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1.
Res Social Adm Pharm ; 16(4): 583-586, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32081569

RESUMEN

The 2019-nCoV infection that is caused by a novel strain of coronavirus was first detected in China in the end of December 2019 and declared a public health emergency of international concern by the World Health Organization on January 30, 2020. Community pharmacists in one of the first areas that had confirmed cases of the viral infection, Macau, joined the collaborative force in supporting the local health emergency preparedness and response arrangements. This paper aimed to improve the understanding of community pharmacists' role in case of 2019-CoV outbreak based on the practical experiences in consultation with the recommendations made by the International Pharmaceutical Federation on the Coronavirus 2019-nCoV outbreak.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Máscaras/provisión & distribución , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Salud Pública , Betacoronavirus , Brotes de Enfermedades , Urgencias Médicas , Monitoreo Epidemiológico , Humanos , Higiene , Macao/epidemiología , Educación del Paciente como Asunto , Farmacéuticos
2.
BMC Health Serv Res ; 20(1): 99, 2020 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041591

RESUMEN

BACKGROUND: People transitioning from hospital- to community-based care are at increased risk of experiencing medication problems that can lead to adverse drug events and poor health outcomes. Community pharmacists provide medication expertise and support during care transitions yet are not routinely included in communications between hospitals and other primary health care providers. The PhaRmacy COMmunication ParTnership (PROMPT) intervention facilitates medication management by optimizing information sharing between pharmacists across care settings. This developmental evaluation sought to assess the feasibility and acceptability of implementing the PROMPT intervention, and to explore how contextual factors influenced its implementation. METHODS: PROMPT was implemented for 14 weeks (January-April, 2018) in the general internal medicine units at two teaching hospitals in Toronto, Canada. PROMPT featured two contact points between hospital and community pharmacists around patient discharge: (1) faxing an enhanced discharge prescription and discharge summary to a patient's community pharmacy and (2) a follow-up phone call from the hospital pharmacist to the community pharmacist. Our mixed-method evaluation involved electronic patient records, process measures using tracking forms, telephone surveys and semi-structured interviews with participating community and hospital pharmacists. RESULTS: The intervention involved 45 patients with communication between 12 hospital and 45 community pharmacists. Overall, the intervention had challenges with feasibility. Issues with fidelity included challenges with the medical discharge summary being available at the time of faxing and hospital pharmacists' difficulties with incorporating novel elements of the program into their existing practices. However, both community and hospital pharmacists recognized the potential benefits to patient care that PROMPT offered, and both groups proposed recommendations for further improvements. Suggestions included enhancing hospital staffing and resources. CONCLUSION: Improving intraprofessional collaboration, through interventions such as PROMPT, positions pharmacists as leaders of medication management services across care settings and has the potential to improve patient care; however, more co-design work is needed to enhance the intervention and its fidelity.


Asunto(s)
Comunicación , Servicios Comunitarios de Farmacia/organización & administración , Relaciones Interprofesionales , Farmacéuticos/psicología , Servicio de Farmacia en Hospital/organización & administración , Cuidado de Transición/organización & administración , Anciano , Anciano de 80 o más Años , Canadá , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Encuestas y Cuestionarios
3.
J Manag Care Spec Pharm ; 26(1): 24-29, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31880223

RESUMEN

INTRODUCTION: The growing emphasis on value-based health care has created a need for innovative population health management strategies. Pharmacists are underused resources for implementation of meaningful population health models that ensure appropriate medication use through optimization of electronic medical record (EMR) technology and pharmacist knowledge. The objective of our program was to improve the health outcomes of a patient population with diabetes while also reducing costs. PROGRAM DESCRIPTION: A virtual pharmacy review (ViPRx) program was used to remotely provide previsit comprehensive medication reviews for patients in the defined population. The pharmacist used the EMR to review medications and relevant histories and to intervene when needed to ensure appropriate medication use. Pharmacist recommendations and supporting statements were delivered to the provider's EMR in-box 1-2 days before a scheduled visit. The information technology resources and virtual model allow the pharmacist to manage patient care and collaborate with providers electronically across multiple clinic locations. OBSERVATIONS: The pharmacist managed a panel of over 700 patients in this virtual model. The program has yielded improvements in key diabetes metrics. Most notable is a 6% increase in the percentage of patients with a hemoglobin A1c (HbA1c) value of 9% or less and a 7% improvement in the controlled low-density lipoprotein (LDL) measure. Monitoring parameters (nephropathy screening, HbA1c, and LDL) increased by 8%-12% from baseline. Additional positive outcomes include improved medication adherence in the defined population as seen by a 1.5% improvement in medication possession ratio for diabetes medications. Reductions in per member per month (PMPM) prescription costs are estimated at $11 per month through discontinuation of unnecessary and duplicate medications. IMPLICATIONS: The results of this case study on the effect of a virtual pharmacy review program demonstrate an opportunity for pharmacists to engage in a population health management model that improves patient outcomes and may reduce the rate at which PMPM prescription drug costs increase. DISCLOSURES: No outside funding supported this work. The authors have no conflicts of interest to disclose. This work was presented at the 2017 Vizient Connections Summit; April 6, 2017; Las Vegas, NV, and the 2018 Cerner Health Conference; October 10, 2018; Kansas City, MO.


