How to link patients with suspicious COVID-19 to health system from the community pharmacies? A route proposal.

Colombia confirmed its first case of the COVID-19 on March 6th, 2020. On March 16th, 2020, 54 cases have been confirmed (36 imported and 18 associated), therefore, Colombia is at highest alert, and it is now trying to avoid or minimize the last stage of "community transmission". We present a route proposal that shows how the community pharmacist may develop his responsibility to contribute to the early detection and appropriate referral of possible cases of the COVID-19. In the route have been considered three possible entrances depending on the needs of the users: anti-flu drugs, symptoms related to COVID-19 infection or the request for items for hygiene and prevention of transmission such as alcohol and face masks. Later, self-care education should be given, and the possible cases should be reported to the telephone lines designated by the mayor or the governor, continuing the healthcare process. Community pharmacies and pharmacy staff play a crucial role in minimizing the stage of "community transmission" of COVID-19, through properly detection and management of possible cases and customer education.

Community Pharmacy Response in the Aftermath of Natural Disasters: Time-Sensitive Opportunity for Research and Evaluation.

One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists' ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

Perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil.

BACKGROUND: During the process of implementation of clinical pharmacy services, internal and external factors may favor or hinder the incorporation of care into the hospital routine. This study aimed to understand the perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil. METHODS: A focus group with 16 pharmacists and interviews with tree key stakeholders including managers in the pharmaceutical, medical, and nursing profession were conducted to understand their perceptions of the implementation clinical pharmacy services in a high complexity public hospital in Brazil. The service proposal was presented to the selected participants before conducting the focus group. Professionals with an overview of the hospital and influence on the relevant departments for the implementation of clinical pharmacy at the institution were selected. Data collected were transcribed and analyzed using the Bardin Content Analysis technique. Data analyzed were systematized into categories and registration units. The methodology involves the organization and analysis of reported content to make inferences. RESULTS: The data obtained were divided into four categories: "Perception of the current situation", "Implementation expectations", "Barriers to implementation", "Implementation facilitators". Participants discussed the stagnation of clinical activities of the pharmaceutical profession in Brazil, a reality that results from a lack of clinical training in the country. Pharmacists expressed their expectations for changes in professional performance. According to the managers, such services would positively affect clinical outcomes for patients. Gaps in academic education, lack of knowledge, and poor communication skills were barriers reported in this study. Pharmacists' clinical experience has been reported to facilitate the provision of services. CONCLUSIONS: This study highlights factors that may influence the implementation of clinical pharmacy services in the institution analyzed, such as resistance, fear, and frustration as barriers, as well the experience in clinical pharmacy of some pharmacists in the institution was one of the facilitators most cited by participants. This knowledge may aid future planning for the implementation of clinical pharmacy in hospitals.

[Satisfaction levels of users and verification of the knowledge of pharmacists in public pharmacies in the State of Espírito Santo, Brazil]. / Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil.

The scope of this study was to determine the satisfaction levels of users of public pharmacies and verify the knowledge of pharmacists in relation to dispensing of medicines. This is a descriptive study, conducted in municipalities in the State of Espírito Santo, in the period from May to August 2013. Data were collected using a structured questionnaire and SPSS20 software was used for statistical analysis. The Student t or ANOVA test was used for data with normal distribution, while the Mann-Whitney or Kruskal-Wallis test was applied for data without normal distribution. The Spearman correlation was used to evaluate patient satisfaction with the service time and the waiting time. The significance level for the tests was 5%. The main results obtained were the high level of dissatisfaction among users and the correlation with the waiting time to be attended. Apart from this, the knowledge of pharmacists in relation to the medication dispensed was classified as satisfactory/regular. The conclusion drawn is that actions are necessary in the management of pharmaceutical service to address the expectations of users in the dispensation of drugs.

