Improving the Quality of Publications in and Advancing the Paradigms of Clinical and Social Pharmacy Practice Research: The Granada Statements / Mejorando la calidad de las publicaciones y avanzando en todos los paradigmas de la investigación de la farmacia asistencial, clínica y social: las declaraciones de Granada

Pharmacy and pharmaceutical sciences embrace a series of different disciplines. Pharmacy practice has been defined as “the scientific discipline that studies the different aspects of the practice of pharmacy and its impact on health care systems, medicine use, and patient care”. Thus, pharmacy practice studies embrace both clinical pharmacy and social pharmacy elements. Like any other scientific discipline, clinical and social pharmacy practice disseminates research findings using scientific journals. Clinical pharmacy and social pharmacy journal editors have a role in promoting the discipline by enhancing the quality of the articles published. As has occurred in other health care areas (i.e., medicine and nursing), a group of clinical and social pharmacy practice journal editors gathered in Granada, Spain to discuss how journals could contribute to strengthening pharmacy practice as a discipline. The result of that meeting was compiled in these Granada Statements, which comprise 18 recommendations gathered into six topics: the appropriate use of terminology, impactful abstracts, the required peer reviews, journal scattering, more effective and wiser use of journal and article performance metrics, and authors’ selection of the most appropriate pharmacy practice journal to submit their work (AU)

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies.

BACKGROUND: Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS: A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS: The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS: There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.

Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review.

INTRODUCTION: The aim was to determine whether professional pharmacy services (PPS) provided to ambulatory patients attending community pharmacy are cost-effective compared with usual care (UC). Areas covered: MEDLINE, Web of Knowledge, Scopus, Cochrane Library and Centre for Reviews and Dissemination databases were searched, and the risk of bias of randomized controlled trials, and the methodological quality of economic evaluations was assessed. A total of 17 economic evaluations of 13 studies were included. Seven studies were classified as high-, three as medium- and three as low-quality. PPS were more effective and less costly than UC in four studies; seven studies concluded that PPS were more effective and more costly and two studies concluded that the service was as effective as the UC, with higher and lower costs. Expert commentary: Although the uncertainty was variable among the studies, a general trend towards the cost-effectiveness of PPS was observed. Decision makers are encouraged to consider the feasibility of implementing PPS.

Percepción de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria / Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy

Objetivo: Explorar la percepción de Formadores Colegiales con experiencia previa sobre su formación y sus funciones futuras en la implantación y sostenibilidad del servicio de Seguimiento Farmacoterapéutico en el ámbito de la farmacia comunitaria española. Método: Estudio cualitativo mediante la técnica del grupo focal. El coordinador de la reunión focal utilizó un guión temático previamente elaborado que permitía explorar la opinión de los Formadores Colegiales sobre sus experiencias y percepciones acerca del futuro de esta nueva figura profesional. El contenido de la conversación fue registrado en una grabadora, transcrito en su totalidad y posteriormente analizado mediante análisis de contenido. Resultados: La reunión grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmacéuticos, en Madrid, tuvo una duración de 95 minutos. Participaron seis Formadores Colegiales. En función de los temas tratados se identificaron dos dimensiones; una primera que abarca las funciones que debe desempeñar un Formador Colegial (resaltando la función de motivador, facilitador de la comunicación y formador metodológico y clínico) y una segunda en las que se describen las características que ese profesional debe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio de Farmacéuticos correspondiente, con lugar físico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otras características). Conclusiones: El presente artículo aporta información relevante sobre la figura innovadora del Formador Colegial, describiendo las características intrínsecas necesarias para desarrollar su labor y las funciones a desempeñar. Dicha información debería ser utilizada por aquellos Colegios Oficiales de Farmacéuticos provinciales que deseen implantar Servicios Profesionales Farmacéuticos, tales como el servicio de Seguimiento Farmacoterapéutico

Objective: To explore opinions and perceptions of Practice Change Facilitator of their training and experiences in assisting in the implementation of Medication Reviews with follow- up in Spanish community pharmacy. Methods: A focus group of six Practice Change Facilitators was conducted at the headquarters of the Spanish General Council of Pharmacists’ Associations. A semi-structured interview guide was used. Results: Two domains emerged underpinned by a number of themes. One domain was related to the interaction between the pharmacy and the Practice Change Facilitator. This included their role as a motivator, a facilitator of internal and external communication, and teacher of the clinical aspects and methodological issues of the process of medication reviews with a follow-up. The second domain was composed of themes including personal traits and characteristics, and by work-related conditions such as flexibility of the individual and contractual obligations. Conclusions: This paper provides qualitative evidence which can be used by employers to further define the role, functions and optimal personal traits of Practice Change Facilitators

Factores que influyen en la participación de farmacéuticos comunitarios en un servicio de atención farmacéutica para pacientes asmáticos / Factors affecting community pharmacists’ participation in a Pharmaceutical care service for asthmatic patients

