The prevalence of adherence to insulin therapy in patients with diabetes: A systematic review and meta-analysis.

BACKGROUND: Adherence to insulin therapy is crucial to achieving good glycemic control for patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). A comprehensive estimation of adherence to insulin therapy in patients with diabetes is currently lacking. OBJECTIVE: To explore the prevalence of adherence to insulin therapy in patients with both T1D and T2D. METHODS: A systematic search was performed using the following databases: PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from the inception of each database to August 2023. Cross-sectional studies were included if they met the following criteria: (1) conducted in patients with T1D or T2D; (2) reported adherence to insulin therapy. The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used to assess the quality of included studies. Pooled estimates of the prevalence of adherence to insulin were calculated as a percentage together with a 95 % confidence interval (95%CI) using a random-effect model. All analyses were conducted using STATA 15 (College Station, Texas, United States); PROSPERO (CRD42022322323). RESULTS: Search results yielded 14,914 articles, of these 57 studies with a total of 125,241 patients met the inclusion criteria. The overall estimated prevalence of adherence to insulin therapy in both types of diabetes was 55.37 % (95%CI: 48.55 %-62.19 %). The adherence for T1D was 52.63 % (95 % CI: 37.37 %-67.87 %), whereas the adherence for T2D was 52.55 % (95 % CI: 43.08 %-62.01 %). The prevalence of adherence in lower middle-income countries was 56.79 % (95 % CI: 27.85 %-85.74 %). CONCLUSIONS: The overall prevalence of adherence to insulin therapy was remarkably low. This requires attention from healthcare practitioners and policymakers to implement appropriate strategic approaches to improve adherence to insulin therapy.

Prevalence of adherence to oral antidiabetic drugs in patients with type 2 diabetes: A systematic review and meta-analysis.

INTRODUCTION: The treatment of type 2 diabetes requires multidimensional management, with medication adherence a crucial aspect of diabetes control. However, recent rigorous estimates of adherence to oral antidiabetic drugs (OAD) are lacking. The objective of this study is to determine the prevalence of adherence to OAD in type 2 diabetes patients. METHODS: A systematic search was performed in PubMed, EMBASE, PsycINFO, and CINAHL from July 2013 to April 2023. Cross-sectional studies published in English were included if they met the following criteria: (1) reported the adherence to OAD using a validated measure; and (2) had a sample size of at least 385 patients with type 2 diabetes. The Joanna Briggs Institute critical appraisal for studies reporting prevalence data was used to assess the quality of the included studies. Pooled estimates of the prevalence of adherence to OAD were calculated as a percentage together with 95% confidence interval (95% CI) using a random-effect model. All analyses were conducted using STATA 17.0; PROSPERO (CRD42023414264). RESULTS: Twenty-six studies involving a total of 69,366 patients met the selection criteria and were included in the meta-analysis. The overall estimated prevalence of adherence to OAD was 55.53% (95%CI: 44.22%-66.85%). Among the included studies, nine were deemed to be of high quality. A sensitivity analysis conducted using only the high-quality studies revealed a prevalence of adherence to OAD at 52.24% (95% CI: 39.63%-64.85%). CONCLUSIONS: The overall prevalence of adherence to OAD was remarkably low among type 2 diabetes patients worldwide. Healthcare practitioners and policy makers should employ appropriate approaches to improve adherence to OAD.

Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol.

INTRODUCTION: Chronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD. METHODS AND ANALYSIS: This study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes. ETHICS AND DISSEMINATION: The trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s). TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622000329763).

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context (AU)

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Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists / Retos en el manejo de enfermedades crónicas no declarables por los farmacéuticos comunitarios indonesios

Objectives: We explored factors influencing Indonesian primary care pharmacists' practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by «grounded-theory». Results: We extracted five emergent themes/factors: pharmacists' attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists' inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists' attitudes, knowledge, skills and their working environment appeared to influence pharmacists' contribution in chronic disease management. To develop pharmacists' involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists' practice in Indonesia to achieve continuity of care (AU)

