Navigating the journey as a peer reviewer: a roadmap to success.

Peer review is an essential step in scientific progress and clinical improvement, providing opportunity for research to be critically evaluated and improved by one's colleagues. Pharmacists from all job settings are called to serve as peer reviewers in the ever-growing publication landscape of the profession. Despite challenges to engagement such as time and compensation, peer review provides considerable professional development for both authors and reviewers alike. This article will serve as a practical guide for peer reviewers, discussing best practices as well as the handling of different situations that may arise during the process.

Documentation and classification of hospital pharmacist interventions: A scoping review.

The practice of documenting pharmacist interventions (PIs) has been endorsed by many hospital pharmacists' societies and organizations worldwide. Current systems for recording PIs have been developed to generate data on better patient and healthcare outcomes, but harmonization and transferability are apparently minimal. The present work aims to provide a descriptive and comprehensive overview of the currently utilized PI documentation and classification tools contributing to increased evidence systematization. A systematic literature search was conducted in PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. Studies from 2008, after the release of the Basel Statements, were included if interventions were made by hospital or clinical pharmacists in a global hospital setting. Publications quality assessment was accomplished using the Mixed Methods Appraisal Tool. A total of 26 studies were included. Three studies did not refer to the documentation/classification method, 10 used an in-house developed documentation/classification method, seven used externally developed documentation/classification tools and six described method validation or translation. Evidence confirmed that most documentation/classification systems are designed in-house, but external development and validation of PI systems to be used in hospital practice is gradually increasing. Reports on validated PI documentation/classification tools that are being used in hospital clinical practice are limited, including in countries with advanced hospital pharmacy practice. Needs and gaps in practice were identified. Further research should be conducted to understand why using validated documentation/classification methods is not a disseminated practice, knowing patients' and organizational advantages.

Older people, medication usage and long-term care pharmacists: a retrospective cohort study.

OBJECTIVE: To investigate the impact of the presence of a pharmacist on medication usage in long-term care facilities. METHODS: The study followed a retrospective cohort design, with a sample of patients aged ≥65 years admitted to three long-term care facilities over 30 months. Data on age, gender, type of stay, the presence or absence of a pharmacist and pharmacotherapeutic profile at admission and discharge were obtained for study patients. Variations in the number of medicines, anticholinergic burden and potentially inappropriate medications at admission and discharge were assessed as outcome variables. Anticholinergic burden and potentially inappropriate medications were assessed using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were used to compare the mean values of the outcome variables. A four-way ANOVA was used to test the association between background and outcome variables. Partial eta squared (η2) was used to measure the effect size. RESULTS: A total of 1366 patients were studied. All outcome variables showed a statistically significant increase at discharge compared with admission. The presence of a pharmacist was statistically significant in improving the number of medicines (p<0.001) and the anticholinergic burden score (p<0.001), while no statistically significant value was reached on potentially inappropriate medications (p=0.642). Small effect size values were obtained for the impact of the pharmacist on the number of medicines and anticholinergic burden scores (η2=0.021 and η2=0.011, respectively). CONCLUSION: These findings suggest that the presence of a long-term care pharmacist can positively impact the use of medication associated with poor health outcomes. An integrated interprofessional approach is needed to address potentially inappropriate medications, anticholinergic burden and polypharmacy in long-term care settings, particularly at the time of discharge.

Defining and supporting a professional role for pharmacists associated with traditional and complementary medicines: a cross-country survey of pharmacists.