O objetivo do presente estudo foi determinar o nível de satisfação dos usuários de farmácias públicas e verificar o conhecimento dos farmacêuticos com relação à dispensação de medicamentos. Trata-se de um estudo descritivo, realizado em municípios de uma mesma região, no interior do Estado do Espírito Santo, no período de maio a agosto de 2013. Os dados foram coletados por meio de questionário estruturado. Para a análise estatística, foi utilizado o Software SPSS20. Para os dados que apresentaram distribuição normal foram aplicados o teste t student ou ANOVA, enquanto que para os demais foram aplicados os testes Mann-Whitney ou Kruskal -Wallis. A correlação de Spearman foi utilizada para avaliar a satisfação do paciente em relação ao tempo de atendimento e ao tempo de espera. O nível de significância adotado para os testes foi de 5%. Os principais resultados obtidos foram o alto nível de insatisfação por parte dos usuários e a correlação com o tempo de espera até o atendimento. Além disso, o conhecimento dos farmacêuticos em relação à dispensação foi classificado como satisfatório/regular. Conclui-se que são necessárias medidas na gestão de serviços farmacêuticos para atender as expectativas dos usuários na dispensação de medicamentos.

Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil / Satisfaction levels of users and verification of the knowledge of pharmacists in public pharmacies in the State of Espírito Santo, Brazil

Resumo O objetivo do presente estudo foi determinar o nível de satisfação dos usuários de farmácias públicas e verificar o conhecimento dos farmacêuticos com relação à dispensação de medicamentos. Trata-se de um estudo descritivo, realizado em municípios de uma mesma região, no interior do Estado do Espírito Santo, no período de maio a agosto de 2013. Os dados foram coletados por meio de questionário estruturado. Para a análise estatística, foi utilizado o Software SPSS20. Para os dados que apresentaram distribuição normal foram aplicados o teste t student ou ANOVA, enquanto que para os demais foram aplicados os testes Mann-Whitney ou Kruskal -Wallis. A correlação de Spearman foi utilizada para avaliar a satisfação do paciente em relação ao tempo de atendimento e ao tempo de espera. O nível de significância adotado para os testes foi de 5%. Os principais resultados obtidos foram o alto nível de insatisfação por parte dos usuários e a correlação com o tempo de espera até o atendimento. Além disso, o conhecimento dos farmacêuticos em relação à dispensação foi classificado como satisfatório/regular. Conclui-se que são necessárias medidas na gestão de serviços farmacêuticos para atender as expectativas dos usuários na dispensação de medicamentos.

Abstract The scope of this study was to determine the satisfaction levels of users of public pharmacies and verify the knowledge of pharmacists in relation to dispensing of medicines. This is a descriptive study, conducted in municipalities in the State of Espírito Santo, in the period from May to August 2013. Data were collected using a structured questionnaire and SPSS20 software was used for statistical analysis. The Student t or ANOVA test was used for data with normal distribution, while the Mann-Whitney or Kruskal-Wallis test was applied for data without normal distribution. The Spearman correlation was used to evaluate patient satisfaction with the service time and the waiting time. The significance level for the tests was 5%. The main results obtained were the high level of dissatisfaction among users and the correlation with the waiting time to be attended. Apart from this, the knowledge of pharmacists in relation to the medication dispensed was classified as satisfactory/regular. The conclusion drawn is that actions are necessary in the management of pharmaceutical service to address the expectations of users in the dispensation of drugs.

[Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia]. / Coordinación entre servicios farmacéuticos para una farmacoterapia integrada: el caso de Cataluña.

Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

Coordinación entre servicios farmacéuticos para una farmacoterapia integrada: el caso de Cataluña / Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia

Resumen Las políticas farmacéuticas han sido consideradas como estratégicas para contribuir con la garantía de la coordinación asistencial y la integración clínica. El presente estudio tiene como objetivo describir los servicios farmacéuticos desarrollados en diferentes niveles asistenciales en la red de salud de Cataluña, así como identificar y analizar los mecanismos e instrumentos que actúan como facilitadores y/o barreras para la coordinación de la farmacoterapia. Se trata de un estudio descriptivo de 12 casos de los servicios farmacéuticos hospitalarios, atención primaria y oficinas de farmacia comunitarias. Se identifica avances que relacionan la percepción, formalización y la coordinación asistencial y clínica de los servicios farmacéuticos. Sin embargo, se identifican también fragilidades y situaciones mejorables en cuanto a la coordinación. Se concluyó que las diferentes herramientas e instrumentos implantados, parece facilitar una mayor posibilidad de integración entre servicios farmacéuticos y de éstos con la red de salud para contribuir con una farmacoterapia integrada.

