Análisis del cumplimiento del plan de consumo de los medicamentos de alto costo. Matanzas. 2012-2017 / Analysis of the fulfillment of the consumption plan of high cost medications. Matanzas. 2012 - 2017

RESUMEN Introducción: los medicamentos de alto costo son medicamentos nuevos, altamente específicos y utilizados en condiciones clínicas complejas, como el tratamiento de algunos tipos de cáncer; enfermedades que comprometen el sistema inmunológico, enfermedades inflamatorias o infecciosas. Objetivo: determinar cumplimiento del plan de consumo de los medicamentos de alto costo en la provincia de Matanzas, en el quinquenio 2012-2017. Materiales y métodos: estudio descriptivo, observacional de seguimiento sobre el cumplimiento del plan de consumo de los medicamentos de alto costo, en la población matancera del año 2012 al 2017. Se analizó el universo de medicamentos incluidos en esta categoría, a partir de la base de datos de suministro de medicamentos que emplea la Empresa Comercializadora de Medicamentos. Se identificaron las variables estudiadas. Resultados: en todo el período de estudio se observó un incremento creciente de los medicamentos de alto costo, en el 88,9 % de ellos el consumo ha estado por encima de la planificación realizada por la provincia. Los costos se incrementaron en un 233 % y además en las prescripciones realizadas de estos productos, se encontraron problemas como escaques vacíos, antibióticos sin impresión diagnóstica y omisión de la forma de presentación del medicamento y/o dosis indicada. Conclusiones: el consumo de muchos medicamentos de alto costo fue mayor que la planificación realizada en la provincia de Matanzas, durante el período analizado. Implicó un incremento significativo del presupuesto destinado a estos fines y se detectaron dificultades en el cumplimiento de lo establecido en las prescripciones de dichos medicamentos (AU).

ABSTRACT Introduction: high cost medications (HCM) are new highly specific medications and used in complex clinical conditions as in treatment of some types of cancer, diseases that compromise the immunological system, inflammatory or infections disorders. Objective: to determine the fulfillment of the consumption plan of high-cost medications in the province of Matanzas in the period 2012-2017. Materials and methods: a descriptive, observational, follow up study on the fulfillment of the consumption plan of high-cost medication by the population of Matanzas2012 year to 2017. The universe of drugs included in this category was analyzed on the bases of the drug-supplying database used by the Drug Commercializing Enterprise (ENCOMED in Spanish). The studied variables were identified. Results: it was observed a growing increase of high-cost drugs use during all the period; in 88.9 % of them the consumption has been above the planning made in the province. The costs increased in 233 %, and besides that in the prescriptions made of these drugs there were found problems like empty boxes, antibiotics without diagnostic impression and omissions of the drug presentation forms and/or the prescribed doses. Conclusions: the consumption of many high-cost drugs was higher than the planning made in the province of Matanzas for the analyzed period. It implied a significant increase of the budget destined for these aims and difficulties were found in the fulfillment of the terms for prescribing these drugs (AU).

La mortalidad del primer cuatrimestre de 2020 en la pandemia por COVID-19. Análisis del Comité de Mortalidad del Hospital Central de la Defensa «Gómez Ulla», Madrid / Mortality in the first four months of 2020 in the COVID-19 pandemic. Analysis of the Mortality Committee of the Hospital Central de la Defensa «Gómez Ulla», Madrid

