A scoping review of pharmacists' clinical activities and impact on the care of patients with multiple myeloma.

BACKGROUND: Treating multiple myeloma is complex, and providing supportive care through an interdisciplinary approach is essential. AIM: To report and synthesize pharmacists' clinical activities and impact on the care of patients with multiple myeloma. METHOD: This was a scoping review that followed the PRISMA-ScR reporting recommendations. A search was conducted in PubMed, Embase, Web of Science, Scopus, and LILACS from the inception of the database until January 10th, 2024. Papers that reported pharmacists' clinical activities in the care of patients with multiple myeloma were included. Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2 was used to characterize the pharmacists' clinical activities. The results are presented as a narrative and tabular synthesis. RESULTS: A total of 2885 records were identified, 10 of which met the inclusion criteria. Pharmacists' clinical activities related to 'direct patient care' (n = 8) and 'medication counseling, education, and training' (n = 7) were the most cited. Most were provided for patients (n = 8), by one-on-one contact (n = 9), and through face-to-face communication method (n = 8), with patient counseling being the main action taken by pharmacists (n = 7). Materials that supported pharmacists' actions were cited in five studies. Integrating pharmacists into interdisciplinary teams led to improved process, clinical, humanistic, and economic outcomes. CONCLUSION: This scoping review emphasizes pharmacists' clinical activities in improving the care of patients with multiple myeloma. There is a need to develop studies with patient-reported outcomes and comprehensive reporting of pharmacists' clinical activities to ensure reproducibility and effective implementation in clinical practice.

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION: Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists. METHODS: To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups. RESULTS: 600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism. CONCLUSIONS: The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

Cross-sectional description of hospital pharmacy services in Puerto Rico in 2022 using the Practice Advancement Initiative 2030 Self-Assessment Tool.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. SUMMARY: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. CONCLUSION: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Competências gerais, específicas e dificuldades para a atuação dos farmacêuticos como preceptores: revisão integrativa / General and specific competencies and difficulties for pharmacists to act as preceptors: an integrative review / Competencias generales y especificas y dificultades del farmacéutico para el trabajo como preceptor: una revisión integrativa

O presente estudo teve como objetivo descrever e analisar as competências gerais, específicas e as dificuldades para a atuação dos farmacêuticos como preceptores. Para isso, foi realizada uma revisão de literatura nas bases de dados eletrônicas PubMed, Web of Science, Embase e Scopus, utilizando artigos publicados sobre competências gerais e específicas dos preceptores farmacêuticos. A busca inicial identificou 355 artigos, dentre os quais 14 atenderam aos critérios de inclusão. Foram encontradas como principais competências gerais: habilidade de comunicação, conhecimento, resolução de problemas, desenvolvimento de pensamento crítico e profissionalismo; como específicas: feedbacks, relacionamento interpessoal, atividades baseadas nas necessidades dos alunos, planejamento, expectativa compartilhada e liderança; e foram vistas como principais dificuldades: necessidade de maior qualificação dos preceptores e falta de tempo para exercer as atividades da preceptoria. O conhecimento dessas competências e dificuldades pode contribuir para uma melhor força de trabalho na educação acadêmica e experiencial em farmácia

The present study aimed aimed at describing and analyzing the general and specific skills and difficulties for pharmacists to act as preceptors. To this end, a literature review was carried out in the electronic databases PubMed, Web of Science, Embase and Scopus, for articles published on general and specific competencies of pharmaceutical preceptors. The initial search identified 355 articles and 14 using articles published met the inclusion criteria. The main general competencies were found to be: communication skills, knowledge, problem solving, development of critical thinking and professionalism; as specific: feedback, interpersonal relationships, activities based on student needs, planning, shared expectations and leadership; and the main difficulties were seen as: need for greater qualification of preceptors and lack of time to carry out preceptorship activities. Knowledge of these skills and difficulties can contribute to a better workforce in academic and experiential pharmacy education

