Modelos de remuneración del servicio de Seguimiento Farmacoterapéutico / Potential remuneration models for medication review with follow-up service in community pharmacy

Introducción: Existen diferentes motivos que justifican la necesidad de remunerar el servicio de seguimiento farmacoterapéutico (SFT). El cálculo de su precio se puede realizar de varias maneras y es importante para que su pago salvaguarde la sostenibilidad de la actividad. Objetivo: Explorar cómo se justifica la necesidad de remunerar la provisión del servicio de SFT, describir las propuestas sobre quién y a quién se debería pagar, así como los modelos de remuneración propuestos. Método: Se realizaron 21 entrevistas semiestructuradas a farmacéuticos Innovadores con experiencia en la realización de SFT y a otros que acababan de comenzar a realizar SFT en el entorno del Programa conSIGUE. Resultados: En ambos grupos, se argumenta que el farmacéutico posee la formación necesaria para proveer el servicio y aventaja la cercanía que tiene con los pacientes. Además, se alude a la asunción de responsabilidad del farmacéutico y al impacto económico y clínico generado por la provisión del servicio. Se sugiere que sea la Administración la que sufrague el servicio y que el pago se efectúe a la farmacia como organización, sin dejar de compensar económica y profesionalmente al proveedor. El precio del servicio debe cubrir, entre otros, los costes de provisión y tener en cuenta el tiempo empleado transcurrido. También se podría valorar la complejidad de los casos, el impacto y eficiencia, el número de pacientes, etc. Conclusión: Es necesario conseguir la remuneración del servicio de SFT con un precio adecuado para que sea sostenible a lo largo del tiempo. Este tipo de servicio debe ser sufragado por la Administración sanitaria aunque no se descarta la participación de los beneficiarios. El pago se debe realizar a la farmacia y el farmacéutico proveedor debe recibir el complemento correspondiente

Introduction: Different reasons justify the need to remunerate the provision of the service of Medication Review with follow-up (MRF). Its price could be obtained through several calculations and its value is essential to sustain the activity. Objective: To explore how is being justified the need to remunerate the MRF’ provision, to describe the proposals on who should pay and to whom, as well as to explore the models of remuneration proposed. Method: 21 semi-structured interviews were conducted with innovative pharmacists experienced in the provision of MRF service and with others that have just been introduced to it within the framework of the conSIGUE program. Results: Pharmacists justified the need to obtain the remuneration of the service for different reasons. In both groups, it is argued that the pharmacist possesses the expertise to provide the service and is surpassed by an easy access to patients. In addition to this, participants referred to the assumption of responsibility and to the economic and clinical impact of the service provision. In both groups the Administration is proposed as the main payer while it is recommended to pay to the pharmacy as an organization as well as, to economically and professionally compensate the provider. The price must cover between others, costs of provision and the spent time. It could be also considered the complexity of the case, the impact and efficiency, the number of patients, etc. Conclusion: It is necessary to obtain the remuneration of MRF’s service with a suitable price in order to sustain the activity. This type of service must be defrayed by the Administration without ruling a patient copayment. The community pharmacy must bill the service provision and the provider must be compensated

Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries.

Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

The inclusion of a business management module within the master of pharmacy degree: a route to asset enrichment? / Inclusión de un módulo de gestión de empresa en el grado de master en farmacia: ¿un camino hacia la mejora?