INTRODUCCIÓN: En diciembre de 2019, Wuhan, China, tuvo un brote de la enfermedad COVID-19, causado por el síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). La enfermedad en poco tiempo se convirtió en pandemia. Los factores de riesgo asociados a su mortalidad están aún por determinar. El Comité de Mortalidad estudia los fallecimientos hospitalarios con el objetivo principal de reducir las muertes evitables. OBJETIVOS: Describir las características de comorbilidad y demográficas de los exitus del primer cuatrimestre de 2020 en el Hospital Central de la Defensa y su relación con COVID-19. MATERIAL Y MÉTODOS: Estudio transversal, descriptivo, observacional y retrospectivo. Datos clínicos y demográficos de los exitus en relación a la presencia de COVID-19. RESULTADOS: De 371 fallecidos, 271 COVID-19 positivos y 100 COVID-19 negativos. Casi 1,8 veces más de la mortalidad esperada en el cuatrimestre (208 a 371). Edad media de los grupos 80 y 84 años, rango entre 35 y 104 años. Estancia hospitalaria en COVID-19 positivos del 10,1% frente a 5,5% en COVID-19 negativos. Exitus extranjeros menor de 70 años 80%. Lugar del exitus: planta hospitalaria (84%). Puntuación media del índice de Charlson: 4 puntos (intercuartil, 2-6), 53% supervivencia estimada a 10 años. Comorbilidades más frecuentes: HTA (70,5%); DM (36,5%); Oncológico (31%); Neumonía (86,7%). Mal estado general al ingreso (81,9%). CONCLUSIONES: La variable con mayor potencia relacionada con la mortalidad fue la edad avanzada. Otro grupo, sin comorbilidades, menor de 51 años, presentó evolución fatal. A pesar de la dificultad para establecer la tasa de mortalidad real por COVID-19, la diferencia entre los exitus esperados y los registrados por el Comité de Mortalidad Hospitalario constituye el valor más aproximado

INTRODUCTION: In December 2019, Wuhan, China had an outbreak of the COVID-19 disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease quickly turned into a pandemic. The risk factors associated with its mortality are yet to be determined. The Mortality Committee studies hospital deaths with the main objective of reducing preventable deaths. OBJECTIVES: To describe the comorbidity and demographic characteristics of the deaths from the first four-month period of 2020 at the Central Defense Hospital and their relationship with COVID-19. MATERIAL AND METHODS: Cross-sectional, descriptive, observational and retrospective study. Clinical and demographic data of deaths in relation to the presence of COVID-19. RESULTS: Of 371 deceased, 271 positive COVID-19 and 100 negative COVID-19-. Almost 1.8 times more than the expected mortality in the four-month period (208 to 371). Average age of the groups 80 and 84 years, range between 35 and 104 years. Hospital stay at positive COVID-19 10.1% compared to 5.5% at negative COVID-19. Foreign exitus under 70 years 80%. Exit location: hospital plant (84%). Average Charlson index score: 4 points (interquartile, 2-6), 53% estimated survival at 10 years. Most frequent comorbidities: HTN (70.5%); DM (36.5%); Oncological (31%); Pneumonia (86.7%). Poor general condition at admission (81.9%). CONCLUSIONS: The variable with the greatest power related to mortality was advanced age. Another group, without comorbidities, younger than 51 years, presented fatal evolution. Despite the difficulty in establishing the actual mortality rate from COVID-19, the difference between the expected deaths and those recorded by the Hospital Mortality Committee constitutes the most approximate value

Pharmacy and therapeutics committees strategy to address olmesartan safety issues at a primary care level.

Background Olmesartan, an antihypertensive drug, has been associated with a severe and potentially life-threatening sprue-like enteropathy, consisting of a serious, chronic diarrhoea and malabsorption syndrome. Treatment with this drug should be discontinued if patients develop such symptoms. Objective To retrospectively determine the reduction in olmesartan prescription following a strategy promoted by pharmacy and therapeutics committees within daily clinical practice to manage updated safety information on olmesartan. Setting Three primary healthcare centres. Method In May 2016, local pharmacy and therapeutics committees integrated by general practitioners, nursing staff and clinical pharmacists sent information about olmesartan safety issues to general practitioners, together with an individual list of their patients who were then being treated with olmesartan. Moreover, information about dose equivalents between angiotensin II receptor blockers and angiotensin II receptor blockers versus angiotensin-converting-enzyme inhibitors was also attached. The strategy aimed to promote individual benefit/risk assessment by general practitioners of the continuation of olmesartan treatment as a means to achieving a decrease in the risk of sprue-like enteropathy. The investigation team retrospectively reviewed the clinical records. Main outcome measure Reduction of olmesartan prescription. Results Olmesartan was discontinued in 44.4% of patients (197/444) in the year after the safety alert e-mail. In their medical records general practitioners registered that, after informing about olmesartan safety warnings, in four cases (0.9%), patients reported gastrointestinal symptoms. Conclusion A multidisciplinary strategy implemented to promote individual benefit/risk assessment regarding continuation of olmesartan treatment showed an important reduction in olmesartan prescriptions 1 year later.

