Evaluating the appropriateness of a community pharmacy model for a colorectal cancer screening program in Catalonia (Spain).

Background The traditional model of community pharmacy has changed, with patients, caregivers and consumers having access to many cognitive services other than the traditional dispensing and supply of medicines. In December 2009, a population-based colorectal cancer screening program started in Barcelona, introducing the community pharmacist and the professional expertise of the pharmacist into the organisational model. Aim To evaluate the program implementation process in the pharmacies, identify barriers and facilitators, and know the opinion of the professionals involved in the colorectal cancer screening program in Catalonia (Spain). Methods Cross-sectional study of the pharmacies that participated in the first round of the program during the first and second trimester of 2010 in Barcelona. A validated questionnaire was used to analyse several functional aspects in the implementation process. Qualitative aspects about the opinion of the pharmacist were studied. A descriptive and bivariate analysis was performed. Results All the pharmacies involved in the program (n = 74) participated in the study. The majority of the sample population was composed of women (70.3%), mean age 44.9 years, and most of them (74%) had attended a specific training session. Pharmacists considered their participation in the program to be an added value to their professional role and a way to increase consumer's confidence on this kind of services. The average time to provide the service was estimated to be less than 10 minutes per consumer. Only three (4.1%) pharmacists considered that the program involved a lot of extra work in the daily activities of the pharmacy. The level of satisfaction of the pharmacists was very high. Conclusions Community pharmacies can be a successful alternative and great resource to implement a population cancer screening program. This functional model can improve the accessibility and participation rates on target population. The level of motivation of the community pharmacist, the specific training program and the perception to give a better care for their patients can be an enabler.

Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.

BACKGROUND: Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis. METHODS: Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance. FINDINGS: Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases. CONCLUSION: This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.

COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

BACKGROUND: COPD case finding is currently recommended at primary and tertiary care levels only. AIM: To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS: Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS: Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS: COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Servicio de sistemas personalizados de dosificación: coste del servicio frente al margen de los medicamentos / Unit dose drug distribution systems: direct service cost versus pharmaceutical fees

Introducción: La preparación de sistemas personalizados de dosifi cación (SPD) dentro del servicio de seguimiento farmacoterapéutico (SFT) ha demostrado ser un instrumento que mejora la adherencia terapéutica del paciente. Para la valoración de su remuneración se analiza el coste de este servicio y si el margen de los medicamentos dispensados e incluidos en el SPD cubre su prestación. Objetivos: Establecer un análisis de costes del servicio; averiguar si, en pacientes polimedicados tipo, el margen de los medicamentos incluidos en el SPD cubre los costes, y conocer el número de medicamentos que deberían incluirse cuyo margen cubra la prestación del servicio. Material y métodos: Para el análisis del coste del servicio, se ha considerado el coste de la preparación del SPD y de la intervención farmacéutica más el coste directo del material utilizado. En el análisis de pacientes reales, se ha calculado el margen de los medicamentos incluidos en el SPD y se ha comparado con el coste calculado de la prestación del servicio. Para el análisis del número de medicamentos, se ha tomado como referencia el precio medio de los medicamentos dispensados al CatSalut y el margen medio actual. Resultados: El coste del servicio por paciente y mes (4 semanas) se ha estimado en 19,85 €. Se necesitarían un mínimo de 8 medicamentos para cubrir este coste. Conclusiones: A partir de los casos analizados, se concluye que es muy difícil cubrir el coste del servicio con el margen de los medicamentos dispensados e incluidos en el SPD. La remuneración debe considerar otros aspectos tras evaluar la efi ciencia del servicio(AU)

Introduction: Pharmaceutical care service with unit dose drug distribution systems (UDDDS/PCS) is an instrument that has showed to improve the patient’s therapeutic adherence. To analyze the service’s remuneration is necessary to establish the direct service costs and to know if the pharmaceutical fees of the medicines included in the UDDDS/PCS is enough to covers it. Aims: To establish the direct service costs analysis; to know if, in polymedicated patient type, pharmaceutical fees of the medicines included in the UDDDS/PCS covers the service costs, and to know the number of medicines needed to include in the UDDDS/PCS whose pharmaceutical fees covers the service. Material and methods: It has been considered for the analysis of the service cost, the following aspects: cost of UDDDS/PCS preparation, cost of pharmaceutical intervention and the direct cost of the used material. In the analysis to real patients, it has been calculated the pharmaceutical fees of the medicines included in the UDDDS/PCS and has been compared with the estimated service cost. In order to analyze the number of medicines it has been taken the average price of the medicines dispensed for the CatSalut and the current average margin as a reference. Results: The cost of the service for patient and month (4 weeks) has been estimated in 19.85 €. It would be need a minimum of 8 medicines to cover this cost. Conclusions: It is very difficult to cover service costs through the pharmaceutical fees of the medicines dispensed and included in the PCS. Regarding to the remuneration of the service, it’s necessary to consider other aspects related to service efficiency evaluation(AU)