Abstract Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

Establishment, Implementation, and Consolidation of Clinical Pharmacy Services in Community Pharmacies: Perceptions of a Group of Pharmacists.

When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.

Evaluation of a pharmacist-performed tuberculosis testing initiative in New Mexico.

OBJECTIVE: To report experiences of the New Mexico pharmacist tuberculosis (TB) testing program. SETTING: Community pharmacies in New Mexico interested in participating in the TB testing initiative from March 2011 to August 2013. PRACTICE INNOVATION: To expand accessibility of TB testing, New Mexico pharmacists were granted the authority to prescribe, administer, and read tuberculin skin tests (TSTs) in March 2011. To receive this special prescriptive authority, pharmacists had to complete a New Mexico Department of Health training program in accordance with the Centers for Disease Control and Prevention guidelines. EVALUATION: Data were collected on the number of TSTs performed and the TST reading follow-up rate. Patient data collected were demographic information, reason for obtaining a TST (e.g., immigration, school, or work), TB risk factors, and TST results. RESULTS: In New Mexico, 43 pharmacists were certified for TB testing during the evaluation period, 25 of whom were actively prescribing and performing TB testing at eight community pharmacies. There were 606 tests administered to 578 patients; 70.9% women, median age 31 years (4-93 years). Employment and school were the main reasons for obtaining a TB test. A total of 578 of 623 (92.8%) patients followed up to have their TSTs read. A total of 18 positive tests (3.1% positivity rate) were identified and appropriate referrals were made. CONCLUSION: New Mexico expanded the scope of practice for pharmacists. Pharmacist-performed TB testing had a valuable public health benefit. TB testing follow-up rates at community pharmacies in New Mexico were high, most likely due to convenient hours, accessible locations, and no required appointments.

Development of a community pharmacy human papillomavirus vaccine program for underinsured university students along the United States/Mexico border.

OBJECTIVE: To describe the development and implementation of a human papillomavirus (HPV) vaccine patient assistance program (PAP) for university students, and to acquire information on the number who accessed the program and completed the series. SETTING: University of Texas at El Paso University Student Health Clinic Pharmacy, Fall 2011-Spring 2014. PRACTICE DESCRIPTION: A community pharmacy located within the university student health clinic providing services to an underinsured student population. PRACTICE INNOVATION: Existing evidence shows the benefit of using PAP in community pharmacies but is nonspecific regarding the use of PAP for vaccines in an uninsured and underinsured Hispanic student population. The implementation of this unique HPV vaccine program in a community setting aims to increase awareness, access, and rates. MAIN OUTCOME MEASURES: Primary measures included results from a needs-assessment questionnaire that were used to implement the HPV vaccine program. After implementation, utilization data were collected on the number of students who qualified and enrolled in the HPV PAP and the number of students who completed the HPV series. RESULTS: The preliminary data from a needs assessment indicated that a majority (72.1%, n = 80) of students did not understand how HPV is transmitted. A total of 89 students qualified for PAP. The majority were women (81%). A total of 71 students (79.8%) received their second dose and 43 (48.3%) completed the series. CONCLUSIONS: Although pharmacists continue to provide vaccine services, minorities such as the Hispanic population continue to be underimmunized. Students may not be taking the proper precautions to prevent the acquisition of HPV. For these reasons services such as this HPV vaccine program are warranted. Pharmacists need to continue to educate and advocate on the importance of vaccines and how they prevent disease.

Assessment of pharmacist's recommendation of non-prescription medicines in Brazil: a simulated patient study.