Background: Over the past decade the profession of pharmacy has steadily evolved. The New Pharmacy Contract exposed pharmacists to a fundamental change in traditional pharmacy business models. Objective: This study will consider whether community pharmacists, pharmacy undergraduates and academic staff within the United Kingdom believe it would be beneficial to incorporate a business management module within the Master of Pharmacy (MPharm) undergraduate degree along with potential mechanisms of delivery. Methods: Further to ethical approval, the questionnaire was distributed to UK registered pharmacists (n=600), MPharm undergraduates (n=441) and academic staff at Liverpool John Moores University (n=44). The questions were formatted as multiple choice questions, Likert scales or the open answer type. On questionnaire completion and return, data were analysed using simple frequencies, cross tabulations and nonparametric techniques in the SPSS (v18). Results: The majority of pharmacists (84.9%) confirmed that business skills affect their everyday responsibilities to a considerable extent. A high proportion of undergraduate students (92.8%) believed that business management skills will impact on their future role. In total, 64.3% of this cohort declared that if a module were introduced they would study it. The majority of staff (79%) agreed that business skills are gaining increased importance within the field of pharmacy. Conclusions: Data suggest that business skills are of relevance to the practice of pharmacy. Appropriate staff to deliver the taught material would include business owners / lecturers and teaching practitioners covering topics including management, leadership, interpersonal skills and regulation. We suggest the inclusion of a business module with the MPharm degree would be of great value in preparing individuals for practice within a modern day healthcare setting (AU)

Antecedentes: Durante la década pasada, la profesión de farmacia ha evolucionado firmemente. El New Pharmacy Contract expuso a los farmacéuticos a un cambio en los modelos tradicionales de negocio. Objetivo: Este estudio considerará si los farmacéuticos, estudiantes de farmacia y académicos en Reino Unido se beneficiarían incorporando un módulo de gestión de empresa en el grado de Master en Farmacia (MPharm) así como los potenciales mecanismos de enseñanza. Métodos: Después de la aprobación de ética, se distribuyó el cuestionario e farmacéuticos en ejercicio en Reino Unido (n=600), estudiantes del MPharm (n=441) y personal académico de la Liverpool John Moores University (n=44). Las preguntas tenían formato de preguntas de elección múltiple, escalas de Likert o preguntas abiertas. Cuando se cumplimentaban y retornaban los cuestionarios, se analizaron los datos usando frecuencias simples, tablas cruzadas y técnicas noparamétricas con el SPSS (v18). Resultados: La mayoría de los farmacéuticos (84,9%) confirmó que las habilidades empresariales afectan sus responsabilidades diarias en grado considerable. Una proporción elevada de estudiantes (92,8%) creía que las habilidades en gestión empresarial tendrían impacto en su papel futuro. En total, el 64,3% de esta cohorte declaró que si se introdujese un módulo, lo estudiarían. La mayoría del personal académico (79%) concordó que las habilidades empresariales están ganando importancia en el campo de la farmacia. Conclusiones: Los datos sugieren que las habilidades empresariales son de relevancia en la práctica de la farmacia. El personal adecuado para proporcionar el material docente debería incluir propietarios, y profesores de prácticas que cubran los temas como gestión, liderazgo, habilidades interpersonales y legislación. Sugerimos que la inclusión de un módulo de empresa en el grado de MPharm sería de gran valor en la preparación de los individuos para el ejercicio en los establecimientos sanitarios modernos (AU)

ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing--2007.

PURPOSE: Results of the 2007 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented. METHODS: A stratified random sample of pharmacy directors at 1264 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. RESULTS: The response rate was 42.0%. The use of nearly all formulary management techniques has declined since 2001 in favor of the use of clinical practice guidelines to promote rational drug therapy. Retrospective methods to improve prescribing are being replaced by concurrent methods including the provision of drug information to prescribers by pharmacists, consultations with prescribers, and the continued gradual adoption of computerized prescriber-order-entry systems with decision support. The trends toward more electronic communication and ease of reference availability and away from resource-intensive methods continue to grow. Accreditation standards prompted the implementation of safe medication practices as shown by the rapid increase in medication reconciliation and the reading back of oral orders to improve prescribing and transcribing. CONCLUSION: The 2007 ASHP survey results indicate that pharmacists are responding to changes in the health care system to find appropriate ways to improve medication use at the prescribing and transcribing steps of the medication-use system.

Re-examining 'professionalism' in pharmacy: a South African perspective.

Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.