Asunto(s)
Glucemia/efectos de los fármacos , Servicios Comunitarios de Farmacia/organización & administración , Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Administración del Tratamiento Farmacológico/organización & administración , Farmacéuticos/organización & administración , Seguro de Salud Basado en Valor/organización & administración , Biomarcadores/sangre , Glucemia/metabolismo , Servicios Comunitarios de Farmacia/economía , Ahorro de Costo , Análisis Costo-Beneficio , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economía , Costos de los Medicamentos , Revisión de la Utilización de Medicamentos , Registros Electrónicos de Salud , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Cumplimiento de la Medicación , Administración del Tratamiento Farmacológico/economía , Grupo de Atención al Paciente/organización & administración , Farmacéuticos/economía , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Resultado del Tratamiento , Seguro de Salud Basado en Valor/economía
4.
J Manag Care Spec Pharm ; 26(1): 30-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31880232

RESUMEN

BACKGROUND: Although several states recognize pharmacists as providers and allow credentialing, this practice is not recognized nationwide. Following adoption of Oregon House Bill 2028, pharmacists are recognized as providers, allowing "health insurers to provide payment or reimbursement for their services to patients." Before this law, and in several instances currently, pharmacist-run programs were financially justified through soft dollars saved by improving patient outcomes, reducing emergency department use, and decreasing readmission rates. OBJECTIVE: To determine if direct billing of third-party payers covers the direct cost of a comprehensive medication management (CMM) program in an ambulatory rural health adult population with uncontrolled diabetes or hypertension. METHODS: This study of a population derived from 2 Oregon rural health primary care clinics was a retrospective chart review of adults (aged ≥18 years) with a primary diagnosis of diabetes mellitus or hypertension who completed a CMM visit with a clinical pharmacist from March 2017 to June 2018. In determining the financial sustainability of a pharmacist-run CMM program, the following primary outcomes were evaluated: (a) percentage of visits completed per insurance type; (b) median reimbursement rate (dollars per visit) per insurance type; and (c) the estimated number of visits per day to cover 100% of the total CMM cost annually. The secondary outcome was the percentage of the major third-party payers that allowed credentialing of pharmacists. All outcomes were evaluated using descriptive statistics. RESULTS: 664 CMM visits were included. Visits per insurance type comprised Medicare Advantage (34%), traditional Medicare (25%), Oregon State Medicaid (20.9%), commercial (17.8%), and self-pay (cash; 1.4%). Median reimbursement rate (dollars per visit) was highest from Oregon Medicaid, followed by Medicare Advantage, and lowest among commercial, self-pay (cash), and traditional Medicare. Total reimbursement received throughout the duration of this pilot project covered 14.1% of the total CMM program cost. It was estimated that approximately 17 visits per day are needed to cover 100% of the total CMM cost annually per pharmacist relying solely on direct revenue within these clinics. Currently, of the 18 contracted insurance companies, only 50% recognize and allow credentialing of pharmacists as providers. CONCLUSIONS: Pharmacist-run services within the 2 rural health primary care clinics were not financially justifiable via direct billing of third-party payers alone. The lack of credentialing, recognition of pharmacists as providers, and reimbursement is inadequate for program expansion and sustainability without relying on additional revenue streams or benefits from improved patient outcomes. Currently, federal insurance significantly contributes to this lack of funding. DISCLOSURES: No outside funding provided support for this research; however, funding from Willamette Valley Community Health was given in the form of a grant to partially fund the comprehensive medication management pilot program. Pharmacists were paid from this grant, while Sublimity Pharmacy compensated pharmacists in the form of benefits. The authors have nothing to disclose. This work was presented in part as a poster at the ASHP Midyear Clinical Meeting; December 4, 2018; Anaheim, CA, and as a peer-reviewed podium presentation at the Northwestern States Residency Conference; May 4, 2019; Portland, OR.


