Improving the Quality of Publications in and Advancing the Paradigms of Clinical and Social Pharmacy Practice Research: The Granada Statements / Mejorando la calidad de las publicaciones y avanzando en todos los paradigmas de la investigación de la farmacia asistencial, clínica y social: las declaraciones de Granada

Pharmacy and pharmaceutical sciences embrace a series of different disciplines. Pharmacy practice has been defined as “the scientific discipline that studies the different aspects of the practice of pharmacy and its impact on health care systems, medicine use, and patient care”. Thus, pharmacy practice studies embrace both clinical pharmacy and social pharmacy elements. Like any other scientific discipline, clinical and social pharmacy practice disseminates research findings using scientific journals. Clinical pharmacy and social pharmacy journal editors have a role in promoting the discipline by enhancing the quality of the articles published. As has occurred in other health care areas (i.e., medicine and nursing), a group of clinical and social pharmacy practice journal editors gathered in Granada, Spain to discuss how journals could contribute to strengthening pharmacy practice as a discipline. The result of that meeting was compiled in these Granada Statements, which comprise 18 recommendations gathered into six topics: the appropriate use of terminology, impactful abstracts, the required peer reviews, journal scattering, more effective and wiser use of journal and article performance metrics, and authors’ selection of the most appropriate pharmacy practice journal to submit their work (AU)

Anatomical and fMRI-network comparison of multiple DLPFC targeting strategies for repetitive transcranial magnetic stimulation treatment of depression.

BACKGROUND: The efficacy of repetitive transcranial magnetic stimulation (rTMS) for depression may vary depending on the subregion stimulated within the dorsolateral prefrontal cortex (DLPFC). Clinical TMS typically uses scalp-based landmarks for DLPFC targeting, rather than individualized MRI guidance. OBJECTIVE: In rTMS patients, determine the brain systems targeted by multiple DLPFC stimulation rules by computing several surrogate measures: underlying brain targets labeled with connectivity-based atlases, subgenual cingulate anticorrelation strength, and functionally connected networks. METHODS: Forty-nine patients in a randomized controlled trial of rTMS therapy for treatment resistant major depression underwent structural and functional MRI. DLPFC rules were applied virtually using MR-image guidance. Underlying cortical regions were labeled, and connectivity with the subgenual cingulate and whole-brain computed. RESULTS: Scalp-targeting rules applied post hoc to these MRIs that adjusted for head size, including Beam F3, were comparably precise, successful in directly targeting classical DLPFC and frontal networks, and anticorrelated with the subgenual cingulate. In contrast, all rules involving fixed distances introduced variability in regions and networks targeted. The 5 cm rule targeted a transitional DLPFC region with a different connectivity profile from the adjusted rules. Seed-based connectivity analyses identified multiple regions, such as posterior cingulate and inferior parietal lobe, that warrant further study in order to understand their potential contribution to clinical response. CONCLUSION: EEG-based rules consistently targeted DLPFC brain regions with resting-state fMRI features known to be associated with depression response. These results provide a bridge from lab to clinic by enabling clinicians to relate scalp-targeting rules to functionally connected brain systems.

Targeting location relates to treatment response in active but not sham rTMS stimulation.

BACKGROUND: Precise targeting of brain functional networks is believed critical for treatment efficacy of rTMS (repetitive pulse transcranial magnetic stimulation) in treatment resistant major depression. OBJECTIVE: To use imaging data from a "failed" clinical trial of rTMS in Veterans to test whether treatment response was associated with rTMS coil location in active but not sham stimulation, and compare fMRI functional connectivity between those stimulation locations. METHODS: An imaging substudy of 49 Veterans (mean age, 56 years; range, 27-78 years; 39 male) from a randomized, sham-controlled, double-blinded clinical trial of rTMS treatment, grouping participants by clinical response, followed by group comparisons of treatment locations identified by individualized fiducial markers on structural MRI and resting state fMRI derived networks. RESULTS: The average stimulation location for responders versus nonresponders differed in the active but not in the sham condition (P = .02). The average responder location derived from the active condition showed significant negative functional connectivity with the subgenual cingulate (P < .001) while the nonresponder location did not (P = .17), a finding replicated in independent cohorts of 84 depressed and 35 neurotypical participants. The responder and nonresponder stimulation locations evoked different seed based networks (FDR corrected clusters, all P < .03), revealing additional brain regions related to rTMS treatment outcome. CONCLUSION: These results provide evidence from a randomized controlled trial that clinical response to rTMS is related to accuracy in targeting the region within DLPFC that is negatively correlated with subgenual cingulate. These results support the validity of a neuro-functionally informed rTMS therapy target in Veterans.

