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1.
Ars pharm ; 62(1): 15-39, ene.-mar. 2021. ilus, tab, graf
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET6-1766

RESUMO

INTRODUCCIÓN: Los errores de medicación se encuentran entre las 10 principales causas de muerte en el mundo y en su mayoría son prevenibles. Los servicios profesionales farmacéuticos asistenciales (SPFA) tratan de garantizar un uso más seguro, efectivo y eficiente de los medicamentos, y por ello los farmacéuticos comunitarios pueden contribuir a reducir errores de la medicación a nivel de atención primaria. Este trabajo pretender ofrecer un marco de evidencia sobre las iniciativas llevadas a cabo por farmacéuticos comunitarios, a nivel estatal, para identificar, reducir o eliminar los errores de medicación en los diferentes puntos de la cadena terapéutica y plantear una revisión, de los puntos críticos de la cadena terapéutica y clasificar los SPFA. MÉTODO: Revisión sistemática exploratoria de bases de datos internacionales y estatales para obtener estudios publicados sobre la intervención del farmacéutico en la detección, reducción o eliminación de los errores de medicación. RESULTADOS: Se han recopilado 39 iniciativas que se han clasificado en 7 puntos críticos de la cadena terapéutica: (I) 7 en dispensación, (II) 4 en validación o revisión del tratamiento, (III) 3 en transición asistencial, (IV) 18 en monitorización del tratamiento, (V) 4 en educación a pacientes y (VI) 3 en indicación. CONCLUSIONES: Los SPFA llevados a cabo a nivel estatal demuestran que sirven para identificar y resolver los errores de medicación y se plantea una nueva clasificación de los 7 puntos de la cadena terapéutica que se identifican como críticos para la farmacia comunitaria y los relaciona con los SPFA que intervienen en cada uno de los puntos


INTRODUCTION: Medication errors, mostly preventable, are among the top 10 causes of death worldwide. Commu¬nity pharmacists provide professional pharmacy services (PPS) to ensure safer, more effective and efficient use of medications, being professionals who should be included in strategies to reduce medication errors at the primary care level. This work aims to offer an evidence framework on the initiatives carried out by community pharmacists, in Spain, to identify, reduce or eliminate medication errors at different points in the therapeutic chain and propose a classification of the critical points of the therapeutic chain to classify PPS. METHOD: Scoping review of international and national databases to obtain published studies where the community pharmacists provide an intervention to detect, reduce or eliminate of medication errors. RESULTS: 39 records have been compiled and have been classified in 7 critical points of the therapeutic chain: (I) 7 in dispensation, (II) 4 in validation/review of the treatment, (III) 3 in healthcare transition, (IV) 18 in treatment monitor¬ing, (V) 4 in education to patients and (VI) 3 in minor ailments service. CONCLUSIONS: The PPS carried out at the state level demonstrate that they serve to identify and resolve medication errors and a new classification of the critical points of the therapeutic chain that exist in the community pharmacy is proposed, and it relates to the PPS that are involved in each point

2.
Aten. prim. (Barc., Ed. impr.) ; 53(1): 43-50, ene. 2021. tab, graf
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET6-1867

RESUMO

OBJECTIVE: To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN: Non-controlled before-and-after study. SETTING: Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS: The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. Outcomes: The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS: The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n = 152). The main GPs' decision was to withdraw the treatment (54.8%, n = 125), which meant that the number of medicines per patient was reduced by 0.92 (9.12 ± 3.82 vs. 8.20 ± 3.81; p < .0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61 ± .13 vs 0.52 ± 0.91; p = .405 and 0.17 (0.33 ± 0.66 vs. 0.16 ± 0.42; p = .007), respectively. The cost per patient was reduced by (Euro)444.9 ((Euro)1003.3 ± 2165.3 vs. (Euro)558.4 ± 1273.0; p = .018). CONCLUSION: The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios


OBJETIVOS: Estimar la efectividad del servicio de detección de discrepancias de la medicación, un servicio de colaboración entre la farmacia comunitaria y la atención primaria. DISEÑO: Estudio de intervención antes-después, sin grupo control. Emplazamiento: Organización Sanitaria Integrada de Bidasoa, Gipuzkoa, España. PARTICIPANTES: El servicio fue ofrecido por un grupo multidisciplinar que incluía farmacéuticos comunitarios (FC), médicos de atención primaria (MAP) y farmacéuticos de atención primaria a pacientes que presentaban discrepancias entre la medicación prescrita en la hoja de tratamiento activo y lo que realmente estaban tomando. Mediciones principales: Las variables principales del estudio fueron el número de medicamentos, tipo de discrepancia y la decisión del MAP. Las variables secundarias fueron tiempo invertido por el farmacéutico, visitas al servicio de urgencias, ingresos hospitalarios y los costes. RESULTADOS: El servicio se ofreció a 143 pacientes, y el MAP resolvió las discrepancias de un total de 126 pacientes. El FC identificó 259 discrepancias de las cuales la mayoría fue que el paciente no estaba tomando un medicamento prescrito (66,7%, n = 152). En la mayoría de los casos, la decisión del MAP fue suspender el tratamiento (54,8%, n = 125); el número de medicamentos que tomaba el paciente se redujo en un 0,92 (9,12 ± 3,82 vs. 8,20 ± 3,81; p < 0,0001). El número de visitas al hospital y los ingresos hospitalarios se redujeron en 0,10 (0,61 ± 0,13 vs. 0,52 ± 0,91; p = 0,405) y 0,17 puntos (0,33 ± 0,66 vs. 0,16 ± 0,42; p = 0,007), respectivamente. El coste por paciente se redujo en 444,9 (Euro) (1.003,3 ± 2.165,3 vs. 558,4 (Euro) ± 1.273,0; p = 0,018). CONCLUSIÓN: El servicio redujo el número de medicamentos que tomaba el paciente e ingresos hospitalarios y esto se relacionó con unos ratios de coste-efectividad positivos

3.
Aten Primaria ; 53(1): 43-50, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32994060

RESUMO

OBJECTIVE: To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN: Non-controlled before-and-after study. SETTING: Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS: The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. OUTCOMES: The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS: The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n=152). The main GPs' decision was to withdraw the treatment (54.8%, n=125), which meant that the number of medicines per patient was reduced by 0.92 (9.12±3.82 vs. 8.20±3.81; p<.0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61±.13 vs 0.52±0.91; p=.405 and 0.17 (0.33±0.66 vs. 0.16±0.42; p=.007), respectively. The cost per patient was reduced by €444.9 (€1003.3±2165.3 vs. €558.4±1273.0; p=.018). CONCLUSION: The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.

4.
J Eval Clin Pract ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32881191

RESUMO

INTRODUCTION: Non-adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non-adherence and to provide patient-centred interventions. OBJECTIVE: To conduct a systematic review of the impact of community pharmacist interventions on patient adherence to lipid lowering medication (LLM) prescriptions and clinical outcomes. SEARCH METHOD: Five databases (MEDLINE, Cochrane Library, Science Direct, Scopus, and Web of Knowledge) were searched systematically to identify relevant reports published by December 2019. Study quality was assessed with the Cochrane risk of bias (RoB 2.0) tool. SELECTION CRITERIA: Controlled trials in which community pharmacists conducted an intervention to improve patient adherence to LLM and clinical outcomes were evaluated. MAIN RESULTS: Five studies (2408 participants) were included in the qualitative analysis. Four studies (n = 2266) were pooled in the meta-analysis. Participants in the intervention group (IG) had better adherence than those in the control group (CG) [odds ratio (OR) = 1.67; 95% confidence interval (CI) 1.38-2.02; P < 0.001; I2 = 54%]. Better adherence rates were obtained when adherence was measured with validated questionnaires than when medication-possession ratio (MPR) measurements were used. Total cholesterol (TC) levels were not included in the meta-analysis due to data variability among the studies. CONCLUSIONS: Pharmacist-led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.