Asunto(s)
Antihipertensivos/economía , Servicios Comunitarios de Farmacia/economía , Costos de los Medicamentos , Planes de Aranceles por Servicios/economía , Hipoglucemiantes/economía , Seguro de Salud/economía , Administración del Tratamiento Farmacológico/economía , Farmacéuticos/economía , Atención Primaria de Salud/economía , Servicios de Salud Rural/economía , Antihipertensivos/uso terapéutico , Servicios Comunitarios de Farmacia/organización & administración , Análisis Costo-Beneficio , Habilitación Profesional/economía , Planes de Aranceles por Servicios/organización & administración , Humanos , Hipoglucemiantes/uso terapéutico , Seguro de Salud/organización & administración , Administración del Tratamiento Farmacológico/organización & administración , Visita a Consultorio Médico/economía , Oregon , Farmacéuticos/organización & administración , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Servicios de Salud Rural/organización & administración
5.
J Manag Care Spec Pharm ; 26(1): 42-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31880234

RESUMEN

BACKGROUND: Influenza (also known as "flu") is estimated to cause between 12,000 and 79,000 deaths annually. Vaccinations are beneficial in preventing influenza cases and reducing the likelihood of severe outcomes. Unfortunately, vaccination coverage is low among uninsured populations. Removing the cost barrier can help increase vaccination coverage in this group, averting flu cases and related morbidity and costs. OBJECTIVE: To model the potential effect of providing no-cost flu vaccinations to uninsured individuals on influenza-related morbidity, mortality, and costs. METHODS: In collaboration with the Department of Health and Human Services and local agencies, Walgreens pharmacies provided free flu vaccinations through a nationwide voucher distribution program. We calculated the redemption rate, potentially averted cases, and estimated cost savings for the 2015-2016 and 2016-2017 flu seasons. Using incidence and vaccine effectiveness estimates from the Centers for Disease Control and Prevention, we calculated the rate of influenza in the general population and the estimated cases averted based on the number of redeemed vouchers. We applied patient age along with parameters from published studies to estimate averted ambulatory care visits, hospitalizations, mortality, productively losses, and overall related costs. RESULTS: During the 2015-2016 flu season, the pharmacy chain distributed 600,000 vouchers with a redemption rate of 52.3%, resulting in 314,033 flu vaccinations. Improvements were subsequently made to the distribution process to increase utilization rates. There were 400,000 vouchers distributed during the 2016-2017 season with a higher redemption rate of 87.2%, resulting in 348,924 flu vaccinations. The estimated number of potentially averted cases was higher during the 2016-2017 season (13,347) than the 2015-2016 season (11,537) due to a higher redemption rate and increased flu activity. Taken together, we estimated that 8,621 ambulatory care visits, 314 hospitalizations, and 15 deaths were averted due to the flu voucher program. Averted health care costs totaled $937,494 in ambulatory care visits and $3,510,055 in hospitalizations. Averted productivity losses ranged from $4,473,509 to $14,613,502. CONCLUSIONS: This study demonstrates the effectiveness of a pharmacy-led partnership with local community-based organizations to promote flu vaccinations among uninsured individuals. Our model found that a no-cost flu voucher program has the potential to reduce influenza-related morbidity, mortality, and costs. DISCLOSURES: This study was funded by Walgreen Co. All authors are employees of Walgreen Co. and affiliated with Walgreens Center for Health and Wellbeing Research. Findings from this study were presented as a podium presentation at the Academy of Managed Care Pharmacy Nexus 2018; October 22-25, 2018; Orlando, FL.


