Evaluating health benefits and cost-effectiveness of a mass-media campaign for improving participation in the National Bowel Cancer Screening Program in Australia.

OBJECTIVES: The Australian National Bowel Cancer Screening Program (NBCSP) offers free 2-yearly immunochemical faecal occult blood testing to individuals aged 50-74 years; national participation in 2015-2016 was 41%. In 2017, a 7-week television-led mass-media campaign to increase participation in the Australian state of Victoria was associated with a 1.31-fold increase in participation for 11 weeks. We aimed to evaluate the cost-effectiveness and health benefits of the 2017 campaign and scaled-up equivalent campaigns run over 4 years in Victoria and nationally. STUDY DESIGN: This study used microsimulation modelling. METHODS: A comprehensive microsimulation model of colorectal cancer (CRC), Policy1-Bowel, was used to simulate three scenarios. Scenario 1 simulated the 2017 campaign in Victoria; Scenarios 2 and 3 assumed that campaigns were run three times annually from 2019 to 2022 in Victoria and Australia-wide, respectively. Total campaign costs of AUD$1million, AUD$10million, and AUD$40million were assumed for Scenarios 1, 2, and 3, respectively. The incremental effects and costs of the campaign on the NBCSP were assessed. A governmental perspective was used. RESULTS: All campaign scenarios were predicted to be highly cost-effective, with cost-effectiveness ratios under AUD$4,800/life-year saved. The actual 2017 campaign in Victoria is estimated to prevent 319 CRC cases and 183 deaths over the following 40 years. A 4-year campaign would prevent 1,750 CRC cases and 987 deaths if conducted in Victoria, and 8,100 cases and 4,330 deaths if conducted Australia-wide. CONCLUSION: Mass-media participation campaigns could be highly cost-effective and maximise the potential life-saving impact of bowel screening. These results support ongoing investment in major bowel screening campaigns.

Cancer costs and gender: a snapshot of issues, trends, and opportunities to reduce inequities using Australia as an example.

As the cancer burden increases, so too does the cost, to health systems, economies, and individuals. There is increasing interest in productivity and out-of-pocket costs for individuals and their carers, but these remain poorly understood. The costs of cancer in women, often carers themselves, are less understood. This summary analysis explored data on the cancer burden in Australia (and health costs in comparable countries), including expenditure reports and literature on macroeconomic outcomes and out-of-pocket costs, to highlight the cost impacts of a cancer diagnosis in women, at a societal and an individual level. Data on productivity costs were skewed toward men, as men are over-represented in paid work compared with women. Data on societal and individual costs of cancer in women were scant, yet the predominance of women in unpaid work suggests the cost is significant. Evidence for the benefits of cancer prevention and early detection suggests that improved targeting of interventions to women would reduce costs at a societal and an individual level. More research is needed on the specific impacts of cancer on women and those they care for, to better target public health and support services to need.

Comparison of mortality in Asbest city and the Sverdlovsk region in the Russian Federation: 1997-2010.

BACKGROUND: The Sverdlovsk region of the Russian Federation is characterised by its abundance of natural resources and industries. Located in this region, Asbest city is situated next to one of the largest open-pit chrysotile asbestos mines currently operational; many city residents are employed in activities related to mining and processing of chrysotile. We compared mortality rates from 1997 to 2010 in Asbest city to the remaining Sverdlovsk region, with additional analyses conducted for site-specific cancer mortality. METHODS: Population and mortality data for Asbest city and Sverdlovsk region were used to estimate crude and age-specific rates by gender for the entire period and for each calendar year. Age-standardized mortality rates were also calculated for the adult population (20+) and Poisson regression was used to estimate standardized mortality ratios, overall and by gender. RESULTS: During the period of 1997 to 2010, there were similar mortality rates overall in Asbest and the Sverdlovsk region. However, there were higher rates of cancer mortality (18 % males; 21 % females) and digestive diseases (21 % males; 40 % females) in Asbest and lower rates of unknown/ill-defined in Asbest (60 % males; 47 % females). Circulatory disease mortality was slightly lower in Asbest. Cancer mortality was higher for men in Asbest from oesophageal, urinary tract and lung cancers compared to the Sverdlovsk region. In women, cancer mortality was higher for women in Asbest from stomach, colon, lung and breast cancers compared to the Sverdlovsk region. CONCLUSIONS: This large population-based analysis indicates interesting differences but studies with individual exposure information are needed to understand the underlying factors.

An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high?

