Outpatient pharmaceutical office: access to medicines in public health

Abstract We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient's diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

An analysis of pharmaceutical care for critical patients of an adult Intensive Care Unit

Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting "prescriber informed only" (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.

The pharmacist's role on transgender care: findings from a literature review

Abstract Transgender is a broad-spectrum term referring to people who do not match their assigned sex at birth. Several issues, including social detachment, poor access to healthcare services, and the lack of social/economic opportunities, have historically affected this population. In this scenario, pharmacists - not mentioned in national and international clinical guidelines/protocols regarding transgender care - might be key professionals to serve and care for this population. The main goal of this literature review was to identify the pharmacists' role in the care of transgender people. The articles were retrieved from scientific databases. After applying filters (e.g., language, full-text availability, and coverage of the research question), seven articles were included in this review. The articles did not present pharmaceutical experiences or practices regarding transgender healthcare. Instead, some articles stressed the inadequate or inappropriate use of hormones and their side effects, also covering the role of this issue in professional development, gaps, and potential opportunities for research and pharmaceutical services. Pharmacists, included in a multi-professional team, could be a key element to promote access to healthcare and the well-being of the transgender population.

Intervention model for detection, prevention and control of COVID-19 in community pharmacy

Abstract The announcement by the WHO of the characterization of the new Coronavirus 2019 disease (COVID-19) as a pandemic, entails an adaptation by the community pharmacy in carrying out its care activity in general, with particular emphasis on "Minor Ailments Service" in particular. The measures taken by the different health administrations in which patient telephone care by primary care offices is prioritized have left more consultations on symptoms in the community pharmacist health-related problems as pharmacies are the closest health facilities to the patient. The similarity between the symptomatology caused by the new Coronavirus with that of some Enteroviruses that cause mild respiratory and gastrointestinal tables (dry cough, fever, sore throat, vomiting, diarrhoea, etc.) makes community pharmacies highly capable places for contagion detection and prevention. A model of protocolized intervention is needed to facilitate the pharmacist's work in discriminating during the indication between minor symptoms and symptoms of referral for possible cases of COVID-19 so that in conjunction with the rest of the staff we help control the disease and make better use of primary care consultations.

Indication or diagnosis should be required on prescriptions.

Although prospective drug utilization review and patient counseling have long been recognized as professional and ethical responsibilities of pharmacists, the implementation of the Omnibus Budget Reconciliation Act of 1990 made them legal responsibilities. Ensuring the safety and effectiveness of prescription pharmaceutical care requires that all members of the prescriber-patient-pharmacist triad are equally informed about the therapeutic plan for which the pharmacist is professionally, ethically, and legally responsible for properly implementing. Providing pharmacists with the clinical indication or diagnosis is an important and long overdue first step. DISCLOSURES: No funding was received for the writing of this article. Warholak has received grant funding through the University of Arizona from Sinfonia Rx, Pharmacy Quality Alliance, and the Arizona Department of Health Services, unrelated to this work. The other authors have nothing to disclose.

Consideraciones éticas en la dispensación de medicamentos en farmacias de Ecuador / Ethical considerations in the dispensing of medications in pharmacies in Ecuador

RESUMEN Introducción: Los farmacéuticos enfrentan conflictos éticos en la dispensación de medicamentos. La resolución de estos asegura un servicio eficaz, seguro, digno y de calidad. Objetivo: Caracterizar desde una perspectiva ética-deontológica la dispensación de medicamentos en las farmacias de Cuenca-Ecuador, 2018. Material y Métodos: La investigación tuvo un diseño no experimental, descriptivo y transversal. La muestra no probabilística fue de 65 dependientes. Se aplicó un cuestionario para identificar la resolución de conflictos éticos y el nivel de conocimientos sobre Ética y Deontología Farmacéutica. Las respuestas fueron codificadas y analizadas con SPSS 23.0. Resultados: Los conflictos más frecuentes fueron el consentimiento informado (83 por ciento), prescripción médica (95 por ciento) y conflicto de intereses (84 por ciento). La resolución ética de los conflictos fue superior en dependientes capacitados en Ética y Deontología, con una correlación de 0,34 (p= (0,009) con el nivel de conocimientos en Deontología Farmacéutica. El nivel de conocimiento sobre Ética y Deontología Farmacéutica fue bajo en 60 por ciento de la muestra, con asociación inversa a la autopercepción de conocimiento (ρ=-0,259; p≤ 0,001). Conclusiones: La resolución empírica de los conflictos éticos durante el ejercicio de la profesión se realiza sin un fundamento ético-deontológico. El nivel de conocimiento en Ética y Deontología requiere una intervención desde la capacitación institucional y formación profesional de modo que se revierta en la adopción de decisiones acertadas que garanticen la seguridad del paciente como persona(AU)