Asunto(s)
Servicios Comunitarios de Farmacia/economía , Costos de los Medicamentos , Accesibilidad a los Servicios de Salud/economía , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/economía , Gripe Humana/prevención & control , Vacunación Masiva/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Servicios Comunitarios de Farmacia/organización & administración , Ahorro de Costo , Análisis Costo-Beneficio , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Vacunas contra la Influenza/efectos adversos , Gripe Humana/mortalidad , Masculino , Vacunación Masiva/efectos adversos , Vacunación Masiva/mortalidad , Pacientes no Asegurados , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
6.
Expert Rev Anti Infect Ther ; 17(12): 1043-1050, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31714841

RESUMEN

Background: Antimicrobial stewardship programs (ASPs) are commonly used worldwide to tackle antimicrobial resistance. The current study aimed to investigate the perspective of pharmacists on community-based ASPs in China.Methods: A multicenter cross-sectional study was conducted in the capital cities of three different provinces of China between March 2019 and July 2019. A systematic random sampling method was used to recruit respondents.Results: A response rate of 87.4% (416/476) was obtained. A large number of respondents (n = 308, 74.0%) believed that ASPs are vital to improving patient care (Median = 4, IQR = 2). Approximately one-third of the respondents (n = 142, 34.1%) always ask patients about their knowledge related to antimicrobials (Median = 4, IQR = 2). Additionally, a considerable number of respondents (n = 127, 30.5%) always, or often (n = 117, 28.1%) collaborated with other healthcare professionals (Median = 4, IQR = 2). Age, gender, and experience were observed to have a significant association (p < 0.05) with median scores of knowledge about antibiotics, perceptions, and practices on ASPs.Conclusions: The perceptions of pharmacists regarding ASPs were positive. However, gaps in knowledge about some aspects of antibiotics and participation in ASPs were found. The development of regional community-based ASPs is urgently required.


Asunto(s)
Antiinfecciosos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Farmacéuticos/estadística & datos numéricos , Adulto , China , Estudios Transversales , Farmacorresistencia Microbiana , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
7.
PLoS One ; 14(10): e0224124, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31639171

RESUMEN

OBJECTIVES: The main objective of this study was to evaluate community pharmacists' awareness and perception about medication reconciliation service and to assess the completeness of collecting patients' medication histories in the community pharmacy setting. METHODS: A cross-sectional study was conducted between February to March 2018 in Amman-Jordan. During the study period, 150 community pharmacists were invited to participate in the study. Each pharmacist completed a validated structured questionnaire evaluating their awareness, current practice, perceived attitude and perceived barriers towards the implementation of medication reconciliation and the collection of medication histories at the community pharmacy setting. RESULTS: A total of 121 pharmacists agreed to participate and filled the questionnaire. Our results showed that only 13.2% of the pharmacists were able to define "medication reconciliation" correctly, and around 31% have a misconception that the medication reconciliation process should be performed only at the inpatient setting. Only 19.8% (n = 24) of the participating pharmacists stated that they ask all patients for a complete current medication list of medications when they arrive at the pharmacy site. Medication histories for most patients were lacking information about the dosage, route, frequency, and time of the last refill for each medication listed. "Patients lack of awareness about all the medications they are receiving" was the main barrier discouraging community pharmacists from collecting medication histories and participating in reconciliation service. CONCLUSION: Community pharmacists in Jordan showed a low awareness about the medication reconciliation concept and demonstrated a modest role in obtaining medication histories in community pharmacies. But still, they showed a positive attitude towards their role in implementing the different steps of medication reconciliation. This suggests that educational workshops to increase pharmacists' awareness about their role and responsibilities in collecting a complete and accurate medication history are warrented.


Asunto(s)
Actitud del Personal de Salud , Servicios Comunitarios de Farmacia/organización & administración , Documentación/normas , Registros Médicos/estadística & datos numéricos , Conciliación de Medicamentos/normas , Farmacéuticos/normas , Medicamentos bajo Prescripción/normas , Adulto , Estudios Transversales , Femenino , Humanos , Jordania , Masculino , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Rol Profesional
8.
Int J Clin Pharm ; 41(6): 1462-1470, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31529269

RESUMEN

Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Simulación de Paciente , Farmacéuticos/organización & administración , Úlcera Gástrica/diagnóstico , Competencia Clínica , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Ibuprofeno/efectos adversos , Masculino , Nigeria , Medicamentos sin Prescripción/administración & dosificación , Farmacéuticos/normas , Rol Profesional , Úlcera Gástrica/etiología , Úlcera Gástrica/terapia , Encuestas y Cuestionarios
9.
Int J Clin Pharm ; 41(6): 1471-1482, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31538280