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies.

BACKGROUND: Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS: A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS: The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS: There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.

El Museo de Anatomía de la Universidad de Chile, un monumento nacional / The anatomy museum of the University of Chile: a national monument

The accrual of anatomical preparations since the nineteenth century in Santiago, Chile, became the so called "anatomical cabinet" under the supervision of professor Julio F Lafargue. Afterwards, this cabinet evolved to form an anatomical museum in the mid twentieth century. It contained preparations using corpses whose identification was not known. Now, the corpses are donated through a body donation program that started thirty years ago. The collection contains, among other interesting items, a situs inversus preparation, Juan Martel's mummy, Tramond house wax preparations and a jibarized head. Nowadays, the museum is open to the community, its collection is recognized as a national historical monument, and has links with other university museums in the country and abroad.

Evidence-informed policy making at country level: lessons learned from the South African Tuberculosis Think Tank.

BACKGROUND: National Tuberculosis Programmes (NTPs) require specialist input to support the development of policy and practice informed by evidence, typically against tight deadlines. OBJECTIVE: To describe lessons learned from establishing a dedicated tuberculosis (TB) think tank to advise the South African NTP on TB policy. INTERVENTION AND EVALUATION METHODS: A national TB think tank was established to advise the NTP in support of evidence-informed policy. Support was provided for activities, including meetings, modelling and regular telephone calls, with a wider network of unpaid expert advisers under an executive committee and working groups. Intervention evaluation used desktop analysis of documentary evidence, interviews and direct observation. RESULTS: The TB Think Tank evolved over time to acquire three key roles: an 'institution', a 'policy dialogue forum' and an 'interface'. Although enthusiasm was high, motivating participation among the NTP and external experts proved challenging. Motivation of working groups was most successful when aligned to a specific need for NTP decision making. Despite challenges, the TB Think Tank contributed to South Africa's first ever TB and human immunodeficiency virus (HIV) investment case, and the decision to create South Africa's first ever ring-fenced grant for TB. The TB Think Tank also assisted the NTP in formulating strategy to accelerate progress towards reaching World Health Organization targets. DISCUSSION: With partners, the TB Think Tank achieved major successes in supporting evidence-informed decision making, and garnered increased funding for TB in South Africa. Identifying ways to increase the involvement of NTP staff and other experts, and keeping the scope of the Think Tank well defined, could facilitate greater impact. Think tank initiatives could be replicated in other settings to support evidence-informed policy making.

[The anatomy museum of the University of Chile: a national monument]. / El Museo de Anatomía de la Universidad de Chile, un monumento nacional.

The accrual of anatomical preparations since the nineteenth century in Santiago, Chile, became the so called "anatomical cabinet" under the supervision of professor Julio F Lafargue. Afterwards, this cabinet evolved to form an anatomical museum in the mid twentieth century. It contained preparations using corpses whose identification was not known. Now, the corpses are donated through a body donation program that started thirty years ago. The collection contains, among other interesting items, a situs inversus preparation, Juan Martel's mummy, Tramond house wax preparations and a jibarized head. Nowadays, the museum is open to the community, its collection is recognized as a national historical monument, and has links with other university museums in the country and abroad.

Community-based active case finding for tuberculosis in rural western China: a cross-sectional study.

SETTING: Current passive case finding strategies are not effective at identifying tuberculosis (TB) patients in rural China. OBJECTIVE: To evaluate a community-based, active case finding (ACF) scheme in identifying symptomatic individuals with TB. DESIGN: We conducted door-to-door household visits of all residents aged 15 years at two rural sites to screen for TB symptoms. Individuals with symptoms were enrolled and asked to provide three sputum samples. All participants underwent chest X-ray, and microbiologic detection of Mycobacterium tuberculosis from sputum samples using microscopy, solid culture and Xpert® MTB/RIF was performed. RESULTS: Among the 19 334 residents screened for TB symptoms, 865 (4.5%) reported having 1 symptom. A total of 52 TB cases were detected, 11 of whom had microbiologic confirmation. Xpert identified all five M. tuberculosis culture-positive cases and yielded an additional three diagnoses. Prevalence of newly detected TB at the two sites through ACF was respectively 475 and 196 per 100 000 population. These estimates are respectively four and eight times, on average, higher than those identified through passive surveillance during the previous 5-year period for the two sites. CONCLUSION: Community-based symptom screening followed by laboratory tests was found to be feasible and effective in increasing TB case finding in rural China.

Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review.

INTRODUCTION: The aim was to determine whether professional pharmacy services (PPS) provided to ambulatory patients attending community pharmacy are cost-effective compared with usual care (UC). Areas covered: MEDLINE, Web of Knowledge, Scopus, Cochrane Library and Centre for Reviews and Dissemination databases were searched, and the risk of bias of randomized controlled trials, and the methodological quality of economic evaluations was assessed. A total of 17 economic evaluations of 13 studies were included. Seven studies were classified as high-, three as medium- and three as low-quality. PPS were more effective and less costly than UC in four studies; seven studies concluded that PPS were more effective and more costly and two studies concluded that the service was as effective as the UC, with higher and lower costs. Expert commentary: Although the uncertainty was variable among the studies, a general trend towards the cost-effectiveness of PPS was observed. Decision makers are encouraged to consider the feasibility of implementing PPS.

eNOS gene Glu298Asp and 4b/a polymorphisms are associated with renal function parameters in Mexican patients with Fabry disease.

Fabry disease (FD) is an inherited X-linked lysosomal disease that causes renal failure in a high percentage of affected individuals. The eNOS gene encodes for endothelial nitric oxide synthase, which plays an important role in glomerular hemodynamics. This gene has two main polymorphisms (Glu298Asp and 4b/a) that have been studied in the context of many different diseases, including those involving cardiovascular and renal alterations. Considering the lack of information regarding eNOS variants and FD, we investigated whether there were associations between eNOS genetic variants and renal function parameters in Mexican patients with FD and renal impairment. In total, 15 FD patients with renal alterations were included in the present study, and associations between eNOS polymorphisms and renal function parameters (urea, creatinine, and GFR) were evaluated. The Asp298 and 4a alleles of the eNOS gene were found to be significantly associated with increased levels of urea and creatinine, and a decreased glomerular filtration rate in FD patients, and this association behaved in a co-dominant fashion. Our results coincide with previous reports showing an association between these polymorphisms and kidney disease, and along with other studies regarding their role in the nitric oxide pathway, suggest that these variants affect the severity of nephropathy in patients with FD.

Strategy for design NIR calibration sets based on process spectrum and model space: An innovative approach for process analytical technology.

The pharmaceutical industry is under stringent regulations on quality control of their products because is critical for both, productive process and consumer safety. According to the framework of "process analytical technology" (PAT), a complete understanding of the process and a stepwise monitoring of manufacturing are required. Near infrared spectroscopy (NIRS) combined with chemometrics have lately performed efficient, useful and robust for pharmaceutical analysis. One crucial step in developing effective NIRS-based methodologies is selecting an appropriate calibration set to construct models affording accurate predictions. In this work, we developed calibration models for a pharmaceutical formulation during its three manufacturing stages: blending, compaction and coating. A novel methodology is proposed for selecting the calibration set -"process spectrum"-, into which physical changes in the samples at each stage are algebraically incorporated. Also, we established a "model space" defined by Hotelling's T(2) and Q-residuals statistics for outlier identification - inside/outside the defined space - in order to select objectively the factors to be used in calibration set construction. The results obtained confirm the efficacy of the proposed methodology for stepwise pharmaceutical quality control, and the relevance of the study as a guideline for the implementation of this easy and fast methodology in the pharma industry.

A double-blind, randomised, placebo-controlled, dose-finding trial of the novel tuberculosis vaccine AERAS-402, an adenovirus-vectored fusion protein, in healthy, BCG-vaccinated infants.