El presente estudio tuvo como objetivo describir y analizar las competencias generales y específicas y las dificultades para la actuación de los farmacéuticos como preceptores. Para ello, se realizó una revisión de literatura en las bases de datos electrónicas PubMed, Web of Science, Embase y Scopus, usando artículos publicados sobre competencias generales y específicas de los preceptores farmacéuticos. La búsqueda inicial identificó 355 artículos, dentro de los quales 14 cumplieron con los criterios de inclusión. Se encontraron como principales competencias generales: habilidad de comunicación, conocimiento, resolución de problemas, desarrollo de pensamiento crítico y profesionalismo; como específicas: retroalimentación, relaciones interpersonales, actividades basadas en las necesidades de los alumnos, planificación, expectativa compartida y liderazgo; y fueron vistas como principales dificultades: necesidad de más cualificación de los preceptores y falta de tiempo para ejercer las actividades de la preceptoría. El conocimiento de estas competencias y dificultades puede contribuir a una mejor fuerza laboral en la educación académica y experiencial en farmacia

Profile, performance, and perception of pharmacist preparedness for the COVID-19 pandemic.

INTRODUCTION: The lack of human resources for disease prevention and control is evident in times of health crisis, such as the COVID-19 pandemic. In public health emergencies, the capacity for adequate assistance and guaranteed access to pharmacological treatment are fundamental and contribute to impact reduction. We aimed to analyze the profile, performance, and characteristics related to the self-perception of preparedness among pharmacists who responded to the COVID-19 pandemic in Brazil. METHOD: A cross-sectional study was conducted in two stages: content validation of a questionnaire and its application to a representative sample of pharmacists in Rio de Janeiro. The snowball technique was used to recruit participants. A logistic regression model was adjusted to determine the effects of the factors on the probability of a pharmacist feeling prepared to act during the pandemic. RESULTS: Six experts approved and validated the questionnaire, and 376 pharmacists were included in the study, 60.6 % of whom were in places specially designated by health authorities to diagnose and treat COVID-19. Professionals participated in various activities related to pandemic demands, including medication management and population guidance. Postgraduate degrees increased the odds of participants feeling prepared to act during the pandemic. Furthermore, pharmacists who worked in reference facilities were more likely to feel ready than those who worked in other places. Professionals who knew treatment guidelines were almost three times more likely to feel prepared than the ones without the knowledge of treatment guidelines. Training or guidance on how to act during the pandemic increased pharmacists' odds of feeling prepared by 2.58 times. CONCLUSION: Pharmacists actuated from diagnosis to treatment and participated in the health activities required during the pandemic. Factors contributing to the self-perception of preparedness were identified. Such factors can be targets for interventions to promote the preparedness of the workforce for future health emergencies.

Teaching Strategies for Professional Identity Education in Pharmacy: A Scoping Review.

OBJECTIVES: To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy. FINDINGS: We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation. SUMMARY: The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.

Prescrição farmacêutica em farmácias comunitárias públicas e privadas de Vitória-ES: barreiras e facilitadores para a implementação da atividade / Pharmacist prescribing in public and private community drugstores in Vitória, Espírito Santo State: barriers and facilitators for the implementation of the activity

Resumo A prescrição farmacêutica avança no mundo, com diferentes países regulando a prática. No Brasil, essa regulação ocorreu em 2013, porém são escassas as informações sobre sua inserção no cotidiano do exercício farmacêutico. Este estudo objetivou analisar a prescrição farmacêutica no município de Vitória-ES, Brasil, e os fatores que influenciam na adesão da prática. Trata-se de um estudo qualitativo com 20 farmacêuticos e 10 gestores de farmácias comunitárias públicas e privadas, realizado a partir de entrevistas, com posterior análise de conteúdo temática para apreender percepções e opiniões. Os farmacêuticos desta pesquisa não prescreviam. Farmacêuticos e gestores identificaram facilitadores para a implementação da atividade, com destaque para os fatores: infraestrutura; fácil acesso ao farmacêutico; e boa receptividade à prescrição. Como barreiras, os fatores foram: número insuficiente de recursos humanos; falta de estímulo institucional à prescrição; e fatores individuais. Além da observação da não execução da prescrição farmacêutica, este estudo trouxe uma oportunidade para identificar elementos que podem estar contribuindo para que o exercício dessa atividade não seja realizado nas farmácias comunitárias. Adaptar rotinas ou contratar pessoal se mostraram as principais modificações necessárias. Paralelamente, ações destinadas a qualificar a formação por meio da educação permanente também se apresentam como necessárias.

