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BMC Health Serv Res ; 18(1): 145, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29486758


BACKGROUND: Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. METHODS: A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacy-based health programs was used to build a theoretical model of the service. RESULTS: Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). CONCLUSION: A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.

Fibrilação Atrial/prevenção & controle , Serviços Comunitários de Farmácia/organização & administração , Farmacêuticos , Autocuidado , Participação dos Interessados , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pesquisa Qualitativa
Res Social Adm Pharm ; 14(8): 765-775, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29033347


BACKGROUND: A key early step to enhance the integration of community pharmacy services (CPSs) into primary care practice is identifying key determinants of practice (i.e., critical circumstances that influence the implementation of such services). Involving relevant stakeholders in identifying key determinants enables findings to be more relevant to the context in which CPSs will be implemented. OBJECTIVE: To identify key determinants of practice that can influence the implementation of government-funded CPSs in a primary health network in Australia. METHODS: A stakeholder collaborative approach was used, encompassing two phases. In the first phase, semi-structured interviews were conducted with ground-level stakeholders in Western Sydney between August 2016 to October 2016. Framework analysis was used to code and analyse the data from the interviews into determinants of pharmacy practice. In the second phase, a workshop was conducted with a mixed-group of ground-level and system-level stakeholders from the primary health network to identify key determinants. A four-quadrant prioritization matrix was employed in the workshop to classify determinants based on their importance and feasibility. RESULTS: Sixty-five determinants of practice that can influence CPS implementation were identified in Phase 1. These determinants were allocated at different levels of the healthcare system, and can exist as a barrier or facilitator or both. Twenty-two key determinants were selected in Phase 2, of which three were agreed to be addressed initially: (1) Patient understanding of the aims of the service; (2) Commitment of the organization and its leaders to provide services; (3) Coordination of the healthcare system to prompt collaboration between pharmacists and GPs. CONCLUSIONS: This collaborative stakeholder approach identified a set of key determinants of pharmacy practice in this Australian primary care setting. To enhance the implementation of CPSs in this region, initial efforts should be aimed at developing implementation strategies based on these key determinants of practice.

Serviços Comunitários de Farmácia/organização & administração , Atenção Primária à Saúde/organização & administração , Participação dos Interessados , Austrália , Serviços Comunitários de Farmácia/economia , Financiamento Governamental , Governo , Humanos , Atenção Primária à Saúde/economia
BMJ Open ; 7(9): e015471, 2017 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-28877940


OBJECTIVES: The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia. METHODS: A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach. RESULTS: Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education. CONCLUSIONS: Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.

Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia/organização & administração , Papel Profissional , Austrália , Humanos , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa
Health Educ Behav ; 44(4): 524-535, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28580805


BACKGROUND: Intervention Mapping is a planning protocol for developing behavior change interventions, the first three steps of which are intended to establish the foundations and rationales of such interventions. AIM: This systematic review aimed to identify programs that used Intervention Mapping to plan changes in health care professional practice. Specifically, it provides an analysis of the information provided by the programs in the first three steps of the protocol to determine their foundations and rationales of change. METHOD: A literature search was undertaken in PubMed, Scopus, SciELO, and DOAJ using "Intervention Mapping" as keyword. Key information was gathered, including theories used, determinants of practice, research methodologies, theory-based methods, and practical applications. RESULTS: Seventeen programs aimed at changing a range of health care practices were included. The social cognitive theory and the theory of planned behavior were the most frequently used frameworks in driving change within health care practices. Programs used a large variety of research methodologies to identify determinants of practice. Specific theory-based methods (e.g., modelling and active learning) and practical applications (e.g., health care professional training and facilitation) were reported to inform the development of practice change interventions and programs. DISCUSSION: In practice, Intervention Mapping delineates a three-step systematic, theory- and evidence-driven process for establishing the theoretical foundations and rationales underpinning change in health care professional practice. CONCLUSION: The use of Intervention Mapping can provide health care planners with useful guidelines for the theoretical development of practice change interventions and programs.

Pessoal de Saúde/educação , Implementação de Plano de Saúde/organização & administração , Prática Profissional/normas , Desenvolvimento de Programas/métodos , Assistência à Saúde/métodos , Implementação de Plano de Saúde/métodos , Humanos , Inovação Organizacional
J Manag Care Spec Pharm ; 22(6): 699-713, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27231797


BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. OBJECTIVES: To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. METHODS: This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. RESULTS: From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. CONCLUSIONS: This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD. DISCLOSURES: Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.