Introduction: An estimated 80% of the world's population use traditional and complementary medicine (T&CM) products as part of their healthcare, with many accessed through pharmacy. This cross-cultural study posed a set of professional practice responsibilities and actions to pharmacists related to T&CM products, with a view toward developing consensus, safeguarding, and promoting the health of the public. Methods: Data were collected from 2,810 pharmacists across nine countries during 2022 via a cross-sectional online survey reported in accordance with the guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Of the 2,810 participants from nine countries, 2,341 completed all sections of the survey. Of these, most agreed (69%) that T&CM product use was common in the community they served, but most did not have adequate training to support consumer needs. Over 75% acknowledged that there were known and unknown safety risks associated with T&CM use. Of 18 professional responsibilities posed, 92% agreed that pharmacists should be able to inform consumers about potential risks, including T&CM side effects and drug-herb interactions. The provision of accurate scientific information on the effectiveness of T&CM products, skills to guide consumers in making informed decisions, and communication with other healthcare professionals to support appropriate and safe T&CM product use were all ranked with high levels of agreement. In order to effectively fulfill these responsibilities, pharmacists agreed that regulatory reforms, development of T&CM education and training, and access to quality products supported by high-quality evidence were needed. Conclusion: General agreement from across nine countries on eighteen professional responsibilities and several stakeholder actions serve as a foundation for the discussion and development of international T&CM guidelines for pharmacists.

Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations.

This exploratory study aimed to identify communication trends typical of pharmacists' clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist's talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients' questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist's rapport-building with the relative was higher when the patient's age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = -0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners' interviews, indicating a lack of  clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.

Long-Term Care medicines formularies: any reasons for pharmacists' concern?

Abstract This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolism, Blood and blood-forming organs, Musculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations

Exploring the use of cognitive enhancement substances among Portuguese university students.

Background: Prescription drug use and the consumption of substances to enhance college students' cognitive performance, described as pharmacological cognitive enhancement (PCE), is a known phenomenon potentially impacting individuals' health. University and college students are two specific subpopulations noted to use PCE (up to 17%, on average). To our knowledge, no data have been published on the use of PCE drugs among university students at a national level in Portugal and the factors that might be associated with this usage. Objective: The main objective was to estimate the prevalence of PCE use by Portuguese university students and to identify the PCE substances commonly used by university students, i.e., those classified as prescription drugs and other legal and nonprescribed substances, including food supplements. Methods: The study followed a cross-sectional exploratory, descriptive design and pursued a convenience sample of students from Portuguese public and private universities (22 higher education institutions). Results: From a sample of 745 university students, 32% indicated the use of prescribed and nonprescribed substances. The most consumed substances were food supplements with CNS stimulants being the most frequent prescription-only drugs but not necessarily accessed through a medical prescription. A significant statistical association was found between substance consumption and the field of study. Health science students reported more food supplements and drug intake, allegedly under prescribed regimens, compared to humanities and exact sciences students. The study discusses the need to better understand the competitive societies that produce and support young students' outputs and the perceived 'need' for performance-enhancing substances. Conclusions: One-third of the university students aimed to improve their performance by pharmacological cognitive enhancement, with a preference for food supplements dispensed in pharmacies. PCE substance consumption in higher education is thus non-negligible. The study suggests the need to improve regulations on potential inequalities in academic rankings and success and an observant attitude concerning implications that negatively affect health in the long run.

Profession Driven Improvement of the Quality of Pharmacy Practice-Implementation of Community Pharmacy Services Quality Guidelines in Estonia.

Constant improvement of the quality of community pharmacy services is important in the development of contemporary patient care. A national and voluntary Community Pharmacy Services Quality Guidelines (CPSQG) was developed to formulate the principles of contemporary pharmacy services, including quality criteria for service provision. The purpose of this study was to identify the implementation of the CPSQG as a profession-driven initiative towards improving and harmonizing community pharmacy services in Estonia. Three cross-sectional electronic surveys were conducted among community pharmacies in Estonia in 2014 (N = 478 pharmacies), 2016 (N = 493), and 2019 (N = 494), and the CPSQG indicators were used for evaluation of the service quality. In this study, the aggregated data, collected in three study years were used to identify the implementation of guidelines into practice. For data analysis, the One-Way ANOVA test and Post-hoc multiple comparisons were used. The results demonstrated slow implementation of the CPSQG, but guidelines-based evaluation enabled a detailed overview of the community pharmacy activities and provided services. In order to develop community pharmacy services more efficiently, the use of implementation science principles, continuous introduction of the CPSQG to the pharmacists, and more active involvement of the state could be considered in the future.

Development of a European competency framework for health and other professionals to support behaviour change in persons self-managing chronic disease.