RESUMEN

Background There are two fundamental approaches to clinical reasoning, intuitive and analytical. These approaches have yet to be well explored to describe how pharmacists make decisions to determine medication appropriateness. Objective (1) to identify the cognitive actions (i.e., operators) that pharmacists employ when they move from one cue (i.e., concept) to another, and (2) to describe the overall clinical reasoning approach taken by pharmacists when checking for medication appropriateness. Setting Pharmacists from a chain pharmacy in Canada were invited to participate in this study. Method Data was collected in private rooms using video recordings to capture simulated patient-pharmacist interactions of a new prescription medication. A simulated case scenario was used to gather two types of verbal reports, concurrent think-aloud and structured retrospective think-aloud from pharmacists. All verbal reports were video-recorded, transcribed verbatim, and analyzed using protocol analysis. Main outcome measure Pharmacists' reasoning approaches when making medication appropriateness decisions. Results A total of 17 pharmacists participated. Pharmacists were most likely to use analytical clinical reasoning approaches when checking prescriptions and three used no clinical reasoning. When the pharmacists were asked specific questions regarding the decision-making model for pharmacy (i.e., check for indication, efficacy, safety, and adherence), 50% reported using analytical decision-making approaches, with a third of the decisions being made in hindsight. Conclusion The majority of the pharmacists followed an analytical decision-making approach to clinical reasoning. When the pharmacists were asked prompting questions about their medication-related decisions, they employed a combination of intuitive and analytical approaches. The pharmacists had the competency to check for medication appropriateness; though this knowledge was mostly restructured during the process of hindsight reasoning.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Toma de Decisiones , Farmacéuticos/psicología , Medicamentos bajo Prescripción/administración & dosificación , Adulto , Canadá , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Simulación de Paciente , Rol Profesional , Relaciones Profesional-Paciente
10.
Int J Clin Pharm ; 41(6): 1499-1506, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31564041

RESUMEN

Background Oral emergency contraceptives containing levonorgestrel or ulipristal acetate are available without prescription and only in pharmacies in Germany since March 2015. Due to this change community pharmacists are responsible for evaluating whether the product is appropriate and to educate women on proper use. Objective To measure the utilization of emergency contraceptives without a prescription and describe potential concerns and safety issues identified by community pharmacists in Germany. Setting The Drug Commission of German Pharmacists' nationwide network of reference pharmacies which includes 860 community pharmacies. Methods Reference community pharmacies were asked to participate in the eleven-questions online survey. Respondents were asked to recall their experiences with oral emergency contraceptives in the past 3 months. Data were collected between January 8 and February 19, 2018. Main outcome measure The survey focused on the utilization of emergency contraceptives without a prescription in Germany, and on the pharmacists' experiences with (potential) problems and concerns regarding safe use. Results In total, 555 community pharmacies (64.5%) participated. Overall 38.2% of community pharmacists stated they dispensed six to ten courses of emergency contraceptives within the past 3 months. In addition, 54.3% of the pharmacists estimated they dispensed emergency contraceptives exclusively without prescription and 35.9% dispensed more than 30% of emergency contraceptives during night-time and emergency services. Moreover, 82.8% of pharmacists stated that emergency contraceptives were requested not by the women concerned but a third person and 44.3% identified uncertainties in woman's self-diagnosis. Three out of four pharmacists had concerns about the effective and safe use of emergency contraceptives. In situations suggesting sexually transmitted diseases, or suspicion for use of force, 59.5% and 55.8% of the pharmacists, respectively, dispensed emergency contraceptives. In cases of acute health impairment or chronic disease, or (potentially) relevant drug/drug interaction, the vast majority (91.0% and 90.5%) did not. Here, most pharmacists referred to gynecologists. Conclusion Pharmacists had safety concerns when dispensing emergency contraceptives. Professional expertise in evaluating the need for oral emergency contraceptives and the proper use is needed.


Asunto(s)
Servicios Comunitarios de Farmacia/estadística & datos numéricos , Anticonceptivos Orales/provisión & distribución , Anticonceptivos Poscoito/provisión & distribución , Farmacéuticos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/organización & administración , Femenino , Alemania , Encuestas de Atención de la Salud , Humanos , Levonorgestrel/administración & dosificación , Norpregnadienos/administración & dosificación , Farmacéuticos/organización & administración , Rol Profesional , Derivación y Consulta/estadística & datos numéricos
11.
Int J Clin Pharm ; 41(5): 1359-1364, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564044