Managing conflicts of interest in pharmacy and therapeutics committees: A proposal for multicentre formulary development.

WHAT IS KNOWN AND OBJECTIVE: While many countries have central agencies responsible for formulary development, within the United States, each hospital, health care system, or insurance provider has their own pharmacy and therapeutic committee, leading to both inefficiencies and inequalities across formularies. The number and variety of processes within pharmacy and therapeutic committees also increases the likelihood that conflicts of interest will influence the development of formularies. We sought to determine how such influences could be reduced by reviewing international evidence related to the presence and harms of conflicts of interest in formulary development. METHODS: Several approaches have been taken to reduce the influence of conflicts of interest in pharmacy and therapeutics committee processes, including include disclosure, recusal, exclusion, universal consideration and dual committees. The feasibility of each of these approaches is considered in the context of the United States. RESULTS AND DISCUSSION: A proposal is drawn from the discussion of various approaches to conflicts of interest in pharmacy and therapeutics committees: multicenter formulary development. WHAT IS NEW AND CONCLUSION: Multicentre formulary development, where resources are pooled across institutions, may lead to a reduction in the influence of conflicts of interest in pharmacy and therapeutics committee processes in the United States, increasing the chances of including the most safe, efficacious and cost-effective drugs on formularies.

Valoración de los comités farmacoterapéuticos en policlínicos / Assessment of Therapeutic Drug Committees at Polyclinics

Introducción: El uso inadecuado de los medicamentos provoca falta de eficacia terapéutica, aparición de reacciones adversas prevenibles y aumento del gasto sanitario. Objetivos: Valorar la composición y el funcionamiento de los comités farmacoterapéuticos de los policlínicos del municipio Boyeros e identificar factores que pueden afectar su funcionamiento. Métodos: Estudio descriptivo, transversal. El universo estuvo constituido por los siete comités farmacoterapéuticos del municipio; se exploraron variables como cargo y profesión de los presidentes y secretarios, miembros permanentes, cantidad de actas de reunión, funciones que realizan, productos de su gestión; esta información se obtuvo por entrevista al presidente del comité y por la revisión de las actas de reuniones efectuadas en el año. Además, se realizó un grupo focal con los presidentes y secretarios de los comités farmacoterapéuticos, entre otros integrantes, cuyos criterios se agruparon según su frecuencia.m Resultados: Predominó la composición inadecuada (71,5 por ciento); todos los presidentes eran médicos, un secretario era enfermera de profesión; existió poca participación de Pediatría (71,4 por ciento), Ginecoobstetricia (42,9 por ciento), Medicina General Integral (28,5 por ciento). El funcionamiento se valoró mal (57,1 por ciento) y regular (42,9 por ciento); sólo 42,9 por ciento tenía entre 9 y 12 actas de reuniones. Se identificó poca percepción de los directores de la importancia del comité, falta de capacitación de sus integrantes y la necesidad de que un profesional asuma esa actividad como única tarea en la institución. Conclusiones: Se identificó que la composición y el funcionamiento de los comités farmacoterapéuticos en el municipio Boyeros no fueron adecuados, lo que también fue reconocido por sus miembros(AU)

