Identification of high-risk patients for referral through machine learning assisting the decision making to manage minor ailments in community pharmacies.

Background: Data analysis techniques such as machine learning have been used for assisting in triage and the diagnosis of health problems. Nevertheless, it has not been used yet to assist community pharmacists with services such as the Minor Ailment Services These services have been implemented to reduce the burden of primary care consultations in general medical practitioners (GPs) and to allow a better utilization of community pharmacists' skills. However, there is a need to refer high-risk patients to GPs. Aim: To develop a predictive model for high-risk patients that need referral assisting community pharmacists' triage through a minor ailment service. Method: An ongoing pragmatic type 3 effectiveness-implementation hybrid study was undertaken at a national level in Spanish community pharmacies since October 2020. Pharmacists recruited patients presenting with minor ailments and followed them 10 days after the consultation. The main outcome measured was appropriate medical referral (in accordance with previously co-designed protocols). Nine machine learning models were tested (three statistical, three black box and three tree models) to assist pharmacists in the detection of high-risk individuals in need of referral. Results: Over 14'000 patients were included in the study. Most patients were female (68.1%). With no previous treatment for the specific minor ailment (68.0%) presented. A percentage of patients had referral criteria (13.8%) however, not all of these patients were referred by the pharmacist to the GP (8.5%). The pharmacists were using their clinical expertise not to refer these patients. The primary prediction model was the radial support vector machine (RSVM) with an accuracy of 0.934 (CI95 = [0.926,0.942]), Cohen's kappa of 0.630, recall equal to 0.975 and an area under the curve of 0.897. Twenty variables (out of 61 evaluated) were included in the model. radial support vector machine could predict 95.2% of the true negatives and 74.8% of the true positives. When evaluating the performance for the 25 patient's profiles most frequent in the study, the model was considered appropriate for 56% of them. Conclusion: A RSVM model was obtained to assist in the differentiation of patients that can be managed in community pharmacy from those who are at risk and should be evaluated by GPs. This tool potentially increases patients' safety by increasing pharmacists' ability to differentiate minor ailments from other medical conditions.

Strengthening patients' triage in community pharmacies: A cluster randomised controlled trial to evaluate the clinical impact of a minor ailment service.

BACKGROUND: Self-perceived minor ailments might conceal other health conditions if patients are not appropriately assisted by health care professionals. The aim of the study was to evaluate the patient-related outcomes of a community pharmacy Minor Ailment Service (MAS) compared to usual pharmacist care (UC). METHODS: A cluster randomised controlled trial was conducted over six months in community pharmacy in the province of Valencia (Spain). Patients seeking care or requesting a product for a minor ailments considered in the study (dermatological problems, gastrointestinal disturbance, pain and upper respiratory tract related symptoms) were included. The intervention consisted of a standardised pharmacist-patient consultation guided by a web-based program using co-developed management protocols and patients' educational material. Patients were followed up by phone ten days later. Primary clinical outcomes were appropriate medical referral and modification of direct product request. Secondary outcomes were symptom resolution and reconsultation rates. RESULTS: A total of 808 patients (323 MAS and 485 UC) were recruited in 27 pharmacies of 21 municipalities. Patients visiting MAS pharmacies had higher odds for being referred to a physician (OR = 2.343, CI95% = [1.146-4.792]) and higher reconsultation rates (OR = 1.833, CI95% = [1.151-2.919]) compared to UC. No significant differences between groups were observed for modification of direct product request and symptom resolution. CONCLUSIONS: The use of management protocols through the MAS strengthened the identification of referral criteria such as red flags in patients suffering minor ailments. These patients with symptoms of minor ailments possibly due to more severe illness were to be referred and evaluated by physicians. Results reinforce that MAS increases safety for those patients consulting in community pharmacy for minor ailments. TRIAL REGISTRATION: Trial registration number: ISRCTN17235323. Retrospectively registered 07/05/2021, https://www.isrctn.com/ISRCTN17235323.

Medicines use review service in community pharmacies in Spain: REVISA project.

Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these services to improve the adherence and knowledge of their medications, besides to reduce medicine-related problems. Objective The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review service in Spanish community pharmacies. Setting Sixty-four community pharmacies from all regions of Spain. Method A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies. A structured interview enabled to pharmacists to obtain a better understanding of patient's medicines use. Main outcome measure Medicines use review-related time and cost, satisfaction and willingness to pay. Results A total of 495 patients were enrolled. The mean age of the patients was 66.1 years, with the majority females (56.4%) and a mean consumption of 5.7 medicines. A total of 2811 medicines were evaluated and 550 referral recommendations were made (29.8% to Primary Care). The mean time employed by the pharmacists in the medicines use review service was 52.8 min (medicines use review-related cost of €17.27). Most patients expressed a high level of satisfaction with this service (98.5%) and a willingness to pay for it (84%). Conclusion Medicines use review service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. This service may offer an opportunity to promote inter-professional collaboration between pharmacists and general practitioners.

Colaboración farmacéutico-médico en la elaboración de protocolos consensuados para el tratamiento de síntomas menores: programa 'INDICA+PRO' / Collaborative care protocols for the management of minor ailments agreed between pharmacists and medical practitioners: INDICA+PRO Study

Introducción: la colaboración entre médicos y farmacéuticos es necesaria en el manejo de los síntomas menores, ya que el paciente acude a ambos profesionales sanitarios para su tratamiento. El objetivo del estudio fue elaborar protocolos de trabajo consensuados entre farmacéuticos comunitarios y médicos de atención primaria para el Servicio de Indicación Farmacéutica (SIF). Material y método: se utilizaron dos metodologías: revisión bibliográfica y grupo de expertos para el consenso. Estos protocolos se actualizaron y diseñaron a partir de un documento previo de 2008. En el grupo de expertos se incluyeron cuatro farmacéuticos comunitarios de SEFAC (2), MICOF (2) y cuatro médicos de atención primaria de semFYC (2) y SEMERGEN (2). Resultados: se consensuaron protocolos de trabajo para 31 síntomas menores distribuidos en cinco grupos: respiratorios, dolor moderado, digestivos, dermatológicos y otros. Se añadieron cinco síntomas nuevos al documento de partida. Respecto a la estructura de cada síntoma se consideró: concepto, causas más frecuentes, criterios de derivación al médico (edad, síntomas de alarma, duración de los síntomas, otros problemas de salud y/o medicamentos y situaciones especiales), recomendaciones para la prevención y tratamiento (no farmacológico y farmacológico). Conclusión: el documento desarrollado mediante colaboración entre profesionales de la medicina y la farmacia es una herramienta que contribuye a la mejora de la actuación del farmacéutico en el manejo de los síntomas menores desde la farmacia comunitaria, con énfasis en la definición de indicadores que señalan la necesidad de derivar el paciente al médico de atención primaria

Background: To increase the collaboration between community pharmacists and medical practitioners working in primary care it is critical to have collaborative protocols in place. Minor ailments could be a good example where this collaboration would benefit patient care as patients are seeking treatment in both settings. These collaborative protocols would assist in diminishing the variability of treatments in both settings. The aim of the study was to develop care protocols for minor ailments agreed between medical practitioners and pharmacists Methods: Two different methodologies were used to arrive at a consensus for the proto-cols: literature review and expert group. Some of the clinical protocols were updated from a previous document created in 2008. Expert group was composed of four community pharma-cists (SEFAC, MICOF) and four medical practitioners (SemFyC y Semergen). Results: Thirty-one protocols for minor ailments were agreed and allocated to five groups (five new minor ailments protocols were added: respiratory tract-related conditions, gastrointestinal disturbance, pain, dermatological problems and others.Protocols were structured following: definition, more frequent causes, referral criteria (pa-tient’s age, red flags, symptom’s duration, patient’s health problems and treatments and physiological situations), recommendations for management (prevention, non-pharmacological and pharmacological treatment) and references used. Conclusions: Clinical protocols agreed between health professionals of medicine and phar-macy are a tool that contribute to better management of minor ailments in community pharmacy

La información al paciente sobre los servicios profesionales farmacéuticos asistenciales de farmacia comunitaria / Information to patients on professional pharmaceutical care services of Community Pharmacy