ABSTRACT Introduction: Pharmacists face ethical conflicts related to the dispensing of medications. Their resolution ensures an effective, safe, dignified, and quality service. Objective: To characterize the dispensing of medications from an ethical-deontological perspective in pharmacies of Cuenca-Ecuador in 2018. Material and methods: A non-experimental, descriptive and cross-sectional study was conducted. The non-probability sample consisted of 65 pharmacists. A survey was applied to identify the resolution of ethical conflicts and the level of knowledge of Pharmaceutical Ethics and Deontology. Data were coded and analyzed with SPSS 23.0. Results: The most frequent conflicts included informed consent (83 percent), medical prescription (95 percent) and conflict of interests (84 percent).The resolution of ethical conflicts was higher in pharmacists with training in Ethics and Deontology, with a correlation of 0.34 (p =0.009) with the level of knowledge of Pharmaceutical Deontology. The level of knowledge of Pharmaceutical Ethics and Deontology was low in 60 percent of the sample, with an inverse association with the self-perception of knowledge (ρ= -0.259; p≤ 0.001). Conclusions: Empirical resolution of ethical conflicts while exercising the profession is carried out without ethical-deontological foundation. The level of knowledge of Ethics and Deontology requires intervention from institutional and professional training so that it is reverted to make the right decisions to guarantee the safety of the patient as a person(AU)

Evaluating the Effectiveness of a Focused Debate on the Development of Ethical Reasoning Skills in Pharmacy Technician Students.

Objective. To evaluate the effectiveness of debating an ethical dilemma on the development of ethical reasoning skills in pharmacy technician students. Methods. A mixture of qualitative and quantitative methods was used. This included analysis of before and after 5-minute papers, a sentiment survey, thematic analysis of student reflective writing and a qualitative questionnaire by an independent observer. Results. Twenty-five students participated in the study. The 5-minute papers showed improvement in student learning. In the sentiment survey, 83% of students agreed or strongly agreed that they had a better understanding of ethical dilemmas following the debate. The main theme identified from student blogs was the variety of different opinions expressed during the debate. Conclusion. Debating was an effective means of exploring ethics with pharmacy technician students.

Selling antimicrobials without prescription - Far beyond an administrative problem.

INTRODUCTION: Selling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. MATERIAL AND METHODS: A prospective study was carried out in January 2013 - February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. RESULTS: The actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. CONCLUSION: It is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population.

A philosophical framework for pharmacy in the 21st century guided by ethical principles.

Pharmacy has a long history of providing products and services for healthcare. In the last century, these roles have taken a strong focus on clinical care with the provision of medicines review, medicines optimisation, and prescribing services being at the forefront. The profession, however, is diverse. Pharmacists operate across a wide range of healthcare practices that often embrace both historic and contemporary roles simultaneously. The purpose of this article is to provide an overarching philosophical framework for pharmacy that encompasses roles that the modern pharmacist may assume. In doing this, we explore how pharmacy services align with healthcare and how different services require different approaches to clinical decision making.

Desenvolvimento e validação de indicadores para avaliação da qualidade do acompanhamento farmacoterapêutico / Development and validation of indicators for quality assessment of medication management