5.
Int J Clin Pharm ; 42(2): 331-335, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32301066

RESUMO

Background Non-adherence is a problem that particularly affects those with chronic diseases. Studying causes for not following the treatment is necessary to choose the best intervention to improve non-adherence. Objective Analyze how the intentionality of non-adherence modulates the effects of professional intervention in patients with hypercholesterolemia. Setting: Community pharmacies and primary care centres in Spain. Methods A 6-month randomized controlled trial was conducted in 46 community pharmacies and 50 primary care centres in Spain. Adherence to statin therapy was measured with the Morisky-Green-Levine test. Non-adherence was classified based on the intentionality. Results 746 Patients were recruited for the study (465 non-adherent and 281 adherent). Of those, 237 were randomly assigned to the intervention group and 228 to the non-intervention group. The 56.5% of non-adherent patients were classified as unintentional non-adherents and 43.5% as intentional non-adherents. More patients in the intervention group finished being adherent compared with the non-intervention group (+ 17.2% for intentional non-adherents and + 27.4% for unintentional non-adherence). The percentage of patients in the intervention group who completed the study as adherent was higher among those who previously had unintentional non-adherence (66.4%) compared to those with intentional non- adherence (55.3%) (p < 0.001). Conclusion Intervention provided to patients with unintentional non-adherence was more effective than intervention provided to patients with intentional non- adherence.

6.
Res Social Adm Pharm ; 2020 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-33461944

RESUMO

BACKGROUND: Implementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered. OBJECTIVES: To examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy. METHODS: A mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created. RESULTS: Implementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy. CONCLUSION: Network analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.

7.
Farm. comunitarios (Internet) ; 11(4): 21-31, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186884

RESUMO

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


Assuntos
Humanos , Relações Interprofissionais , Protocolos Clínicos , Farmácias , Atenção Primária à Saúde , Assistência Farmacêutica , Tratamento Farmacológico/métodos , Comunicação Interdisciplinar , Automedicação , Análise por Conglomerados
8.
Health Serv Res ; 54(3): 658-668, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30957240

RESUMO

OBJECTIVE: To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING: Forty-six community pharmacies and 50 primary care centers of Spain. STUDY DESIGN: Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention-to-treat (ITT) analysis was performed with multiple imputation to replace the missing data. DATA COLLECTION: Adherence, total cholesterol levels, and lifestyle behaviors. FINDINGS: The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30-1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81-3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). CONCLUSIONS: The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.


Assuntos
Clínicos Gerais/organização & administração , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Farmacêuticos/organização & administração , Idoso , Colesterol/sangue , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha
9.
Int J Clin Pharm ; 39(4): 750-758, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28434119

RESUMO

Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.


Assuntos
Serviços Comunitários de Farmácia/economia , Análise Custo-Benefício/métodos , Revisão de Uso de Medicamentos/economia , Revisão de Uso de Medicamentos/métodos , Farmacêuticos/economia , Papel Profissional , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Espanha/epidemiologia
10.
Res Social Adm Pharm ; 13(3): 614-627, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27423785

RESUMO

Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1-5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Conduta do Tratamento Medicamentoso/organização & administração , Satisfação do Paciente , Farmacêuticos/organização & administração , Humanos , Papel Profissional , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo
11.
Res Social Adm Pharm ; 13(2): 313-320, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27185270