La prestación de servicios profesionales farmacéuticos asistenciales (SPFA) al paciente des-de la farmacia comunitaria ha de realizarse observando una serie de garantías sanitarias y legales previas que aseguren los derechos del paciente. Toda actuación en el ámbito de la salud de un paciente necesita su consentimiento libre y voluntario una vez que haya recibido la in-formación adecuada. Esta información que, como regla general, se proporcionará verbalmente (salvo en los casos de procedimientos invasivos, que son los que entrañan riesgos más graves), ha de ser veraz e incluir como mínimo la finalidad y la naturaleza de cada intervención, sus riesgos y sus consecuencias, y se debe comunicar al paciente de forma comprensible y adaptada a sus necesidades, de forma que le ayude a tomar decisiones de acuerdo con su propia y libre voluntad. De este modo, para que el paciente consienta que se le preste un SPFA ha de recibir previamente una información específica sobre dicho servicio. Aunque esta información se po-dría proporcionar solo verbalmente, al ser los SPFA servicios novedosos con los que el paciente no está familiarizado, es recomendable proporcionarla también por escrito ya que esta vía per-mite garantizar que se comunica de forma uniforme, comprensible, evitando equivocaciones y olvidos, y además el paciente tendrá más tiempo para estudiarla en su casa. Este artículo analiza la información mínima que se debe proporcionar a los pacientes y usuarios en la prestación de los SPFA. Además, muestra como ejemplo tanto la información que se proporciona al paciente en cinco de los SPFA que gestiona la aplicación SEFAC e_XPERT®, como un modelo de consen-timiento informado válido para dichos servicios y que incluye el resto de información necesaria que también se debe comunicar previamente al paciente

The provision of professional pharmaceutical care services (SPFA) to the patient from the community pharmacy must be carried out by observing a series of previous health and legal guarantees that ensure the rights of the patient. Any action in the area of a patient’s health requires his or her free and voluntary consent once he or she had received the appropriate information. This information will, as a general rule, be provided orally (except in the case of invasive procedures, which are the ones with the most serious risks), must be truthful and include at least the purpose and nature of each intervention, its risks and its consequences, and must be communicated to the patient in a way that is understandable and adapted to his or her needs, in a way that helps you make decisions according to your own free will. Thus, in order for the patient to consent to the provision of an SPFA, he must first receive specific information about that service. Although this information could be provided only verbally, as SPFAs are novel services with which the patient is not familiar, it’s advisable to provide it also in writing, as this way ensures that it communicates uniformly, comprehensively, avoiding mistakes and forgetfulness, and also that the patient will have more time to study it at home. This article discusses the minimum information to be provided to patients and users in the provision of SPFA. In addition, it shows, as an example, the information provided to the patient in five of the SPFA that manage the SEFAC e_XPERT®application, as well as an informed consent model which includes all other necessary information which must also be communicated to patient

El consentimiento y el tratamiento de los datos sanitarios del paciente en la prestación y realización de estudios de investigación de servicios profesionales farmacéuticos asistenciales / The assent and the treatment of the sanitary information of the patient in the presentation and accomplishment of studies of investigation of professional pharmaceutical care services

La prestación de servicios profesionales farmacéuticos asistenciales de farmacia comunitaria al paciente desde la farmacia comunitaria (SPFA) ha de realizarse observando una serie de garantías sanitarias y legales previas que aseguren los derechos del paciente. La información, la autonomía para decidir, la intimidad y el consentimiento son elementos básicos a considerar por el farmacéutico comunitario previamente a la prestación de los SPFA. El conocimiento de estas garantías condiciona la relación clínica del farmacéutico con el paciente, afianzan la prestación de SPFA en la farmacia comunitaria y dota de seguridad jurídica a la actuación pro-fesional del farmacéutico. Este artículo analiza las obligaciones legales acerca de los diferentes tipos de consentimientos necesarios en la práctica farmacéutica, así como la información que es necesario proporcionar a los pacientes y las implicaciones relacionadas con la normativa vigente sobre protección de datos personales

The provision of professional pharmacy services from the Community Pharmacy (SPFA) to the patient must be carried out in accordance with a series of prior health and legal guarantees that ensure the patient's rights. Information, decision-making autonomy, privacy and consent are basic elements to be considered by the community pharmacist prior to the provision of the SPFA. The co-knowledge of these guarantees' conditions the pharmacist's clinical relationship with the patient, strengthens the provision of SPFA in the community pharmacy and gives legal certainty to the professional performance of the pharmacist. This article analyses the legal obligations regarding the different types of consents required in pharmaceutical practice, as well as the information that needs to be provided to patients and the implications related to current regulations on the protection of personal data

Intervención del farmacéutico comunitario en la vacunación de adultos con patología respiratoria / Intervention of community pharmacist in the vaccination of adults with respiratory disease