Objetivo: Identificar, mediante el modelo PRECEDE, los factores predisponentes, facilitadores y reforzantes que influían en la participación de un grupo de farmacéuticos en el proyecto AFasma. Método: Estudio cualitativo mediante entrevistas semiestructuradas y observación participante de los farmacéuticos incluidos en el grupo de intervención del estudio AFasma. Resultados: Los factores predisponentes motivantes para el farmacéutico fueron: formación en asma, realización profesional, fidelización del paciente y valoración de la farmacia. Los factores desmotivantes fueron: dedicación de tiempo, ausencia de relación farmacéutico-médico, falta de personal y de publicidad, y dificultades para ofrecer el servicio. Los factores facilitadores presentes fueron: habilidades de comunicación farmacéuticopaciente, cumplimentación correcta de las hojas de recogida de datos, uso correcto del inhalador y pago por servicio. Por el contrario, se detectó: baja capacidad para ofertar el servicio, ausencia de una zona de atención personalizada, dudas con la valoración de la técnica de inhalación y educación en asma, y ausencia de implicación de todo el personal de la farmacia. Los factores reforzantes identificados con mayor frecuencia a favor de la realización del estudio fueron: satisfacción personal y profesional, mejora de la relación farmacéutico-paciente y actualización en farmacología, mientras que entre los identificados en contra el más frecuente fue la alta dedicación de tiempo requerida. Conclusiones: La utilización del modelo PRECEDE logró identificar los factores predisponentes, facilitadores y reforzantes que condicionaron la participación de un grupo de farmacéuticos en el estudio AFasma. Con los resultados obtenidos se podría diseñar un conjunto de estrategias para apoyar la realización de estudios similares y facilitar una posible implantación del servicio (AU)

Objective: Identify trough the PRECEDE model those factors predisposing, reinforcing and enabling the participation of a group of pharmacists in the AFasma project. Methods: Qualitative study through semi-structured interviews and participant observation of the pharmacists included in the intervention group of the AFasma project. Results: Predisposing factors motivating the pharmacist were: asthma training, professional satisfaction, patient loyalty and increase pharmacy value. Those desmotivating were: lack of time, lack of physician-pharmacist collaborative working relationship, lack of staff and marketing and difficulties in offering the service. Facilitating factors were: pharmacist-patient communication skills, ability to complete data forms, correct inhaler technique and payment for the service. In contrast, there was a lack of skills to offer the service to the patient, lack of a patient counseling area, doubts with the inhaler technique assessment and asthma non-pharmacological advice, and pharmacy staff not working as a team. Reinforcing factors supporting the service were: professional and personal satisfaction, improvement of the pharmacist-patient relationship, pharmacology training. The reinforcing factor against the service was the time spent during the project. Conclusions: Using the PRECEDE model we were able to identify the factors predisposing, facilitating and enabling the participation of a group of pharmacist in the AFasma project. With the factors identifi ed a number of strategies could be developed in order to support further studies and facilitate a potential implementation of the service (AU)

Adherence: a review of education, research, practice and policy in Spain / Cumplimiento: revisión de la educación, investigación, práctica y política en España

Aims: To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade. Methods: A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites. Results: Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional. Conclusions: At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future (AU)

Objetivo: Describir la educación, práctica e investigación sobre adherencia farmacológica llevadas a cabo en la última década por farmacéuticos en España. Métodos: Se hizo una revisión de la bibliografía de los últimos 10 años en Medline y Embase. Además, se consultaron otras fuentes bibliográficas farmacéuticas españolas para recuperar artículos de interés publicados en la última década. Los artículos se incluyeron si contaban con la participación de un farmacéutico y se medía la adherencia a la medicación, o si existía una intervención farmacéutica para monitorizar y/o mejorar la adherencia, de forma directa o indirecta. Se seleccionaron también los artículos que desarrollaban herramientas para la evaluación de la adherencia. También, se revisaron los programas de formación impartidos en pre y postgrado de farmacia. La evaluación de las políticas sobre este asunto se realizó analizando las páginas web de los Ministerios de Educación y de Sanidad y Política Social a nivel estatal, así como sus homólogos a nivel autonómico. Resultados: Los farmacéuticos no reciben formación ninguna enfocada específicamente a la adherencia. Tampoco existe política ni práctica sanitaria obligatoria que deban seguir los farmacéuticos independientemente del ámbito sanitario donde ejerzan su profesión. Respecto a la investigación, se encontraron 24 estudios que cumplieron con los criterios de inclusión. De ellos, 10 trataban de alguna intervención farmacéutica para monitorizar y/o mejorar la adherencia y 14 sólo pretendían evaluar la adherencia. En diez de los estudios, participaron farmacéuticos hospitalarios en colaboración con otro profesional de la salud. Conclusiones: Actualmente en España, la actividad investigadora del farmacéutico está poco desarrollada en el campo de la adherencia farmacológica. Los servicios que proporcionan los farmacéuticos a los pacientes para mejorar la adherencia no se implementan de forma generalizada. No obstante, parece ser que los esfuerzos que se están realizando últimamente para implantar nuevas iniciativas pueden constituir una base para que en un futuro cercano se comiencen a prestar servicios cognitivos encaminados a mejorar la adherencia de los pacientes (AU)