Objetivos: Exploramos .los factores que influyen en el ejercicio de los farmacéuticos de atención primaria indonesios sobre el manejo de enfermedades crónicas no declarables y propusimos un modelo que explica la relación entre los factores. Métodos: Realizamos entrevistas semi-estructuradas en profundidad a farmacéuticos que trabajan en centros de salud comunitaria (Puskesmas, n=5) y en farmacias comunitarias (apotek, n=15) de la provincia de Java del Este. Entrevistamos a los farmacéuticos participantes usando indonesio bahasa para explorar las barreras y facilitadores para su ejercicio en las enfermedades crónicas no declarables. Grabamos todas las entrevistas, las transcribimos literalmente, las tradujimos al inglés y las analizamos usando un abordaje basado en la «grounded theory». Resultados: Extrajimos cinco temas/factores emergentes: actitudes de los farmacéuticos, entorno Puskesmas/apotek, formación del farmacéutico, asociaciones profesionales farmacéuticas, y gobierno. Los respondentes creían que los farmacéuticos de atención primaria tienen un papel limitado en el manejo de enfermedades crónicas. Un entorno desfavorable y la percepción de que los farmacéuticos tienen conocimientos y habilidades inadecuadas fueron comunicados por muchos como barreras al ejercicio del farmacéutico. La escasez de estándares profesionales, guías, lideranza y reglamentos gubernamentales emparejados con las bajas expectativas de los farmacéuticos entre pacientes y médicos también contribuían para la falta de envolvimiento en el manejo de enfermedades crónicas. En nuestro modelo presentamos la interacción de estos factores. Conclusión: Las actitudes, conocimiento, habilidades y el entorno laboral de los farmacéuticos parecieron influenciar la contribución de los farmacéuticos en el manejo e las enfermedades crónicas. Para desarrollar el envolvimiento de los farmacéuticos en el manejo de enfermedades crónicas se requiere apoyo de los educadores de farmacia, de los propietarios de farmacia, de las asociaciones profesionales y del gobierno. Nuestros hallazgos ensalzan la necesidad de una coordinación sistemática entre farmacéuticos y decidores para mejorar el ejercicio delos farmacéuticos de atención primaria en Indonesia para alcanzar la continuidad de los cuidados (AU)

Factors influencing pharmacy students' attitudes towards pharmacy practice research and strategies for promoting research interest in pharmacy practice / Factores que influyen en las actitudes de los estudiantes de farmacia hacia la investigación en farmacia práctica y estrategias para promover el interés en investigar en farmacia práctica

Objectives: To (1) investigate the relationships between students’ characteristics and their (a) perceptions of research in general and (b) attitudes towards pharmacy practice research; (2) identify strategies that could be used by pharmacy educators to promote research interest in pharmacy practice; and (3) identify perceived barriers to the pursuit or completion of a pharmacy practice research degree. Methods: A survey was administered to all students enrolled in each year of the four-year pharmacy undergraduate program, University of Sydney, Australia. Perceptions of research in general were measured using 4 items on a five-point semantic-differential scale and attitudes towards pharmacy practice research were measured using 16 items on a five-point Likert scale. Student characteristics were also collected as were responses to open-ended questions which were analysed using content analysis. Results: In total 853 students participated and completed the survey (83% response rate). Participants’ characteristics were associated with some but not all aspects of research and pharmacy practice research. It appeared that positive attitudes and perspectives were influenced strongly by exposure to the ‘research’ process through projects, friends or mentors, previous degrees or having future intentions to pursue a research degree. Results from both the quantitative and qualitative analyses suggest positive attitudes and perceptions of research can be nurtured through the formal inclusion in research processes, particularly the utility of practice research in clinical practice across the four years of study. Participants indicated there was a lack of awareness of the needs, benefits and career opportunities associated with pharmacy practice research and voiced clear impediments in their career path with respect to the choice of practice research-related careers. Conclusions: Future research should investigate changes in perceptions and attitudes in a single cohort over the four-year degree, other factors influencing students’ perceptions and attitudes, and evaluate the effectiveness of research promoting strategies and programs (AU)