Introducción: El uso inadecuado de los medicamentos provoca falta de eficacia terapéutica, aparición de reacciones adversas prevenibles y aumento del gasto sanitario. Objetivos: Valorar la composición y el funcionamiento de los comités farmacoterapéuticos de los policlínicos del municipio Boyeros e identificar factores que pueden afectar su funcionamiento. Métodos: Estudio descriptivo, transversal. El universo estuvo constituido por los siete comités farmacoterapéuticos del municipio; se exploraron variables como cargo y profesión de los presidentes y secretarios, miembros permanentes, cantidad de actas de reunión, funciones que realizan, productos de su gestión; esta información se obtuvo por entrevista al presidente del comité y por la revisión de las actas de reuniones efectuadas en el año. Además, se realizó un grupo focal con los presidentes y secretarios de los comités farmacoterapéuticos, entre otros integrantes, cuyos criterios se agruparon según su frecuencia. Resultados: Predominó la composición inadecuada (71,5 percent); todos los presidentes eran médicos, un secretario era enfermera de profesión; existió poca participación de Pediatría (71,4 percent), Ginecoobstetricia (42,9 percent), Medicina General Integral (28,5 percent). El funcionamiento se valoró mal (57,1 percent) y regular (42,9 percent); sólo 42,9 percent tenía entre 9 y 12 actas de reuniones. Se identificó poca percepción de los directores de la importancia del comité, falta de capacitación de sus integrantes y la necesidad de que un profesional asuma esa actividad como única tarea en la institución. Conclusiones: Se identificó que la composición y el funcionamiento de los comités farmacoterapéuticos en el municipio Boyeros no fueron adecuados, lo que también fue reconocido por sus miembros(AU)

Regulação, circulação e distribuição da penicilina em Portugal (1944-1954) / Regulation, circulation and distribution of penicillin in Portugal (1944-1954)

Portugal foi um dos primeiros países do mundo, não participantes na II Guerra Mundial, a obter penicilina para uso civil. Em 1944 o medicamento começou a ser importado dos Estados Unidos da América pela Cruz Vermelha Portuguesa, mas como as quantidades eram escassas a sua distribuição foi confiada a uma comissão controladora constituída pela instituição. Em 1945, com o aumento da produção mundial, a penicilina foi integrada no circuito comercial de venda de medicamentos. A Comissão Reguladora dos Produtos Químicos e Farmacêuticos, fundada em 1940, enquadrada na política normalizadora do Estado Novo, com a finalidade de tutelar a atividade farmacêutica e o comércio dos medicamentos, exerceu um importante papel na regulação da venda do antibiótico. Entre 1945 e 1947 a penicilina foi importada como medicamento. A partir de 1947 a penicilina começou a ser importada como matéria-prima e em 1948 foram lançadas no mercado as primeiras especialidades farmacêuticas com penicilina preparadas em Portugal. Para garantir a qualidade dos medicamentos e minimizar a existência de produtos sem eficácia terapêutica comprovada a Comissão Reguladora dos Produtos Químicos e Farmacêuticos estabeleceu, em 1942, um laboratório para proceder à verificação analítica de medicamentos e produtos medicinais. Somente a partir de 1948, após o início da produção nacional de medicamentos com penicilina, é que o antibiótico começou a ser verificado analiticamente. A produção industrial de penicilina em Portugal surgiu em 1966. No presente artigo pretendemos demonstrar o papel da Comissão Reguladora dos Produtos Químicos e Farmacêuticos na regulamentação e no controlo da penicilina em Portugal no contexto dos outros medicamentos, bem como dar a conhecer o modo de regulação, circulação e distribuição da penicilina em Portugal nos anos 40 e 50 do século XX (AU)