Gestión clínica de la decisión terapéutica: intervención desde un Servicio de Farmacia de Área de Salud / Clinical management of therapeutic decision-making: intervention on the part of a health area pharmacy service

Introducción. La actividad médica obliga a tomar constantemente decisiones terapéuticas, a menudo en uncorto lapso de tiempo. La variabilidad clínica también se refleja en la toma de decisiones terapéuticas. Lasmedidas de formación-actualización no han demostrado eficacia permanente.Objetivos. a) Diseñar una estrategia formativa capaz de proporcionar al médico la metodología para evaluarla información científica y tomar decisiones terapéuticas, y b) evaluar el impacto de dicha intervención.Metodología. Estudio de intervención para evaluar el impacto de una estrategia educativa de formación endecisión terapéutica e investigación clínica, aleatorizado, comparativo antes-después, con doble grupo controly simple ciego.Grupo de intervención (participantes del curso); grupo control positivo (centros que reciben las sesiones);grupo control negativo (centros que no reciben las sesiones). Evaluación de resultados mediante indicadoresde uso relativo de medicamentos: hipolipemiantes, antibióticos (respiratorio, otorrinolaringología, urinario),antihipertensivos, antidiabéticos. Análisis previo basal, intermedio y final.Resultados. Tras la intervención, se obtiene una mejora de:­ 2,74% en dosis diaria definida (DDD) de diuréticos/DDD antihipertensivos.­ 3,74% en DDD metformina/DDD antidiabéticos orales.­ 4,25% en DDD simvastatina/DDD reductores del colesterol y triglicéridos.Conclusiones. La intervención ha sido muy bien aceptada por el grupo de alumnos y por el grupo de médicosque reciben las sesiones.• Los resultados en cuanto a la implementación de las propuestas formativas en los indicadores de uso de losmedicamentos no han sido homogéneos y, en algunos casos, contrapuestos.• Otros aspectos, como los factores psicológicos, de comunicación y de habilidades docentes deben ser planteadosen distintos proyectos formativos

Introduction. The practice of medicine constantly obliges physicians to make therapeutic decisions, oftenwithin short periods of time. Clinical variability is also reflected in therapeutic decision-making. Measuresfor training and updates have not been shown to have a lasting efficacy.Objectives. 1) To design a training strategy capable of providing the physician with the methodology toevaluate scientific information and make decisions in therapeutics and 2) to evaluate the impact of thisintervention.Methodology. A randomized, comparative, single-blind intervention study, with a before-and-after designand two control groups, to evaluate the impact of an educational strategy involving training in therapeuticdecision-making and clinical research.Intervention group (participants in the course), positive control group (centers in which the sessions areoffered), negative control group (centers in which the sessions are not offered). The results were evaluatedaccording to indicators of the relative utilization of lipid-lowering agents, antibiotics (for respiratory tract;ear, nose and throat; and urinary tract infections), antihypertensives, antidiabetic agents, with pre-studybaseline, mid-study and final analyses.Results. At the end of the intervention, the following improvements were observed: increase of 2.74% in defineddaily dose (DDD) of diuretics/DDD of antihypertensives, of 3.74% in DDD of metformin/DDD of oralantidiabetic agents and of 4.25% in DDD of simvastatin/DDD of cholesterol and triglyceride-loweringdrugs.Conclusions. The intervention was well accepted by the group of students and the group of physicians whoattended the sessions. The results with respect to the implementation of the proposed training in drug utilizationwere inconsistent and, in some cases, conflicting. Psychological factors and those involving communicationand teaching skills should be addressed in future training projects

La Cooperativa de Hospitales de Antioquia y la política farmacéutica nacional / The Cooperative of Hospitals of Antioquia and the pharmaceutical national policy

Se presenta una síntesis de las principales acciones desarrolladas durante los últimos años por la Cooperativa de Hospitales de Antioquia —Centro colaborador de la Organización Mundial de la Salud y la Organización Panamericana de la salud—, concordantescon la política farmacéutica de Colombia. Igualmente, se analiza la forma como estas acciones han contribuido a su desarrollo e implementación en el país

Estructuración y adecuación de un sistema centralizado de distribución de medicamentos por dosis unitaria, proyecto del hospital San Vicente de Paúl, de Caldas, Antioquia / Structuring and adjusting a centralized system for medicament distribution by unitary dose, a project of the hospital San Vicente de Paúl, in Caldas, Antioquia

