Abstract: Objective To identify and prioritise facilitators for practice change in Spanish community pharmacy. Setting Spanish community pharmacies. Method Qualitative study. Thirty-three semi-structured interviews were conducted with community pharmacists (n = 15) and pharmacy strategists (n = 18), and the results were examined using the content analysis method. In addition, two nominal groups (seven community pharmacists and seven strategists) were formed to identify and prioritise facilitators. Results of both techniques were then triangulated. Main outcome measures Facilitators for practice change. Results Twelve facilitators were identified and grouped into four domains (D1: Pharmacist; D2: Pharmacy as an organisation; D3: Pharmaceutical profession; D4: Miscellaneous). Facilitators identified in D1 include: the need for more clinical education at both pre- and post-graduate levels; the need for clearer and unequivocal messages from professional leaders about the future of the professional practice; and the need for a change in pharmacists' attitudes. Facilitators in D2 are: the need to change the reimbursement system to accommodate cognitive service delivery as well as dispensing; and the need to change the front office of pharmacies. Facilitators identified in D3 are: the need for the Spanish National Professional Association to take a leadership role in the implementation of cognitive services; the need to reduce administrative workload; and the need for universities to reduce the gap between education and research. Other facilitators identified in this study include: the need to increase patients' demand for cognitive services at pharmacies; the need to improve pharmacist-physician relationships; the need for support from health care authorities; and the need for improved marketing of cognitive services and their benefits to society, including physicians and health care authorities. Conclusion Twelve facilitators were identified. Strategists considered clinical education and pharmacists' attitude as the most important, and remuneration of little importance. Community pharmacists, in contrast, considered remuneration as the most important facilitator for practice change.
Abstract: The aim of this study was to translate into Portuguese and validate the Pharmacy Services Questionnaire (PSQ). The instrument includes 20 questions that measure user satisfaction with pharmacy services, and is organized according to two factors. It uses a Likert scale of answers from 1 (poor) to 5 (excellent). The PSQ-Brazil was applied to 137 diabetics from 31 to 89 years of age (60.6% women), clients of private pharmacies, mostly users of public health services (65.7%), with low education (67.9% elementary schooling or less), and who used an average of 4.3 medicines per person. Overall score in the sample was 3.6 (SD = 1.1 [95%CI 3.4-3.8]). After factor analysis, 'pleasant exposure' and 'treatment management' included 8 and 12 items, respectively, and were significantly correlated with each other (r = 0.92, p < 0.001) and with the overall score. The instrument obtained a Cronbach's alpha of 0.98 for the overall score. The pleasant exposure and treatment management variables showed alphas of 0.94 and 0.98. PSQ-Brazil shows adequate reliability and validity for use in the country.
Abstract: OBJECTIVE: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system. METHODS: In a prospective clinic study, 161 patients were divided into two groups, of which only one group received PF for 12 months. From the results, we calculated data of effectiveness and costs. The primary endpoint was the economic evaluation PF by using an indicator of effectiveness (changes in glycated hemoglobin), which was related to the costs of pharmaceutical care. Secondary endpoints were values of blood pressure, waist circumference and body mass index of patients, also related to costs of pharmaceutical care. RESULTS: A real reduction of 1.3% of HbA1 was observed in the PF group, in comparison to control group. The annual cost of the reduction in 1% in HbA1 values in the PF group patients was $45.15. This feature to improve the control of type 2 diabetic patients can be implemented with annual investments of about $225.76 per patient, using PF and monitoring of blood glucose test. CONCLUSIONS: It is possible to reduce the HbA1 values to desired levels by using PF. This can be considered an additional resource for the attainment of metabolic control, resulting in this study a cost of $37.62 per patient, per year, to reduce 1% in the HbA1 values.
