Providing Oncology Pharmacy Services During the Coronavirus Pandemic: French Society for Oncology Pharmacy (Société Francaise de Pharmacie Oncologique [SFPO]) Guidelines.

PURPOSE: Patients with cancer are at higher risk for contracting the COVID-19 infection and are more likely to have higher morbidity and mortality. This is a big challenge for oncology teams that have to treat patients to avoid contamination by SARS-CoV-2. The aim of the current work is to present oncology pharmacy practice guidelines during the COVID-19 pandemic to secure the pharmaceutical care of patients with cancer. METHODS: The bureau of the French Society for Oncology Pharmacy proposed these recommendations according to the French High Authority of Health following the Guidelines of Good Practice, slightly modified according to the pandemic crisis situation. These guidelines were developed by a working group of 7 experts in oncology pharmacy practice. Furthermore, the guidelines were assessed by 31 independent reviewers. RESULTS: One hundred percent of reviewers approved the guidelines and 90% of them suggested some improvements. The final version incorporates the best comments and consists of 26 recommendations organized in 8 different sections. CONCLUSION: These guidelines allow secure pharmaceutical management of patients with cancer during the COVID-19 pandemic.

Brazilian generics market change after Farmácia Popular program.

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

Brazilian generics market change after Farmácia Popular program

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

The involvement of pharmacies in the screening of undiagnosed atrial fibrillation.

Early identification of atrial fibrillation (AF) is now a priority in cardiovascular prevention because AF is common although often asymptomatic, and is associated with poor outcomes that are highly preventable with appropriate medical treatment. In Italy, AF prevalence among subjects aged ≥65 years ranges from 5 to 6% in observational studies based on the diagnosis recorded by general practitioners to 10-11% in studies where ECG screening is routinely offered. It is thus evident that a large number of subjects are not detected by conventional approach, and new strategies are required to increase early detection of AF. In particular, the changing position of pharmacies in the health system should be considered. Because of its small geographical size, insular nature and captive population, the Isle of Elba represents an ideal setting to test new strategies for stroke reduction. The Elba-FA project was thus designed to determine the feasibility and impact of the combined involvement of pharmacies and general practices to screen undiagnosed AF, with the ultimate aim of reducing the burden of stroke and arterial thromboembolism. The findings obtained with this approach might have broad implications for cardiovascular prevention at the general population level in Italy.

Trends in the prescription of clozapine in a psychiatric hospital: a 5-year observational study / Tendência na prescrição de clozapina em um hospital psiquiátrico: estudo observacional de 5 anos

Abstract Introduction Clozapine is a well-recognized effective treatment for some patients with treatment-resistant schizophrenia (TRS). Although it has potential benefits and approximately 30% of patients have a clinical indication for clozapine use, prescription rates are low. Objective To evaluate clozapine prescription trends over a 5-year period in a tertiary psychiatric hospital. Methods In this observational study, data prospectively collected by the Medical and Statistical File Service (Serviço de Arquivo Médico e Estatístico) and the Pharmacy Division of Instituto de Psiquiatria de Santa Catarina between January 2010 and December 2014 were summarized and analyzed by investigators blinded to data collection. The number of 100 mg clozapine pills dispensed by the Pharmacy Division to the inpatient units was the outcome and considered a proxy measure of clozapine prescriptions. The number of occupied inpatient unit beds and the number of patients admitted with F20-F29 (ICD-10) diagnoses during the study period were considered to be possible confounders. Results A multiple linear regression model showed that time in months was independently associated with an increase in the number of clozapine pills dispensed by the Pharmacy Division (β coefficient = 15.82; 95% confidence interval 10.88-20.75). Conclusion Clozapine prescriptions were found to have increased during the 5-year period studied, a trend that is opposite to reports from several other countries.

Resumo Introdução Clozapina é um medicamento reconhecidamente eficaz para alguns pacientes com esquizofrenia refratária ao tratamento. Apesar dos seus potenciais benefícios e de sua indicação clínica para aproximadamente 30% dos pacientes, a frequência de prescrição de clozapina é baixa. Objetivos Avaliar a tendência na prescrição de clozapina durante um período de 5 anos em um hospital psiquiátrico. Métodos Neste estudo observacional, dados coletados prospectivamente pelo Serviço de Arquivo Médico e Estatístico e pela Divisão de Farmácia (DF) do Instituto de Psiquiatria de Santa Catarina foram analisados por pesquisadores cegos para a coleta de dados. O número de comprimidos de clozapina 100 mg dispensados pela DF às enfermarias foi considerado a variável dependente e a medida de prescrição de clozapina. Número de leitos de internação ocupados e número de pacientes admitidos com diagnósticos F20-F29 (CID-10) durante o período de estudo foram considerados possíveis confundidores. Resultados Após análise com modelo de regressão linear múltipla, tempo em meses foi independentemente associado com aumento do número de comprimidos de clozapina 100 mg dispensados pela DF (coeficiente β = 15,82; intervalo de confiança de 95% 10,88-20,75). Conclusão Houve um aumento na prescrição de clozapina durante o período de 5 anos estudado, uma tendência oposta à relatada em vários outros países.