Objetivos: (1) Investigar la relación entre las características de los estudiantes y su (a) percepción de la investigación en general, (b) actitudes hacia la investigación en farmacia práctica, (2) identificar las estrategias que podrían ser usadas por los educadores de farmacia para promover el interés en la investigación en farmacia práctica; y (3) identificar las barreras percibidas para elegir o completar un grado en investigación en farmacia práctica. Métodos: Se administró un cuestionario a todos los estudiantes matriculados en cada año de los cuatro años del programa de grado de farmacia de la Universidad de Sídney, Australia. Se midieron las percepciones de la investigación en general usando 4 ítems de una escala semántica-diferencial de 5 puntos, y se midieron las actitudes hacia la investigación en farmacia práctica usando una escala de Likert de 5 puntos con 16 ítems. También se recogieron las características de los estudiantes en respuestas abiertas que fueron analizadas mediante un análisis de contenido. Resultados: En total 853 estudiantes participaron y completaron el cuestionario (83% tasa de respuesta). Las características de los participantes se pudieron asocial con algunos, pero no con todos, los aspectos de la investigación y de la investigación en farmacia práctica. Resultó que las actitudes y las perspectivas positivas estaban fuertemente influenciadas por la exposición al proceso de ‘investigación’ a través de proyectos, amigos o mentores, graduaciones previas o intenciones futuras de iniciar un grado de investigación. Los resultados de los análisis cualitativos y cuantitativos sugirieron que las actitudes y las percepciones positivas pueden ser alimentadas a través de la inclusión formal en procesos de investigación, particularmente la utilidad de la investigación práctica en la práctica clínica durante los cuatro años de estudios. Los participantes indicaron que había una falta de consciencia de las necesidades, beneficios y oportunidades de carrera asociadas a la investigación de farmacia práctica, y enunciaban impedimentos claros en su carrera de progreso en relación a la elección de carreras de investigación en farmacia práctica. Conclusión: Futuras investigaciones deberían analizar los cambios en percepciones y actitudes en una cohorte durante los cuatro años de estudios, otros factores que influyen las percepciones y actitudes de los estudiantes, y evaluar la efectividad de estrategias y programas de promoción de la investigación (AU)

Measuring consumer preference for models of diabetes care delivered by pharmacists / Medida de las preferencias de los consumidores por los modelos de cuidados diabéticos prestados por farmacéuticos

Evaluation of a community pharmacy disease management program for type 2 diabetes, ‘SugarCare’, was conducted. Compared with the standard care offered by pharmacists, this enhanced program offered patients closer monitoring of blood glucose levels, counselling about lifestyle, etc. The SugarCare study was funded by a grant but if the care is to continue some other method of financing must be found. Objectives: This study aimed to measure consumer preference for one of the two types of care offered in the SugarCare study, the control/standard and the intervention/enhanced service; the strength of that preference; and participants’ willingness to pay (WTP) for their preferred care. Methods: SugarCare was a parallel groups, control versus intervention, repeated measures design conducted in three areas of NSW, Australia. Patients in the Intervention group (enhanced care) had one initial visit to the pharmacy with six follow up visits over approximately 9 months. At these visits blood glucose was downloaded and patient care issues addressed. At the end of the service, a survey instrument was mailed to the intervention and control participants who were asked to read it and then expect a telephone call within 2 weeks of receipt. Responses were requested over the phone and the survey instrument completed by the researcher. WTP data were collected using a modified payment card method. Results: Overall, 44/75 (59%; 47%-70% 95%CI) respondents expressed a preference for Scenario B (the enhanced care) while 31/75 (41%; 31%-52% 95%CI) preferred Scenario A (standard care) however, the difference was not statistically significant. The median maximum WTP was AUD10 for the enhanced care and AUD3.50 for the standard care (p<0.03). Conclusions: While the WTP values expressed were significantly higher for the enhanced care they did not match with the cost providing that diabetes care. Discrete choice analysis has the potential to overcome some of the difficulties encountered with the contingent valuation technique used here. Further research is required before WTP values such as these could be used with confidence to determine funding policy (AU)