Abstract Pharmacist prescribing advances in the world with different countries regulating this activity. In Brazil, this regulation took place in 2013, but there is little information about its insertion in the routine of pharmacist practice. This study aimed to analyze the pharmacist prescribing in the city of Vitória, Espírito Santo state, Brazil, and the factors that influence adherence to the practice. This is a qualitative study based on interviews with 20 pharmacists and 10 managers of public and private community drugstores with subsequent content analysis to apprehend perceptions and opinions. The pharmacists in this research did not prescribe. Pharmacists and managers identified facilitators for the implementation of the activity, highlighting the following factors: infrastructure; easy access to the pharmacist; and good receptivity to the prescription. As barriers, the factors were insufficient number of human resources; lack of institutional stimulus to prescribing; and individual factors. In addition to the observation of non-execution of pharmacist prescribing, this study provided an opportunity to identify elements that may contribute to the non-existence of this activity in community drugstores. Adapting routines or hiring staff were the main necessary changes. At the same time, actions aimed at qualifying training through permanent education are also necessary.

Cross-cultural adaptation and psychometric evaluation of the "Modification of Hall's professionalism scale for use with pharmacists".

BACKGROUND: Professionalism is the demonstration of behaviors that guide the actions of health professionals. In Pharmacy, its implementation is possible through assessment instruments for pharmacists, such as the "Modification of Hall's Professionalism Scale for Use with Pharmacists". OBJECTIVE: To translate the "Modification of Hall's Professionalism Scale for Use with Pharmacists" into a Brazilian Portuguese version and evaluate its psychometric properties for pharmacists. METHOD: The methodological process of this study took place in three stages: translation and cross-cultural adaptation of the instrument original version into a Brazilian Portuguese version; validation of the scale content through consensus among geographically distinct experts and, finally; examination of the scale psychometric measurement properties through a convenience sample of 600 Brazilian pharmacists. At this stage, construct validity was verified using Exploratory Factor Analysis (EFA) and reliability was examined by calculating the composite reliability. RESULTS: The adapted instrument to a Brazilian Portuguese version demonstrated content validity with coefficients considered acceptable, above 0.8. The EFA demonstrated a structure supported by six factors and 39 items. The H index suggested high stability for all factors as well as composite reliability. CONCLUSION: The Brazilian Portuguese version of the instrument presented appropriate content validity coefficients and psychometric properties. This measure may be useful for future studies on professionalism regarding teaching strategies and assessment of this construct among pharmacists.

The perspectives of pharmacy student preceptors on a service-learning program in primary health care: A qualitative study.

Background: There are a few studies about preceptorship in primary health care settings, but they didn't assess all possible contributions of this experience, such as preceptor behavioral changes and impact on health services. Objective: This study aimed to analyze the perspective of pharmacy student preceptors on a service-learning program carried out in a primary health care setting. Methods: This was a qualitative descriptive study, with semi-structured interviews and thematic analysis. The themes were defined deductively, according to levels of Kirkpatrick's theory about the impact of educational activities. Results: The preceptors showed positive and negative reactions to the structure of the service-learning program, developed their knowledge, changed behaviors such as collaborative interprofessional practice, and reported improvements in the health units. Conclusions: From the perspective of pharmacy student preceptor preceptors, the service-learning program had an impact on all levels expected for an educational activity according to Kirkpatrick's theory: reaction, learning, behavior, and results. These findings may inform the design of service-learning programs.