Portugal did not participate in World War II but was one of the first countries in the world to receive penicillin for civilian use. The Portuguese Red Cross began to import the antibiotic from the United States of America in 1944 and appointed a controlling committee to oversee its distribution, due to the small amount available. In 1945, as world production increased, penicillin began to be distributed through the normal channels. An important role in its regulation was played by the official department responsible for controlling pharmaceutical and chemical products in Portugal, the Comissão Reguladora dos Produtos Químicos e Farmacêuticos (Regulatory Committee for Chemical and Pharmaceutical Products). Penicillin was imported as a raw material from 1947 and the first medicaments containing penicillin, prepared in Portugal, were released into the commercial circuit in 1948. A laboratory had been established in 1942 by the Comissão Reguladora for the analytical verification of medicaments and medicinal products with the aim of certifying their quality and minimizing the number of products with no attested therapeutic efficacy. The number of medicaments analysed by this laboratory increased substantially from 72 in the year of its foundation (1942) to 2478 in 1954, including, after 1948, medicaments containing penicillin. The aim of the present paper was to elucidate the role of the Comissão Reguladora dos Produtos Químicos e Farmacêuticos in regulating and controlling the distribution of penicillin in Portugal during the 1940s and 1950s

El compromiso en la sociedad en nuestro ADN / Commitment with society in our DNA

No disponible

Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ) / Desarrollo, confiabilidad test-retest y validez del pharmacy value-added services questionnaire (PVASQ)

Objective: (i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. Methods: Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach’s alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ. Results: The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (testretest) reliability was good. The overall Cronbach’ s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated. Conclusions: This study is the first to develop and establish the reliability and validity of the Pharmacy Value- Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients’ intention to adopt pharmacy value-added services to collect partial medicine supply (AU)

Objetivo: (i) Desarrollar el Pharmacy Value-Added Services Questionnaire (PVASQ) utilizando temas salidos de entrevistas, (ii) establecer la fiabilidad y validez del cuestionario. Métodos: Utilizando la Teoría del Comportamiento Planeado aumentada como modelo teórico, unas entrevistas presenciales extrajeron los creencias sobre los servicios farmacéuticos de valor añadido. Se construyó el PVASQ inicialmente en Ingles incorporando temas importantes y más tarde se tradujo al malayo, con traducción y retro-traducción. La Intención (INT) de adoptar servicio farmacéuticos de valor añadido se predice por las Actitudes (ATT), Normal Subjetiva (SN), Control Comportamental Percibido (PBC), Conocimiento y Expectativas. Usando una escala de Likert de 7 puntos y una escala dicotómica se evaluó la fiabilidad test-retest (N=25) administrando el cuestionario dos veces en el intervalo de una semana. La consistencia interna se midió con el alfa de Cronbach y la validez de constructo entre dos administradores se evaluó con el estadístico kappa y el coeficiente intra-clase (ICC). Se realizó un análisis factorial confirmatorio (CFA) (N=410) para evaluar la validad de constructo del PVASQ. Resultados: Los coeficientes kappa indicaron una fuerza de acuerdo moderada a casi perfecta en el test-retest. Los ICC para todas las escalas probaron que la fiabilidad intra-evaluador (test-retest) era buena. El alfa de Cronbach global (N=25) es de 0,912 y 0,908 para cada tiempo medido. Los resultados del CFA (N=410) mostraron que la mayoría de los ítems cargaban fuerte y correctamente en sus correspondientes factores. Sólo se eliminó un ítem. Conclusiones: Este estudio es el primero para desarrollar y establecer la fiabilidad y validez del Pharmacy Value Added Services Questionnaire utilizando la Teoría del Comportamiento Plneado como modelo teórico. La versión traducida al malayo del PVASQ es fiable y válida para predecir las intenciones de los pacientes para adoptar servicios farmacéuticos de valor añadido al recoger su provisión de medicamentos (AU)

The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.