Abstract: Objective The aim of this research was to assess the effects of a series of four training courses comprised of 13 synchronous videoconferences on the implementation of cognitive services in Spanish community pharmacies. Setting A phone survey to continuing training course attendants. Methods A random sample of 225 pharmacists registered in a 2004 videoconference course was selected. The phone-survey questionnaire included quality perception elements rated on a 5-point Likert scale, and a series of questions used to identify position in the Rogers 5-step innovation-decision model. An algorithm was used to translate the questions into Rogers' categories. To discover determinants of attendants position in these categories, bivariate analysis, simple correspondence analysis, and logistic regressions were performed. Main outcome measure Position in Rogers' diffusion of innovation steps regarding the adoption of pharmacotherapy follow-up. Results The perception of the course quality rated between good and very good for the majority of respondents. A significant association between having attended two or more of these four courses and the Persuasion/Decision step in Rogers's model appeared. No association was found between course attendance and the Implementation/Confirmation step of patient follow-up. Fifty percent of those who indicated they implemented the service reported following-up with less than 10 patients, and only 25% reported following up with more than 20 patients. Conclusions Although participation in these courses was associated with higher steps in Rogers' model, significant association appeared only with Persuasion/Decision steps and not with the Implementation/Confirmation step, reflecting an attitude but not a performance change.
Abstract: Objective: To assess the compliance of Acta Medica Portuguesa of international guidelines for layout of serial publications. Methods: Compliance assessment of international guidelines for serial publications included in a recent review published by the Spanish Foundation for Science and Technology. Only chapters regarding layout, but not those related with instructions for authors and editorial policy were assessed. Compliance of chapters of general characteristics and issue table of contents was evaluated from Acta Medica Portuguesa web page; the chapter contributions was evaluated analyzing the layout of the articles published in 2007. Results: In 2007, 70 articles were published in the 6 issues constituting the volume 20 of Acta Medica Portuguesa. Out of the 76 criteria assessed, 7 were considered as non-applicable. From the remaining 69 criteria, Acta Medica Portuguesa complies with 27 (39.1%). Discussion: Simple solutions are suggested to comply with 51 criteria (73.9%), being 10 criteria considered as under discussion when thinking on online journals edition. Current study has not assessed criteria of instructions for authors and editorial policy, which should soon undergo another assessment. Conclusion: Acta Medica Portuguesa complies about 39% of criteria from the guidelines for journal layout, but with slight modifications could achieve near 75% of compliance.
Abstract: OBJECTIVE: To evaluate the psychometric properties of Brazilian version of Diabetes Quality of Life measure (DQoL-Brazil). METHODS: The DQOL was translate to Portuguese, following a recommended protocol, and applied to 121 subjects (56.2% females) with average diagnostic to type 2 diabetes of 8.1 (SD=7.13) years, (range 32-89 years old). RESULTS: The translated measure showed high internal consistency (Cronbach's alpha = 0.92). A positive correlation (p < 0.01) was found between all the items and their scales and the total score of instrument, except in the items 18 and 35. These items were excluded from the translated version of DQoL. In concurrent validity analysis, patients with HbA1C higher than 9% presented a significantly higher (p = 0.01) total score for DQoL. CONCLUSION: DQoL-Brazil presents reliability and validity to be used in type 2 diabetes adult patients.
Abstract: BACKGROUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as "Mini Cuestionario de Calidad de Vida en Hipertensión Arterial" (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbachs alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbachs alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges assessment attained a high level of agreement (75.44%). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.
Abstract: INTRODUCTION: Elderly drug therapy needs special care considering physiopathological alterations of this age group that increase the risk of adverse drug events occurrence and due to the high number of drugs used. Several tools have been created, as tables of drugs and groups of drugs to be avoided in patients 65 years old and over. Beers Criteria of 2002 update is the most used tool. GOALS: To operationalize Beers Criteria to be used by health care professionals in Portugal. METHODS: Analysis of the drugs and therapeutic classes included into the Beers Criteria approved for market in Portugal and the identification of other approved substances included in the pharmacological classes mentioned in Beers Criteria. The two tables in the Beers criteria were adapted to substances approved in Portugal, even including other marketed active substances belonging to therapeutic classes mentioned in Beers criteria. Levels of inappropriateness and the potential effects after their use in elderly were also included. In Beers table 1, 34 included substances don't have approval in Portugal, and 4 have different denominations. In Beers table 2, three tricyclic antidepressants, 12 typical antipsychotics, 5 doses for short-action benzodiazepines, and 28 NSAIDs (being two coxibs) were included. CONCLUSIONS: The Portuguese operationalization of the Beers Criteria allows the creation of a tool that helps prescribers to choose drugs and doses for a safer prescription to the elderly. These adapted tables allow benchmarking among studies assessing inappropriateness of use of drugs in different countries using Beers Criteria.