Introducción: La cobertura vacunal de gripe y neumonía son bajas en la Comunidad Valenciana. La farmacia comunitaria es un recurso sanitario asistencial de atención primaria que puede ayudar a detectar pacientes de riesgo susceptibles de vacunación que no han sido vacunados. Objetivos: Investigar las causas de los que no quieren vacunarse e intervenir para que se vacunen. Material y métodos: Estudio de intervención cuasiexperimental realizado en 11 farmacias de la Comunidad Valenciana a pacientes con patología respiratoria en los que estaba indicada la vacunación antigripal y/o antineumocócica. Resultados: Participaron 392 pacientes. El 53% y el 12% estaban vacunados para gripe y neumonía respectivamente. Tres pacientes estaban vacunados sólo de neumonía. Los hombres se vacunan más que las mujeres en ambas patologías encontrándose diferencias significativas. Pacientes con niveles de estudios altos se vacunan menos, aunque no es significativo. Uno de cada cuatro pacientes a los que se recomendó vacunarse de gripe refirió vacunarse, aumentando la tasa de vacunación al 65%. Para la vacuna antineumocócica refirieron vacunarse el 7%, lo que supuso un incremento del 18%. Discusión: La cobertura vacunal en la Comunidad Valenciana no alcanza los objetivos propuestos por la Organización Mundial de la Salud (OMS), algunos pacientes tienen reparos a vacunarse. Es necesario revisar el impacto y los mensajes de las campañas de vacunación. Los farmacéuticos comunitarios pueden mejorar esta situación. Conclusiones: La intervención de la farmacia comunitaria aumenta el número de pacientes de riesgo dispuestos a vacunarse de la gripe y la neumonía, por lo que contar con el apoyo de la farmacia comunitaria podría potenciar y mejorar los resultados del sistema sanitario

Introduction: Vaccine coverage of influenza and pneumonia is low in Comunidad Valenciana. The community pharmacy is a primary health care resource. It can help to identify unvaccinated patients at risk for vaccination, investigate the causes and intervene to get them vaccinated. Methodology: Multicenter cross-sectional study with intervention carried out in 11 community pharmacies in Comunidad Valenciana in patients with respiratory pathology in which influenza and/or pneumococcal vaccination were indicated. Results: There were 392 patients participating. 53% and 12% were vaccinated for influenza and pneumonia, respectively. Three patients were vaccinated for pneumonia only. Men were vaccinated more than women in both pathologies and significant differences were found. Patients with high levels of education were vaccinated less, although it is not significant. One in four patients who were recommended for influenza vaccination said be vaccinated, increasing vaccination rate until 65%. 7% said to be vaccinated of pneumococcal vaccine, increasing the rate until 18%. Discussion: The vaccination coverage in Comunidad Valenciana does not reach the objectives proposed by the WHO. Some patients hesitate to be vaccinating. It is necessary to check the impact and the messages of vaccination campaigns. The community pharmacists can improve this situation. Conclusions: The community pharmacy’s intervention increases the number of at-risk patients willing to be vaccinated against influenza and pneumonia, for these reasons, health system should therefore be actively involved

Demanda de antibióticos sin receta en farmacia comunitaria / No disponible

Introducción: El autocuidado es el método más utilizado para el mantenimiento de la salud. No tiene por que ser erradicado, pero sí debe reconducirse hacia una automedicación responsable. La automedicación con antibióticos reúne unas características especiales que la hacen distinta a cualquier otra. Un error en el tratamiento tiene repercusiones para el paciente y también para toda la sociedad a través de la generación de resistencias. Material y método: Durante cuatro períodos de estudio de una semana en las cuatro estaciones del año, 1.788 farmacéuticos en 971 farmacias registraron todas las demandas de antibióticos por vía oral que recibían. Si la demanda era sin receta intentaban averiguar si iba a ser utilizado para automedicación o si de alguna forma había un médico detrás de esa demanda. En caso de determinar que era para automedicación intentaban evitarla ofreciendo al paciente otra solución, que podía ser derivar al médico o dispensar otro medicamento que no necesitara receta. Resultados: Se recogieron 52.753 registros válidos, de los cuales 11.899 (22,6%) se hicieron sin receta, y de ellos 9.862 fue el propio paciente o cuidador el que realizó la petición. De todas las demandas sin recetas realizadas por el paciente/cuidador sólo se consideraron automedicación 4.489 (45,52%). En 1.520 (34%) se dispensó otro medicamento, en 1.576 (35%) se remitió al médico y en 1.393 (31%) el paciente rechazó la intervención. El problema de salud para el que más se pedía automedicación fue molestias de garganta. seguido de gripe/resfriado. El antibiótico más demandado para automedicación fue la amoxicilina, y concretamente el Clamoxy(R). Discusión: El problema de la automedicación con antibióticos existe y puede considerarse importante, ya que alcanza al 10% de toda la demanda de antibióticos por vía oral. Los farmacéuticos podemos intervenir eficazmente para disminuirla, ya que hablando con el paciente conseguimos evitar el 69% de esta automedicación (AU)