A produção de conhecimento sobre a seleção de medicamentos baseada em evidências e executada por Comissões de Farmácia e Terapêutica é ainda escassa no Brasil, apesar da ampla discussão sobre o tema em países desenvolvidos. Este estudo buscou conhecer e analisar os aspectos relacionados à seleção de medicamentos em quatro hospitais universitários de grande porte no Rio de Janeiro, por meio de abordagem qualitativa. Entrevistas, observação direta e análise documental instrumentaram a coleta de dados qualitativos e quantitativos. A análise considerou duas dimensões: (i) estrutura e organização para o processo de seleção e (ii) critérios e métodos utilizados para avaliação. Apenas dois hospitais possuíam Comissão de Farmácia e Terapêutica (CFT) ativa. A estrutura para a tomada de decisão era deficiente e os membros das Comissões apontaram pouca experiência e disponibilidade para a atividade. Os métodos de avaliação e critérios observados indicaram um processo de seleção acrítico nestes hospitais, comprometendo a assistência farmacêutica e potencialmente prejudicando o sistema de saúde. Apesar da metodologia qualitativa não permitir a extrapolação de resultados, é possível que este cenário seja parecido com o de outros hospitais universitários brasileiros.

Using multidose eyedrops in a health care setting: a policy and procedural approach to safe and effective treatment of patients.

IMPORTANCE: Quality and safety of eyedrop use for patients treated in a health care setting play a vital role in the delivery of health care. OBJECTIVE: To describe the development of a policy and procedural approach to the use of multidose eyedrops in multiple patients, approved and accepted by The Joint Commission in compliance with preferred practice standards in ophthalmology, the safe handling and administration of multidose eyedrops, and cost benefits of a multidose eyedrop approach. DESIGN, SETTING, AND PATIENTS: Using a policy and procedural approach, we petitioned The Joint Commission for approval and evaluated the cost benefits of implementation of a multidose process for eyedrop administration in patients undergoing surgery and treatment at the Utah Valley Regional Medical Center, Provo. RESULTS: The Joint Commission approved our policy and procedural approach, implemented in April 2012. Cost savings to both patients and the facility were significant. Costs to patients undergoing a single cataract operation were decreased as much as $283.85. Costs to the facility were decreased by $330.91 per cataract case. CONCLUSIONS AND RELEVANCE: Approval of our policy and processes indicates that The Joint Commission validates our policy and its adherence to accepted preferred practice guidelines of safe handling and administration of multidose eyedrops and establishes precedence that may be followed by other eye care facilities and health care organizations in the future. Our policy provides a safe and effective process for administering eyedrop medications to patients as well as controlling excessive health care costs to both patients and health care facilities.

Implementación y evaluación de un programa de asesoramiento farmacéutico en cáncer de pecho / Implementation and evaluation of a breast cancer pharmaceutical advisory programme

Introducción: Las pruebas de screening son vitales para combatir el cáncer, ya que permiten la detección temprana de la enfermedad en individuos que no han desarrollado síntomas. Objetivo: Demostrar que la implementación por farmacéuticos comunitarios de un programa de asesoramiento sobre cáncer de pecho, aumenta la implementación de medidas de detección precoz. Material y métodos: Se realizó un ensayo prospectivo cuasi-experimental en cinco farmacias comunitarias, en la Universidad CEU-Cardenal Herrera y a través de la página Web www.elcancerdemama.es entre Junio de 2009 y Mayo de 2011. Participaron pacientes de cinco oficinas de farmacia, estudiantes universitarias y visitantes de la página Web. Las participantes complementaron cuestionarios para recoger datos sobre factores de riesgo y sobre la implementación de medidas de detección precoz. Adicionalmente, en las oficinas de farmacia y en la universidad, los farmacéuticos proporcionaron información personalizada sobre el cáncer de pecho y sobre cómo realizar correctamente el autoexamen. A los 40 días se realizó un seguimiento para comprobar la adherencia. Evaluamos la intervención del farmacéutico en el programa de detección precoz. Resultados: Participaron 1.452 mujeres. Son factores de riesgo (p<0,05) tener antecedentes familiares directos de cáncer de pecho, menarquia temprana, menopausia tardía, obesidad y sobrepeso, nuliparidad y terapia hormonal sustitutiva. La realización correcta del autoexamen mamario aumentó del 16 al 82% (p<0,05). Un 12% de las mujeres tiene riesgo elevado (p<0,005). Un 6% de las mujeres detectó anomalías al realizar el autoexamen. Conclusiones: La campaña de asesoramiento farmacéutico mejoró la actitud frente a la enfermedad, especialmente en términos de autoexamen mamario

