literature search were also screened to identify relevant studies. Title, abstract, and full-text review as well as data extraction and risk of bias assessment were performed independently by 2 reviewers. Due to high heterogeneity, results were not meta-analyzed and instead presented as a narrative synthesis. RESULTS A total of 14 studies, including 13 randomized controlled trials (RCTs) and 1 open-label intervention, were included, from which 11 unique eHealth tools were identified. In addition, 14 RCTs found statistically significant increases in positive medication changes as a result of using eHealth tools, as did the single open-label study. Moreover, 8 RCTs found improvement in patient symptoms following eHealth tool use, especially in adolescent asthma patients. Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of eHealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behavior, health service utilization, adverse effects, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy. CONCLUSIONS Evidence suggests that the use of eHealth tools may improve patient symptoms and lead to medication changes. Patients generally found eHealth tools useful in improving communication with health care providers. Moreover, health-related outcomes among frequent eHealth tool users improved in comparison with individuals who did not use eHealth tools frequently. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how eHealth tools can be used to effectively manage use of medications to improve medication management and patient outcomes.