Se acepta que el sistema centralizado de distribución de medicamentos por dosis unitaria (SCDMDU) contribuye a garantizar la efectividad terapéutica y administrativa y a disminuir los riesgos asociados con la utilización de estos insumos. Sin embargo, losanálisis de las inversiones económicas que se deben realizar para su estructuración limitan su presencia en nuestro medio. Buscando evidenciar las bondades del SCDMDU y sobre la base de que inicialmente no se requiere de una inversión económicaimportante, se diseñó un estudio longitudinal prospectivo de antes–después que posibilitara evaluar su impacto sobre los costos directos e indirectos en el servicio de pensionados de la ESE Hospital San Vicente de Paúl, de Caldas, Antioquia. El estudiose desarrolló durante 136 días (50 días en los que se midieron las variables de estudio en el sistema anterior, 36 días de capacitación y estructuración del SCDMDU y 50 días en los que se repitieron las mediciones iniciales). La información se procesó mediante EPI–INFO 6.03 y se analizó estadísticamente con el test de la t por parejas. Se obtuvo disminución en los costos por medicamentos de $1.306.221 (13,80 por cien ); en el valor de las solicitudes para reposición del inventario, de $500.940 (67,63 por cien ) y en las devoluciones, de $583.354 (39,46 por cien ). También se ve que este sistema facilita la detección y corrección oportuna de errores en los procesos asociados. Los resultados obtenidos evidencian que un SCDMDU contribuye a mejorar la calidad de la atención y a la optimización de los recursos, aspectos que son demandados por las condiciones creadas por la Ley 100/93 en Colombia

Effects of a management technician on structured working in Dutch community pharmacies.

OBJECTIVE: To study the effects of 'stepwise working with the help of a management technician' on structured working with regard to patient education in a sample of Dutch community pharmacies. METHODS: The intervention program provided the management technician with knowledge, tools and skills needed for the organisation of patient education activities in her community pharmacy. Twenty-eight pharmacies were selected for the study. After matching, each pharmacy was randomly assigned to either the experimental or control group. In the pharmacies of the experimental group, a technician was selected to become the management technician. MAIN OUTCOME MEASURES: Pharmacy technicians were assessed by means of written questionnaires at baseline and immediately after the intervention (12 months). The outcomes were the variables that were directly targeted by the intervention, and included technicians' perception of the availability of policy plans, support for patient education activities towards their implementation, evaluation, and provisions for continuity. RESULTS: After 12 months, the following indicators for structured working were noted to have increased in the experimental group compared to the control group: the technicians in the experimental group more often reported an awareness of policy plans, less lack of continuity of activities, support and evaluation for implementing patient education activities. We also observed that the control group had a higher baseline level and the effects on support and evaluation showed differences between pharmacies. The observed increases were more pronounced in pharmac higher exposure to the intervention, and in the case of support and evaluation relevant in this more exposed group. CONCLUSION: We found indications for effects of the intervention program, especially in the pharmacies with increased exposure. However, results could be influenced by regression to the mean, as the control group started with a higher mean than the experimental group. We conclude that technicians' participation in the management of patient education activities appears to be effective when she has a minimum of hours to spend on this task in her pharmacy.

Gestión de un servicio de farmacia hospitalaria / No disponible

Al igual que la sanidad en general, la farmacia, hospitalaria ha experimentado una evolución importante en estos últimos años. El sector sanitario se está enfrentando a nuevos retos, como son los cambios demográficos y tecnológicos, lo que hace que económicamente tengan efectos muy marcados sobre la asistencia sanitaria y la salud. Los hospitales se ven afectados por todos estos cambios, tanto por lo que se refiere a organización, como a las funciones que se están desarrollando. En un futuro muy próximo los profesionales sanitarios tendremos que asumir mayores responsabilidades en la gestión de utilización de los recursos (AU)

No disponible

Making sense of outpatient pharmacy management. How to control pharmacy costs while delivering quality care.