BACKGROUND: The number of medicines available without a prescription has increased in Brazil as elsewhere. The Brazilian National Health Surveillance Agency recently passed a resolution emphasizing the role of Brazilian pharmacists in promoting rational use of medicines. However, evidence that Brazilian pharmacists monitor the use of non-prescription medicines in the community promoting rational use of medicines is lacking. OBJECTIVE: To assess practice behavior of pharmacists in Brazil when providing nonprescription medicines in the community pharmacy setting. SETTING: The study was conducted in 25 community pharmacies from a city of Aracaju in Brazil. METHODS: Simulated patients visited a convenience sample of 25 pharmacies twice from March to July 2010. During the visits, simulated patients enacted two standardized scenarios: treatment for a persistent headache and childhood diarrhea accompanied by fever. The interactions with the pharmacists were audiovisually recorded using a hidden micro camera. Recordings were later used to fill out a questionnaire designed to evaluate practice behavior of community pharmacists. MAIN OUTCOME MEASURE: The communication and counseling skills of pharmacists in the recommendation of non-prescription medicines, aiming at the rational use of medicines. RESULTS: Pharmacists in the study spent on average 1.5 min counseling the simulated patient. At least one question was asked to assess signs and symptoms in 50.0 % of the simulated patient visits in the headache scenario and in 56.0 % of visits in the childhood diarrhea scenario. Non-pharmacological treatment was suggested in 25 % of visits in the childhood diarrhea scenario. During the counseling process, no pharmacist advised the simulated patient about possible drug interactions, adverse reactions and what to do if the patient forgot to take the medicine. The pharmacists had low scores in measures of non-verbal communication. The sample of this study presented poor communication skills, compromising the treatment of the patients. CONCLUSION: This study showed that the pharmacists' counseling in the simulated patient assessment was insufficient, indicating a need for substantial improvement in practice behavior.

Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial.

BACKGROUND: Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease (CVD), more evidence derived from randomized controlled trials (RCTs) is needed, including assessment of the effect of community pharmacist interventions in patients with CVD. OBJECTIVE: To assess the effectiveness of the Dader Method for pharmaceutical care on achieving therapeutic goals for blood pressure (BP), total cholesterol (TC), and both BP and TC (BP/TC) in patients with CVD and/or high or intermediate cardiovascular (CV) risk attending community pharmacies in Spain. METHODS: Patients aged 25 to 74 years attending community pharmacies with a prescription for at least 1 drug indicated for CVD or CV risk factors were randomized to 2 groups: an intervention group that received pharmaceutical care, which was provided by specially trained pharmacists working in collaboration with physicians, and a control group that received usual care (routine dispensing counseling) and verbal and written counseling regarding CVD prevention. Patients were recruited from December 2005 to September 2006, and both groups were followed for 8 months. Study outcomes were assessed at baseline and at 16 and 32 weeks after randomization. The primary outcome measures were the proportions of patients achieving BP, TC, and BP/TC therapeutic goals (BP lower than 140/90 mm Hg for patients with uncomplicated hypertension and lower than 130/80 mm Hg for patients with diabetes, chronic kidney disease, or history of myocardial infarction or stroke; TC lower than 200 mg per dL for patients without CVD and lower than 175 mg per dL for patients with CVD). Secondary outcomes were mean BP and TC values. BP was assessed manually by the pharmacist after a 10-minute rest in the supine position. This measurement was performed twice for every participant, and the average of the 2 measurements was calculated. TC was measured by the pharmacist during the study visit using the enzymatic dry method. Statistical analyses were performed using 2-tailed McNemar tests, Pearson chi-square tests, and Student's t-tests; P < 0.05 was considered statistically significant. RESULTS: 714 patients were included in the study (356 intervention, 358 control), and the mean [SD] age was 62.8 [8.1] years. The 2 groups were similar at baseline in clinical and demographic characteristics, including the proportion of patients at therapeutic goals for BP, TC, and BP/TC. After 8 months of follow-up, there were statistically significant differences in favor of pharmaceutical care in the proportions of patients who achieved therapeutic goals for BP (52.5% vs. 43.0%, P=0.017), TC (56.5% vs. 44.1%, P=0.001), and BP/TC (37.1% vs. 21.8%, P < 0.001). CONCLUSION: Compared with usual care plus written education, pharmaceutical care focused on patient evaluation and follow-up in collaboration with physicians improved the achievement of BP, TC, and BP/TC treatment goals in patients with CVD and/or high or intermediate CV risk attending community pharmacies in Spain.