BACKGROUND: Healthcare and other professionals are expected to support behaviour change in people living with chronic disease. However, effective behaviour change interventions are largely absent in routine encounters. The Train4Health project, a European strategic partnership for higher education, sought to address this problem. The primary aim of this study, which is part of an early work package, was to develop an interprofessional competency framework for health and other professions to support behaviour change for the self-management of chronic disease at a European level. A secondary aim was to derive a set of behaviour change techniques (BCTs) from an established taxonomy to link with framework competencies. METHODS: The study comprised two interlinked parts. Part 1 involved a two-round e-Delphi study with an interprofessional panel of 48 experts across 12 European countries to develop the behaviour change competency framework. Preparatory work included drafting a list of competency statements based on seven existing frameworks. Part 2 involved an expert panel of six behavioural psychologists deriving a set of BCTs to link with framework competencies. Their feedback was based on preparatory work, which focused on seven high priority chronic diseases for self-management, identified through European projects on self-management and identifying five relevant target behaviours from key clinical guidelines. A literature search yielded 29 effective BCTs for the target behaviours in the selected chronic diseases. RESULTS: Twenty-seven competency statements, were presented in Round 1 to the Delphi panel. Consensus was achieved for all statements. Based on comments, two statements were removed, one was added, and 14 were modified. All 15 statements subjected to Round 2 were consensus-approved, yielding a total of 12 foundational competencies for behaviour change in self-management of chronic disease and 14 behaviour change competencies. Four behaviour change competencies related to BCTs. Behavioural psychologists' feedback led to a core set of 21 BCTs deemed applicable to the five target behaviours across the seven chronic diseases. CONCLUSIONS: A behaviour change competency framework comprising 26 statements for European health and other professionals to support self-management of chronic disease was developed, linked with a core set of 21 BCTs from an established taxonomy.

Training and standardization of simulated patients for multicentre studies in clinical pharmacy education

OBJECTIVE: To evaluate the training and standardization methods of multiple simulated patients (SPs) performing a single scenario in a multicenter study. METHODS: A prospective quasi-experimental study, using a multicenter approach, evaluated the performance of five different individuals with the same biotype during a simulation session in a high-fidelity environment. The SPs training and standardization process consisted of four steps and six web or face-to-face mediated: Step 1: simulation scenario design and pilot test. Step 2: SPs selection, recruitment and beginning training (Session 1: performance instructions and memorization request.) Session 2: check the SPs' performances and adjustments). Step 3 and session 3: training role-play and performance's evaluation. Step 4: SPs' standardization and performances' evaluation (Sessions 4 and 5: first and second rounds of SPs' standardization assessment. Session 6: Global training and standardization evaluation. SPs performance consistency was estimated using Cronbach's alpha and ICC. RESULTS: In the evaluation of training results, the Maastricht Simulated Patient Assessment dimensions of SPs performances "It seems authentic", "Can be a real patient" and "Answered questions naturally", presented "moderate or complete agreement" of all evaluators. The dimensions "Seems to retain information unnecessarily", "Remains in his/her role all the time", "Challenges/tests the student", and "Simulates physical complaints in an unrealistic way" presented "moderate or complete disagreement" in all evaluations. The SPs "Appearance fits the role" showed "moderate or complete agreement" in most evaluations. In the second round of evaluations, the SPs had better performance than the first ones. This could indicate the training process's had good influence on SPs performances. The Cronbach's alpha in the second assessment was better than the first (varied from 0.699 to 0.978). The same improvement occurred in the second round of intraclass correlation coefficient that was between 0.424 and 0.978. The SPs were satisfied with the training method and standardization process. They could perceive improvement on their role-play authenticity. CONCLUSIONS: The SPs training and standardization process revealed good SPs reliability and simulation reproducibility, demonstrating to be a feasible method for SPs standardization in multicenter studies. The Maastricht Simulated Patient Assessment was regarded as missing the assessment of the information consistency between the simulation script and the SPs provision

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The COPHELA (Cooperation in Quality Assurance for Pharmacy Education and Training between Europe and Latin America) Project.