Se realizó la evaluación del programa de gestión de enfermedad para diabetes tipo 2, ‘SugarCare’. En comparación con los cuidados normales, este programa ofrecía a los pacientes un seguimiento más próximo de la glucemia, consejo sobre hábitos de vida, etc. El estudio SugarCare estuvo financiado por una beca, opero si se quiere que los cuidados continúen debe encontrarse otro método de financiación. Objetivos: Este estudio pretendió medir las preferencias de los consumidores por uno de los dos tipos de cuidados ofrecidos en el estudio SugarCare, el control/estándar y el servicio intervención/avanzado; la fuerza de esas preferencias; y la voluntad de los participantes de pagar (WTP) por el cuidado preferido. Métodos: SugarCare era un diseño en grupos paralelos, control contra intervención, con mediciones repetidas en tres áreas de New South Wales (Australia). Los pacientes en el grupo intervención (cuidados elevados) tenían una visita inicial a la farmacia con seis visitas de seguimiento durante aproximadamente 9 meses. En esas visitas, se medía la glucemia y se resolvían problemas en de los pacientes. Al final del servicio, se envió un cuestionario a los participantes control e intervención y se les pedía que lo leyesen y esperasen una llamada de teléfono a las dos semanas de recibirlo. Se solicitaban las respuestas al teléfono y el investigador completaba el cuestionario. Los datos de WTP se recogieron utilizando un método de tarjeta de pago modificado. Resultados: 44/75 respondentes (59%; 47%-70% 95%CI) expresó preferencias por el escenario B (cuidados avanzados) mientras que 31/75 (41%; 31%-52% 95CI) prefirió el escenario A (cuidaos estándar), sin embargo la diferencia no fue estadísticamente significativa. La mediana del WTP máximo fue de 10 dólares australianos (AUD) para los cuidados avanzados y de 3,30AUD para los cuidados estándar (p<0,03). Conclusiones: Mientras que los valores de WTP expresados eran significativamente más altos para los cuidados avanzados, no encajaban con el coste de proporcionar esos cuidados diabéticos. El análisis de selección discreta tiene la posibilidad de superar algunas de las dificultades encontradas con la técnica de evaluación de contingencia utilizada aquí. Se necesitan investigaciones adicionales antes de que los valores de WTP como estos puedan ser utilizados con confianza para determinar políticas de financiación (AU)

Adherence: a review of education, research,practice and policy in Australia / Adherencia: revisión de educación, investigación, práctica y política en Australia

Community pharmacists are well placed to deliver adherence support services as well as other pharmaceutical services to patients. They are often the last point of contact with patients collecting medicines in the healthcare chain, and they tend to be visited by patients on a regular basis to collect prescription medicines. They have the opportunity to reinforce information already received from other health practitioners, provide further information and monitor adherence to therapy. The past decade has seen an increase in focus on the importance of adherence to therapy, not only in the higher education sector, but also in government policy and community pharmacy practice. Adherence monitoring and promotion has not only become the foundation of courses taught in pharmacy schools, but has become an essential component of disease management and pharmaceutical services delivered by community pharmacists. Aims: This article aims to describe the education, research, practice and policy in the area of adherence to therapy in Australia with a focus on community pharmacists. Methods: A search of MEDLINE and International Pharmaceutical Abstracts as well as hand searches of the bibliographies of retrieved articles was conducted for the period 2000-2008. All pharmacy schools in Australia were also contacted to obtain information on the patient adherence to therapy content of their courses. Results: Ten studies met the inclusion criteria. Only one study had a specific adherence focus, with the remainder including adherence support and monitoring as part of the overall interventions delivered by the community pharmacists. In the majority of cases the interventions resulted in an improvement in patients’ adherence to therapy. The research was supported by government and pharmacy professional organisation initiatives in the area of cognitive pharmaceutical services. All universities which responded delivered specific patient adherence courses. Conclusions: Australian pharmacy schools are educating cohorts of students who will have the skills to monitor and support patient medication adherence in the context of contemporary pharmacy practice. This is supported by research evidence, government policy and fits well into the move to expand community pharmacy services to include chronic disease state management and primary health care (AU)