PURPOSE: To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using US mortality rates. METHODS: Analysis of age-standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developed countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using US mortality rates, were calculated and compared with observed deaths in Australia (1994-2010). RESULTS: In all four countries, incidence rates initially peaked between 1992 and 1994, but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8 % (1998-2008). Mortality rates in the USA (APC: -2.9 %; 2004-2010), Canada (APC: -2.9 %; 2006-2011) and England (APC: -2.6 %; 2003-2008) decreased at a faster rate compared with Australia (APC: -1.7 %; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared with US rates over 17 preceding years. CONCLUSIONS: Prostate cancer incidence rates are likely heavily influenced by prostate-specific antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.

Percepción del paciente mayor polimedicado sobre el rol del farmacéutico comunitario / Perception of the polymedicated elderly patient about the community pharmacist’s role

Introducción: Actualmente casi un 80% del gasto sanitario español corresponde a las personas mayores de 65 años que, debido a su pluripatología, se convierten en pacientes polimedicados. El farmacéutico comunitario es uno de los agentes de salud que puede ayudar a controlar este gasto y mejorar la calidad del uso de los medicamentos debido a su cercanía y accesibilidad, aunque actualmente sólo se le reconozca un rol dispensador de medicamentos. Objetivos: Explorar la percepción que tiene el paciente mayor polimedicado sobre el rol del farmacéutico. Material y métodos: Se utilizó un método exploratorio basado en la investigación cualitativa, usando como medio de obtención de información la entrevista semiestructurada y como marcos teóricos la Teoría del Rol complementada con la Teoría de las Creencias en Salud. Resultados: Los pacientes mayores polimedicados identifi can con el rol de profesional sanitario principalmente a su médico de cabecera y al personal de enfermería, relegando al farmacéutico a funciones de índole menor y, sobre todo, con un rol dispensador de medicamentos y productos sanitarios, aunque resaltan la gran accesibilidad y la confianza que tienen con este profesional. Conclusión: Los pacientes mayores polimedicados en España esperan del farmacéutico un buen trato y un rol dispensador. Esto puede deberse a la baja expectativa que se tiene del farmacéutico para realizar servicios profesionales distintos de los clásicos (dispensación). Los farmacéuticos deberían empezar a cambiar su rol actual implantando servicios para que la percepción del paciente cambie(AU)

Introduction: Nowadays, almost 80 percent of the health expenditure in Spain corresponds to people over 65 years of age as a result of their multiple pathology, have become polymedicated patients. Community pharmacists are community health workers who can help to control this expense and improve the quality of use of the medications due to the proximity and approachability although nowadays they are only known in their role as the medication dispenser. Materials and methods: An exploratory method was used, based on the qualitative research and semi-structured interviews were conducted as a means to get information, combining both the Role Theory and Health Belief Model as theoretical frameworks. Results: Polymedicated elderly patients tend to associate the role of health care professionals with their general practitioners and community nurses, giving less priority to the function of the pharmacists. Pharmacists are often relegated to a minor role and particularly to the supplying of drugs and healthcare products, that is, their dispensary role. However, patients are likely to highlight the great accessibility and trust they have towards these professionals. Conclusion: The polymedicated elderly patients expect from the pharmacist in Spain is a good rapport with their patients, besides a dispensary role. This could be a consequence of the low expectations that they have of the pharmacists concerning the services they provide. Pharmacists are assumed not to offer other services different to the classical services (dispensing). They should start changing their current role by introducing new services in order to change the perception that patients have about them(AU)

Exploración de las percepciones de los farmacéuticos comunitarios en la práctica del seguimiento farmacoterapéutico dentro del contexto del programa conSIGUE / Pharmacist experience of delivering medication reviews with follow up within the project conSIGUE

Introducción: Para la realización del estudio principal del programa conSIGUE se han desarrollado dos fases prepiloto (Murcia y Granada) y una fase piloto (Cádiz), en las que han participado sesenta farmacias. Objetivos: Explorar la percepción de los farmacéuticos participantes en estas fases sobre su experiencia como proveedores de seguimiento farmacoterapéutico, sobre las difi cultades encontradas y las áreas de mejora identificadas, en el conteto del programa conSIGUE. Método: Para la obtención de información se eligió el grupo focal. Todos los grupos focales tuvieron lugar en las sedes de los tres colegios de farmacéuticos, y en todos los casos participaron el mismo coordinador y la misma observadora. Las reuniones se grabaron y se transcribieron íntegramente. Se realizó un análisis de contenido utilizando el software NVivo®. Resultados: Se realizaron un total de ocho grupos focales. Las mayores difi cultades para la realización del servicio son la falta de tiempo, de personal y la falta de formación y experiencia clínica para realizar las diferentes intervenciones. El seguimiento permite mejorar la organización interna de la farmacia, la relación entre los miembros del equipo, conocer mejor Bot Plus, superar el miedo a relacionarse con los médicos y modificar el tipo de relación con los pacientes. Además, produce una importante satisfacción personal. Los formadores colegiales son valorados muy positivamente. Conclusiones: La figura del formador colegial es de gran interés tanto en los momentos iniciales de implantación del servicio como en su sostenibilidad en el tiempo, ya que permite solucionar los problemas que surgen en la práctica del seguimiento(AU)