BACKGROUND: Several novel tuberculosis vaccines are currently in clinical trials, including AERAS-402, an adenovector encoding a fusion protein of Mycobacterium tuberculosis antigens 85A, 85B, and TB10.4. A multicentred trial of AERAS-402 safety and immunogenicity in healthy infants was conducted in three countries in sub-Saharan Africa, using an adaptive design. METHODS: In a double-blind, randomised, placebo-controlled, dose-finding trial, we enrolled BCG-vaccinated, HIV-uninfected infants aged 16-26 weeks. Infants in the safety/dose-finding phase received two doses of AERAS-402 across three dose levels, or placebo, intramuscularly on days 0 and 28. Infants in the expanded safety phase received three doses of the highest dose level, with the 3rd dose at day 280. Follow up for safety and immunogenicity was for up to two years. RESULTS: We enrolled 206 infants (52 placebo and 154 AERAS-402 recipients) into the dose-finding phase and 281 (141 placebo and 140 AERAS-402 recipients) into the expanded safety phase. Safety data were acceptable across all dose levels. No vaccine-related deaths were recorded. A single serious adverse event of tachypnoea was deemed related to study vaccine. Antibodies directed largely against Ag85A and Ag85B were detected. Low magnitude CD4+ and CD8+ polyfunctional T cell responses were observed at all dose levels. The addition of a third dose of AERAS-402 at the highest dose level did not increase frequency or magnitude of antibody or CD8+ T cell responses. CONCLUSIONS: AERAS-402 has an acceptable safety profile in infants and was well tolerated at all dose levels. Response rate was lower than previously seen in BCG vaccinated adults, and frequency and magnitude of antigen-specific T cells were not increased by a third dose of vaccine.

Calpain-10 gene polymorphisms and risk of type 2 diabetes mellitus in Mexican mestizos.

The calpain-10 gene is expressed primarily in tissues important in glucose metabolism; thus, some of its polymorphisms have been associated with type 2 diabetes. In this study, we examined the association between the calpain-10 single-nucleotide polymorphism (SNP)-43, SNP-19, and SNP-63 and type 2 diabetes in Mexican mestizos. We included 211 patients and 152 non-diabetic subjects. Polymerase chain reaction was used to identify alleles. We compared allele, genotype, haplotype, and diplotype frequencies between both groups and used the chi-square test to calculate the risk. The allele frequency of SNP-43 allele 1 was 70% in controls and 72% in patients; the GG, GA, and AA genotype frequencies were 48.7, 42.8, and 8.5% in controls and 51.2, 41.7, and 7.1% in patients, respectively. For SNP- 19, the prevalence of allele 1 (2R) was 32% in controls and 39% in patients. In controls, homozygosity (2R/2R) was 10.5%, heterozygosity was 42.8%, and 3R/3R was 46.7%; in cases, these values were 13.3, 50.7, and 36.0%, respectively. For SNP-63, the frequency of allele 1 was 87% in controls and 83% in patients; genotype frequencies in controls were 75.7% (CC), 23% (CT), and 1.3% (TT), and were 69.7, 27.5, and 2.8%, respectively for the cases. Genotype distributions were consistent with Hardy-Weinberg equilibrium. No significant intergroup differences for allele, genotype, haplotype, or diplotype frequencies were observed. We found no association between these polymorphisms and diabetes. However, our sample size was small, so the role of calpain-10 risk alleles should be further examined.

Pure 9p trisomy derived from a terminal balanced unreciprocal translocation.

The 9p trisomy is a relatively frequent disorder, while pure 9p trisomies are less frequent and usually derived from 9;22 translocations, duplications or 9p extra chromosomes. Here we report a patient with pure trisomy 9p derived from a terminal balanced unreciprocal translocation. The patient derived to the genetic service by psychomotor delay, presented at 2 years and 11 months: short stature, open anterior fontanelle, dysplastic ears, facial dysmorphisms, long and broad first toes with hypoplastic nails, central nervous system and skeletal alterations. The patient karyotype was: 46,XY,der(10)t(9;10) (p13.1;qter)mat while the mother karyotype was: 46,XX,t(9;10)(p13.1;qter). The presence of the subtelomeric region of 10q showed by FISH as well as the duplication of 9p subtelomere was further confirmed with multiplex ligation dependent probe amplification (MLPA) for the subtelomeric region of all chromosomes. The mechanism of formation seems to be due to a telomere break in 10q leading to loss of telomeric functions, permitting the 9p fusion; this has been supported with molecular probes showing telomere shortening in interstitial telomeric repeats, which are unable to prevent chromosome fusion. This is one of the few cases reported with terminal translocations (not jumping) preserving the subtelomeric region and highlights the importance of subtelomeric probes in terminal arrangements, and the utility of molecular probes, such as MLPA in defining this kind of abnormalities. In the clinical context, the patient presented a high proportion of 9p trisomy features which is expected considering the large 9p segment involved and the presence of the critical region 9p22.