COPHELA (Cooperation in Quality Assurance for Pharmacy Education and Training between Europe and Latin America), a collaborative project between the European Union (EU) and Latin America, will produce on-line courses for the master degree in pharmacy. The program runs from 2019 through 2021. It is funded by the Erasmus+ program of the Education, Audio-visual and Culture Executive Agency (EACEA) of the European Commission. The partners are EU and Latin American universities. These are accompanied by associated partners from EU and Latin American universities, as well as from governmental and non-governmental organizations, such as pharmacy chambers and educational associations. The project is coordinated by the University of Granada, Spain (first author of this paper). It will produce distance learning master degree courses in a dozen fields of specialized pharmaceutical science education and practice, ranging from patient care to industrial pharmacy. This paper describes the design of the project and is intended to evoke constructive comments. It also represents a call for the recruitment of additional associated partners.

Instrumentos para avaliação de habilidades de comunicação no cuidado em saúde no Brasil: uma revisão de escopo / Instruments for assessing communication skills in the area of healthcare in Brazil: a scoping review / Instrumentos para evaluación de habilidades de comunicación en el cuidado de salud en Brasil: una revisión de alcance

O ensino de habilidades de comunicação é indispensável aos profissionais de saúde. Este estudo objetivou identificar instrumentos validados no português do Brasil que avaliam habilidades de comunicação de estudantes ou profissionais da saúde. Para tanto, foi realizada uma revisão de escopo que incluiu estudos de validação de instrumentos para avaliação de habilidades de comunicação de estudantes/profissionais da área da Saúde. Foram identificados quatro instrumentos, traduzidos e validados para o português do Brasil. Validação de conteúdo, validação de construto e o teste de consistência interna foram realizados com maior frequência. Esta revisão identificou um número reduzido de instrumentos para avaliar habilidades de comunicação e dados limitados de validade e confiabilidade dos instrumentos.(AU)

Teaching communication skills to health professionals is extremely important. This study aimed to identify instruments validated for Brazilian Portuguese that assess communication skills of health students or professionals. We carried out a scoping review that included validation studies of instruments for assessing communication skills of students/professionals from the area of Health. Four instruments were identified, translated into Brazilian Portuguese and validated for this language. Content validation, construct validation and the internal consistency test were the most frequently performed ones. This review identified a reduced number of instruments to assess communication skills and limited data about the instruments' validity and reliability.(AU)

La enseñanza de habilidades de comunicación es indispensable para los profesionales de la salud. El objetivo de este estudio fue identificar instrumentos validados en portugués de Brasil que evalúan habilidades de comunicación de estudiantes o profesionales de la salud. Para ello, se realizó una revisión de alcance que incluyó estudios de validación de instrumentos para evaluación de habilidades de comunicación de estudiantes/profesionales del área de la salud. Se identificaron cuatro instrumentos, traducidos y validados al portugués de Brasil. La validación de contenido, la validación del constructo y el test de consistencia interna se realizaron con mayor frecuencia. Esta revisión identificó un número reducido de instrumentos para evaluar habilidades de comunicación y datos limitados de validez y confiabilidad de los instrumentos.(AU)

Sign Language in Brazilian Pharmacy Education.

Objective. To evaluate undergraduate pharmacy curricula at Federal Institutions of Higher Education in Brazil in order to identify sign language courses and other content related to the provision of care to deaf patients. Methods. A cross-sectional, descriptive study was conducted between March and June 2017. Data were collected from the websites of undergraduate pharmacy education programs in Brazil. Sign language courses were classified according to type (mandatory or elective), nature (theoretical or theoretical-practical), course period and workload. The course contents were extracted and analyzed by content analysis. Results. Of the 35 schools of pharmacy included in the study, 18 (51.4%) included a sign language course in their curriculum. Eighteen (100%) of the sign language courses were elective, one (5.6%) was theorical-practical, 16 (89.0%) did not have a predetermined point in the curriculum for students to complete the course, and 11 (61.1%) had a workload equal to or greater than 60 hours. The main pedagogical content identified related to the teaching and learning of sign language. Conclusion. Learning sign language in undergraduate pharmacy is important for these professionals could provide humanistic and integral care to deaf patients. Therefore, there is considerable room for improvement in teaching sign language to undergraduate pharmacy students in Brazil.