Introduction: Prior to undertaking a main study, “conSIGUE” 60 pharmacies participated in two pre-pilot phases (Murcia y Granada) and one pilot (Cádiz). Objectives: To explore the experiences and perception of participating pharmacists when undertaking medication review with follow-up. Methods: Focus groups were used as the qualitative technique. All the meetings took place at the three Professional Association headquarters and were conducted by the same researchers. The groups were tape-recorded with a content analysis was performed NVivo®. Results: Eight focus groups were completed. Lack of time, f human resources and the lack of clinical education and skills to do pharmaceutical interventions were identified as the major barriers. Medication review with follow-up was seen to improve the internal organization of the pharmacy, the relationship among members of the staff, the knowledge and use of Bot-plus (a drug information program). The service helped to overcome the fear of physicians and modifi ed the relationship with patients. It also produced a great level of personal satisfaction for the pharmacists. The mentoring programme was assessed very positively. Conclusions: The use of a mentoring element, through the professional college facilitator, to the program appeared to be very important in the initiation and sustainability of the service as it assists to practically solve individualised problems faced by specific pharmacists(AU)

Categorización de las farmacias españolas según la teoría de difusión de las innovaciones de Rogers en relacion a la práctica del seguimiento farmacoterapéutico / Categorization of Spanish community pharmacies in relation to the provision of medication review with follow up, according to the theory of diffusion of the innovations by Rogers

Introduccion: El presente estudio pretende categorizar las farmacias españolas en función de su situación en el proceso de decisión-innovación de Rogers en relación a la provisión del Seguimiento Farmacoterapéutico (SFT).Metodo: Se empleó un cuestionario, no validado, previamente utilizado con el mismo objetivo, mediante la técnica de CATI. Las variables dependientes fueron las cinco fases del proceso de implantación/adopción de Rogers [Conocimiento (F-C); Persuasión (F-P); Decisión (F-D); Implantación (F-I); Mantenimiento (F-M)], a las que se sumó la fase previa al conocimiento (No conocen). Las farmacias en F-M se sub-categorizaron en función del número de pacientes en Seguimiento, siempre que éste fuera superior a 1: (F-M1) de 2 a 5 pacientes; (F-M2) 6 a 10 pacientes; (F-M3) 11 a 25 pacientes; (F-M4) 26 a 50; (F-M5) 51 a 100 y (F-M6) 101 ó más pacientes. Las farmacias con un único paciente se incluyeron en F-I.Resultados: Se obtuvieron 1.135 respuestas (tasa de respuesta = 54%). Su distribución según el proceso de decisión/innovación de Rogers es la siguiente: No conocen (353; 31,1%); F-C (351; 30,9%); F-P (145; 12,8%); F-D (129; 11,4%); F-I (100; 8,8%); F-M (57; 5,0%). Las subcategorías en la F-M son: F-M1(15; 26,3%); F-M2 (12; 21,1%); F-M3 (10; 17,5%) F-M4 (10; 17,5%); F-M5 (4; 7,0%). Hay grandes diferencias entre las distintas CCAA siendo Aragón la que tiene mayor porcentaje de farmacias en F-I y F-M mientras que Cantabria es la que mayor desconocimiento refleja (50,0%) con un 0% en las F-I y F-M. También se observa un 0% en F-M en La Rioja, Canarias y Asturias. La existencia de una ZAP se muestra como un facilitador para la realización del servicio y la presencia de un responsable del SFT parece que es importante para conseguir su mantenimiento una vez implantado el mismo. Conclusiones: A pesar de los esfuerzos realizados por diferentes organizaciones e instituciones para impulsar la implantación y sostenibilidad del SFT, de acuerdo con los datos obtenidos es posible afirmar que este servicio se encuentra muy poco implantado en España. El hecho de que en la farmacia exista una zona de atención personalizada (ZAP) se muestra como un elemento que facilita la implantación del SFT. Por otra parte, la existencia de un farmacéutico responsable del servicio aparece como un elemento que permite la sostenibilidad del mismo una vez implantado. Es necesario modificar los objetivos de la formación postgrado de los farmacéuticos. Esta debe estar menos orientada a aumentar el conocimiento y más orientada a mejorar las habilidades y competencias, es decir, debe estar encaminada al cambio de comportamiento (AU)