RESUMO

BACKGROUND: The roles of community pharmacists are evolving to include provision of expanded professional pharmacy services, thus leading to an increased interest in pharmacist-patient interactions. Role theory can be used to explain the interaction between this pair of individuals, by focusing on the roles performed by each one. OBJECTIVE: To develop and test a model that relates patients' image of the pharmacist to their expectations of pharmacist's role, and how this then influences patients' reactions toward the pharmacist's role. METHODS: A qualitative study was undertaken, and a questionnaire was created for the development of the model, based on role theory. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using confirmatory factor analysis (CFA). Structural equation modelling (SEM) was used to explain relationships between dimensions of the final model. RESULTS: A final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: χ2(109) = 227.662, P = 0.000, RMSEA = 0.05, SRMR = 0.05, GFI = 1.00, NNFI = 0.90, CFI = 0.92). SEM indicated that "perceived pharmacist image" was associated positively and significantly with both "professional expectations" (the standardized path coefficient of (H) = 0.719, P < 0.05), as well as "courtesy expectations" (the standardized path coefficient of (H) = 0.582, P < 0.05). At the same time, "professional expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.358, P < 0.05), but negatively with "Negative reactions" (the standardized path coefficient of (H) = -0.427, P < 0.05). "Courtesy expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.081, P < 0.05), as well as "negative reactions" (the standardized path coefficient of (H) = 0.450, P < 0.05). CONCLUSIONS: A valid and reliable model of patients' image of the pharmacist related to their expectations and reactions to the pharmacist's role was developed and tested. When the perceived image of the pharmacist is enhanced, patients' expectations of the pharmacist are heightened; in turn, these expectations were associated with reactions of patients.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Modelos Teóricos , Farmacêuticos/organização & administração , Relações Profissional-Paciente , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Projetos Piloto , Papel Profissional , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
Psychol Health Med ; 22(5): 578-587, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27295564

RESUMO

Professional pharmaceutical services may impact on patient's health behaviour as well as influence on patients' perceptions of the pharmacist image. The Health Belief Model predicts health-related behaviours using patients' beliefs. However, health beliefs (HBs) could transcend beyond predicting health behaviour and may have an impact on the patients' perceptions of the pharmacist image. This study objective was to develop and test a model that relates patients' HBs to patient's perception of the image of the pharmacist, and to assess if the provision of pharmacy services (Intervention group-IG) influences this perception compared to usual care (Control group). A qualitative study was undertaken and a questionnaire was created for the development of the model. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using Confirmatory Factor Analysis (CFA). Structural Equation Modelling (SEM) was used to explain relationships between dimensions of the final model and to analyse differences between groups. As a result, a final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: x²(80) = 125.726, p = .001, RMSEA = .04, SRMR = .04, GFI = .997, NFI = .93, CFI = .974). SEM indicated that 'Perceived benefits' were significantly associated with 'Perceived Pharmacist Image' in the whole sample. Differences were found in the IG with also 'Self-efficacy' significantly influencing 'Perceived pharmacist image'. A model of patients' HBs related to their image of the pharmacist was developed and tested. When pharmacists deliver professional services, these services modify some patients' HBs that in turn influence public perception of the pharmacist.


Assuntos
Atitude Frente a Saúde , Serviços Comunitários de Farmácia , Farmacêuticos , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários
13.
Int J Clin Pharm ; 37(5): 931-40, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26040837

RESUMO

BACKGROUND: Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy. OBJECTIVE: The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation. SETTING: Community pharmacies in Spain. METHOD: The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service. MAIN OUTCOME MEASURE: Economic, clinical, and humanistic measures were used to assess the impact of the service. RESULTS: 132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95% = 0.10-0.99)] and in emergency department visits [OR = 0.16 (IC 95% = 0.05-0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5%) were non-adherent to their treatment. This number decreased to 1 (0.8%) after the follow-up [OR = 0.007 (IC 95%: 0.001-0.053) p < 0.001]. CONCLUSION: A community pharmacy based medication review with follow-up service delivered by a trained pharmacist, has positive effects across clinical, economic, and humanistic outcomes. These results are consistent with previous studies. Incorporating community pharmacists into the multidisciplinary team is a reliable solution to improve health care.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Prescrição Inadequada/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Espanha
14.
Ars pharm ; 56(1): 8-16, ene.-mar. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-132101