RESUMEN

Background Colorectal cancer is the third most common cancer worldwide. Screening with several methods can accurately detect early-stage cancer and polyps and reduce colorectal cancer mortality in adults aged 50 to 75 years. Objective Test the feasibility, interest and potential impact of a colorectal cancer screening in Swiss community pharmacies. Setting 771 community pharmacies of Switzerland participated in a 6-week campaign. Method The pharmacists evaluated the risk factors through a questionnaire among individuals aged between 50 to 75 years old who did not have had a colonoscopy over the previous 10 years. Pharmacists delivered a Faecal Immunochemical Test (FIT) to those without risk. Patients with identified risk factors or with a positive result were referred to a physician. Patients with a negative result were given lifestyle advice and invited for a new screening in two years. Main outcome measure The impact was measured through the number of persons screened, of tests delivered and of referrals to a physician performed. Results Within 6 weeks, 23,024 persons were screened in pharmacies. In total, 760 patients (3%) had risk factors and were directly referred to physicians. The remaining 22,264 received a FIT, and 97% of these individuals performed and sent the FIT to the laboratory. Of the 21,701 tests analysed, 93% were negative. All individuals with positive results (7%) were referred to a physician. Conclusion Having the opportunity to take colorectal cancer prevention measures with a low threshold, like in a community pharmacy encourages the population to perform the screening.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Servicios Comunitarios de Farmacia/organización & administración , Tamizaje Masivo/métodos , Farmacéuticos/organización & administración , Anciano , Neoplasias Colorrectales/prevención & control , Pruebas Diagnósticas de Rutina/métodos , Detección Precoz del Cáncer/métodos , Heces/química , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Suiza
12.
Addict Sci Clin Pract ; 14(1): 30, 2019 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-31474225

RESUMEN

The global rise in opioid-related harms has impacted the United States severely. Current efforts to manage the opioid crisis have prompted a re-evaluation of many of the existing roles in the healthcare system, in order to maximize their individual effects on reducing opioid-associated morbidity and preventing overdose deaths. As one of the most accessible healthcare professionals in the US, pharmacists are well-positioned to participate in such activities. Historically, US pharmacists have had a limited role in the surveillance and treatment of substance use disorders. This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy (OAT). Each of these activities present a potential means to further engage pharmacists in the identification and treatment of opioid use disorders (OUDs). Through a careful examination of these approaches, we hope that new strategies can be adopted to leverage the unique role of the community pharmacist to help reduce opioid-related harms in the US.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/terapia , Farmacéuticos , Rol Profesional , Analgésicos Opioides/administración & dosificación , Actitud del Personal de Salud , Sobredosis de Droga/tratamiento farmacológico , Reducción del Daño , Accesibilidad a los Servicios de Salud , Administración del Tratamiento Farmacológico/organización & administración , Naloxona/uso terapéutico , Programas de Intercambio de Agujas , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Educación del Paciente como Asunto/organización & administración , Prescripciones/normas , Estados Unidos
13.
Pharm. pract. (Granada, Internet) ; 17(3): 0-0, jul.-sept. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-188112

RESUMEN

Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening


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Asunto(s)
Humanos , Servicios Comunitarios de Farmacia/organización & administración , Neoplasias Cutáneas/epidemiología , Protección Radiológica/estadística & datos numéricos , Protectores Solares/farmacocinética , Radiación Solar/efectos adversos , Detección Precoz del Cáncer/métodos , Estudios Transversales , Factores de Riesgo , Variación Biológica Poblacional
14.
Am J Health Syst Pharm ; 76(14): 1079-1085, 2019 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-31415687

RESUMEN

PURPOSE: To describe the development of a collaborative community-academic postgraduate year 1 pharmacy residency program in San Diego that provides a hybrid experience of opportunities in community practice, ambulatory care, and teaching. SUMMARY: Residency training programs are being developed to better match the evolving role of the community pharmacist. In 2016, the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences partnered with Ralphs Pharmacy, a division of the Kroger Co., to launch a 1-year community residency to develop community-based pharmacists with diverse patient care, leadership, and education skills. Learning experiences include pharmacy operations, clinical services focusing on chronic disease management and education, teaching, and practice-based research. Training settings include community pharmacy, corporate pharmacy, ambulatory care, and academia. Graduates are prepared to work in these settings as well as capitalize on advanced training opportunities, including postgraduate year 2 residencies and professional certifications. The program has been successfully accredited, and graduates have completed the program: one completed a postgraduate year 2 residency, and both have obtained a management or clinical pharmacist position. CONCLUSION: An innovative community-academic residency program preparing postgraduate year 1 learners for careers in community-based pharmacy, corporate, ambulatory care, and academic settings was developed, with positive preliminary outcomes.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Educación de Postgrado en Farmacia/organización & administración , Residencias en Farmacia/organización & administración , Desarrollo de Programa , Universidades/organización & administración , Acreditación , California , Centros Comunitarios de Salud/organización & administración , Humanos , Colaboración Intersectorial , Aprendizaje , Farmacéuticos , Corporaciones Profesionales/organización & administración , Enseñanza
15.
J Manag Care Spec Pharm ; 25(9): 995-1000, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31456493