Percepción de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria / Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy

Objetivo: Explorar la percepción de Formadores Colegiales con experiencia previa sobre su formación y sus funciones futuras en la implantación y sostenibilidad del servicio de Seguimiento Farmacoterapéutico en el ámbito de la farmacia comunitaria española. Método: Estudio cualitativo mediante la técnica del grupo focal. El coordinador de la reunión focal utilizó un guión temático previamente elaborado que permitía explorar la opinión de los Formadores Colegiales sobre sus experiencias y percepciones acerca del futuro de esta nueva figura profesional. El contenido de la conversación fue registrado en una grabadora, transcrito en su totalidad y posteriormente analizado mediante análisis de contenido. Resultados: La reunión grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmacéuticos, en Madrid, tuvo una duración de 95 minutos. Participaron seis Formadores Colegiales. En función de los temas tratados se identificaron dos dimensiones; una primera que abarca las funciones que debe desempeñar un Formador Colegial (resaltando la función de motivador, facilitador de la comunicación y formador metodológico y clínico) y una segunda en las que se describen las características que ese profesional debe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio de Farmacéuticos correspondiente, con lugar físico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otras características). Conclusiones: El presente artículo aporta información relevante sobre la figura innovadora del Formador Colegial, describiendo las características intrínsecas necesarias para desarrollar su labor y las funciones a desempeñar. Dicha información debería ser utilizada por aquellos Colegios Oficiales de Farmacéuticos provinciales que deseen implantar Servicios Profesionales Farmacéuticos, tales como el servicio de Seguimiento Farmacoterapéutico

Objective: To explore opinions and perceptions of Practice Change Facilitator of their training and experiences in assisting in the implementation of Medication Reviews with follow- up in Spanish community pharmacy. Methods: A focus group of six Practice Change Facilitators was conducted at the headquarters of the Spanish General Council of Pharmacists’ Associations. A semi-structured interview guide was used. Results: Two domains emerged underpinned by a number of themes. One domain was related to the interaction between the pharmacy and the Practice Change Facilitator. This included their role as a motivator, a facilitator of internal and external communication, and teacher of the clinical aspects and methodological issues of the process of medication reviews with a follow-up. The second domain was composed of themes including personal traits and characteristics, and by work-related conditions such as flexibility of the individual and contractual obligations. Conclusions: This paper provides qualitative evidence which can be used by employers to further define the role, functions and optimal personal traits of Practice Change Facilitators

Depresión respiratoria neonatal y fentanilo intratecal / Neonatal Respiratory Depression and Intrathecal Fentanyl

Objetivo: Establecer la prevalencia de depresión respiratoria neonatal en pacientes expuestas a fentanil intratecal durante cesárea. Métodos: Estudio Observacional Retrospectivo Analítico Tipo Corte Transversal realizado en la Clínica Materno-Infantil de la Corporación Saludcoop en pacientes llevadas a cesárea y que recibieron Fentanil intratecal para anestesia regional en los años 2007 y 2008. Desenlaces primarios: APGAR Bajo (APGAR<7) y APGAR Severo (APGAR<4). Resultados: 2165 Registros de cesáreas y fentanil intratecal con dosis media de 19,21mcg DE=0,206mcg). Prevalencia de APGAR Bajo al nacer al minuto 01=1,77% (DE=0,63%), al minuto 05=0,11% (DE 0,163%), al minuto 10=0%; siendo estos dos últimos valores diferentes al valor del minuto 01 (ANOVA Test Scheffé p=0,031) y sin diferenciarse entre ellos (minutos 5 y 10) (ANOVA p=0,861). APGAR Severamente disminuido al nacer al minuto 1=0,059% (DE 0,058), a los minutos 5 y 10=0%. Los tres valores severamente disminuidos no presentaron diferencias estadísticamente significativas entre sí (ANOVA p=0,861). Conclusiones: La prevalencia de Depresión Respiratoria medido con el test de APGAR al nacer es baja; el compromiso severo del APGAR presenta una tendencia a 0 en todos los minutos de su valoración; aun así es cuestionable la fiabilidad de la herramienta diagnóstica APGAR) al existir discrepancias en el análisis con una escala mucho más sensible para el diagnóstico (Test de Silverman). La importancia de este estudio solo radica como evaluación de prevalencia y fuente de hipótesis de investigación, no como estudio de asociación o predicción.