Background: Screening is a vital process when combating cancer because it allows the early detection of the disease in individuals who have not developed symptoms yet. Aims: The aim of the present study was to show that the implementation by community pharmacists of a breast cancer screening programme coupled with risk assessment increases women's confidence in screening practices. Methods: A prospective quasi-experimental trial was conducted in five Spanish community pharmacies, at Valencia's Cardenal Herrera University and through the website www.elcancerdemama.es between June 2009 and March 2011. The participants that took part in the study were: clients of five community pharmacies interested in the programme, pharmacy and veterinary students at Cardenal Herrera University and visitors of the website. They completed questionnaires designed to collect data about risk factors for breast cancer and the implementation of measures for its early detection. In addition, pharmacists provided women with personalized information about breast cancer and how to perform breast self-examination (BSE) at the community pharmacies and at the university. A follow-up was carried out 40 days later to check the participants’ adherence to the programme. We evaluated pharmacists’ interventions in relation to breast cancer screening. Results: A total of 1,452 women were included in the study. A direct family history of breast cancer, early menarche, late menopause, obesity and overweight, null parity and hormone replacement therapy were found to be risk factors for breast cancer (p<0.05). Women's confidence in performing a correct BSE improved from 16% to 82% (p<0.05). 12% of the women were considered to have a high risk of developing breast cancer (p<0.005). 6% of the women detected abnormalities while making a BSE. Conclusions: The pharmacists' awareness-raising campaign resulted in an improvement of self-directed behaviours across all age groups, particularly in terms of BSE

Formulary systems and pharmacy and therapeutics committees in the Western Pacific Region: exploring two Basel Statements.

PURPOSE: The use of formulary systems and pharmacy and therapeutics (P&T) committees in the Western Pacific Region (WPR) and the factors associated with their use were explored. METHODS: Minor additions were made to a previously validated survey and reviewed by a WPR advisory committee. The Basel Statements 26 and 27 survey was made available in eight languages and sent electronically to 1989 hospital pharmacy directors through respective hospital pharmacy associations in the WPR. RESULTS: A total of 797 responses (40%) from 34 nations were received. Of these responses, 87% of hospitals (691 of 797) used a formulary. Also, 93% of respondents (619 of 664) indicated that their hospital had a P&T committee. However, only 44% of respondents (274 of 626) reported that more than half of their formulary medicines were linked to standard treatment guidelines. Furthermore, only 41% of hospitals (247 of 601) had a policy for off-label medication use. The pharmacy directors' perceived benefits of formularies were correlated with having more formulary medicines linked to standard treatment guidelines, basing their use on the best available evidence, and having a policy for the use of off-label medicines. CONCLUSION: A large proportion of hospitals in the WPR have implemented formularies and P&T committees. Although formularies are commonly used, their effectiveness may be limited, as formularies are often not linked to standard treatment guidelines or the best available evidence.

Impact of a faculty orientation and development committee.

This paper describes the faculty enrichment activities and outcomes of a faculty orientation and development committee at a college of pharmacy. The committee used a continuous quality improvement (CQI) framework that included needs assessment, planning and implementation of programs and workshops, assessment of activities, and evaluation of feedback to improve future programming. Some of the programs established by the committee include a 3-month orientation process for new hires and development workshops on a broad range of topics including scholarship (eg, research methods), teaching (eg, test-item writing), and general development (mentorship). Evidence of the committee's success is reflected by high levels of faculty attendance at workshops, positive feedback on workshop evaluations, and overall high levels of satisfaction with activities. The committee has served as a role model for improving faculty orientation and retention.