Los farmacéuticos comunitarios están bien posicionados para proporcionar servicios de apoyo a la adherencia así como otros servicios farmacéuticos a los pacientes. A menudo son el último punto de contacto con los pacientes que recogen medicamentos en la cadena sanitaria, y suelen ser visitados regularmente por los pacientes para adquirís sus recetas. Tienen la oportunidad de reforzar la información ya recibida de otros profesionales de la salud, proporcionar información adicional y monitorizar la adherencia al tratamiento. En la pasada década se ha visto un aumento de importancia de la adherencia al tratamiento, no solo en el sector de la educación superior, sino también en las políticas gubernamentales y la práctica de la farmacia comunitaria. Seguimiento y promoción de la adherencia ha sido, no solo la base de cursos en las facultades de farmacia, sino que se ha convertido en elemento esencial de los servicios farmacéuticos y la gestión de la enfermedad proporcionados por farmacéuticos comunitarios. Objetivos: Este articulo trata de describir la educación, investigación práctica y política en el área de la adherencia al tratamiento en Australia centrándose en los farmacéuticos comunitarios. Métodos: Se realizaron búsquedas en Medline e International Pharmaceutical Asbtracts, así como manuales, para recuperar artículos del periodo 2000-2008. También se contactó con todas las facultades de Farmacia de Australia para obtener información sobre el contenido sobre adherencia al tratamiento de los pacientes en sus cursos. Resultados: Diez estudios cumplieron los criterios de inclusión. Sólo un estudio se enfocaba específicamente en adherencia, con un apoyo que incluía recordatorio y monitorización como parte de la intervención completa realizada por farmacéuticos comunitarios. En la mayoría de los casos las intervenciones produjeron una mejoróia de la adherencia de los pacientes al tratamiento. La investigación fue apoyada por el gobierno y la organización profesional farmacéutica en el área de los servicios cognitivos farmacéuticos. Todas las Universidades que respondieron proporcionan cursos específicos de adherencia de los pacientes. Conclusiones: Las Facultades de Farmacia de Australia están educando promociones de estudiantes que tendrán las habilidades de monitorizar y apoyar la adherencia a la medicación de los pacientes en el contexto de la farmacia comunitaria contemporánea. Esto está apoyado en la evidencia de la investigación, política gubernamental, y encaja en el movimiento de expansión de los servicios de farmacia comunitaria para incluir la gestión de enfermedades crónicas y los cuidados primarios de salud (AU)

Balancing risk versus benefit: the elderly patient’s perspective on warfarin therapy / Sopesando riesgo y beneficio: perspectiva del paciente anciano a tratamiento con warfarina

Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored. Objective: To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy. Method: A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term (6 months) warfarin therapy were recruited by voluntary response to study flyers. Results: 17 patients and carers (mean age 77.2 SD=7.5 years) participated in one of two focus groups. Five core themes emerged regarding warfarin therapy: inadequate knowledge and understanding about it, patients/carers variable experience of information provision, cycle of reactions to being on it, issues in its practical management, and the spectrum of experiences with it. Overall, participants were very accepting of the therapy, describing a high level of compliance, despite initial fears and anxieties, and a relative lack of knowledge. Patients felt somewhat abandoned in their management of warfarin due to the lack of ongoing support services in the community, and inadequate information provision. Conclusions: Elderly patients and their carers appear to be quite accepting of warfarin therapy, in contrast to the perceptions of health care professionals. More effort is needed, however, in terms of information provision, particularly in the form of community-based services, to assist patients in the long-term management of warfarin (AU)

El tratamiento con warfarina se sub-utiliza en los ancianos de alto riesgo. Los clínicos perciben que los ancianos son reacios a este tratamiento, sin embargo la perspectiva de los pacientes y de sus cuidadores aún no ha sido estudiada. Objetivo: Explorar en profundidad las perspectivas de los pacientes ancianos y/o sus cuidadores sobre el uso de tratamiento con warfarina. Método: Se realizó un estudio cualitativo, utilizando entrevista semi-estructurada en grupos. Las discusiones grabadas se transcribieron a papel, y se analizaron temáticamente para identificar los temas emergentes. Las discusiones en grupos se realizaron en un gran hospital universitario de Sydney durante un periodo de dos meses. Mediante respuesta voluntaria a folletos, se reclutó a individuos de 65 o más años (y/0 sus cuidadores) que estaban utilizando crónicamente (6 o más meses) tratamiento con warfarina. Resultados: 17 pacientes y cuidadores (edad media 77,2 DE=7,5 años) participaron en uno de los dos grupos focales. Emergieron 5 temas principales en relación al tratamiento con warfarina: conocimiento y entendimiento inadecuado, experiencia variable de pacientes/cuidadores de la información proporcionada, ciclo de reacciones de estar bajo esto, problemas de manejo práctico, y espectro de experiencias con el tratamiento. Generalmente los participantes aceptaban bien el tratamiento, describiendo altos niveles de cumplimiento, a pesar de sus miedos y ansiedades inicial, y la relativa falta de conocimiento. Los pacientes se sentían algo abandonados en su manejo del tratamiento con warfarina debido a la falta de servicios de apoyo continuo en la comunidad y de la inadecuada provisión de información. Conclusión: Los pacientes ancianos y sus cuidadores parecen estar tranquilos aceptando el tratamiento con warfarina, en contraste con la percepción de los profesionales de la salud. Sin embargo se necesita un mayor esfuerzo en relación a la provisión de información, especialmente en los servicios comunitarios, para ayudar a los pacientes en el manejo de la warfarina a largo plazo (AU)