Level of satisfaction of clients of public pharmacies dispensing high-cost drugs in Espírito Santo, Brazil

ABSTRACT The aim of this study was to evaluate the level of satisfaction of pharmaceutical services and to determine the socioeconomic profile of public pharmacy clients. This is a cross-sectional observational study using a quantitative approach. The sample was calculated from the monthly number of patients seen in pharmacies and was stratified for each pharmacy. Data were analysed using SPSS 11.5 software and by observing the simple relative frequencies for qualitative variables. For the quantitative variables, the analysis of variance (ANOVA) and post-hoc Fisher tests were performed. Data are expressed as mean ± standard deviation (SD). The results show that, in general, patients at "Farmácias cidadãs" are satisfied with the services. However, when stratified, we found that the greatest satisfaction was related only to structural and organizational aspects, while the pharmaceutical services are unsatisfactory. When relating satisfaction to the socioeconomic characteristics, a difference between waiting time (39.07 ± 19.53), attendance by pharmacist (8.91 ± 5.14) and education was observed. It is concluded that users are satisfied with the services of state "Farmácias cidadãs" of Espírito Santo, but there should be improvements in relation to pharmaceutical services and the interpersonal relationships between health professionals and users of the public health system in Brazil.

RESUMO O objetivo do presente estudo foi avaliar o nível de satisfação dos serviços farmacêuticos e a determinação do perfil socioeconômico de clientes de farmácias públicas. Trata-se de um estudo observacional transversal com abordagem quantitativa. A amostra foi calculada através de dados da quantidade mensal de pacientes atendidos nas farmácias e estratificada para cada unidade do Estado. Os dados foram analisados por meio programa SPSS 11.5, observando-se as frequências relativas simples para as variáveis qualitativas. Para as variáveis quantitativas efetuaram-se análise de variância de uma via (ANOVA) e teste post-hoc de Fisher. Os dados foram expressos como a média ± desvio padrão (DP). Os resultados revelam que, em geral, os usuários atendidos nas farmácias cidadãs estão satisfeitos com os serviços, porém, quando estratificado por pergunta, avaliou-se que a maior satisfação está relacionada apenas aos aspectos estruturais e organizacionais e que o serviço farmacêutico é insatisfatório. Quando relacionada à satisfação com as características socioeconômicas, observou-se diferença entre tempo de espera (39.07 ± 19.53), de atendimento pelo farmacêutico (8.91 ± 5.14) e escolaridade. Conclui-se que os usuários estão satisfeitos com os serviços das farmácias cidadãs estaduais do Espírito Santo, porém deve haver melhora em relação ao atendimento farmacêutico e à relação interpessoal entre profissionais de saúde e usuários do sistema público de saúde brasileiro.

Antismoking centers in Milan's communal pharmacies: analysis of the 2010-2011 campaign.

AIMS AND BACKGROUND: According to recent assessments from the Italian Istituto Superiore della Sanità, information and assistance to smokers are still far from satisfactory. We evaluated the impact of a new smoking cessation service located in pharmacies. Smokers' individual characteristics were also considered. MATERIAL AND METHODS: A 1-year pilot study was carried out from October 2010 to September 2011. Five pharmacies in Milan were selected. A psychologist with experience in smoking cessation was present in each pharmacy one afternoon per week, and pharmacists were trained by a team from the Antismoking Center of the Fondazione IRCCS Istituto Nazionale dei Tumori. Each pharmacy was equipped with informative material, carbon monoxide analyzers, and motivational and nicotine dependence questionnaires, in addition to a clinical briefcase. Counseling sessions were also arranged upon request. RESULTS: In the first 12 months of activity, 216 persons asked for a consultation. The sample, aged 15-79 years, reported the following median values: 30 pack/years, 14 ppm CO, and a Fagerström Test of Nicotine Dependence score of 5. More than one-third of the sample (40.3%) had one pathology and 25% had more than one. In some cases (15.7%), people just wanted information about what the service offered. For those who tried to quit, smoking cessation rates were 33.3% at 3 months, 28% at 6 months, and 24.6% at 1 year. Three kinds of pharmacologic therapies were suggested to smokers: nicotine replacement therapy (75.5%), varenicline (17.5%), and bupropion (7%). CONCLUSIONS: The results show that an accessible and free smoking cessation service is considered useful by smokers as demonstrated by the large number of requests compared with other smoking centers in Italy. Increased involvement of pharmacists in supporting smoking cessation makes this a promising initiative for the near future.

