Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems.

BACKGROUND: For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector. OBJECTIVE: To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept. METHODS: A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article. RESULTS: The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001). CONCLUSIONS: There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.

Primary health care policy and vision for community pharmacy and pharmacists in Spain.

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.

Primary health care policy and vision for community pharmacy and pharmacists in Spain

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced

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Effectiveness of the Dader Method for pharmaceutical care in patients with bipolar I disorder: EMDADER-TAB: study protocol for a randomized controlled trial.

BACKGROUND: Bipolar I disorder (BD-I) is a chronic mental illness characterized by the presence of one or more manic episodes, or both depressive and manic episodes, usually separated by asymptomatic intervals. Pharmacists can contribute to the management of BD-I, mainly with the use of effective and safe drugs, and improve the patient's life quality through pharmaceutical care. Some studies have shown the effect of pharmaceutical care in the achievement of therapeutic goals in different illnesses; however, to our knowledge, there is a lack of randomized controlled trials designed to assess the effect of pharmacist intervention in patients with BD. The aim of this study is to assess the effectiveness of the Dader Method for pharmaceutical care in patients with BD-I. METHODS/DESIGN: Randomized, controlled, prospective, single-center clinical trial with duration of 12 months will be performed to compare the effect of Dader Method of pharmaceutical care with the usual care process of patients in a psychiatric clinic. Patients diagnosed with BD-I aged between 18 and 65 years who have been discharged or referred from outpatients service of the San Juan de Dios Clinic (Antioquia, Colombia) will be included. Patients will be randomized into the intervention group who will receive pharmaceutical care provided by pharmacists working in collaboration with psychiatrists, or into the control group who will receive usual care and verbal-written counseling regarding BD. Study outcomes will be assessed at baseline and at 3, 6, 9, and 12 months after randomization. The primary outcome will be to measure the number of hospitalizations, emergency service consultations, and unscheduled outpatient visits. Effectiveness, safety, adherence, and quality of life will be assessed as secondary outcomes. Statistical analyses will be performed using two-tailed McNemar tests, Pearson chi-square tests, and Student's t-tests; a P value <0.05 will be considered as statistically significant. DISCUSSION: As far as we know, this is the first randomized controlled trial to assess the effect of the Dader Method for pharmaceutical care in patients with BD-I and it could generate valuable information and recommendations about the role of pharmacists in the improvement of therapeutic goals, solution of drug-related problems, and adherence. TRIAL REGISTRATION: Registration number NCT01750255 on August 6, 2012. First patient randomized on 24 November 2011.

Agreement between community pharmacy and ambulatory and home blood pressure measurement methods to assess the effectiveness of antihypertensive treatment: the MEPAFAR study.

The usefulness of the community pharmacy blood pressure (CPBP) method in the diagnosis or treatment of hypertension has not been adequately addressed in controlled studies. The authors' aim was to assess the agreement between awake ambulatory blood pressure (ABP), home blood pressure (HBP), and CPBP in treated hypertensive patients. This was a cross-sectional study carried out in 169 patients in which blood pressure (BP) was measured at the pharmacy (4 visits), at home (4 days), and by 24-hour ABP monitoring. Lin correlation-concordance coefficient (CCC) and Bland-Altman plots were used to evaluate quantitative agreement. The qualitative agreement to establish the degree of BP control was evaluated using κ coefficient. The agreement was acceptable between HBP and CPBP (CCC=0.80 for systolic BP [SBP] and 0.80 for diastolic BP [DBP]; κ=0.62) and moderate between awake ABP and CPBP (CCC=0.74/0.67, respectively; κ=0.56). The Bland-Altman plots also showed lowest mean differences (0.5/0.3 for SBP and DBP, respectively) for the comparison between CPBP and HBP. The CPBP has a better agreement with HBP than with awake ABP. Thus, the CPBP measurement method could be a good alternative to HBP monitoring, whereas it cannot be used as a screening test to assess the degree of BP control by awake ABP.

Impact of pharmacists' participation in a pharmacotherapy follow-up program.

OBJECTIVE: To evaluate the impact of a continuing pharmacy education (CPE) course on Spanish community pharmacists' participation in a pharmacotherapy follow-up program. DESIGN: Participation in a CPE course offered 4 times over a 4-year period via satellite teleconferencing was monitored and the data analyzed to determine the course's impact on community pharmacists' participation in a pharmacotherapy follow-up program. ASSESSMENT: Community pharmacists' participation in the pharmaceutical care CPE course had a slightly positive impact on their participation in the pharmacotherapy follow-up program. In the best profiles, there was a probability of 7.3% that participants would participate in the pharmacotherapy follow-up program. CONCLUSIONS: Completion of pharmaceutical care CPE courses did not have a significant impact on pharmacists' participation in a pharmacotherapy follow-up program.