Um dos elementos para melhoria da qualidade dos serviços farmacêuticos clínicos é medir a qualidade do cuidado prestado e os indicadores podem ser usados nesta avaliação. O presente trabalho teve como objetivos identificar estudos sobre indicadores de qualidade para serviços farmacêuticos clínicos e desenvolver e validar um instrumento de indicadores para avaliação dos serviços de acompanhamento farmacoterapêutico prestados para pacientes ambulatoriais. Para tanto, uma busca abrangente da literatura foi conduzida nas bases de dados PubMed/Medline, Scopus, Lilacs e DOAJ por esses estudos. Os instrumentos apresentados pelos estudos foram avaliados em relação à qualidade das propriedades psicométricas. A seguir, foi desenvolvido um instrumento de indicadores-chave de desempenho. O grupo de pesquisa estabeleceu sete indicadores possíveis para avaliação de especialistas da área através de duas rodadas da técnica Delphi para validação de conteúdo. Ainda, farmacêuticos foram convidados a participar por meio de um questionário para validação de construto e confiabilidade do instrumento. A busca bibliográfica identificou 3.276 registros, dos quais 12 estudos completaram os critérios de inclusão. No geral, o maior número de estudos foi baseado em pesquisas para avaliar a satisfação dos pacientes e usou a revisão da literatura combinada com opinião de especialistas para o desenvolvimento do instrumento. Todos os estudos apresentaram algumas propriedades psicométricas do instrumento. A consistência interna e a validade de conteúdo foram os critérios mais relatados dos estudos, e nenhum deles apresentou o critério de estabilidade. Onze (68,8%) especialistas participaram da primeira rodada da técnica Delphi e nove (81,8%) especialistas completaram as 2 rodadas. Um novo indicador foi desenvolvido após a avaliação do painel de especialistas na primeira rodada. No geral, a validade de conteúdo e construto foi alcançada para o instrumento final. Os resultados desta tese apontam que os instrumentos dos estudos identificados na revisão sistemática apresentaram propriedades psicométricas, porém de forma incompleta ou não satisfatória. Ainda, um instrumento com seis indicadores foi desenvolvido e validado para o Serviço de Acompanhamento Farmacoterapêutico prestado para pacientes ambulatoriais

One of the elements of quality improvement of medication management services is measuring the quality of care and key performance indicators (KPIs) can be used in this assessment. The study is aimed to identify quality indicators instruments in pharmaceutical care services and to develop and validate KPI instrument for medication management services provided for outpatients. For this, comprehensive literature search was performed in databases PubMed/Medline, Scopus, and Lilacs. The psychometric quality of the instruments was determined. In addition, a key performance indicators instrument was developed. A working group established 7 possible KPIs for assessment of the expert panel through an internet based 2-round Delphi approach. An internet questionnaire was developed for pharmacists in order to construct validity and reliability of the instrument. The literature search yielded 3,276 records, of which 12 studies satisfied the inclusion criteria. Overall, the greatest number of studies were based surveys to assess patients' satisfaction and used literature review combined with expert's opinion for the instrument development. All studies presented some psychometrics properties of the instrument. Internal consistency and content validity were the most reported criteria of the studies and none of them presented stability. Eleven (68.8%) experts participated in the Delphi round 1 and nine (81.8%) experts completed the 2 Delphi rounds. A new KPI was develop after expert panel assessment in the first round. Overall, content and construct validity were reached for final instrument. The results of this thesis point out that instrument of the studies identified in the systematic review presented some psychometrics properties, but did not describe them satisfactorily. In addition, a set of six key performance indicators was developed and validated for medication management services provided for outpatients

A qualitative analysis of student-written law and ethics cases: A snapshot of PY2 student experience.

INTRODUCTION: This study was designed to better understand pharmacy students' experiences and recognition of legal and ethical tensions existing in pharmacy practice as demonstrated in student-written law and ethics cases. METHODS: A qualitative analysis of 132 student-written cases representing the team efforts of 1053 students over a 12-year time period was conducted. Student-written cases were coded and analyzed thematically. RESULTS: Our results demonstrate the types of ethical and legal issues our students have experienced in pharmacy practice during the first five quarters of their professional education. Our data highlight three themes: 1) ethical dilemmas presented when the law is misapplied; 2) ethical dilemmas presented when an institutional policy or law was viewed as insufficient; and 3) ethical dilemmas presented as provider distress. The third theme was further subdivided into five subthemes. CONCLUSION: The themes that emerged from this study represent some of the ethical dilemmas that second professional year students have encountered and how these dilemmas may intersect with legal boundaries. Educators can use cases demonstrating these themes to reinforce law and ethics education in the curriculum, thus helping prepare students for pharmacy practice. This article recommends how and when to use case examples.

The Emergence of Second-Generation Lethal Injection Protocols: A Brief History and Review.