Communication skills in Brazilian pharmaceutical education: a documentary analysis

Objective: To characterize the inclusion of the teaching of communication skills in the curriculum of Pharmacy Schools of Federal Institutions of Higher Education. Methods: An exploratory study of documental analysis of curriculum of Pharmacy Schools was carried out. A convenience sample was selected from undergraduate pharmacy courses of Federal Institutions of Higher Education (IFES). The variables collected were related to the identification of the course, its nature (elective or mandatory), workload, semester, and program content. Results: Among the 49 undergraduate pharmacy courses of IFES, 35 (71.4%) had their curriculum available online. The teaching of communication in health was identified in 26 (74.3%) curriculum. In this study, three courses (7.2%) specifically aimed at teaching communication skills, while 39 (92.9%) had content related to this subject. Most courses (22; 52.4%) belonged to the field of Social, Behavioral, and Administrative Sciences. As for the course period, there was a concentration in the third (19%) and fourth (28.6%) years. The main content present in the curriculum was related to the principles and techniques of health communication (42.8%). Conclusions: Data obtained enabled the identification of gaps in the curricula of undergraduate courses in pharmacy concerning the inclusion of the teaching of communication skills. These results can be used to reflect the current models adopted in Brazil for the teaching of this skills, especially after the recent publication of the new curricular guidelines for undergraduate pharmacy courses

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Assessing Medical Prescription Forms as a Communication Tool in Trans-European Health Care.

OBJECTIVE: The objective of the study was to compare the medical prescription forms in European Union (EU) countries, evaluating their convergence toward the implementation of cross-border care, as proposed by the existing EU health-care directives. It also aims to assess how the existing EU prescription models fulfill higher standards of medication prescribing quality and patient safety. METHODS: Prescription forms from all EU countries were purposively collected. The prescription fields and other content elements were qualitatively and quantitatively analyzed. Forms were statistically compared with each other and a theoretical EU cross-border prescription form, using hierarchical cluster analysis and nonparametric testing. FINDINGS: None of the EU countries' prescriptions include all the elements required by the cross-border legislation (CBL), with most countries having seven or less mandatory elements. Cluster analysis revealed that countries with similar prescription forms are geographically nearer. Important elements from the EU directive to assure patient safety are also absent such as the International Classification of Diseases, the patient's ID according to the European Health Insurance Card, and the patient's contact. However, Western and Nordic countries showed higher standardization when compared to the CBL and model. CONCLUSION: Political action is still needed to harmonize medical prescription forms between countries, serving the common goal of trans-European health care and to increase EU patients' safety using medications and other prescribed treatments.

Self-medication and non-prescription drug counseling: Illustrating profession uncertainty within Turkish pharmacy practice.

BACKGROUND: Recommending effective minor ailment treatments and using non-prescription or over-the-counter (OTC) medicines is a pharmacist's duty. Although common in most European countries, self-medication counseling practices may differ from country to country. OBJECTIVES: This study explored Turkish community pharmacists' attitudes concerning the present self-medication market, professional responsibilities toward patients' self-care, and the usefulness of e-learning for patients' counseling education. METHODS: The study was comprised of three phases: initially, a document content analysis searched for relevant OTC regulatory and/or practice frameworks; secondly, qualitative individual interviews on self-medication with purposively selected Turkish community pharmacists were performed; finally, a focus group with practitioners and continuing education experts was conducted to deepen previous results. A thematic data analysis, based on the attitudinal theory, was conducted, supported by MAXQDA v12 software. RESULTS: Sixteen documental sources allowed the extraction of three initial main themes: self-medication, classification of medicines and pharmacists' role. Individual interviews outlined four themes that informed the focus group discussion, which produced four new themes. Themes and their codes reflected dissimilar practitioners' cognitions towards OTCs, OTC usage and self-medication, particularly if compared to other European conceptualizations. Contradictory feelings towards the value of OTCs for professional development, e.g., patient counseling influenced by profit-based expectations, were identified. CONCLUSION: Turkish community pharmacists and their minor ailments treatment competences have yet to thrive as a relevant professional intervention. There are risks of missing the best pharmacy practice standards, thus losing their contribution to rational self-care. Besides weakening the societal recognition of the profession to help individuals' everyday health decisions and well-being, there might be a reduced active role in public health.