Evaluation of the hypertensive state in treated patients: selection of appropriate blood pressure measurements per visit to the community pharmacy.

OBJECTIVE: To assess the agreement between repeated blood pressure (BP) measurements taken by community pharmacists during visits to the community pharmacy on four separate occasions, and to assess the agreement between the community pharmacy BP (CPBP) measurement method and ambulatory BP monitoring (ABPM) in order to determine the CPBP measurements from each visit needed to evaluate the hypertensive state of treated patients. METHODS: The study was a cross-sectional study of treated hypertensive patients aged older than 18 years from eight community pharmacies. BP was measured during four visits to the community pharmacy (three measurements per visit) and for 24 h using ABPM (ABPM started on the third visit to the pharmacy). The Lin correlation-concordance coefficient, the Bland-Altman method, and the κ coefficient were used to assess the agreement between CPBP measurements from each visit. The κ coefficient was used to assess the agreement between the CPBP measurement method and ABPM to establish the patient's hypertensive state. The average CPBP was calculated using four methods: (i) three measurements/four visits, (ii) two measurements/four visits, (iii) three measurements/three visits, and (iv) two measurements/three visits. RESULTS: One hundred and seventy-six treated hypertensive patients were included. Overall, the agreement between the second and third CPBP measurement at each visit was higher than the agreement between other paired measurements (first vs. third and first vs. second), for both systolic BP and diastolic BP. The agreement between the CPBP measurement method and ABPM was not statistically different when analyzed using all variations of the average CPBP calculation. CONCLUSION: The agreement between repeated BP measurements taken by community pharmacists at each visit was greater between the second and the third measurements. In contrast, the agreement between the CPBP measurement method and ABPM did not improve when the first CPBP measurement that was taken at each visit was excluded. As a result, the three CPBP measurements taken at each visit to the pharmacy could be used to evaluate the hypertensive state of treated patients.

Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study.

OBJECTIVE: To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients. SETTING: Eight community pharmacies in Gran Canaria, Spain. METHOD: A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) ≥ 200/110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment <4 weeks, history of cardiovascular disease <6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h). MAIN OUTCOME MEASURE: The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis. RESULTS: Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (ß = 0.35; P < 0.001). The regression analysis for diastolic CPWCE revealed female gender (ß = 4.88; P < 0.001), BMI (ß = 0.48; P < 0.001) and community pharmacy DBP (ß = 0.24; P < 0.001) as independent determinants. CONCLUSION: In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP and BMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased.

Magnitude of the white-coat effect in the community pharmacy setting: the MEPAFAR study.

BACKGROUND: There is little information regarding the community pharmacy blood pressure (CPBP) measurement method and their differences with home (HBP) or ambulatory BP (ABP). The aim of this study was to measure such differences and their variation over successive visits. METHOD: Cross-sectional study carried out in eight pharmacies in Gran Canaria (Spain). The study included 169 treated hypertensive patients. BP was measured at the pharmacy (four visits), at HBP (4 days) and 24-h ABP monitoring. We defined pharmacy white-coat effect (PWCE) as differences between CPBP and HBP (home PWCE) or daytime ABP (ambulatory PWCE). RESULTS: The overall (pooled values for all visits) ambulatory PWCE was not significantly different from zero for systolic BP (SBP) (-0.4 mm Hg (95% confidence interval (CI): -1.8 to 1.1)), but greater than zero for diastolic BP (DBP) (3.4 mm Hg (95% CI: 2.3 to 4.6)). The overall home PWCE was not significantly different from zero, both for SBP (1.2 mm Hg (95% CI: -0.1 to 2.6)) and DBP (0.1 mm Hg (95% CI: -0.7 to 1.0)). The ambulatory and home PWCE on the first visit were greater than zero (P < 0.001) (SBP/DBP): 3.5/4.8 and 1.9/1.5 mm Hg, respectively; but showed important reductions at the second visit and became not significantly different from zero, except the ambulatory PWCE in DBP, which persisted until the last visit. CONCLUSION: The trend in the PWCE decreased over the successive visits to the pharmacy. Only the ambulatory PWCE in DBP proved to be statistically greater than zero after the second visit. Repeated CPBP measurements could be a useful alternative to assess the response to antihypertensive treatment.

