Pharmacists can no longer ignore the medication use problems encountered by the blind people. This study may serve as an initial step for planning improvements in pharmaceutical services provided to blind patients. The government, pharmaceutical companies and pharmacists must work in collaboration to address the special needs of the blind.

Background People with visual impairment often report poorer health and encounter many challenges when using medicines. Pharmacists can play a significant role in optimising medicines use for these patients. However, little is known about pharmacists’ current practices when providing services to this population nor the impact of such services, if any, on medicines optimisation-related outcomes. Aim of the review This systematic review aims to identify the types, and assess the effectiveness of, interventions provided by pharmacists on medicines optimisation-related outcomes. Method Systematic searches of the following electronic databases were carried out from date of inception to March 2018: Cochrane Library; MEDLINE; EMBASE; International Pharmaceutical Abstracts; Scopus; and Cumulative Index to Nursing and Allied Health Literature. Several trial registries and grey literature resources were also searched. Any randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies, or interrupted time series analyses reporting on interventions provided by pharmacists to adult visually impaired patients and/or their caregivers in order to improve medicines optimisation-related outcomes of medicine safety, adherence, patient satisfaction, shared decision making, or quality of life were included. Results A total of 1877 titles/abstracts were screened, and 27 full text articles were assessed for eligibility. On examination of full texts, no studies met the inclusion criteria for this review. Conclusion This review highlights the need for future research that would be vital for promoting the safe and effective use of medicines and the delivery of pharmaceutical care services to people with visual impairment.

Introduction Pharmaceutical services for visually impaired (VI) individuals are lacking, both worldwide and in Saudi Arabia (SA). Little evidence exists for effective pharmaceutical interventions to support medicines optimisation in this population (1). The Medical Research Council advocates theory-based intervention development and feasibility testing before full implementation. A feasibility study ‘asks whether something can be done, should we proceed with it, and if so, how’. Aim To design and test the feasibility of IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired). Methods Phase 1 focused on developing the intervention. Using the theoretical domains framework (TDF) (2), 26 hospital/community pharmacists in SA were interviewed about their dispensing/counselling behaviour with a view to developing an intervention. The research team identified nine key TDF domains and selected eight behaviour change techniques (BCTs) to include in the intervention which could potentially enhance the pharmacist’s knowledge, skills and help them monitor their behaviour. The BCTs were operationalised to produce an intervention package including a training session for pharmacists, behaviour goal setting and review sheets, a checklist with 25 steps to follow during dispensing/counselling (e.g., Ask “What is the best method to provide information about medications to you and/or your caregiver?”), sample patient scenarios, and an intervention record and manual. Phase 2 tested the feasibility of the intervention and study procedures (recruitment, data collection) at two hospital outpatient pharmacies. Two pharmacists, recruited through the pharmacy supervisor, were trained and provided with all intervention materials. Pharmacists were asked to implement the intervention with VI adult patients taking ≥3 medicines. Due to difficulties in identifying patients prior to attending the pharmacy, records of those requesting refills for out-of-stock medicines were used to recruit patients. Outcomes focused on the feasibility of recruitment, and collecting data on pharmacists’ experience and patients’ medicines/medical conditions. Pharmacists and patients provided feedback through interviews and telephone-administered questionnaires, respectively. Descriptive statistics and thematic analysis were used to analyse data. Results Two pharmacists implemented the IDC-VI with five patients. The patient recruitment process was practical at the time, but not feasible for a future study as the pharmacy stopped collecting records of those requesting out-of-stock medications. Data on pharmacists’ experience and patients’ clinical data were easily collected via interviews or extracted from medical/pharmacy records, respectively. The dispensing/counselling process took 15-30 minutes. Both pharmacists thought the intervention was useful, but were concerned about its acceptability/practicability, due to heavy workload and time constraints at the pharmacy. Shortening the dispensing/counselling checklist was suggested to improve acceptability. Three patients reported that the service had somewhat influenced how they took their medications due to the additional information obtained. Two patients reported very little or no influence at all. Conclusion The IDC-VI used a novel approach in developing and testing an intervention targeting pharmaceutical care services to VI patients. It was potentially feasible. Numbers completing the study were small, although the final sample was inclusive in terms of age, gender, and visual impairment levels. Amendments are required before testing the intervention in a larger pilot trial. References 1. Kentab BY, Barry HE, Al-Aqeel SA, Hughes CM. A systematic review of pharmacists' interventions to support medicines optimisation in patients with visual impairment. Int J Clin Pharm. 2019;41(6):1400-7. 2. Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2015;20(1):130-50.