Pharmacists’ views on involvement in pharmacy practice research: strategies for facilitating participation

In order for community pharmacy practice to continue to evolve, pharmacy practice research on potential new services is essential. This requires the active participation of community pharmacists. At present, the level of involvement of community pharmacists in pharmacy practice research is minimal. Objectives: To ascertain the attitudes of a group of research-experienced community pharmacists towards participating in research; to investigate the barriers and facilitators to participation; to identify potential strategies to increase the involvement of community pharmacists in research. Methods: A focus group was conducted with a purposive sample of 11 research-experienced community pharmacists. A pharmacist academic moderated the focus group using a semi-structured interview guide. The participants were asked a bout their attitudes towards research, previous involvement in research, barriers to their involvement and strategies to overcome these barriers. The session was audio-taped and notes were taken by an observer. Thematic analysis of the notes and audio-tape transcripts was conducted. Results: Three themes emerged around pharmacists' attitudes towards research: pharmacists’ perception of the purpose of research, pharmacists' motivation for involvement in research, and pharmacists’ desired role in research. Barriers to research participation were grouped into four themes: pharmacists’ mindset, communication, infrastructure (time, money and staff), and skills/knowledge. Strategies to address each of these barriers were suggested. Conclusions: Participants recognised the importance of research towards advancing their profession and this was a motivating factor forinvolvement in research. They perceived their role in research primarily as data collection. A series of practical strategies to overcome the barriers participation were offered that researchers may wish to consider when promoting research outcomes and designing research projects (AU)

Para que la práctica farmacéutica continúe evolucionando, es esencial la investigación de farmacia práctica sobre nuevos servicios. Esto requiere la participación activa de farmacéuticos comunitarios. Actualmente, el nivel de participación de los farmacéuticos comunitarios en la investigación en farmacia práctica es mínimo. Objetivos: Evaluar las actitudes de un grupo de farmacéuticos comunitarios con experiencia en investigación; investigar las barreras y facilitadores para la participación; identificar las posibles estrategias para aumentar la participación de los farmacéuticos comunitarios en investigación. Métodos: Se realizó un grupo focal con una muestra conveniente de 11 farmacéuticos comunitarios con experiencia en investigación. Un profesor de farmacia moderó el grupo focal utilizando una guía de entrevista semi-estructurada. Se preguntó a los participantes sobre sus actitudes hacia la investigación, participación previa en investigaciones, barreras para su participación y estrategias para superar esas barreras. La sesión fue grabada y un observador tomó notas. Se realizó un análisis temático de las notas y de las transcripciones del as cintas. Resultados: Emergieron tres temas sobre las actitudes de los farmacéuticos hacia la investigación: la percepción de los farmacéuticos del propósito del a investigación, la motivación para la participación de los farmacéuticos en investigación y el papel que desean los farmacéuticos en la investigación. Las barreras para la investigación se agruparon en cuatro temas: mentalidad de los farmacéuticos, comunicación, infraestructura (tiempo, dinero y personal) y habilidades/conocimientos. Se sugirieron estrategias para afrontar cada una de esas barreras. Conclusiones: Los participantes reconocieron la importancia de la investigación para el avance de su profesión y este era el factor motivador para su participación en la investigación. Percibían su papel en la investigación fundamentalmente como de recogida de datos. Se ofrecieron varias estrategias para superar las barreras a la participación que los investigadores deberían considerar cuando promocionen los resultados de investigaciones y cuando diseñen proyectos de investigación (AU)