Efectividad de un programa de atención farmacéutica en la mejora del control de la presión arterial en pacientes hipertensos mal controlados. Estudio PressFarm / Effectiveness of a pharmaceutical care program in the improvement of blood pressure monitoring in poorly controlled hypertensive patients. PressFarm Study

IntroducciónLas actividades de atención farmacéutica son un recurso para aumentar el grado de control de pacientes con enfermedades crónicas. El objetivo de este estudio es evaluar la eficacia de una intervención del farmacéutico comunitario a hipertensos tratados con mal control de su presión arterial (PA).Material y métodosEstudio experimental, longitudinal, prospectivo, randomizado y sin enmascaramiento, realizado en 102 farmacias comunitarias. Cuatrocientos sesenta y un pacientes con hipertensión arterial no controlada fueron asignados paritariamente a un grupo intervención (GI), al que se aplicó un protocolo de seguimiento validado, y a un grupo control (GC). Se evaluó el porcentaje de pacientes controlados, el grado de cumplimiento, el descenso medio de las cifras de PA y el número de problemas relacionados con el medicamento (PRM) detectados y corregidos.ResultadosAjustando por edad, género y nivel de estudios, el grado de control a los tres meses de seguimiento fue de un 27% en el GC y de un 37,2% en el GI (intervalo de confianza [IC] del 95%: 7,0–13,0; p=0,03). A los seis meses ascendió hasta un 38,3% en el GC y a un 55,2% en el GI (p=0,001).ResultadosLos valores de la PA sistólica (PAS) a los 3 y a los 6 meses experimentaron un descenso medio de 11,0mmHg en el GC y de 16,08mmHg en el GI (IC del 95%: 1,13–9,02; p=0,012), y de 14,7mmHg en el GC y de 20,95mmHg en el GI (IC del 95%: 2,12–10,02; p=0,003).ResultadosLa disminución de la PA diastólica (PAD) a los 3 y a los 6 meses fue de 4,76mmHg en el GC y de 8,40mmHg en el GI (IC del 95%: 0,57–6,73; p=0,021), y de 4,92mmHg de media en el GC y de 7,48mmHg en el GI (IC del 95%: 0,04–5,07; p=0,046).ResultadosExisten diferencias significativas en el porcentaje de cumplidores en el GI entre el inicio del estudio, que era de 69 pacientes (30%), y el final de la intervención, que fue de 141 pacientes (..) (AU)

IntroductionPharmaceutical care activities provide a resource to increase the degree of control in chronic disease patients. This study has aimed to evaluate the efficacy of a community pharmaceutical intervention in treated hypertensive patients with poor control of the blood pressure (BP).Material and methodsThis was an experimental, longitudinal, prospective, randomized and unmasked study conducted in 102 community pharmacies. A total of 461 patients whose high blood pressure was not controlled were equally assigned to an intervention group (IG) in which a validated follow-up protocol was applied and to a control group (CG). The percentage of controlled patients, degree of compliance, mean decrease in blood pressure values and number of drug-related problems (DRP) detected and corrected were evaluated.ResultsAfter adjusting for age, gender and study level, the degree of control at 3 months of follow-up was 27% in the CG and 37.2% in the IG (95% CI: 7.0–13.0; p=0.03). At 6 months, it reached 38.3% in the CG and 55.2% in the IG GI (p=0.001).ResultsThe SBP values at 3 and 6 months experienced a mean decrease of 11.0mm Hg in the CG and of 16.08mmHg in the IG (95% CI: 1.13–9.02mm Hg; p=0.012) and of 14.7mm Hg in the CG and of 20.95mmHg in the IG (95% CI: 2,12–10,02mm Hg; p=0.003) respectively.ResultsDecrease of the DBP at 3 and 6 months was 4.76mm Hg in the CG and 8.40mmHg in the IG (95% CI: 0.57–6,73mm Hg; p=0.021), and a mean of 4.92mm Hg in the CG and 7.48mmHg in the IG (95% CI 0.04–5.07mm Hg; p=0.046), respectively.ResultsThere are significant differences in the percentage of compliers in the intervention group between the onset of the study, which was 69 patients (30%) and the end of the intervention when it was 141 patients (60.8%) (p=0.01). (..) (AU)