Objective: To establish the prevalence of neonatal respiratory depression in patients exposed to intrathecal fentanyl during Cesarean section. Methods: Cross-sectional Analytical Observational Retrospective Study conducted at the Mother and Child Clinic of the Saludcoop Corporation in patients undergoing C-section who received intrathecal fentanyl for regional anesthesia in 2007 and 2008. Primary endpoints: low APGAR score (APGAR<7) and severe APGAR (APGAR<4). Results: 2165 records of C-sections and intrathecal fentanyl with a mean dose of 19.21mcg (SD=0.206mcg). Prevalence of low APGAR at 1.5 and 10 minutes was 1.77% (SD=0.63%), 0.11% (SD 0.163%), and 0%, respectively. The latter two values were different from the 1-minute value (ANOVA Scheffé Test, p=0.031) and there was no difference between them (minutes 5 and 10) (ANOVA p=0.861). Severely diminished APGAR results were, 0.059% (SD 0.058) 1 minute after birth and 0% at 5 and 10 minutes. There were no statistically significant differences between the three severely diminished values (ANOVA p=0.861). Conclusions: The prevalence of respiratory depression measured with the APGAR test at birth is low; severely compromised APGAR shows a trend towards 0 in the different minutes of assessment. However, the reliability of the diagnostic tool (APGAR) is questionable, considering discrepancies when the analysis is done with a far more sensitive diagnostic tool (Silverman test). The importance of this study relates only to the assessment of prevalence and its use as a source of a research hypothesis, and not as an association or prediction study.

Factores que influyen en la participación de farmacéuticos comunitarios en un servicio de atención farmacéutica para pacientes asmáticos / Factors affecting community pharmacists’ participation in a Pharmaceutical care service for asthmatic patients

Objetivo: Identificar, mediante el modelo PRECEDE, los factores predisponentes, facilitadores y reforzantes que influían en la participación de un grupo de farmacéuticos en el proyecto AFasma. Método: Estudio cualitativo mediante entrevistas semiestructuradas y observación participante de los farmacéuticos incluidos en el grupo de intervención del estudio AFasma. Resultados: Los factores predisponentes motivantes para el farmacéutico fueron: formación en asma, realización profesional, fidelización del paciente y valoración de la farmacia. Los factores desmotivantes fueron: dedicación de tiempo, ausencia de relación farmacéutico-médico, falta de personal y de publicidad, y dificultades para ofrecer el servicio. Los factores facilitadores presentes fueron: habilidades de comunicación farmacéuticopaciente, cumplimentación correcta de las hojas de recogida de datos, uso correcto del inhalador y pago por servicio. Por el contrario, se detectó: baja capacidad para ofertar el servicio, ausencia de una zona de atención personalizada, dudas con la valoración de la técnica de inhalación y educación en asma, y ausencia de implicación de todo el personal de la farmacia. Los factores reforzantes identificados con mayor frecuencia a favor de la realización del estudio fueron: satisfacción personal y profesional, mejora de la relación farmacéutico-paciente y actualización en farmacología, mientras que entre los identificados en contra el más frecuente fue la alta dedicación de tiempo requerida. Conclusiones: La utilización del modelo PRECEDE logró identificar los factores predisponentes, facilitadores y reforzantes que condicionaron la participación de un grupo de farmacéuticos en el estudio AFasma. Con los resultados obtenidos se podría diseñar un conjunto de estrategias para apoyar la realización de estudios similares y facilitar una posible implantación del servicio (AU)

Objective: Identify trough the PRECEDE model those factors predisposing, reinforcing and enabling the participation of a group of pharmacists in the AFasma project. Methods: Qualitative study through semi-structured interviews and participant observation of the pharmacists included in the intervention group of the AFasma project. Results: Predisposing factors motivating the pharmacist were: asthma training, professional satisfaction, patient loyalty and increase pharmacy value. Those desmotivating were: lack of time, lack of physician-pharmacist collaborative working relationship, lack of staff and marketing and difficulties in offering the service. Facilitating factors were: pharmacist-patient communication skills, ability to complete data forms, correct inhaler technique and payment for the service. In contrast, there was a lack of skills to offer the service to the patient, lack of a patient counseling area, doubts with the inhaler technique assessment and asthma non-pharmacological advice, and pharmacy staff not working as a team. Reinforcing factors supporting the service were: professional and personal satisfaction, improvement of the pharmacist-patient relationship, pharmacology training. The reinforcing factor against the service was the time spent during the project. Conclusions: Using the PRECEDE model we were able to identify the factors predisposing, facilitating and enabling the participation of a group of pharmacist in the AFasma project. With the factors identifi ed a number of strategies could be developed in order to support further studies and facilitate a potential implementation of the service (AU)