Omissões de prescrição e inclusão de novos medicamentos na farmacoterapia de pacientes idosos na atenção primária à saúde / Prescribing omissions and inclusion of new medications in the pharmacotherapy of older adults in primary care

A falta de uso de um medicamento necessário envolve riscos consideráveis para o idoso. Por meio da prestação de serviços de gerenciamento da terapia medicamentosa (GTM), os farmacêuticos podem contribuir na identificação de condições de saúde não tratadas que precisam de tratamento farmacológico. O objetivo deste estudo é descrever potenciais omissões de prescrição identificadas por farmacêuticos que cuidam de idosos na atenção primária brasileira e se elas estão incluídas na ferramenta START - Screening Tool to Alert to Right Treatment. Os dados foram coletados dos prontuários de 585 idosos acompanhados em serviços de GTM na atenção básica em Minas Gerais, Brasil, de 2014 a 2017. Os farmacêuticos identificaram a necessidade de adicionar pelo menos um medicamento para 28,4% dos pacientes idosos, totalizando 233 medicamentos relacionados a 31 diferentes problemas de saúde não tratados. Um terço (n = 79) dos medicamentos sugeridos pelos farmacêuticos correspondeu a algum critério proposto pela ferramenta START. Estes resultados enfatizam a importância do atendimento holístico ao paciente nos serviços de GTM.

The lack of use of a necessary medication involves considerable risks to the older person. Through the provision of comprehensive medication management (CMM) services, pharmacists may identify untreated health conditions that need pharmacological treatment. The purpose of this study is to describe potential prescribing omissions identified by pharmacists taking care of older adults in Brazilian primary care and whether they are included in the Screening Tool to Alert to Right Treatment (START). Data were collected directly from the records of 585 older adults followed up in CMM services in primary care in Minas Gerais, Brazil, from 2014-2017. Pharmacists identified the need to add at least one medication for 28.4 % of the older patients, totaling 233 drugs related to 31 different untreated health problems. One third (n=79) of the drugs suggested corresponded to some criterion proposed by START. These results emphasize the importance of holistic patient care in CMM services.

Role of pharmacist in the management of Hansen's Disease: A scoping review.

Background: Stakeholders and healthcare professionals have an essential role in the elimination of Hansen's Disease. Of these, pharmacists provide core services that assist the management of these patients with the supply of medicines and clinical actions. Objectives: To summarize evidence on the role of pharmacist in the management of Hansen's Disease. Methods: A literature search was performed in MEDLINE, Embase, Scopus, Web of Sciences, LILACS, and Google Scholar for studies published until September 29th, 2022 without language restriction. Studies that reported actions provided by pharmacists in the management of patients with Hansen's Disease were included. The pharmacist interventions identified in the studies were described based on key domains in DEPICT v.2. Two independent reviewers performed study selection and data extraction and any disagreements were resolved by third and fourth authors. Results: A total of 751 records were identified, of which 8 studies fully met the eligibility criteria. Most of them were conducted in Brazil (n = 5), in an ambulatory setting (n = 8) and the most common study design was descriptive cross-sectional (n = 6). Different roles of pharmacists were identified, such as medication review, therapeutic drug monitoring, patient education, drug information, and dispensing. All studies described pharmacist interventions for patients through one-on-one contact and face-to-face. Pharmacists were responsible for patient counseling (n = 8), suggestions for change in therapy (n = 2), and monitoring results report (n = 2). The studies reported benefits associated with pharmacist interventions, despite the limited descriptions regarding these actions. Conclusions: Few studies that described the activities of pharmacists in the management of Hansen's Disease were found. As the studies did not offer a satisfactory level of description and quality, further research should be conducted to strengthen this field.

Knowledge, Attitudes, and Practices in Antibiotic Dispensing amongst Pharmacists in Trinidad and Tobago: Exploring a Novel Dichotomy of Antibiotic Laws.