The history of capital punishment in the United States is long and controversial. In many cases, lethal injection has brought medical personnel, ethically and professionally charged with preserving life, into the arena of assisting the state in taking life. U.S. Supreme Court decisions, including Baze v. Rees (2008) and Glossip v. Gross (2015), have evaluated and condoned lethal injection protocols. Despite the judicial validation of some midazolam-containing protocols, controversy exists about the level of unconsciousness provided due to the ceiling effects of the drug. Drug shortages, induced in part by manufacturers under pressure by death penalty opponents and governments opposed to capital punishment, have forced states to sometimes use creative means to obtain medications for use in lethal injection, even proposing to allow inmates to supply their own drugs for use in execution. Others have resorted to using compounding pharmacies and enacting tougher execution secrecy laws to protect the identities of those involved in the process. Professional organizations representing health care team members, including nursing, medicine, and pharmacy, among others, have roundly denounced the medicalization of capital punishment. Legal challenges continue to mount at all levels, leading to an uncertain future for lethal injection.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips.

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.

Medication Refusal: Resident Rights, Administration Dilemma.

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Assessment of pharmaceutical services in HIV/AIDS health units in the city of Niterói, Brazil

ABSTRACT This study aimed to conduct an assessment of pharmaceutical services in HIV/AIDS in the city of Niteroi, Brazil, with emphasis on management. It was done a descriptive cross-sectional study, and the approach used was a normative assessment focused on quality. The indicators used were analyzed individually or grouped according to the components of pharmaceutical services. The assessment identified some good points, especially regarding the good availability of ARVs, and good guide patients in the use of these drugs, and also some problems such as low levels of compliance in relation to good dispensing practices criteria and storage and a high time for the distribution of medicines. The result was a degree of 50.3% compliance with the quality criteria, considered only regular in accordance with trial made. Proposals were suggested for actions and interventions, especially in relation to the improvement of structural conditions of pharmacies of health facilities in the city, and increased training of professionals involved in the services.

Aid-in-dying practice in Europe and the United States: Legal and ethical perspectives for pharmacy.

This article briefly reviews 'aid-in-dying' options such as euthanasia and physician-assisted suicide in Europe and the US Physician-assisted suicide is now legal in four US States. Current practices, medications used and statistics relating to prescription frequency and death rates from the participating States are briefly discussed. This paper also examines the role of pharmacists in assisted suicides; legal, ethical and professional challenges that they face, and future implications on pharmacist education to enable them to make an educated decision about their involvement in aid-in-dying practices.

Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents.

PURPOSE OF REVIEW: Conscientious objection to reproductive healthcare (refusal to perform abortion, assisted reproductive technologies, prenatal diagnosis, contraception, including emergency contraception and sterilization, etc.) has become a widespread global phenomenon and constitutes a barrier to these services for many women. Adolescents are a particularly vulnerable group because some providers object to specific aspects of their reproductive healthcare because of their status as minors. RECENT FINDINGS: Recent peer-reviewed publications concerning conscientious objection address provider attitudes to abortion and emergency contraception, ethical arguments against conscientious objection, calls for clarification of the current laws regarding conscientious objection, legal case commentaries, and descriptions of the country-specific impact of policies in Russia and Italy. SUMMARY: Conscientious objection is understudied, complicated, and appears to constitute a barrier to care, especially for certain subgroups, although the degree to which conscientious objection has compromised sexual and reproductive healthcare for adolescents is unknown. Physicians are well positioned to support individual conscience while honoring their obligations to patients and to medical evidence.

[Prick of conscience in the pharmaceutical profession]. / Výhrada svedomí v profesi farmaceuta.

The work of the pharmacist in a pharmacy requires from him not only to solve professional and economic issues, but often the ethical ones as well. For a patients good it is necessary to choose a morally correct decision, but the fulfilment of any patients wish according to his or her own ideas of good is not a law for the health worker. The paper describes the situations when the pharmacist when fulfilling the requirement of the patient (often in the form of a medical prescription) may feel prick of conscience. A questionnaire survey has revealed that prick of conscience confronts more often those who are being trained for the profession than those who already practise it. The right for prick of conscience is considered unfounded by some pharmacists with practical experience, whereas undergraduates view it as a possibility of expressing ones own attitude. The paper analyzes the issues which in both categories of respondents are considered to be prick of conscience: oral hormonal contraception, including postcoital contraception, and preparations produced from the cells of aborted embryos.