Cigarette sales in pharmacies in the USA (2005-2009).

BACKGROUND: Several US jurisdictions have adopted policies prohibiting pharmacies from selling tobacco products. Little is known about how pharmacies contribute to total cigarette sales. METHODS: Pharmacy and total cigarette sales in the USA were tabulated from AC Nielsen and Euromonitor, respectively, for the years 2005-2009. Linear regression was used to characterise trends over time, with observed trends extrapolated to 2020. RESULTS: Between 2005 and 2009, pharmacy cigarette sales increased 22.72% (p=0.004), while total cigarette sales decreased 17.43% (p=0.015). In 2005, pharmacy cigarette sales represented 3.05% of total cigarette sales, increasing to 4.54% by 2009. Extrapolation of these findings resulted in estimated pharmacy cigarette sales of 14.59% of total US cigarette sales by 2020. CONCLUSIONS: Cigarette sales in American pharmacies have risen in recent years, while cigarette sales nationally have declined. If current trends continue, pharmacy cigarette market share will, by 2020, increase to more than four times the 2005 share.

Contracepção de emergência no contextodas farmácias: revisão crítica de literatura / Emergency contraception in the context of pharmacies: critical literature review

A revisão de literatura busca discutir as políticas de provisão da contracepção de emergência (Ce), notadamente por meio das farmácias, na literatura internacional e nacional. a pesquisa foi realizada nas bases de dados Medline/Pubmed, sociological abstracts e scielo Brasil, considerando o período de janeiro/2005 a dezembro/2009. os descritores utilizados foram: emergency contraception e pharmacy; incluindo-se também anticoncepção de emergência para o contexto brasileiro. Para análise, foram selecionados 36 artigos, 29 internacionais e sete nacionais. a discussão dos resultados contemplou duas perspectivas analíticas: disponibilidade e barreiras à Ce nas farmácias, verificando a posição dos farmacêuticos sobre o método; e a posição das usuárias/consumidoras da Ce a respeito do contraceptivo e seus locais de provisão, no contexto nacional e internacional. tais estudos evidenciam que a adoção de políticas públicas favoráveis à distribuição/venda da Ce pelas farmácias confere, de modo geral, avaliação positiva de farmacêuticos e usuários, principalmente devido à possibilidade de dispensar o contraceptivo de forma mais ágil. os países que adotaram tal política discutem a necessidade de aconselhamento em saúde sexual e reprodutiva para os consumidores no âmbito da própria farmácia. entretanto, no Brasil, o medicamento quase sempre é vendido sem receita médica e orientação do farmacêutico, pois não há política pública que inclua a provisão pelas farmácias.

Pharmaceutical care in community pharmacies: practice and research in Estonia.

OBJECTIVE: To describe practice and research related to pharmaceutical care in Estonia following the country's restoration of independence from Russia in 1991. FINDINGS: The transition from a Soviet to a free market economy has impacted the healthcare and pharmacy systems in Estonia. Following independence, ownership of community pharmacies was transferred from the State government to individual pharmacists. However, pharmacy ownership is no longer restricted to pharmacists and recent years have seen the emergence of large pharmacy chains. The number of community pharmacies in Estonia increased from 270 in 1992 to 523 in 2007. In addition to dispensing, Estonian pharmacies retain a focus on compounding of extemporaneous products and supply of herbal medications. Research into pharmaceutical care has addressed topics including pharmaceutical policy and the quality of pharmacy services provided at community pharmacies. DISCUSSION: There has been limited pressure to date from the governmental institutions and patient organizations to introduce extended pharmaceutical services. However, the trend toward providing health services in primary care will create greater responsibilities and new opportunities for community pharmacists. Recent inclusion of clinical pharmacy and interprofessional learning in the undergraduate pharmacy curriculum will help ensure ongoing development of the profession and high-quality pharmacy services in the future. CONCLUSIONS: Pharmaceutical care services in Estonian community pharmacies have become more patient-oriented over the past 17 years. However, community pharmacies continue to retain a focus on traditional roles.

Providing patient care in community pharmacies in Spain.

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.

Merchandising of cigarettes in San Francisco pharmacies: 27 years later.