Abstract: BACKGROUND: The complexity of pharmacotherapy is a result of a multiplicity of prescribed regimen factors, including the number of different drugs in the regimen, the number of dosage units per dose, the total number of prescribed doses per day and administration instructions. The Medication Regimen Complexity Index (MRCI) is a specific, reliable and valid tool used to measure the complexity of pharmacotherapy, originally developed in English language. OBJECTIVE: Transcultural translation and validation of this tool into Brazilian Portuguese. METHODS: A cross-sectional study was developed with 95 type-2 diabetes patients, receiving multiple medications. The validation process included translation into Portuguese, back-translation and pre-test of the tool, creating a new version called the Pharmacotherapy Complexity Index (PCI). The psychometric parameters were assessed, including convergent validity, discriminant validity and reliability (interclass and test-retest correlation). RESULTS: The complexity of pharmacotherapy measured by the MRCI-Brazil had an average score of 15.7 points (SD=8.36). MRCI-Brazil showed significant correlation with the number of medications (r=0.86; p<0.001) and age of patients (r=0.28, p=0.005). Interrater reliability analysis found an intra-class correlation (ICC) of 0.99 (p<0.001) and test-retest correlation was of 0.997 (p<0.001). CONCLUSION: The results have shown that the Brazilian version of the MRCI presents adequate validity and reliability, and may be useful in clinical practice and research involving the analysis of the drug regimen complexity.
Abstract: OBJECTIVE: To describe the evolution of antidepressant use in primary care in the Valencian region (Spain) from 2000 to 2004 and to analyze the effects of reference-based price and generic drugs introduction on drug utilization and cost saving. METHODS: Retrospective observational study in primary care using sales data collected from antidepressant group (N06A), corresponding to the period 2000-2004. Defined daily dose (DDD)/1000 inhabitants per day were obtained as consumption data. Cost and cost/DDD rate evolution was related to reference price system implantation. RESULTS: Antidepressant utilization progressively increased by 44.0% from 30.3 DDDs/1000 per day in 2000 to 43.5% in 2004. Selective serotonin reuptake inhibitors (SSRIs) comprised 77% of the total consumption where paroxetine, sertraline and fluoxetine were the most used drugs in 2004. The proportion of relative use and cost of fluoxetine declined after a reference price and the introduction of generic competitors were put into effect in 1999; cost/DDD was reduced by 1.8. Third-generation antidepressants showed a fast rising rate i.e. venlafaxine utilization multiplied by 2.2; this drug with the higher cost/DDD was not subjected to the reference price system. Reduction in citalopram utilization was related to a replacement by its recently marketed enantiomer escitalopram. CONCLUSIONS: In 2004, reference price policy and the implementation of generic drugs reduced the antidepressant cost by DDD. However, antidepressant expenditure increased since 2000 due to a continued growth in consumption (SSRIs and novel agents) and a displacement of prescriptions to drugs that were not included in the reference price policy.
Abstract: OBJECTIVE: To identify and assess barriers for dissemination, implementation, and sustainability of different cognitive services in Spanish community pharmacies. DESIGN: Qualitative study through semi-structured interviews followed by a descriptive analysis. METHOD: Two groups of experts related to Spanish community pharmacy were chosen. One with 15 community pharmacists with a relevant professional activity, while the other group (n=18) was related to pharmacy strategists. RESULTS: The lack of university clinical oriented learning, lack of pharmacists' attitude towards change and some uncertainty over their professional future were identified as barriers at the pharmacists' level. In relation to pharmacy as an organization the lack of clear messages by their leaders and the small volume of Spanish pharmacies were identified as barriers. In the category of pharmacy profession, the current reimbursement system, the lack of university clinical education, and the lack of leadership by current representative organizations were the barriers found. The lack of real involvement by health authorities, the lack of knowledge about the objectives of pharmacy cognitive services, and the lack of demand of these services by patients where also identified as barriers. CONCLUSIONS: Finally, 12 barriers were identified and grouped into 6 categories. These barriers fit in with the barriers identified in other countries.
Abstract: The aim of the study was to assess the clinical pharmacology information provided in the summaries of product characteristics (SPCs) of European drugs compared with their package inserts. A list of the 150 most prescribed drugs at the local Health Service was assessed. To analyze clinical pharmacology information contained in package inserts and SPCs, Spyker's systematized scoring approach was used (scoring from 0 to 2). Ninety-one SPCs (84.3%) and 108 package inserts were obtained. The mean score for core information provided in the package inserts was 7.94 (confidence interval (CI) 95 %: 7.34-8.53), whereas for the SPCs it was 17.62 (CI 95 %: 16.48-18.75; 35.2% of the maximum). One core information item and two extra credit items were not contained in any of the SPCs. In the European Union the clinical pharmacology information found in SPCs is clearly insufficient. An improved access to and regular review of the SPCs might substantially improve the access and quality of clinical pharmacology and other prescribing information.