The inappropriate consumption, use, and dispensing of antibiotics are problems faced globally, with a pattern of inappropriate consumption differing in higher-income countries due to the ease of accessibility of antibiotics. The main drivers of consumption and inappropriate use are the over-the-counter sales of antibiotics by pharmacies. Trinidad and Tobago (T&T), a twin island state in the Caribbean, has two Acts of Parliament that regulate antibiotics: the Antibiotics Act and the Food and Drug Act, yet the Over-the-Counter (OTC) sale of antibiotics still exists. This study sought to determine the knowledge, attitudes, and practices regarding the OTC dispensing of antibiotics in T&T. A cross-sectional study gathered data from pharmacists in both the private and public sectors of Trinidad over 7 months. The results showed that antibiotic resistance and antibiotic abuse were seen as significant problems. The level of experience, gender (female), and age (younger) were significantly associated with having good overall knowledge of good dispensing habits and antibiotic laws (p = 0.036, p = 0.047, and p = 0.001, respectively). Pharmacists generally agreed that antibiotics under the Food and Drug Act may have contributed to OTC dispensing in the private sector (p = 0.013) and that all antibiotics should be under the Antibiotic Act (p = 0.002). Additionally, it was found that the dispensing of antibiotics OTC in the private sector (p = 0.006) occurred: without doctors' advice and without requesting prescriptions; because it was perceived as lawful (especially by older pharmacists); and because of the perceived motivation of profit. Regulation enforcement was perceived as deficient. OTC dispensing for reasons, such as misunderstanding of laws, occurs in T&T.

Global overview of pharmacist and community pharmacy actions to address COVID-19: A scoping review.

Introduction: Pharmacists and community pharmacies play an important role in managing, identifying and preventing the spread of the COVID-19 outbreak. Objectives: To characterize the global panorama of action by pharmacists and community pharmacies in facing the COVID-19 pandemic. Methods: The scoping review was based on the search for scientific articles in the databases: PubMed; Scopus; ScienceDirect and Web of Science. The search was carried out on August 31, 2021. The selection process was divided into 3 phases: i) title analysis; ii) analysis of study abstracts; iii) analysis of the full texts of the studies selected in the previous step. Studies were independently selected by two investigators and discrepancies resolved by consensus during focus group discussions led by a third reviewer. Results: The final search yielded 36 articles for the review. The main strategies for coping with COVID-19 were grouped into 4 categories defined by consensus between the authors: (1) services for providing care to the patient; (2) product management; (3) infection prevention and control practices in community pharmacy; (4) preparation, sources of information used and training offered/received. Through these, the aim was to involve technical managerial, technical assistance and pedagogical technical actions adopted, as well as structure and process indicators that allowed the continuity of the offer of services. Conclusion: During the pandemic, pharmacists and community pharmacies have been providing essential health services to communities. The results of this review may help to identify the changes adopted to face the COVID-19 pandemic and may contribute to improving the quality of practices in these establishments during the pandemic and after it, in similar situations.

Long-Term Care medicines formularies: any reasons for pharmacists' concern?

Abstract This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolism, Blood and blood-forming organs, Musculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations

Professional practice of pharmacists in private community pharmacies of Minas Gerais, Brazil

Abstract Considering the wide accessibility of population to private community pharmacies, Pharmaceutical Services must be provided comprehensively in such establishments. This research aims to understand how pharmaceutical practice is developed by pharmacists in private community pharmacies of Minas Gerais, Brazil. Qualitative descriptive research was performed. Data were collected through online questionnaires (n=113) and interviews (n=12) with pharmacists working in such institutions and they were analyzed according to Bardin's Content Analysis, with the contribution of software IRAMUTEQ. Two main categories of analysis were formed: "Professional training of pharmacists and the working conditions in private community pharmacies" and "Pharmaceutical Services in private community pharmacies of Minas Gerais". Pharmacists understood the population's healthcare as the main purpose of their professional practice. However, the routine focused on the technical management of medicines and the lack of private rooms hindered the provision of qualified assistance. Furthermore, commercial strategies were identified as motivators for ethical dilemmas and conflicts among the work team. It is suggested that the growth of the pharmaceutical retail market in Minas Gerais should be accompanied by favorable conditions for the production of care, so that pharmaceutical practice in these institutions can be developed in an ethical and responsible way.