Clinical value of blood pressure measurement in the community pharmacy.

AIM OF THE STUDY: To investigate whether the measurement of blood pressure in the community pharmacy is a valuable method to diagnose hypertension, to assess the need and the effectiveness of anti-hypertensive treatments, or, in general, to make clinical decisions. METHOD: Information has been extracted from articles published in English and in Spanish, from January 1989 to December 2009, in indexed magazines in MEDLINE and EMBASE. To perform the search, multiple and specified terms related to the community pharmacy setting, to blood pressure measurement and to the comparison and agreement between blood pressure measurement methods were used. Selected articles were those that: (1) compared and/or measured the agreement (concordance) between community pharmacy blood pressure measurements obtained in repeated occasions, or (2) compared and/or measured the agreement between the community pharmacy blood pressure measurement method and other measurement methods used in clinical practice for decision-making purposes: blood pressure measurement by a physician, by a nurse and home or ambulatory blood pressure monitoring. Articles were included and analyzed by two investigators independently, who essentially extracted the main results of the manuscripts, emphasizing the assessment of the blood pressure measurement methods used and the completed statistical analysis. RESULTS: Only three studies comparing the community pharmacy blood pressure measurement method with other methods and one comparing repeated measurements of community pharmacy blood pressure were found. Moreover, these works present significant biases and limitations, both in terms of method and statistical analysis, which make difficult to draw consistent conclusions. CONCLUSION: Further research of high quality is needed, which results can guide the clinical decision-making based on the community pharmacy blood pressure measurement method.

Effectiveness of a videoconference training course on implementing pharmacy services.

OBJECTIVE: The aim of this research was to assess the effects of a series of four training courses comprised of 13 synchronous videoconferences on the implementation of cognitive services in Spanish community pharmacies. Setting A phone survey to continuing training course attendants. METHODS: A random sample of 225 pharmacists registered in a 2004 videoconference course was selected. The phone-survey questionnaire included quality perception elements rated on a 5-point Likert scale, and a series of questions used to identify position in the Rogers 5-step innovation-decision model. An algorithm was used to translate the questions into Rogers' categories. To discover determinants of attendants position in these categories, bivariate analysis, simple correspondence analysis, and logistic regressions were performed. MAIN OUTCOME MEASURE: Position in Rogers' diffusion of innovation steps regarding the adoption of pharmacotherapy follow-up. RESULTS: The perception of the course quality rated between good and very good for the majority of respondents. A significant association between having attended two or more of these four courses and the Persuasion/Decision step in Rogers's model appeared. No association was found between course attendance and the Implementation/Confirmation step of patient follow-up. Fifty percent of those who indicated they implemented the service reported following-up with less than 10 patients, and only 25% reported following up with more than 20 patients. CONCLUSIONS: Although participation in these courses was associated with higher steps in Rogers' model, significant association appeared only with Persuasion/Decision steps and not with the Implementation/Confirmation step, reflecting an attitude but not a performance change.

Facilitators for practice change in Spanish community pharmacy.

OBJECTIVE: To identify and prioritise facilitators for practice change in Spanish community pharmacy. SETTING: Spanish community pharmacies. METHOD: Qualitative study. Thirty-three semi-structured interviews were conducted with community pharmacists (n = 15) and pharmacy strategists (n = 18), and the results were examined using the content analysis method. In addition, two nominal groups (seven community pharmacists and seven strategists) were formed to identify and prioritise facilitators. Results of both techniques were then triangulated. MAIN OUTCOME MEASURES: Facilitators for practice change. RESULTS: Twelve facilitators were identified and grouped into four domains (D1: Pharmacist; D2: Pharmacy as an organisation; D3: Pharmaceutical profession; D4: Miscellaneous). Facilitators identified in D1 include: the need for more clinical education at both pre- and post-graduate levels; the need for clearer and unequivocal messages from professional leaders about the future of the professional practice; and the need for a change in pharmacists' attitudes. Facilitators in D2 are: the need to change the reimbursement system to accommodate cognitive service delivery as well as dispensing; and the need to change the front office of pharmacies. Facilitators identified in D3 are: the need for the Spanish National Professional Association to take a leadership role in the implementation of cognitive services; the need to reduce administrative workload; and the need for universities to reduce the gap between education and research. Other facilitators identified in this study include: the need to increase patients' demand for cognitive services at pharmacies; the need to improve pharmacist-physician relationships; the need for support from health care authorities; and the need for improved marketing of cognitive services and their benefits to society, including physicians and health care authorities. CONCLUSION: Twelve facilitators were identified. Strategists considered clinical education and pharmacists' attitude as the most important, and remuneration of little importance. Community pharmacists, in contrast, considered remuneration as the most important facilitator for practice change.