Abstract: INTRODUCTION: The large amount of information in the medical area creates management problems, being necessary systematic methods for filing and retrieval. With information on the context of clinical records, methods must integrate controlled biomedical terminologies and desirable characteristics oriented to the structure, content and clinical results. The objective is to test the applicability and capacity for retrieval of a multidimensional system developed for classification and management of health information. METHODS: Three hundred questions were randomly selected, by computerized method, from the questions received in six years (Medicine Information Service, Pharmaceutical Department, Coimbra University Hospitals). They were characterized and applicability evaluated by classified amount and need to alter the system, which is composed of various independent dimensions, incorporating concepts sometimes hierarchical. Questions retrieval was tested searching information in a dimension or between dimensions. RESULTS: All questions were classified: 53% are clinical cases with illnesses incidence in the genitourinary system; metabolic, nutritional and endocrine disease; cancer; infections and nervous system. In 81%, the object is a drug, mostly anti-infectious and anti-neoplastic agents. The therapeutic and safety areas had been the most requested, regarding the subjects: use, adverse reactions, drug identification and pharmaceutical technology. As to applicability, it was necessary to add some concepts and modify same hierarchical groups, that didn't modify the basic structure, nor had collided with the desirable characteristics. The limitations were related with the incorporated external classification systems. The search in the subject dimension of the concept drug administration retrieved 19 questions. The search between two dimensions: antiinfectious (external) and teratogenicity (subject) retrieved three questions. In the two examples, it was possible to retrieve information from any one of the levels of the hierarchy, from the most general to the most specific and even from external dimensions. CONCLUSIONS: The use of the system in this sample showed its applicability in clinical information classification and filing, retrieval capacity and flexibility, supporting modifications without interfering with desirable characteristics. This tool allows retrieval of patient-oriented evidence that matters.
Abstract: AIM: To assess the medical information provided by manufacturers in response to a specific request, and to compare the responses between generic and brand-name companies. SETTING: Community pharmacy in Spain. METHOD: A systematic request for product monographs was made between 1999 and 2002 to manufacturers registering new medicines in Spain. A standardised letter was sent to the medical affairs departments. If there was no reply after 3 months, a second standardised letter was sent requesting the monograph. Blood derivatives, intravenous medicines, and radiological contrast agents were excluded. MAIN OUTCOME MEASURES: The delay that occurred in receiving information and the type of material sent in response to the request was compared between the two types of companies. RESULTS: About of 833 medicines from 185 manufacturers were registered during the time period studied. After applying exclusion criteria, 805 medicines, including 419 (52.0%) generic and 386 (48.0%) brand-name products, were analyzed. No replies were received for 242 (30.0%) requests 183 (43.7%) generics and 59 (15.3%) brand-names; P < 0.005). We received 369 (65.5% of 533) replies after the first request: 140 of 236 (59.3%) generics and 229 of 327 (70.0%) brand-names (P = 0.009). The average response delay was 9.7 days [CI95%: 8.65-10.68]. There was a statistically significant difference between generic and brand-name companies after the first request (P = 0.001), but not after the second request (P = 0.312). CONCLUSION: Brand-name manufacturers reply more often, more quickly, and with better quality information than generic manufacturers.
Abstract: PAHO establishes guidelines that must be met by drug information centers (DIC) and the drug information services (DIS).
Objective: To describe the operations, activities, and resources of the DICs and the DISs affiliated with public institutions of Costa Rica, and their adjustment to the provisions set forth by the PAHO.
Methods: Descriptive study conducted in May 2003. The officers in charge of each of the seven public DICs or DISs in Costa Rica were interviewed, and inquiries were made regarding aspects of the structure and process of their centers.
Results: In Costa Rica there are seven public drug information units, that is, four DICs and three DISs. One of the DICs is located in this university, and the remaining six centers and services are in located in hospitals. Five of the centers do not have the primary sources required by the PAHO. Fifteen out of the 36 tertiary sources recommended are not available in any of the centers. 100% of the information units carry out four main activities: answering inquiries from the hospital community, answering inquiries from users outside the hospital, implementing education programs for patients and risk groups, and rotation programs for student training.