As múltiplas violências vivenciadas por farmacêuticas no ambiente laboral / The multiple violences experienced by pharmacist women in the workplace / Las múltiples violencias experimentadas por las farmacéuticas en el entorno laboral

Resumo A divisão sexual do trabalho ocasiona iniquidade entre gêneros, bem como situações de violência direcionadas às mulheres no ambiente laboral. Na área farmacêutica, a maioria feminina e a inserção em múltiplos cenários, que envolvem contato com público e parcerias profissionais diferenciadas, potencializam a exposição à violência. Assim, o objetivo deste estudo foi analisar situações de violência vivenciadas por farmacêuticas no ambiente laboral. Para tal, utilizou-se método qualitativo, com análise de conteúdo, realizada no software NVivo®, de uma survey on line, respondida por farmacêuticas (n=381) registradas no Conselho Regional de Farmácia de Minas Gerais, Brasil. Como resultado, identificou-se quatro categorias: 'Convivendo com o desrespeito, ameaças e vulnerabilidade', 'O sexismo e o machismo estrutural que cala, diminui e atordoa', 'A discriminação contra a mulher como obstáculo à equidade' e 'Assédio sexual e objetificação da mulher'. Emergiram diversas expressões de violências no ambiente laboral provenientes de múltiplos agressores. Farmacêuticas reconheceram prejuízo profissional e pouco reconhecimento pela capacidade técnica. Conclui-se que os relatos expuseram a falta de proteção da integridade farmacêutica no ambiente de trabalho. Espera-se que esses resultados tragam à luz a desigualdade de gênero no trabalho farmacêutico, com destaque para situações de violência, ampliando a discussão e proporcionando evolução dessa profissão majoritariamente feminina.

Abstract The sexual division of labor causes inequality between genders, as well as situations of violence directed to women in the workplace. In the pharmaceutical area, the majority of women and insertion in multiple scenarios, involving contact with public and differentiated professional partnerships, enhance exposure to violence. Thus, the objective of this study was to analyze situations of violence experienced by pharmacists in the workplace. For this, a qualitative method was used, with content analysis, performed in the NVivo® software, of an online survey, answered by pharmacists (n=381) registered in the Regional Pharmacy Council of Minas Gerais, Brazil. As a result, four categories were identified: 'Living with disrespect, threats and vulnerability,' 'Sexism and structural chauvinism that shuts down, diminishes and torments,' 'Discrimination against women as an obstacle to equity' and 'Sexual harassment and objectification of women.' Several expressions of violence in the labor environment emerged from multiple aggressors. Pharmacists recognized professional impairment and little recognition for technical capacity. We concluded that the reports exposed the lack of protection of pharmaceutical integrity in the workplace. It is expected that these results bring to light the gender inequality in pharmaceutical work, with emphasis on situations of violence, expanding the discussion and providing evolution of this mostly female profession.

Resumen La división sexual del trabajo ocasiona iniquidad entre los géneros, así como situaciones de violencia dirigidas a las mujeres en el entorno laboral. En el ámbito farmacéutico, la mayoría de las mujeres y la inserción en múltiples escenarios, que implican contacto con el público y asociaciones profesionales diferenciadas, potencian la exposición a la violencia. Por lo tanto, el objetivo de este estudio fue analizar las situaciones de violencia experimentadas por las farmacéuticas en el entorno laboral. Para esto, se utilizó un método cualitativo, con análisis de contenido, realizado en el software NVivo®, de una encuesta en línea, respondida por farmacéuticas (n=381) registradas en el Consejo Regional de Farmacia de Minas Gerais, Brasil. A consecuencia, se identificaron cuatro categorías: 'Conviviendo con falta de respeto, amenazas y vulnerabilidad', 'el sexismo y el machismo estructural que cala, disminuye y atormentó', 'la discriminación contra la mujer como obstáculo a la equidad' y 'el acoso sexual y la objeción de la mujer'. Han surgido varias expresiones de violencia en el entorno laboral procedentes de múltiples agresores. Los productos farmacéuticos han reconocido el daño profesional y el escaso reconocimiento de la capacidad técnica. Se concluye que los informes haciendo hincapié de manifiesto la falta de protección de la integridad farmacéutica en el entorno laboral. Se espera que estos resultados traigan a la luz la desigualdad de género en el trabajo farmacéutico, haciendo hincapié en las situaciones de violencia, ampliando el debate y dando lugar a la evolución de esa profesión principalmente femenina.