OBJECTIVE: To estimate changes since 1976 in the proportion of San Francisco pharmacies that sell cigarettes and to characterise the advertising of cigarettes and the merchandising of non-prescription nicotine replacement therapy (NRT) products in these retail establishments. METHODS AND SETTING: 100 randomly selected San Francisco pharmacies were visited in 2003. Pharmacies were characterised based on the sale of cigarettes, advertising for cigarettes, and the merchandising of non-prescription NRT products. RESULTS: In 2003, 61% of pharmacies sold cigarettes, a significant decrease compared to 89% of pharmacies selling cigarettes in 1976 (p < 0.001); 84% of pharmacies selling cigarettes also displayed cigarette advertising. Non-prescription NRT products were stocked by 78% of pharmacies, and in 55% of pharmacies selling cigarettes, the NRT products were stocked immediately adjacent to the cigarettes. CONCLUSIONS: Since 1976, there has been a decline in the overall proportion of pharmacies in San Francisco that sell cigarettes yet most pharmacies, particularly traditional chain pharmacies, continue to merchandise the primary known risk factor for death in the USA.

[Connecting between hospital, clinical and pharmacy--present and future].

SUBJECT: Along with the promotion of "home medical care", an increasing number of clinics provide home medical care as part of their services or are dedicated to home medical care partly as a result of the reform of the healthcare system. This is considered to be the manifestation of the desire of patients to live their own lives and the intention of the healthcare professionals to satisfy patient needs. We examine what insurance pharmacies should and must do to provide higher-quality services to satisfy such patient needs, this time focusing on the community coordination for the purpose of providing the services which can give sense of security to patients. METHOD: Cases of HPN during the period from July 2002 to June 2003 were subdivided into those in which we were involved before and after the discharge from the hospital and those in which we were involved only after the discharge from the hospital to home medical care and comparatively studied from various perspectives. Existing coordination systems are introduced and discussed to achieve the desirable coordination systems. PRESENT AND FUTURE: In the home guidance service, some patients consult with us on the issues on which they hesitate to consult with doctors or nurses. This suggests that we can contribute to the mental care for patients and their care givers. In order to make the best use of our position, the coordination with hospitals is essential for insurance pharmacies. The degree of contribution to the improvement of QOL or the mitigation of anxiety over inexperienced issues is considered to differ depending on the preparatory period between the cases in which we were involved before and after the discharge from the hospital and those in which we were involved only after the discharge from the hospital to home medical care. The analysis of the differences in the actual cases is considered to be significant to seek for the ideal coordination.

Private pharmacies in tuberculosis control--a neglected link.

In most settings in India, private pharmacies dispense prescriptions for anti-tuberculosis drugs made out by private practitioners. In a cross-sectional study, we assessed the dispensing practices for tuberculosis and knowledge about the national tuberculosis programme of 300 pharmacies. In all, 2800 prescriptions were dispensed monthly by the pharmacies. Doctors' prescriptions were for durations of several months, but half of the patients bought drugs one dose at a time for self-administration. This practice might promote drug resistance. Although 95% of pharmacists were not aware of the existence of the tuberculosis programme, the majority (97%) were willing to learn and contribute towards tuberculosis control. The need and the potential of private pharmacies for participation in tuberculosis control are highlighted.

[Smoking cessation in pharmacies--evaluation of the smoking cessation campaign "Tobacco adieu!" among pharmacists in Basel]. / Raucherentwöhnung in Apotheken--Evaluation der Raucherentwöhnungskampagne "Tabak adieu" der Apotheker/-innen beider Basel.

Now as in the past, tobacco consumption is a major health problem in Switzerland. Efforts to reduce tobacco consumption include different preventive strategies. Although dispensary pharmacists have increased their efforts in health promotion and prevention in recent years, their role in tobacco prevention has not been documented so far. The "Tobacco Adieu!" campaign to support smoking cessation was introduced in pharmacies as a low threshold offer in Basle in 1996. This paper assesses the process and the effect of this effort. Participating pharmacies were interviewed during the evaluation and all consultations in this area were recorded in questionnaires. Customers requesting counselling from pharmacies during the campaign were also asked to fill in a questionnaire regarding their smoking behaviour and their experiences in the pharmacy. The offer was well accepted by the public: During the four week period, about 2,000 client contacts for smoking cessation took place in the 63 participating pharmacies. Compared to the pre-campaign situation, more intensive counselling took place. Clients who received counselling in the pharmacies generally attested to its good quality. In addition to counselling, further care during the smoking cessation phase was offered to clients who wanted to quit smoking. Follow-up visits were agreed in 76 percent of the cases. The project shows that smokers can be motivated to consider cessation and supported in the process by pharmacists. Therefore, pharmacies can be used as a low threshold offer in this context. Expansion of this programme in public pharmacies seems justified. However, continuing education and a motivated team are the prerequisites for successful counselling of smokers in pharmacies.