Conclusions: The activities developed by the DISs and the DICs in Costa Rica are similar to each other; they respond not only to the PAHO’s guidelines, but they also have similarities with the activities and operations of other DICs worldwide. Primary, secondary, and tertiary bibliographical support must be strengthened.
Abstract: The present study aimed to assess knowledge and attitudes of the pharmacists on dispensing drugs to pregnant women.
Methods: Cross-sectional study in 150 community pharmacies randomly selected in Curitiba (Brazil). A closed end questionnaire with 25 questions were used, including dispensing scenarios containing risk types A, B, D or X and questions on pharmacist interaction with pregnant women, physicians, and information sources availability.
Results: Pharmacists performed appropriately in 53% of the encounters. Lower success were associated to prednison and captopril (24.8% in both), end cases producing more doubts were captopril (31.7%) and simvastatin (30.7%). Most of the pharmacists state have advised drugs to pregnant women or contact to the physician to discuss about a prescription related with this issue. A Majority (64.4%) did not feel able to understand FDA risk classification and did not have trustable information sources in pharmacy.
Conclusions: Pharmacists dispensing drugs in Curitiba are not able to interpret information on the use of drugs in pregnant women, and they don have reliable information sources on the use of dugs in pregnancy. However, they advice and counsel drugs to pregnant women and discuss with physicians therapeutic strategies.
Abstract: OBJECTIVE: To assess customers' expectations and satisfaction with a community pharmacy which does not provide advanced professional cognitive services (APCS). Method: A non-validated questionnaire was designed; the questionnaire included items on expectations with pharmacy services and on satisfaction with the existing services. An independent interviewer was appointed to survey people leaving the pharmacy; the questionnaire was administered on two randomly chosen days. RESULTS: The mean age of respondents (n=61) was 46 years. Expectations: The most highly ranked item was "Drug available in the pharmacy" (4.97 on a 5-point Likert scale), followed by "Having queries and questions about health problems answered" (4.84). People found it easy "To seek advice on health problems or about medicines from the pharmacist at the counter" (4.48). The lowest ranked item was "reduced waiting time" (3.13). The overall Satisfaction with pharmacy services was high (4.89). CONCLUSIONS: Customers reported a high level of satisfaction in a pharmacy where advanced cognitive services were not available. However, this should not discourage pharmacists from implementing APCS, because patients' expectations are based only on experiences with current distributive services, which fulfill their perceived needs.
Abstract: OBJECTIVE: Our aim was to estimate the prevalence of medicine-related problems, understood as negative clinical outcomes, that result in hospital emergency department (ED) visits and to establish relationships among risk factors and the appearance of pharmacotherapy negative outcomes. METHODS: Methods A stratified two-stage probabilistic sampling approach was used which consisted of stratified random sampling of patients visiting the ED followed up by interviews. A systematic appraisal tool was used to identify pharmacotherapy negative outcomes within the framework of the information gathered. Bivariate and multivariate analyses were carried out. Cost per process was estimated. RESULTS: The prevalence of pharmacotherapy negative outcomes producing ED visits was 33.17% (95%CI: 31.09-35.25). These negative outcomes could be divided into three categories: ineffectiveness (19.76%; 95%CI: 17.92-21.60), necessity/use (10.52%; 95%CI: 9.48-11.56), and lack of safety (2.89%). About 73% (95%IC: 70.03-76.23) of the negative outcomes were considered to be preventable. Average cost per negative outcome was 329.5 euros (95%CI: 185.4-473.5). Factors associated with the appearance of negative outcomes were age, number of medicines taken, and the combined effect of both of these factors. Compared with those participants younger than 18 years, patients between 45 and 64 years of age presented an odds ratio (OR) of 2.52 (95%CI: 1.1-5.78), while those older than 65 years had an OR of 3.63 (95%CI: 1.27-10.35). Compared with people not using medicine(s), patients using one to two different medicines presented with an OR = 19.91 (95%CI: 8.28-47.87), and those using more than three medicines had an OR = 22.71 (95%CI: 3.05-69.26). Finally, compared with patients younger than 18 years and not using medicines, patients aged 45-64 years taking three or more different medicines presented with an OR = 64.07, while those older than 65 years taking three or more medicines presented with an OR = 31.50. CONCLUSION: The prevalence of negative clinical outcomes was 33%, of which more than 73% of these were preventable. Factors associated with their appearance were age, number of medicines, and their combined effect.