Introduction: Selfcare is the more frequent method for health maintenance. It doesn't have to be eradicated, but to improve it toward a responsible self-medication. Self-medication with antibiotics gathers some special characteristics that make it different to any one. Errors in treatment have impact on the patient, and also on the whole society through the generation of resistance. Material and method: 1.788 pharmacists in 971 community pharmacies registered all demands of antibiotics per os, four weeks in a year (one per season). If demand was without recipe they tried to elicit if it will be used for self-medication or if in some way it was prescribed by a physician. When self-medication, they tried to avoid it offering the patient another solution that could be referral to a physician, or to substitute antibiotic by a medication not needing recipe. Results: 52.753 registrations were collected, of which 11899 (22,6%) without recipe. Of all the demands (9862) without recipes carried out by the patient/caretaker were self-medication 4.489 (45,52%). Answering the request, 1.520 (34%) received another medication, 1.576 (35%) were referred to a physician, and 1.393 (31%) patients rejected pharmacist’s intervention. More frequent health problem for self-medication was throat pain; second was flu/cold. More popular antibiotic for self-medication was amoxicilina (by its brand name Clamoxy(R)). Discussion: Demand of antibiotic for self-medication is frequent and it can be considered an important problem since it reaches almost 10% of the whole demand of antibiotics per os. Pharmacists have opportunities to filter it as speaking with the patient may avoid 69% (AU)

Las consultas de indicación farmacéutica en la farmacia comunitaria / No disponible

Introducción. Actualmente la farmacia comunitaria es un establecimiento de asistencia sanitaria dentro del sistema sanitario nacional y un hecho que lo demuestra es la demanda de indicación farmacéutica. Objetivos. Caracterizar (cuali y cuantitativamente) la indicación farmacéutica en la farmacia comunitaria. Métodos Estudio descriptivo transversal. Se registran todas las consultas de indicación farmacéutica (edad y sexo del paciente, motivo de consulta, si es el propio paciente el que consulta, tiempo utilizado, medicamentos y productos que se recomiendan, etc.) que tienen lugar en 9 farmacias comunitarias de Valencia. Resultados De 154 consultas realizadas. (un 16%; IC95%: 14%-18%), se resolvieron el 78% (119). La persona que consulta es el propio paciente en un 66%, de edad media 38 años (DE: 19) y sexo femenino (50%). El farmacéutico atiende las consultas en un 72% (111) y las resuelve en un 78% (119). Un 16% de los casos en que se resolvió la consulta de IF no se dispensó nada ni se derivó al médico. El tiempo medio empleado por las consultas de indicación fue de 4 minutos. Conclusiones. La indicación farmacéutica es una actividad de Atención Farmacéutica en la que la farmacia comunitaria debe involucrarse y a través de la cual se cubren mayoritariamente las necesidades del paciente respecto a su problema de salud

Introduction. Community pharmacies are health centres. One of the demands are the responding to symptoms consultations. Objectives. To study the responding to symptoms consultation in the community pharmacy. Methods Cross-sectional study. All responding to symptoms consultations were registered (age and gender of patient, demands, time of consultation, drugs and sanitary products recommended, etc..) in 9 community pharmacies of Valencia. Results. There were 154 consultations (16%; IC95%: 14%-18%) which were resolved in 78%. The person demanding of consultation were the own patient in 66% occasions with mean age 38 years (SD: 19) and female (50%). Pharmacists attended personally in 72% (111) of consults and were resolved 78% (119). In 16% occasions were not sold any product nor derived the patient to doctor. The mean time to resolved the responding to symptoms consultation were 4 minutes. Conclusions. The responding to symptoms consultation is a pharmaceutical care activity and community pharmacies must be involved