Pharmacy brings together some of the major themes ushering US healthcare into the 21st century: concern about iatrogenesis, patient consumerism, resurgence of healthcare costs, and wide disparity in access to flourishing technology.

Pharmacy without walls.

Attributes of excellence in pharmacy management are described: big-picture thinking, the ability to exploit change, and willingness to take risks. Big-picture thinking means understanding trends that are shaping health care in order to determine where pharmacy fits. Health systems look beyond inpatient care and use case managers to maximize resource use; pharmacists might serve as case managers. Managed care has caused physicians to be more receptive to resource-management strategies, such as clinical pathways; pharmacists can collaborate in the development of clinical pathways. Pharmacists can serve as physician extenders; for example, by conducting anticoagulation or hypertension clinics. Pharmacists need flexibility to adapt to changes in the internal organization of acute care institutions; they will need to learn about the clinical, behavioral, operational, and fiscal aspects of managing the total patient. New reporting relationships give pharmacists the opportunity to demonstrate to other members of the health care team their role in preventing, managing, and resolving drug-related problems throughout the continuum of care. Risk-taking can mean setting ambitious goals. By setting and achieving ambitious goals for products and services, pharmacists can raise patients' and other health care providers' expectations for pharmacy services. Pharmacists' success will depend on their willingness to experiment with new services and discard services that do not substantially advance patient care. Pharmacists must monitor changes in the provision of health care, determine the implications for their practice and seek opportunities for participation outside the walls within which they have traditionally practiced.

Integrated patient-specific model of pharmacy practice.

The deficiencies of traditional models for the provision of clinical pharmacy services are discussed, and a patient-specific model that integrates drug distribution and clinical pharmacy functions is proposed. Traditional models have either designated specific individuals as providers of clinical pharmacy services or have combined distributive and supportive services with clinical services. In both cases, clinical services have been of secondary importance. Such models have resulted in inconsistent clinical services for which the patient is not necessarily the primary focus and have made it difficult for pharmacists to understand their mission. The lack of a well-defined primary clinical role for pharmacists has confused health-care providers and created problems for managers attempting to evaluate pharmacists and justify clinical services. The integrated patient-specific model is based on the ethical imperative that the patient must be central to any health-care endeavor. Under this model, clinical pharmacy services are of central importance and distributive services are integrated as a secondary but still very important aspect of comprehensive institutional pharmacy services. Critical elements of the integrated model include a patient-centered philosophy of practice, a definition of clinical pharmacy work, and a managerial framework. The integrated patient-specific model of pharmacy practice puts pharmacists in a professional relationship with patients and explicitly defines clinical services and priorities.

Turbulence and tranquility in the new decade: pharmacy leader--managers in patient care.

Management challenges that face pharmacy in the 1990s are described. Tichy's rope metaphor--intertwined cultural, technical, and political strands of an organization--is applied to problems faced by pharmacy managers; effective managers keep the organization strong by preventing the strands from working at cross-purposes to unravel the rope. Pharmacy's culture--its shared beliefs and values--is changing as "altruistic" institutional pharmacists form home care businesses, pharmacists identify more strongly with the profession than with their institutions, clinical pharmacists identify more strongly with the medical team, and cost control becomes more important. Institutional pharmacy must identify its desired outcomes and apply technology to achieve them. The patient's bedside is the best place for pharmacists to influence prescribing and monitor drug therapy; technology could be used to process patient information at the bedside and to dispense medications there. Current unit dose distribution systems isolate the functions of physician, pharmacist, and nurse, which must be integrated to make the system efficient and responsive. Standardized doses and dosage forms could be developed that are consistent with patient-care protocols; use of protocols allows the effectiveness of treatment methods to be evaluated and eliminates unnecessary therapy. Pharmacy can further its patient-care goals through political success with the medical staff; a pharmacy practice plan developed for a specific clinical area and presented to the medical staff is an example. Collaboration of pharmacists and physicians in a unified institutional strategy for drug use helps ensure appropriate decisions about therapy and prevents manufacturers from attempting to isolate an institution's pharmacists from its medical staff.(ABSTRACT TRUNCATED AT 250 WORDS)