RESUMEN

The shift to a value-based health care system has incentivized providers to implement strategies that improve population health outcomes while minimizing downstream costs. Given their accessibility and expanded clinical care models, community pharmacists are well positioned to join interdisciplinary care teams to advance efforts in effectively managing the health of populations. In this Viewpoints article, we discuss the expanded role of community pharmacists and potential barriers limiting the uptake of these services. We then explore strategies to integrate, leverage, and sustain these services in a value-based economy. Although community pharmacists have great potential to improve population health outcomes because of their accessibility and clinical interventions that have demonstrated improved outcomes, pharmacists are not recognized as merit-based incentive eligible providers and, as a result, may be underutilized in this role. Additional barriers include lack of formal billing codes, which limits patient access to services such as hormonal contraception; fragmentation of Medicare, which prevents alignment of medical and pharmaceutical costs; and continued fee-for-service payment models, which do not incentivize quality. Despite these barriers, there are several opportunities for continued pharmacist involvement in new care models such as patient-centered medical homes (PCMH), accountable care organizations, and other value-based payment models. Community pharmacists integrated within PCMHs have demonstrated improved hemoglobin A1c, blood pressure control, and immunization rates. Likewise, other integrated, value-based models that used community pharmacists to provide medication therapy management services have reported a positive return on investment in overall health care costs. To uphold these efforts and effectively leverage community pharmacist services, we recommend the following: (a) recognition of pharmacists as providers to facilitate full participation in performance-based models, (b) increased integration of pharmacists in emerging delivery and payment models with rapid cycle testing to further clarify the role and value of pharmacists, and (c) enhanced collaborative relationships between pharmacists and other providers to improve interdisciplinary care. DISCLOSURES: This article was funded by the National Association of Chain Drug Stores. The authors have no potential conflicts of interest to report.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Servicios Comunitarios de Farmacia/normas , Administración del Tratamiento Farmacológico/organización & administración , Administración del Tratamiento Farmacológico/normas , Farmacéuticos/organización & administración , Farmacéuticos/normas , Organizaciones Responsables por la Atención/organización & administración , Organizaciones Responsables por la Atención/normas , Ahorro de Costo/normas , Planes de Aranceles por Servicios/normas , Costos de la Atención en Salud/normas , Humanos , Medicare/organización & administración , Medicare/normas , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Rol Profesional , Estados Unidos
17.
Am J Health Syst Pharm ; 76(6): 360-365, 2019 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-31361840

RESUMEN

PURPOSE: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures. Pre-post PSCC implementation, PPSs were compared using a chi-square test. RESULTS: Overall, the lowest composite PPS (Staffing, Work Pressure, and Pace) and the highest composite PPS (Patient Counseling) ranked the same in both survey periods. Of the nine PSCC pharmacies, statistically significant (p < 0.05) PPS improvements occurred in 4 composites including Teamwork (11.9%), Communication About Mistakes (18%), Staff Training and Skills (20.6%), and Staffing, Work Pressure, and Pace (11.8%). PSCC pharmacies also reported a 9.3% (NS) improvement in overall rating of pharmacy patient safety post PSCC implementation. Separate analysis of pharmacist responses was consistent with pharmacy level results, but technician results differed slightly in overall rating of safety perceptions. CONCLUSION: Presence of the PSCC appeared to increase pharmacy employees' perceptions of safety culture in the community pharmacies, an integral part of overall patient safety.


Asunto(s)
Actitud del Personal de Salud , Centrales de Llamados/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Seguridad del Paciente , Administración de la Seguridad , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Consejo/organización & administración , Implementación de Plan de Salud , Humanos , Errores de Medicación/prevención & control , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Técnicos de Farmacia/psicología , Técnicos de Farmacia/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos
18.
Am J Health Syst Pharm ; 76(6): 353-359, 2019 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-31361842

RESUMEN

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.