Preliminary assessment of antivenom availability and management in the public health system of Costa Rica: An analysis based on a survey to pharmacists in public health facilities.

Availability and accessibility of safe and effective antivenoms are key elements for the successful treatment of snakebite envenoming (SBE). This study provides a preliminary analysis on the way antivenoms are managed by the public health system in Costa Rica and on the role played by pharmacists in the overall management of antivenoms. This was an observational, cross-sectional study based on an online survey sent to pharmacists working at Caja Costarricense de Seguro Social (Costa Rican Social Security System; CCSS) in different locations in Costa Rica. Characteristics and location of health facilities, as well as antivenom availability and management details, were analyzed. Responses from a total of 96 pharmacists, corresponding to 55 different healthcare facilities, were included in this study. Most respondents worked at pharmacies located in urban communities (69.0%) and in the secondary level of care, which includes clinics, and regional and peripheral hospitals (55.2%). Overall, participants reported antivenom availability at all levels of care and in centers having various operating schedules, although they were not available in some facilities in regions where SBE is uncommon or do not attend SBE cases because of the proximity of more complex health centers. On average, the stocks of anticoral and polyvalent antivenoms per health facility were compatible with the dose of antivenom required for treating a SBE case. More than half of participants reported knowing the availability of protocols for the management of SBE and the correct use of antivenom at their healthcare facilities. Of the total respondents, 49% agreed on possessing all the resources needed for the correct management of these medicines at their facilities, and 65.6% indicated that they know the procedures for antivenom storage and management. Our findings provide a first description of the availability of antivenoms in the public health system of Costa Rica, including the primary care level. Results also underscore the perceived role of participating pharmacists in the management of these life-saving drugs and the need to improve their knowledge on this topic.

Antimicrobial dispensing process in community pharmacies: a scoping review.

BACKGROUND: Antimicrobial resistance remains a major global public health concern, and antimicrobial dispensing in community pharmacies is an important factor in preventing this damage. However, the current literature focuses on the technical and attitudinal aspects related to antimicrobial dispensing, with little emphasis on the interventions provided in this service. Thus, this study aimed to determine the antimicrobial dispensing process in community pharmacies. METHODS: A scoping review was performed in September 2020 using the PubMed, EMBASE, LILACS, Web of Science, and Cochrane databases. The search terms included words related to dispensing, antibacterial agents, and pharmacies in various combinations. Two reviewers screened the titles, abstracts, and full-text articles according to the eligibility criteria, and extracted the data. The findings were presented in a descriptive form. RESULTS: Of the 7713 studies screened, 35 were included, of which 22 (63%) were published in Asia. Most studies followed a cross-sectional design (n = 27), and the simulated patient was the most often used method to assess the antimicrobial dispensing process (n = 22). Moreover, 31 (89%) studies investigated antimicrobial dispensing without prescription, and only four (11%) studies evaluated antimicrobial dispensing with prescription. In the 35 studies, the most frequently asked questions were about drug allergies (n = 19) and patient symptoms (n = 18), and counseling mainly focused on the side effects (n = 14), precautions (n = 14), how to take the medication (n = 12), and duration of medication use (n = 11). Another common intervention was referral (n = 15). Among clinical cases, counseling on medication use occurred often in cases of urinary tract infection (51%) and otitis media (50%). CONCLUSIONS: Antimicrobial dispensing processes have been primarily investigated in low- and middle-income countries, with a focus on dispensing antimicrobials without prescriptions. During the dispensing process, pharmacists mostly posed minimal questions and counseling, highlighting the deficiencies that persist in this practice. Our results indicate the need for multifaceted strategies, such as implementing educational, regulatory or administrative strategies and changes in cultural background, especially in low- and middle-income countries, that aim to reduce indiscriminate use of antimicrobials. Therefore, qualifying the antimicrobial dispensing process is a fundamental factor for improving the rational use of antimicrobials and reducing microbial resistance.