Informing the homeopathic practice for Turkish pharmacists: reviewing the example of Portuguese community pharmacies.

INTRODUCTION: Alternative and complementary therapy systems, such as homeopathy, have long been used around the world. Since 1995 homeopathy has been officially recognized in Europe as a system of medicine or a medical specialty. Portuguese community pharmacists have long-standing experience with homeopathic products. By contrast, healthcare professionals in Turkey are less experienced with homeopathic practice although there is a new regulatory setting in place. There are a limited number of studies addressing pharmacists' role within the homeopathic system. AIM: To investigate the attitudes (knowledge, feelings and behaviour) of experienced Portuguese pharmacy practitioners who deal with homeopathy, and thus to inform Turkish pharmacy practice and policy on homeopathy-related success factors. METHODS: A qualitative cross-sectional design was followed, using semi-structured and face-to-face individual interviews with purposively selected Portuguese pharmacists experienced with homeopathic medicines. Audio-recordings were transcribed verbatim and the transcriptions imported into QSR NVivo v10 software for qualitative coding and analysis. Using a thematic content approach, the extracted codes were grouped and indexed by recurrent themes through a reflective procedure and constant comparison. RESULTS & DISCUSSION: Six general themes emerged, the most relevant being participants' feelings of gratitude for the ability to work in homeopathy; other themes were a helpful regulatory body, clear practice boundaries, scientific support and product quality assurance. Specialized homeopathic education was considered the most important factor for success. This was related to patients' positive perceptions and acceptance, suggesting an increase in public awareness through the pharmacy network. CONCLUSIONS: Portuguese pharmacists' attitudes towards their homeopathic practices highlighted the key elements for success in a field that is usually distant from traditional pharmaceutical education and practice. The present findings provide guidance for Turkish pharmacists willing to expand their professional scope and to embrace complementary medicines.

How to best manage time interaction with patients? Community pharmacist workload and service provision analysis.

BACKGROUND: Primary health care disease management models are rooted in multidisciplinary participation; however, implementation of services is lagging behind desires and predictions. Barriers like workload and lack of demand have been described. The aim of this research is to observe the workload and work patterns of Portuguese community pharmacists, and relate it with the demand of pharmaceutical services. METHOD: A time-and-motion observational study was performed to describe community pharmacists' workload in a sample of four pharmacies in the metropolitan Lisbon area. A reference list of activities to be observed was developed by reviewing other studies of community pharmacy work. This study took place during a weekday's 8-h shift, focusing on pharmacists' activities. Data to be collected included the type and duration of the activity, who performed it and where. To estimate the demand of pharmaceutical care services, "thematic-patient scenarios" were developed. These scenarios were based on the defined daily dose and package size of the most consumed medicines in Portugal, combined with data obtained from the four pharmacies' information systems on the day the observational study took place. RESULTS: Between 67.0% and 81.8% of the registered activities were pharmacist-patient interactions. These interactions summed 158.44 min, with a mean duration of 3.98 min per interaction. On average, participant pharmacies' professionals handled 4.2 prescriptions and 0.9 over-the-counter (OTC) consultations per hour. About one third of the day was spent performing administrative and non-differentiated tasks. About 54.92 min were registered as free time, 50% of which were "micro pauses" with 1 min or less. The most dispensed therapeutic subgroup was antihypertensive drugs, while the dispensation of antidiabetics was characterized by a high number of packages sold per interaction. From the developed scenarios, one can estimate that a chronic patient may visit the pharmacy 4-9 times per year, depending on the condition presented. CONCLUSION: Workload results are very similar to findings from studies in other countries, which may be an indication of uniformity of community pharmacy practice across countries. The amount of time a pharmacist has at the counter to interact with a patient during a year renders disease management or therapeutic management non-viable. Also, the perception of "lack of time," many times reported as a barrier for service provision, must be called into question, since substantial available time was found. However, to turn this available time into usable time, redesign of work processes and new role definition are necessary. Both better management and new communication channels should be developed to address this gap and increase patient follow-up services.

