Abstract: Pharmacists' involvement in outpatient dialysis centres in Australia is currently limited, despite the positive contribution of pharmacists to renal patients' medication management and health outcomes outlined in the literature. An expanded role for pharmacists in this setting may be required as a consequence of the increasing burden of renal disease in the population.
Abstract: Patients with chronic kidney disease have multiple comorbidities and require complicated therapeutic regimens. The role of pharmacists caring for these patients has been documented, but no review of the impact of these interventions has occurred to date. The aim of this work is to assess the impact of pharmacists' interventions in patients with chronic kidney disease.
Abstract: BackgroundImplementation of pharmacy services in dialysis centers seems to be limited and requires acceptance from nephrologists. The aim of this study was to explore the opinions of Australian and Portuguese nephrologists toward a potential future provision of clinical pharmacy services in outpatient dialysis centers.MethodsA qualitative study using semistructured interviews was conducted with a purposeful sample of 7 Australian and 14 Portuguese nephrologists. The audiotaped interviews were transcribed verbatim and thematically analyzed.ResultsThree themes emerged from the analysis: 'attitudes of nephrologists towards pharmacist involvement', 'types of pharmacy services' and 'consequences of implementation of pharmacy services'. Australian nephrologists showed positive attitudes and reported several pharmacy services that could be performed by pharmacists in dialysis centers, whereas Portuguese nephrologist views restricted pharmacists to administrative duties. In addition, Portuguese nephrologists showed concerns with professional boundaries and demonstrated lack of awareness and knowledge of pharmacist skills. Pharmacy services suggested by Australian nephrologists included medication review, medication reconciliation, medication history update, patient and staff education, patient compliance improvement and development and implementation of anemia protocols. Nephrologists expected economic benefits from the services implementation by minimizing the inappropriate use of drugs, avoiding medication errors, and reducing drug wastage due to noncompliance.ConclusionsAustralian and Portuguese nephrologists hold different views regarding the future provision of pharmacy services in outpatient dialysis centers. Acceptability seems to be related to a previous acquaintance with pharmacists and pharmacy services. Different health policies in the two countries that promote collaborative practice between physicians and pharmacists may also account for the differences.
Abstract: To evaluate the internal reliability, factor structure and construct validity of the Pharmacy Safety Climate Questionnaire (PSCQ) when applied to a pan-European sample of community pharmacies.
Abstract: Prescription of potentially inappropriate medication (PIM) in the elderly has gained growing attention from healthcare professionals, researchers, healthcare providers and politicians worldwide for safety issues. Taking into consideration the increased susceptibility of elderly patients to certain medicines, criteria to identify PIM and to alert professionals to prevent their prescription have been created.
Abstract: Portugal has an uneven, city-centered bias in the distribution of hemodialysis centers found to contribute to health care inequities. A model has been developed with the aim of minimizing access inequity through the identification of the best possible localization of new hemodialysis facilities. The model was designed under the assumption that individuals from different geographic areas, ceteris paribus, present the same likelihood of requiring hemodialysis in the future. Distances to reach the closest hemodialysis facility were calculated for every municipality lacking one. Regions were scored by aggregating weights of the "individual burden", defined as the burden for an individual living in a region lacking a hemodialysis center to reach one as often as needed, and the "population burden", defined as the burden for the total population living in such a region. The model revealed that the average travelling distance for inhabitants in municipalities without a hemodialysis center is 32 km and that 145,551 inhabitants (1.5%) live more than 60 min away from a hemodialysis center, while 1,393,770 (13.8%) live 30-60 min away. Multivariate analysis showed that the current localization of hemodialysis facilities is associated with major urban areas. The model developed recommends 12 locations for establishing hemodialysis centers that would result in drastically reduced travel for 34 other municipalities, leaving only six (34,800 people) with over 60 min of travel. The application of this model should facilitate the planning of future hemodialysis services as it takes into consideration the potential impact of travel time for individuals in need of dialysis, as well as the logistic arrangements required to transport all patients with end-stage renal disease. The model is applicable in any country and health care planners can opt to weigh these two elements differently in the model according to their priorities.
Abstract: Local and national scientific journals have been widely criticized by some authors. Additionally, they are quite rarely indexed at international databases, which results in a reduced visibility of their articles.
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: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system.
Abstract: 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.
Abstract: 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.
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 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.
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: 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.
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: 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: 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: 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: 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: 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 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: 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 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: 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: 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: 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: 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: 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: 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: 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.