Doenças Cardiovasculares/prevenção & controle , Serviços Comunitários de Farmácia , Prática Clínica Baseada em Evidências/métodos , Farmacêuticos , Papel Profissional , Doenças Cardiovasculares/epidemiologia , Bases de Dados Factuais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
Patient Prefer Adherence ; 9: 569-78, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25926723


BACKGROUND: Low adherence to pharmacological treatments is one of the factors associated with poor blood pressure control. Questionnaires are an indirect measurement method that is both economic and easy to use. However, questionnaires should meet specific criteria, to minimize error and ensure reproducibility of results. Numerous studies have been conducted to design questionnaires that quantify adherence to pharmacological antihypertensive treatments. Nevertheless, it is unknown whether questionnaires fulfil the minimum requirements of validity and reliability. The aim of this study was to compile validated questionnaires measuring adherence to pharmacological antihypertensive treatments that had at least one measure of validity and one measure of reliability. METHODS: A literature search was undertaken in PubMed, the Excerpta Medica Database (EMBASE), and the Latin American and Caribbean Health Sciences Literature database (Literatura Latino-Americana e do Caribe em Ciências da Saúde [LILACS]). References from included articles were hand-searched. The included papers were all that were published in English, French, Portuguese, and Spanish from the beginning of the database's indexing until July 8, 2013, where a validation of a questionnaire (at least one demonstration of the validity and at least one of reliability) was performed to measure adherence to antihypertensive pharmacological treatments. RESULTS: A total of 234 potential papers were identified in the electronic database search; of these, 12 met the eligibility criteria. Within these 12 papers, six questionnaires were validated: the Morisky-Green-Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); and Martín-Bayarre-Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach's α, varied from 0.43 to 0.889. Additional statistical techniques utilized to assess the psychometric properties of the questionnaires varied greatly across studies. CONCLUSION: At this stage, none of the six questionnaires included could be considered a gold standard. However, this revision will assist health professionals in the selection of the most appropriate tool for their individual circumstances.

Ars pharm ; 55(1): 1-7, ene.-mar. 2014.
Artigo em Espanhol | IBECS | ID: ibc-121020


Objetivos: El uso terapéutico de los factores estimulantes de colonias de granulocitos resulta desconocido en comparación con el uso como profilaxis de los mismos. El objetivo de este estudio fue recopilar la información relativa al uso terapéutico encontrada en estudios llevados a cabo del año 2003 en adelante. Métodos: La búsqueda se realizó en siete bases de datos electrónicas en mayo de 2012. Resultaron elegibles los estudios publicados en inglés, francés y español desde el año 2003 en adelante. Se buscaron estudios que abordasen el uso terapéutico de filgrastim y pegfilgrastim en neutropenia febril secundaria a quimioterapia. La búsqueda se completó revisando las referencias de los artículos seleccionados. Resultados: Hubo cuatro estudios que reunieron los criterios de selección. Uno se llevó a cabo en un hospital del Líbano, otro en un hospital británico, otro fue un estudio multicéntrico en España y el último se realizó en Australia a través de una encuesta electrónica a especialistas en cáncer. En el estudio del Líbano, 59 de 137 ciclos de tratamiento con factores estimulantes de colonias de granulocitos se realizaron como uso terapéutico. En el estudio LEARN en España, el 29,7% de los pacientes que usaron factores estimulantes de colonias de granulocitos los utilizaron como tratamiento, al igual que el 17,3% de los pacientes que recibieron pegfilgrastim. El 9,7% de los tratamientos con filgrastim fueron terapéuticos en el hospital británico. Finalmente, en Australia, el 27% de los hematólogos utilizarían factores estimulantes de colonias de granulocitos en el primer caso de los que se les presentaron (bajo riesgo de complicaciones médicas). El 7% de los oncólogos los utilizaría en su caso de bajo riesgo de complicaciones médicas y el 9% los utilizaría en el segundo caso (riesgo mayor). La duración media de la terapia en los diferentes estudios varió de 4,8 a 6 días. El efecto adverso más frecuente fue el dolor de huesos. Conclusiones: Según los resultados de esta revisión, los factores estimulantes de colonias de granulocitos de uso diario se utilizaron más que el pegfilgrastim para uso terapéutico, siendo el último poco utilizado e incluso considerado una excepción. Las terapias fueron cortas y seguras

Aim: The use of granulocyte colony-stimulating factors in the therapeutic setting of febrile neutropenia is still unknown with regard to the prophylaxis one. The aim of the present work was to collect the information about this therapeutic use found out in the studies performed since 2003. Methods: Seven electronic databases were searched in May 2012. Eligibility included works published in English, French and Spanish from 2003 on. Studies that involved the therapeutic use of filgrastim or pegfilgrastim in chemotherapy-induced febrile neutropenia were sought. Reviews, meta-analysis and works published as abstracts were excluded. The search was completed by checking the reference lists from the selected studies. Results: One of them was performed in a hospital in the Lebanon, another one in a British hospital, another was a multi-centre study in Spain and the last one was performed in Australia through an electronic survey made to cancer specialists. In the Lebanon study, 59 out of 137 granulocyte colony-stimulating factors treatment courses were performed in the therapeutic setting. In the LEARN study in Spain 29.7% patients treated with daily granulocyte colony-stimulating factors used them as treatment, so did 17.3% patients receiving pegfilgrastim. 9.7% treatments with filgrastim were therapeutic in the British hospital. Finally, in Australia 27% haematologist would use granulocyte colony-stimulating factors in case 1 (low risk of medical complications). 7% oncologists would use them in their low risk case of medical complications and 9% would use them in case 2 (higher risk). The mean duration of the therapy in the different studies ranged between 4.8 and 6 days. The most frequent adverse effect was bone pain. Conclusions: The results from the present review showed that daily granulocyte colony-stimulating factors were used more than pegfilgrastim in the treatment setting, being the latter used very little and even considered an exception. Therapies were short and safe

Humanos , Neutropenia/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Segurança do Paciente , Fatores de Risco