Abstract: Pharmaceutical care models and practices differ in various countries. Reimbursement for cognitive services, for example, varies across countries in Europe, Asia, and the Americas. Practice-based research has blossomed in many countries, with different emphases and challenges. This international series will describe the organization of community pharmacy within the healthcare system and report the status of practice-based research. Each paper will focus on one country. The series will conclude with a summary by the series editors describing the key themes across the papers, outlining milestones yet to be achieved, and proposing a research agenda for community pharmacy practice.
Abstract: OBJECTIVE: To review the current status of Spanish community pharmacy, both in practice and research terms, and analyze its future trends. FINDINGS: Spain has a social security system where all citizens receive health care, social services, and pensions. All medical care and surgery are free for citizens; however, community pharmacies in Spain are privately owned. There are geographic and population standards for the establishment of new pharmacies, resulting in an average of 1 pharmacy per 2000 residents. Almost all pharmacies offer the same services: compounding, weight and blood pressure measurement, and cholesterol and glucose testing. There are also other, less-implemented services, such as methadone supply or directed observed treatments. Most of these services are freely provided, except compounding (fee for service), methadone, and directed observed treatments. University pharmacy practice departments do not exist in Spain, which leads to scarce research in this area. DISCUSSION: Efforts have been made to describe and measure the prevalence of negative clinical outcomes produced by pharmacotherapy and create an operational procedure to provide pharmacotherapy follow-up. CONCLUSIONS: Spain has many community pharmacies, but there is little pharmacy practice research. Some advanced cognitive services exist, but few are being remunerated.
Abstract: Objective: To generate a universal classification of different intervention types that can be developed by a pharmacist while conducting pharmacotherapy follow-up.
Methods: Retrospective observational study. Pharmacist interventions sent to the Dader Program are analyzed for the year 2002. A draft listing the first 300 interventions is written for the classification. The list was updated by insertion of the remaining interventions.
Results: Nine types of pharmacist intervention were identified and grouped in three categories: quantity of drug, pharmacological strategy, and patient education. Out of 2,361 pharmacist intervention sheets analyzed, 491 were excluded from the results. The most prevailing pharmacist interventions were those oriented towards the replacement of a drug (23,6 %), followed by those regarding the addition of a drug for the patient (23,5 %). Interventions oriented towards decreasing voluntary noncompliance (14,8 %), withdraw of a drug (14,6 %) and modification of the dose (13,4 %) were also reported. The remaining definite types of intervention were: education about non-pharmacological measures (3,4 %), decreasing of involuntary noncompliance (3,4 %), modification of dosing (2,2 %) and modification of administration schedule (1,2 %).
Conclusions: A universal classification can be established where interventions that can be realized by a pharmacist in search for a solution or to prevent pharmacotherapy negative clinical outcomes are reflected and defined.
Abstract: Assessing medication complexity may be useful to the pharmacist providing pharmacotherapy follow-up, because this allows a more accurate approach to the way a patient uses the medicines.
The aim of the present stud was to evaluate the Regimen Medication Complexity Index (MRCI) in diabetic patients under pharmacotherapy follow-up, and also the applicability of the situation sheet by Aguas et al. as information source on the process of use of medicines.
Results showed that, considering situation sheet as the only source, it was no possible to precisely calculate medication complexity. This indicates that the current form of the situation sheet may be improved in some issues on recording medication process of use, specially regarding the use with meals or at specific hours. To meet these necessities, some modifications to the original form are proposed.
Abstract: The implementation of cognitive services in the community pharmacy is proving to be slower than expected. A number of authors have described barriers to implementation, and facilitators that might contribute to accelerating the process. This paper reviews the literature on these two groups of elements in Spain.
Descriptions of the barriers show no common pattern, and some of the studies contain important omissions. Moreover, we have been unable to find any papers specifically dealing with the search for facilitators.