Variación del conocimiento al asistir a un taller de asma para farmacéuticos comunitarios / Changes in knowledge after attending a community pharmacists’ asthma workshop

Antecedentes: Los farmacéuticos pueden jugar un papel importante tanto en la detección de asma como en su seguimiento. Objetivos: Determinar la variación de conocimiento, y las variables asociadas, de los farmacéuticos asistentes al taller de «Seguimiento Farmacoterapéutico en Asma bronquial en Adultos» que realizan el Cetro de Atención Farmacéutica del laboratorio Stada: (CAF-Stada) Método: Todos los asistentes al taller de «Seguimiento Farmacoterapéutico en Asmabronquial en Adultos» completaron un test antes dela sesión y otro después. Aquellos que abandonaron el taller o no cumplimentaron los test fueron excluidos del estudio. El test puntuaba de 0 a 10 y se analizaron las variaciones en las puntuaciones. Resultado: De los 90 participantes, 79 cumplieron los criterios de inclusión. El 81,4% fueron mujeres y la edad media fue de 38,8 años [IC95%=36,65-40,81]. La puntuación media en el test inicial fue 3,65 [IC95%=3,29-4,01]; el 72,2% de los farmacéuticos obtuvo una puntuación inferior a 5 puntos. La puntuación media en el test final fue7,33 [IC95%=7.01-7,65]. La variación de conocimiento media fue 3,68 [IC95%=3,29-4,07]. No hay relación estadísticamente significativa entrevariación de conocimiento y las otras variables analizadas (edad, género, otros cursos, o cargo en la farmacia). Conclusión: El taller de «Seguimiento Farmacoterapéutico en Asma bronquial en Adultos» que realizan el CAF-Stada) aumenta el conocimiento general del farmacéutico (AU)

Background: Pharmacists can play an important role in both the detection of asthma and itsmonitoring in patients with asthma. Objective: To assess the change in asthma knowledge, and associated variables, ofpharmacists attending the «Pharmacotherapy follow up of Adult Bronchial Asthma» workshops run by the Pharmaceutical Care Center of Stada Laboratories. Methods: All participants in the «Pharmacotherapy follow-up of Adult Bronchial Asthma» workshops completed a pre-test and a post-test. Those who left the workshop and those who did not complete the tests were not included in the analysis. Tests were scored from 0 to 10, and the change in scores was analyzed. Results: Of the 90 participating pharmacists, 79fulfilled the inclusion criteria. 81% (64) were female, and their average age was 38.8 years [CI95%=36.65-40.81]. The average pre-test score was 3.65[CI95%=3.29-4.01]; 72.2% of the pharmacistsscored less than 5 points. The average post-test score was 7.33 [CI95%=7.01-7.65]. The average change in scores was 3.68 [CI95%=3.29-4.07] . No statistical significance was found between this change in scores and other variables analyzed (age, gender, previous training, or position in the pharmacy). Conclusion: CAF Stada «Adult Bronchial Asthma» workshops increased pharmacists' general knowledge (AU)

Changes in knowledge after attending a community pharmacists' asthma workshop.

BACKGROUND: Pharmacists can play an important role in both the detection of asthma and its monitoring in patients with asthma. OBJECTIVE: To assess the change in asthma knowledge, and associated variables, of pharmacists attending the "Pharmacotherapy follow- up of Adult Bronchial Asthma" workshops run by the Pharmaceutical Care Center of Stada Laboratories. METHODS: All participants in the "Pharmacotherapy follow-up of Adult Bronchial Asthma" workshops completed a pre-test and a post-test. Those who left the workshop and those who did not complete the tests were not included in the analysis. Tests were scored from 0 to 10, and the change in scores was analyzed. RESULTS: Of the 90 participating pharmacists, 79 fulfilled the inclusion criteria. 81% (64) were female, and their average age was 38.8 years [CI95%= 36.65-40.81]. The average pre-test score was 3.65 [CI95%=3.29-4.01]; 72.2% of the pharmacists scored less than 5 points. The average post-test score was 7.33 [CI95%=7.01-7.65]. The average change in scores was 3.68 [CI95%=3.29-4.07]. No statistical significance was found between this change in scores and other variables analyzed (age, gender, previous training, or position in the pharmacy). CONCLUSION: CAF Stada "Adult Bronchial Asthma" workshops increased pharmacists' general knowledge.