Competências de Comunicação Clínica: Objetivos de Ensino-Aprendizagem para um Currículo Nuclear nas Áreas da Saúde / Clinical Communication Skills: Teaching-Learning Objectives for a Core Curriculum in the Areas of Health

RESUMO Este ensaio destaca a importância das competências de comunicação clínica (CCC) nas ciências da saúde. Estas competências podem ser ensinadas, aprendidas e avaliadas, e vários estudos evidenciam para as vantagens de uma formação específica nesta área, potenciando a relação que os profissionais da área da saúde estabelecem com os pacientes, cuidadores informais e equipas de saúde, com resultados melhorados nos indicadores de saúde e cuidados mais humanizados. Confrontados com dificuldades na integração de programas específicos de comunicação nos curricula, assim como um défice no processo de avaliação e feedback estruturado, é crucial um investimento na formação pedagógica e no desenvolvimento curricular. Conscientes da escassez de trabalhos sistemáticos que apontam para um consenso sobre as competências e objetivos de ensino-aprendizagem das CCC, o sub-grupo Core Curriculum do comité de ensino (tEACH) da Associação Europeia de Comunicação em Saúde (EACH) desenvolveu e alcançou um consenso para um currículo nuclear nas diferentes áreas da saúde. Neste contexto, surgiu o Health Professions Core Communication Curriculum – HPCCC, que pode servir como referencial flexível de acordo com as necessidades específicas e contribuir para uma maior sistematização das iniciativas de CCC em saúde em língua portuguesa.

ABSTRACT This essay addresses the importance of clinical communication skills (CCC) in the health sciences. These skills can be taught, learned and assessed, and several studies have shown the advantages of specific training in this area, enhancing the relationship that healthcare professionals establish with patients, informal careers and health teams, with improved results in health indicators and more humanized care. Faced with difficulties in integrating specific communication programs in the curricula, as well as a deficit in the assessment process and structured feedback, an investment in teacher training and curriculum development is crucial. Aware of the lack of systematic studies that point to a consensus on the skills and CCC teaching-learning objectives, the Core Curriculum sub-group of the Teaching Committee (tEACH) of the European Association of Communication in Health (EACH) developed and achieved a consensus for a core curriculum in the different areas of healthcare. In this context, the Health Professions Core Curriculum Communication – HPCCC emerged, which can serve as a flexible framework in accordance with the specific needs and contribute to greater systematization of CCC initiatives in healthcare spoken in Portuguese.

How pharmacist-patient communication determines pharmacy loyalty? Modeling relevant factors.

BACKGROUND: Portuguese community pharmacies provide pharmaceutical services, such as therapeutic outcomes follow-up, supplemented by relevant point-of-care testing that require continuity of provision to be effective. OBJECTIVES: To identify factors of technical and communication nature that during a patient interview contribute to patients' loyalty. METHODS: A cross-sectional descriptive study, with a purposive sample of community pharmacies providing pharmaceutical care, was conducted. Patient interviews were taped and transcribed verbatim. Duration, segments and utterances were identified and time stamped, using a previously validated coding scheme. To identify predictors of loyalty, logistic regression analyses were performed. RESULTS: From 59 interviews, participants' average age was 65.7 years and 42 (71.2%) were female; 45 (76.3%) interviews were classified as outcomes measurements and 14 (23.7%) as pharmaceutical consultations, with 33.2% of the patients booking a following appointment. The significant items to explain loyalty were associated with lifestyle and psychosocial exchange, age of the patient, and the presence of all interview segments (i.e. a complete consultation). CONCLUSION: Contrary to common professional beliefs and practice orientation it would appear that pharmacists' technical skills are not the essential factors that promote patients' loyalty needed for continuity of care, at least in the same extent as the social and lifestyle-related content of the exchange. Pharmaceutical care education should focus on relational skills as much as on medication-related competencies.