Abstract: AIM OF THE STUDY: To determine the opinions of a volunteer group of community pharmacists concerning general and specific issues related to continuing education. METHODS: Participants were required to complete questionnaires before and after attendance at a refresher course, and score the relevant options provided on a scale from 0 to 10. The responses of the survey were analyzed to identify preferences and to detect any possible changes in opinion. MAIN OUTCOME MEASURE: Arithmetic means of pharmacists' opinions. RESULTS: The teaching methods preferred by the community pharmacists were workshops for resolution of practical cases (9 +/- 0.25 and 8.88 +/- 0.13) and the distance-learning computer programmes (6.74 +/- 0.25 and 8.18 +/- 0.20). In selecting which topics that should be taught, the participants gave the highest ratings to healthcare needs (8.75 +/- 0.14 and 8.57 +/- 0.15) and the demands of the pharmacists (8.15 +/- 0.16 and 8.40 +/- 0.16), with pharmaceutical care being the most requested topic (29 points). Participants preferred courses lasting 20 to 50 hours (6.94 +/- 0.26 and 7.89 +/- 0.16), without preference for schedule. CONCLUSION: Community pharmacists in Galicia show a great interest in the provision and organization of continuing education activities that meet their needs and expectations.
Abstract: Medicines are a great contribution to the rising life expectancy in XX century. But a lot of drug safety problems were reported since 1960's. More recently, ineffectiveness is also being considered as a problem. Since 1975, the term 'drug-related problem' (DRP) is being used for several definition and purposes. This has led to a number of different DRP classifications. The aim of the present review is to gather different positions, definitions and classifications of DRP. And to present a more modern concept, which is also named as pharmacotherapy failure, corresponding to negative clinical outcomes resulting from the use or the lack of use of medicines. Those pharmacotherapy failures include necessity, effectiveness and safety problems.
Abstract: The cross-cultural translation from spanish to portuguese (european) of the Second Consensus of Granada on Pharmacotherapy failure has the objective to provide clinicians and researchers, working in drug therapy follow-up, with a working tool translated with the accuracy and the reliability that a biomedical document requires. The common origin of the spanish and portuguese languages emphasizes the need to do a cross-cultural translation. Errors of translation or wrong interpretations can be due to falses cognates. The cross-cultural translation followed three steps: translation, back-translation and review of the translation of the original text of the Second Consensus of Granada on Pharmacotherapy failure. The result was the portuguese version of the Second Consensus of Granada on Pharmacotherapy failure, presented in the annex I.
Abstract: This paper has as aim to analyze availability of assessments tools for quality of life in diabetes, potentiality used pharmacist by a pharmacist providing pharmacotherapy follow-up and by a clinical researcher. It focuses on tools measuring health-related quality of life (HRQoL) specific for patients having diabetes type 1 or type 2, and it rises from a systematic review on all paper using specific quality of life questionnaires for diabetes during 1990 decade retrieved in Medline. Tools were assessed regarding his conceptual and measure model, its reliability, validity, sensitivity to change, easiness to understand, use practical aspects, alternative forms, and available linguistic adaptations, Paper is divided into two parts. At first part, the concept of quality of life and health related quality of life, and its measure are analyzed, and review criteria are presented. In the second part, a comparative analysis of available tools and their applicability to pharmacist was made
Abstract: This paper has as aim to analyze availability of assessments tools for quality of life in diabetes, potentiality used pharmacist by a pharmacist providing pharmacotherapy follow-up and by a clinical researcher. It focuses on tools measuring health-related quality of life (HRQoL) specific for patients having diabetes type 1 or type 2, and it rises from a systematic review on all paper using specific quality of life questionnaires for diabetes during 1990 decade retrieved in Medline. Tools were assessed regarding his conceptual and measure model, its reliability, validity, sensitivity to change, easiness to understand, use practical aspects, alternative forms, and available linguistic adaptations, Paper is divided into two parts. At first part, the concept of quality of life and health related quality of life, and its measure are analyzed, and review criteria are presented. In the second part, a comparative analysis of available tools and their applicability to pharmacist was made.
Abstract: One of the applications developed within the EU-funded projects TESEMED and TESEMED-II is a program for the information and continuous training of community pharmacists, with the aim to empower them as advisors of the citizens about self-medication topics. Several programs are being developed on the basis of ad-hoc developed protocols about minor ailments (currently, cold and flu, haemorrhoids, constipation and cough). Each program includes three modules: a hypertextual version of the protocol, an interactive scheme of it, and an educational tool called Encounter Simulator, that trains the pharmacist about the protocol by means of simulated pharmacist-customer interactions. The testing of these applications with 84 community pharmacists offers positive results in terms of expectations, program characteristics and perceived usefulness.