The role of curriculum committees in pharmacy education.

OBJECTIVE: To conduct a follow-up survey of curriculum committee chairs in US colleges and schools of pharmacy to describe current committee structures and functions and determine whether changes have occurred over time. METHODS: A descriptive cross-sectional study design using a 30-item survey instrument regarding the structure, function, and charges of curriculum committees was sent to 100 curriculum committee chairs. Several new variables were added to the questionnaire to explore the use of systematic reviews, oversight of experiential education, and the impact of accreditation standards on work focus. RESULTS: Eighty-five chairs responded. Curriculum committees are on average 1 person larger, less likely to have a student vote, more likely to have formal charges, and more likely to be involved in implementing an outcomes-based curriculum compared with 1994. Committees have shifted their work focus from review of curricular content to curricular revision. CONCLUSIONS: Curriculum committees continue to evolve as they respond to changes in pharmacy education and accreditation standards.

Variability in activity and results from drug assessments by pharmacy and therapeutics committees in Spanish hospitals.

OBJECTIVE: To quantify the Spanish Pharmacy and Therapeutics Committees (P&TC) activity with regard to assessing and selecting drugs and describing variability in decisions made to include them. METHOD: Descriptive, cross-sectional study based on a questionnaire aimed to 513 hospitals with more than 75 beds. We included questions referring to the P&TC resolutions, the therapeutic positioning and assessment reports. Recruitment was carried out between November 2007 and January 2008. Variability among P&TC conclusions were presented in five categories or levels of coincidence. RESULTS: One hundred and seventy-five hospitals participated, with a response rate of 34% (54% of beds). The mean (SD) number of drug-indications assessed per hospital was 10.35 (7.45). The proportion of assessments that conclude with drug inclusion or rejection was 75.3 and 21.4%, respectively. 16.2% concluded with therapeutic equivalence. Conditions for use were established for 64% of them, and 33% were included in a clinical guide. With regard to variability, 81.0% of assessments coincided with the conclusion to include or reject the drug. A contradictory decision was made for 19.0%. CONCLUSIONS: Drug assessment and selection activity in hospitals involve an amount of work. The proportion of drugs approved is similar in different types of hospitals. There is extensive variability as regards deciding upon inclusion and is similar to studies conducted in other countries. They indicate that a standardising methodology would be recommendable.

Literature review on the structure and operation of Pharmacy and Therapeutics Committees.

AIM OF THE REVIEW: To review the literature on the structure and operation of hospital Pharmacy and Therapeutics Committees from an international point of view and examine the factors that influence decision-making of these committees. METHOD: We performed a literature search in the Medline and Embase databases from 1997 to January 2009 with the search terms: formulary system decision making, pharmacy and therapeutics committee, formularies hospital, drug formulary, survey, drug selection and outcome assessment health care. Inclusion criteria were the following: studies analyzing Pharmacy and Therapeutics Committees published in English or Spanish from 1997 to January 2009. Exclusion criteria were: publications which were editorials or opinion pieces, studies relating to one hospital, and studies where full text could not be attained. The analysis was divided into structural/organizational data and data on factors affecting the decision-making process. RESULTS: Seventeen studies met the inclusion criteria. Pharmacy and Therapeutics Committees and formularies were present in more than 90% of the hospitals in four of the five countries examined. Therapeutic interchange programs existed only in two of these countries. The mean number of committee members ranged between six and eight. More than 89% of the committees included a pharmacist. Standard operating procedures were implemented by 89% of the committees. The most influential factors in the decision-making were clinical trial results or drug costs rather than pharmacoeconomic studies. Other local organization-dependent factors were also important. CONCLUSIONS: The structure and operating procedures of Hospital Pharmacy and Therapeutics Committees are similar in select Western countries. Information from clinical trials is the most influential factor in the decision-making process.