Introduction: The aim of the study is to categorize Spanish Community Pharmacies in relation to their position in the innovation-decision process by Rogers, in relation to the provision of Medication Review with follow up.Methods: A non validated questionnaire, previously used with the same objective, was used through a CATI methodology. The dependent variables were the five different innovation/decision phases defined by Rogers [Knowledge (F-C); Persuasion (F-P); Decision (F-D); Implementation (F-I); Maintenance (F-M). Another further phase was added including pharmacists in a phase previous to knowledge (No knowledge). Pharmacies in F-M were sub categorized in relation to the number of patients receiving the service: (F-M1) from 2 to 5 patients; (F-M2) 6 to 10 patients; (F-M3) 11 to 25 patients; (F-M4) 26 to 50 patients); (F-M5) 51 to 100 and (F-M6) 101 or more patients. Pharmacies with only one patient were included in F-I.Results: 1135 answers were received (response rate = 54%). Their distribution, according to the innovation/decision process by Rogers, was as follows: No knowledge (353; 31.1%); F-C (351; 30.9%); F-P (145; 12.8%); F-D (129; 11.4%); F-I (100; 8.8%); F-M (57; 5.0%). The F-M sub categories were: F-M1 (15; 26.3%); F-M2 (12; 21.1%); F-M3 (10; 17.5%) F-M4 (10; 17.5%); F-M5 (4; 7.0%). There are huge differences among Autonomous Communities, being Aragon the one with more pharmacies located in F-I and F-M, while Cantabria shows the most high level of no-knowledge (50.0%) having a 0.0% in F-I and F-M. A 0% in F-M is also shown in La Rioja, Canarias and Asturias. The existence of a private consultation room (ZAP) is shown as a facilitator for the provision of the service, and the existence of a responsible for the service seems to be very important to the sustainability of the service after it implementation. Conclusions: However the great efforts already done by different organizations and institutions to promote the implementation and sustainability of Medication Review with follow up, according to the data obtained in this study is possible to affirm that so far this service is poorly implemented in Spain. The existence of a private consultation room (ZAP) is shown as a facilitator for the implementation of Medication Review with follow up. On the other hand the existence of a pharmacist being the responsible for the service is shown as a support to the sustainability of the service, once this has been implemented. It seems necessary to change post degree educational programs. These shouldn’t be directed only to improve knowledge, but to develop skills and competencies, what means that these programs should try to change behaviours (AU)

Conclusions: However the great efforts already done by different organizations and institutions to promote the implementation and sustainability of Medication Review with follow up, according to the data obtained in this study is possible to affirm that so far this service is poorly implemented in Spain. The existence of a private consultation room (ZAP) is shown as a facilitator for the implementation of Medication Review with follow up. On the other hand the existence of a pharmacist being the responsible for the service is shown as a support to the sustainability of the service, once this has been implemented. It seems necessary to change post degree educational programs. These shouldn’t be directed only to improve knowledge, but to develop skills and competencies, what means that these programs should try to change behaviours (AU)

Un enfoque holístico e integrado de la implantación de los servicios farmacéutico cognitivos / A holistic and integrated approach to implementing cognitive pharmaceutical services

La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentrasometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidorescomo de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su prácticahacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estosservicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en susdefiniciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellospueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisionesclínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión estánrelacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a laspolíticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes delcambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y lainvestigación en práctica farmacéutica que se ha venido realizando con anterioridad han sidosintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamientoholístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puedeenmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organizaciónprofesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con laimplantación de servicios ha mostrado la aplicación de programas de implantación que han incluidouno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrolladoun modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado yholístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) quepretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, elservicio de seguimiento farmacoterapéutico

Community pharmacy is part of the health care system which is currently under economic pressureand facing changes in demands from consumers and government. In response, the pharmacyprofession is becoming more patient orientated and implementing cognitive pharmaceutical services(CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels andBENRIMOJ S.I. Enfoque holístico e integrado de la implantación de los servicios farmacéutico… 70Ars Pharm, 51-2; 69-88.using different tools. However, they can be classified using a broad hierarchical model based onclinical decision making and the extent of change required (Box 1). The challenges faced by theprofession are related the development of a new patient orientated model of pharmacy which affectshealth care policy, education and research, the evolution of the market, the individual andorganisational approaches to change and the implementation of CPS. These issues and previousresearch conducted in pharmacy practice have been synthesised to provide a platform for change thatcan guide a holistic and integrated approach to CPS implementation. Implementation can beconceptually framed in six levels: clinical, service provision, community pharmacy, professionalorganisation, government and stakeholder (Figure 1). Past experience with service implementation hasseen the application of programs that include one or two of these levels in practice rather than aholistic approach. A concentric model was developed to illustrate the implementation of CPS and theholistic and integrated approach required to support change. A program (conSIGUE) being conductedin Spain has attempted to integrate all six levels to support the implementation and evaluation of amedication management service (Seguimiento Farmacoterapéutico)