RESUMO

Objetivos: Se realizó una búsqueda en la Web de los Departamentos de Práctica Farmacéutica, Farmacia Social o Farmacia Administrativa con página web que incluyera alguna de esas denominaciones en el link (DPF), en todas las Facultades de Farmacia del Mundo en 2006. Método: Se utilizó el listado de la Federación Internacional Farmacétuica (FIP) en el que figuran todas las Facultades de Farmacia del mundo. Palabras clave: Práctica Farmacéutica, Farmacia Social y F. Administrativa en español, inglés y portugués. Resultados: Se identificaron 718 Facultades de Farmacia de las que 192 cumplían los criterios de inclusión. En ellas había 83 DPF que incluían las palabras clave. En Oceanía se identificaron 9 DPF, en Europa 22 y en Asia 8. En América 43, todas ellas situadas en Norteamérica, mientras que en África tan solo se identificó un único DPF. Conclusiones: El mayor grado de implantación de DPF tiene lugar en países de gran desarrollo. Son departamentos autónomos, independientes de otros departamentos, y con una estructura multidisciplinar


Aims: A Web based research was desgined in 2006 to search for Pharmacy Practice, Social and Administrative Pharmacy departements in all Pharmacy Schools in the world. Material and Methods: The International Federation Pharmacy list of all Faculty of Pharmacy in the world was used. The key words used were: Pharmacy Practice, Social Pharmacy and Administrative Pharmacy in different languages: English, Spanish and Portuguese. Results: 718 Faculties of Pharmacy were identified, 192 reaching the inclusion criteria. 83 out of them had a PPD with a key word in their web site. In Oceania there were 9 PPD, in Asia 8 and in Europe 22. In America 43, all of them located in North America while in Africa there was only one university with a PPD. Conclusions: The biggest rate of implementation of PPD happens in well developed countries. They are autonomous, independent from other departments and with a multidisciplinary structure


Assuntos
Assistência Farmacêutica/tendências , Tecnologia Farmacêutica/tendências , Centrais Farmacêuticas , Faculdades de Farmácia , Serviços Comunitários de Farmácia , Educação em Farmácia/tendências
15.
Aten. prim. (Barc., Ed. impr.) ; 47(1): 7-14, ene. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-131735

RESUMO

OBJETIVO: Diseñar y pilotar un protocolo para el servicio de dispensación de medicamentos. DISEÑO: Se partió de los requisitos propuestos en el Consenso de Atención Farmacéutica del Ministerio de Sanidad, se realizó una búsqueda bibliográfica y se aplicaron técnicas cualitativas de consenso. Para el pilotaje se realizó un estudio observacional transversal de marzo a junio de 2009. Emplazamiento: 53 farmacias comunitarias de 24 provincias españolas. PARTICIPANTES: Pacientes que solicitaron uno o varios medicamentos concretos con o sin receta médica para uso propio o para alguien a su cuidado. MEDICIONES PRINCIPALES: La información personalizada sobre el medicamento (IPM), los problemas relacionados con los medicamentos (PRM) y los resultados negativos asociados a la medicación (RNM) detectados por el farmacéutico en cada dispensación, así como la percepción de operatividad del farmacéutico sobre el protocolo. RESULTADOS: Se realizaron 870 dispensaciones, se detectaron 423 (48,6%) casos de falta de información en los que se ofreció IPM. En un 10,11% de las dispensaciones realizadas se detectaron PRM y 68 sospechas de RNM (7,81%): de seguridad (n = 35; 51,5%), efectividad (n = 29; 42,6%) y necesidad (n = 4; 5,8%). El 65,21% de los farmacéuticos afirmaron que el proceso estructurado es operativo. CONCLUSIONES: El protocolo diseñado permite detectar las carencias de información del paciente sobre sus medicamentos, así como los PRM y RNM siendo una herramienta fácil de utilizar y aplicable


OBJECTIVE: The aim of this article is to design and pilot a protocol for the dispensing of medications service. DESIGN:Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. SETTING: A total of 53 community pharmacies from 24 Spanish counties. Participant: Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. MAIN MEASUREMENTS: The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. RESULTS: A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. CONCLUSIONS: The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply


Assuntos
Humanos , Masculino , Feminino , Desenho de Fármacos , Dispensários de Medicamentos , Conhecimento do Paciente sobre a Medicação/legislação & jurisprudência , Conhecimento do Paciente sobre a Medicação/métodos , Conhecimento do Paciente sobre a Medicação , Serviços de Informação sobre Medicamentos/legislação & jurisprudência , Serviços de Informação sobre Medicamentos/organização & administração , Sistemas de Informação em Farmácia Clínica , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos , Conhecimento do Paciente sobre a Medicação/normas , Conhecimento do Paciente sobre a Medicação/tendências , Estudos Transversais/métodos , Estudos Transversais , Serviços de Informação sobre Medicamentos/normas , Serviços de Informação sobre Medicamentos
16.
Aten Primaria ; 47(1): 7-14, 2015 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-24731543

RESUMO

OBJECTIVE: The aim of this article is to design and pilot a protocol for the dispensing of medications service. DESIGN: Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. SETTING: A total of 53 community pharmacies from 24 Spanish counties. PARTICIPANT: Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. MAIN MEASUREMENTS: The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. RESULTS: A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. CONCLUSIONS: The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Projetos Piloto , Inquéritos e Questionários
17.
Pharm Pract (Granada) ; 11(4): 185-90, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24367457

RESUMO

BACKGROUND: In 1999, the Pharmacists Association of Gipuzkoa, a Spanish province with a population of 700,000, initiated a campaign to reduce the common practice in community pharmacies of dispensing antibiotics without prescription. OBJECTIVE: The study was designed to assess the ongoing effectiveness of this program in reducing nonprescription dispensing of antibiotics. METHODS: In March 2009, 2 young women posed as simulated patients and visited each of the 280 operating community pharmacies in Gipuzkoa. In 139 of these pharmacies, randomly selected, the simulated patients feigned the symptoms of an uncomplicated urinary tract infection and requested an unspecified antibiotic. In the remaining 141, the actress requested a specific antibiotic, only describing her symptoms upon request by the dispensing staff. The rate of nonprescription dispensing had previously been estimated at 70.5% in 2000 and 42.2% in 2004. Univariate and multivariate analyses were performed, based on a number of variables related to the pharmacy and staff. RESULTS: In the current study, antibiotics were dispensed without prescription by 49 of 280 pharmacies (17.5%). The product- and symptom-based scenarios had similar rates of 16.3% and 18.7%, respectively. The only variables which appeared to affect the nonprescription dispensing rate were the gender of the dispenser, being males more likely to dispense (OR=3.135, 95%CI [1.286, 7.646]), and the number of previous antibiotic-awareness campaigns in which the pharmacy had participated (OR=1.057, 95% CI [1.008, 1.107]). The community population, its number of pharmacies, the years in business of each pharmacy, or its revenue, did not appear to influence the nonprescription dispensing rate. CONCLUSIONS: A long-term multifactorial program set up by the pharmacists association of Gipuzkoa, Spain, appears to have been effective in reducing the rate at which antibiotics are dispensed without a prescription in community pharmacies.