Asunto(s)
Centrales de Llamados/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Errores de Medicación/prevención & control , Seguridad del Paciente , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Prescripciones de Medicamentos/estadística & datos numéricos , Eficiencia Organizacional/estadística & datos numéricos , Implementación de Plan de Salud , Humanos , Auditoría Administrativa/estadística & datos numéricos , Comportamiento Multifuncional , Farmacéuticos/organización & administración , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Técnicos de Farmacia/organización & administración , Técnicos de Farmacia/psicología , Técnicos de Farmacia/estadística & datos numéricos , Rol Profesional/psicología , Evaluación de Programas y Proyectos de Salud , Administración de la Seguridad/organización & administración , Encuestas y Cuestionarios/estadística & datos numéricos , Teléfono , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos
19.
Am J Health Syst Pharm ; 76(13): 980-990, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-31361883

RESUMEN

PURPOSE: Complementary health approaches including the use of dietary supplements (DS) such as vitamin, mineral, nutritional, and herbal supplements are popular in the United States. Beyond a statement issued by the American Society of Health-System Pharmacists (ASHP) in 2004, knowledge about the role of pharmacists related to DS use is largely unknown. The objectives of this study were to identify pharmacists' and other key stakeholders' perceptions and opinions about assuming roles that ensure the appropriate and safe use of DS. METHODS: A grounded theory approach involving in-depth, semi-structured key informant audio-recorded phone interviews with 12 practicing pharmacists and 10 key stakeholders were conducted. Key themes were identified using open coding, grouping, and categorizing. RESULTS: Participants believed the majority of their patients self-select and purchase DS from a pharmacy, often in conjunction with conventional medicines, and reported concerns about the regulatory standards, efficacy, and safety of DS. Despite acknowledging their ethical and professional responsibilities regarding DS, as identified by the ASHP statement and other sources, the majority of pharmacists are not expecting their profession to adopt these in the near future because of multiple barriers. CONCLUSIONS: There is a substantial disconnect between awareness of DS use and pharmacists adopting professional responsibilities regarding DS. The barriers identified are multifaceted, indicating the need for a joint effort from key stakeholders in developing a coordinated approach to supporting pharmacists in their practice efforts to ensure the appropriate and safe use of DS.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Suplementos Dietéticos/efectos adversos , Educación del Paciente como Asunto/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Actitud del Personal de Salud , Comportamiento del Consumidor , Estudios Transversales , Femenino , Teoría Fundamentada , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Farmacéuticos/psicología , Participación de los Interesados , Estados Unidos
20.
BMJ Open ; 9(6): e025114, 2019 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-31186245

RESUMEN

OBJECTIVES: To assess the feasibility and acceptability of a community pharmacy lifestyle intervention to improve physical activity and cardiovascular health of men with prostate cancer. To refine the intervention. DESIGN: Phase II feasibility study of a complex intervention. SETTING: Nine community pharmacies in the UK. INTERVENTION: Community pharmacy teams were trained to deliver a health assessment including fitness, strength and anthropometric measures. A computer algorithm generated a personalised lifestyle prescription for a home-based programme accompanied by supporting resources. The health assessment was repeated 12 weeks later and support phone calls were provided at weeks 1 and 6. PARTICIPANTS: 116 men who completed treatment for prostate cancer. OUTCOME MEASURES: The feasibility and acceptability of the intervention and the delivery model were assessed by evaluating study processes (rate of participant recruitment, consent, retention and adverse events), by analysing delivery data and semi-structured interviews with participants and by focus groups with pharmacy teams. Physical activity (measured with accelerometry at baseline, 3 and 6 months) and patient reported outcomes (activation, dietary intake and quality of life) were evaluated. Change in physical activity was used to inform the sample size calculations for a future trial. RESULTS: Out of 403 invited men, 172 (43%) responded and 116 (29%) participated. Of these, 99 (85%) completed the intervention and 88 (76%) completed the 6-month follow-up (attrition 24%). Certain components of the intervention were feasible and acceptable (eg, community pharmacy delivery), while others were more challenging (eg, fitness assessment) and will be refined for future studies. By 3 months, moderate to vigorous physical activity increased on average by 34 min (95% CI 6 to 62, p=0.018), but this was not sustained over 6 months. CONCLUSIONS: The community pharmacy intervention was feasible and acceptable. Results are encouraging and warrant a definitive trial to assess the effectiveness of the refined intervention.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Ejercicio Físico , Promoción de la Salud/organización & administración , Estilo de Vida , Aptitud Física , Neoplasias de la Próstata/terapia , Anciano , Anciano de 80 o más Años , Algoritmos , Ingestión de Energía , Estudios de Factibilidad , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Reino Unido
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