Prescrição farmacêutica: uma revisão sobre percepções e atitudes de pacientes, farmacêuticos e outros interessados / Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals

Resumo A prescrição farmacêutica é uma experiência em expansão em alguns países desenvolvidos, com diferentes sistemas de saúde. Conhecer a contribuição que essa atividade pode desempenhar no processo de assistência à saúde e investigar sua aceitação é de fundamental interesse para os países que a regularam. Este estudo de revisão de literatura, portanto, objetivou desenhar o estado da arte da investigação acadêmica sobre percepção, opiniões e atitudes no contexto da prática da prescrição farmacêutica em países que a adotaram. Para isso, realizou-se investigação nas bases de dados MEDLINE, Scopus, Embase, SciELO e LILACS, resultando na seleção de 17 estudos. Da análise dos artigos, emergiram três categorias de discussão: "compreensão da prática e benefícios percebidos"; "aceitação e adesão à prática"; "barreiras à prática". Os resultados mostraram aceitação e percepções variáveis nos diferentes públicos, dependendo, entre outras questões, do nível de conhecimento e experiência dos pacientes e dos profissionais de saúde, do perfil do farmacêutico ou da modalidade de prescrição. Este estudo aponta alguns desafios envolvidos na prática da prescrição farmacêutica e seus achados podem ser úteis para sugerir caminhos para o fortalecimento da prática.

Abstract Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: "understanding of the practice and perceived benefits", "acceptance and adherence to the practice, and "hindrances to the practice". The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.

O farmacêutico na Atenção Primária à Saúde no Brasil: análise comparativa 2014-2017 / The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017

RESUMO O farmacêutico tem importante papel nas unidades de saúde da Atenção Primária à Saúde (APS). No entanto, ainda são escassos no Brasil estudos que abordem a influência do farmacêutico na rede assistencial de saúde. O artigo tem como objetivo verificar em que medida a inserção dos farmacêuticos nas Unidades Básicas de Saúde (UBS) do País está associada à ampliação de aspectos estruturais das farmácias e à disponibilidade de medicamentos. Trata-se de estudo transversal, retrospectivo e analítico, que utilizou dados secundários do 2º (2014) e 3º (2017) ciclos da avaliação externa do Programa de Melhoria de Acesso e da Qualidade da Atenção Básica (PMAQ-AB) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Os resultados mostraram importante centralização na dispensação de medicamentos ao longo do 2º e 3ºs ciclos PMAQ-AB. Em contrapartida, identificou-se melhora nos aspectos estruturais nas farmácias das UBS e incremento tanto na disponibilidade média de medicamentos como no total de UBS com disponibilidade de medicamentos ≥80%. Tais avanços foram ainda maiores na existência de farmacêutico cadastrado na UBS. Evidenciou-se a relevância do farmacêutico na APS no Sistema Único de Saúde, uma vez que sua presença potencializa tanto a disponibilidade de medicamentos como também propicia melhores condições estruturais dos serviços de farmácia da APS.

ABSTRACT The pharmacist play a vital role in PHC. However, studies addressing how pharmacists influence the health care network are still scarce. We aim to verify to what extent the inclusion of pharmacists in PHC Units (UBS) in the country is associated with the expanded structural aspects of pharmacies and drug availability in Brazil. This cross-sectional, retrospective, and analytical study employed secondary data from cycles 2 (2014) and 3 (2017) of the external evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB) and the National Register of Health Facilities (CNES) databases. The results showed an essential centralization in drug dispensing over PMAQ-AB cycles 2 and 3. In contrast, we identified an improvement in the structural aspects of the UBS pharmaceutical services and an increase in the mean drug availability and the total UBS with drug availability ≥ 80%. Such advances were even more significant in the presence of registered pharmacists at the UBS. We conclude by stating that the presence of pharmacists in the PHC of the Unified Health System (SUS) enhances drug availability and provides better structural conditions for PHC pharmacy services.