18.
Pharm. pract. (Granada, Internet) ; 11(4): 185-190, oct.-dic. 2013.
Artigo em Inglês | IBECS | ID: ibc-118171

RESUMO

Background: In 1999, the Pharmacists Association of Gipuzkoa, a Spanish province with a population of 700,000, initiated a campaign to reduce the common practice in community pharmacies of dispensing antibiotics without prescription. Objective: The study was designed to assess the ongoing effectiveness of this program in reducing nonprescription dispensing of antibiotics. Methods: In March 2009, 2 young women posed as simulated patients and visited each of the 280 operating community pharmacies in Gipuzkoa. In 139 of these pharmacies, randomly selected, the simulated patients feigned the symptoms of an uncomplicated urinary tract infection and requested an unspecified antibiotic. In the remaining 141, the actress requested a specific antibiotic, only describing her symptoms upon request by the dispensing staff. The rate of nonprescription dispensing had previously been estimated at 70.5% in 2000 and 42.2% in 2004. Univariate and multivariate analyses were performed, based on a number of variables related to the pharmacy and staff. Results: In the current study, antibiotics were dispensed without prescription by 49 of 280 pharmacies (17.5%). The product- and symptombased scenarios had similar rates of 16.3% and 18.7%, respectively. The only variables which appeared to affect the nonprescription dispensing rate were the gender of the dispenser, being males more likely to dispense (OR=3.135, 95%CI [1.286, 7.646]), and the number of previous antibioticawareness campaigns in which the pharmacy had participated (OR=1.057, 95% CI [1.008, 1.107]). The community population, its number of pharmacies, the years in business of each pharmacy, or its revenue, did not appear to influence the nonprescription dispensing rate. Conclusion: A long-term multifactorial program set up by the pharmacists association of Gipuzkoa, Spain, appears to have been effective in reducing the rate at which antibiotics are dispensed without aprescription in community pharmacies (AU)


Antecedentes: En 1999, el Colegio de Farmacéuticos de Gipuzkoa, una provincia española con una población de 700.000 habitantes, inició una campaña para reducir la práctica común de dispensar antibióticos sin receta. Objetivo: Este estudio fue diseñado para evaluar la efectividad de este programa en la reducción de la dispensación de antibióticos. Métodos: En marzo 2009, 2 mujeres jóvenes actuaron como pacientes simuladas y visitaron todas las 280 farmacias comunitarias en ejercicio en Gipuzkoa. En 139 farmacias aleatoriamente seleccionadas, las pacientes simuladas fingieron síntomas de una infección urinaria no complicada y solicitaron un antibiótico sin especificar. En las restantes 141, las actrices solicitaron un antibiótico específico, describiendo sus síntomas solo si se lo solicitaba el personal dispensador. La tasa de dispensación sin receta había sido establecida previamente en el 70,5% en 2000 y 42.2% en 2004.Se realizaron análisis univariados y multivariados basados en algunas variables relacionadas con el personal de la farmacia. Resultados: En el presente estudio 49 de las 280 farmacias (17,5%) dispensaron antibióticos sin receta. Los escenarios de producto y de síntomas tuvieron tasas similares de 16,3% y 18,7%, respectivamente. Las únicas variables que parecían influir en la tasa de dispensación sin receta fueron el género del dispensador, siendo los hombres más proclives a dispensar (OR=3,135, IC95% [1,286, 7,646]), y el número de campañas de concienciación en las que había participado la farmacia previamente (OR=1,057, CI95% [1,008, 1,107]). La población de la localidad, su número de farmacias, la antigüedad de la farmacia o su cifra de negocios no parecieron influir en la tasa de dispensación sin receta. Conclusión: El programa multifactorial a largo plazo del Colegio de Farmacéuticos de Gipuzkoa, España, parece que fue efectivo en la reducción de la tasa de antibióticos dispensados sin receta en farmacias comunitarias (AU)


Assuntos
Humanos , Masculino , Feminino , Antibacterianos/economia , Antibacterianos/uso terapêutico , Medicamentos sem Prescrição/economia , Simulação de Paciente , Farmácias/organização & administração , Automedicação/economia , Automedicação/estatística & dados numéricos , Boas Práticas de Dispensação , Medicamentos sob Prescrição/economia , Prática Profissional/organização & administração
19.
Aten. prim. (Barc., Ed. impr.) ; 45(7): 368-375, ago.-sept. 2013. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-116497

RESUMO

Objetivo: Priorizar facilitadores para la implantación de nuevos servicios profesionales farmacéuticos identificados en estudios previos, que permitan diseñar estrategias de implantación del seguimiento farmacoterapéutico (SFT) en España. Diseño, emplazamiento y participantes: Análisis factorial exploratorio (AFE). Inicialmente, y siguiendo la metodología RAND/UCLA, se elaboró un borrador de cuestionario basado en la revisión bibliográfica previamente realizada. Se pasó a un panel de expertos que generó un cuestionario definitivo que, una vez pilotado, se utilizó con una muestra significativa de farmacéuticos, titulares y adjuntos, que se encontraban trabajando en farmacias comunitarias españolas mediante el método computer-assisted telephone interviewing (CATI).Para comprender los constructos subyacentes en dicho cuestionario, se realizó un AFE. Se ensayaron diferentes abordajes como el análisis factorial de componentes principales y el método de factorización del eje principal. La mejor interpretabilidad se obtuvo cuando al utilizar el método de extracción de factorización del eje principal (PAF) con rotación Direct Oblimin, que explicaba el 40,0% de la varianza. Resultados: Se obtuvieron 4 factores, que se definieron como «Incentivos», «Campañas externas», «Experto en SFT» y «Profesionalidad del farmacéutico». Conclusiones: Para la implantación y sostenibilidad del SFT es necesario que este se remunere; que se deben comunicar correctamente en qué consiste el servicio a la población y al resto de profesionales sanitarios; que es necesaria una formación más clínica para que el farmacéutico pueda abordar las nuevas tareas asistenciales y que el SFT exige una mayor responsabilidad y compromiso del farmacéutico como profesional sanitario (AU)


Objective: to prioritize previously identified in Spain facilitators for the implementation of new Pharmaceutical Services that allow designing strategies for the implementation of Medication Review with follow-up (MRFup) service. Design, setting and participants: Exploratory factor analysis (EFA). A draft of a questionnaire was performed based on a previous literature review and following the RAND/UCLA methodology. An expert panel worked with it and generated a definitive questionnaire which, after piloting, was used with a representative sample of pharmacists, owners or staff members, who were working in community pharmacy, using computer-assisted telephone interviewing (CATI) methodology. To understand underlying constructs in the questionnaire an EFA was performed. Different approaches were tested such as principal components factor analysis and principal axis factoring method. The best interpretability was achieved using the Factorization of Principal axis method with Direct Oblimin rotation, which explained the 40.0% of total variance. Results: This produced four factors defined as: «Incentives», «External campaigns», «Expert in MRFup» and «Professionalism of the pharmacist». Conclusions: It can be stated that for implementation and sustainability of MRFup Service it is necessary being paid; also it must be explained to health professional and society in general. Practice of MRFup service demands pharmacists receiving a more clinical education and assuming more responsibilities as health professionals (AU)


Assuntos
Humanos , Assistência Farmacêutica/organização & administração , Conduta do Tratamento Medicamentoso/organização & administração , Competência Profissional , Prioridades em Saúde/organização & administração , Planejamento Estratégico , Papel Profissional
20.
Aten Primaria ; 45(7): 368-75, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-23746461

RESUMO

OBJECTIVE: to prioritize previously identified in Spain facilitators for the implementation of new Pharmaceutical Services that allow designing strategies for the implementation of Medication Review with follow-up (MRFup) service. DESIGN, SETTING AND PARTICIPANTS: Exploratory factor analysis (EFA). A draft of a questionnaire was performed based on a previous literature review and following the RAND/UCLA methodology. An expert panel worked with it and generated a definitive questionnaire which, after piloting, was used with a representative sample of pharmacists, owners or staff members, who were working in community pharmacy, using computer-assisted telephone interviewing (CATI) methodology. To understand underlying constructs in the questionnaire an EFA was performed. Different approaches were tested such as principal components factor analysis and principal axis factoring method. The best interpretability was achieved using the Factorization of Principal axis method with Direct Oblimin rotation, which explained the 40.0% of total variance. RESULTS: This produced four factors defined as: «Incentives¼, «External campaigns¼, «Expert in MRFup¼ and «Professionalism of the pharmacist¼. CONCLUSIONS: It can be stated that for implementation and sustainability of MRFup Service it is necessary being paid; also it must be explained to health professional and society in general. Practice of MRFup service demands pharmacists receiving a more clinical education and assuming more responsibilities as health professionals.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Análise Fatorial , Feminino , Seguimentos , Humanos , Masculino , Espanha , Inquéritos e Questionários
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