Pharmacists' actions when patients use complementary and alternative medicine with medications: A look at Texas-Mexico border cities.

OBJECTIVES: To determine how often pharmacists inquire about patients' complementary and alternative medicine (CAM) use, actions taken in response to patients' CAM use, and demographic or professional characteristics that predict differences in pharmacists' actions. METHODS: A survey was mailed to 400 randomly selected community pharmacists who resided in Texas-Mexico border cities. RESULTS: Most (63.8%) pharmacists had encountered patients who were using CAM. They documented CAM use in 9.8% of cases and monitored for drug-related problems in 39.4%. Among users, pharmacists sometimes to usually (3.4 ± 1.4 [mean ± SD]) took actions such as referring patients to their physicians. Pharmacists were not particularly comfortable (3.2 ± 1.0) with responding to CAM inquiries but believed patients needed adequate CAM knowledge. Pharmacists rarely to sometimes (2.6 ± 1.2) asked patients about their CAM use. Inquiry about CAM use was greater when information could be documented in profiles (F = 4.29, P = 0.02) and when pharmacists had additional training in CAM (t = -2.59, P = 0.01). Also, in pharmacies that stocked herbal or homeopathic products, pharmacists were more likely to recommend other CAM therapies appropriate for patients' conditions (t = -3.27, P < 0.01). CONCLUSION: Pharmacists were not very proactive in inquiring about CAM use, and their actions (e.g., referral to physician) were somewhat passive. More routine inquiry and documentation are needed. Pharmacists should routinely ask about and document CAM use by patients in order to optimize drug therapy outcomes.

Knowledge, compliance, and satisfaction: an evaluation of the SIMPLE program.

OBJECTIVE: Evaluate the increase in medication use knowledge, participants' compliance, and satisfaction with the pharmacist through the SIMPLE program (Sepa [Know] Información correcta sobre [Correct information about] Medicinas [Medicines], Pregunte [Ask], Lea la etiqueta [Read the label], y Evite problemas [and Avoid problems]). DESIGN: Quasi-experimental type using a convenience sample. SETTING: Community pharmacies in Puerto Rico. PATIENTS AND PARTICIPANTS: 60 years of age or older in need of education for appropriate use of medications, using three or more medications for chronic diseases, were functional, and signed an informed consent and privacy agreement. A total of 316 elderly were enrolled. Complete documentation for the six encounters was obtained for 250 participants. INTERVENTIONS: The program was implemented through six encounters between pharmacists and participants in community pharmacies. Medication use knowledge and participants' compliance were measured by analyzing the baseline data and follow-up encounters. Participants' satisfaction with the pharmacist was evaluated using the Satisfaction With Pharmacist (SWiP) scale. MAIN OUTCOME MEASURES(S): Medication use knowledge, participant's compliance, and satisfaction with the pharmacist. RESULTS: Compliance improved from 55.2% before the program to 90.0% after the program. Knowledge of medication use improved from 36.8% before the program to 94.4% after the program. There was an increase in the "very much" response for all items in the SWiP scale. CONCLUSION: An increase in knowledge and compliance with medication therapy by the participants was observed after participation in the program. Participant-pharmacist relationship was reaffirmed and enhanced after participation in the program.

Application of the SCORE and Wilson-Grundy methods for the assessment of cardiovascular risk in community pharmacies.

BACKGROUND: The assessment and follow-up of patients with risk factors, or with cardiovascular disease (CVD), involves estimating and monitoring their CVD risk (CVDR). There are different opinions about the most appropriate method for this. OBJECTIVE: To compare the SCORE system and the Wilson-Grundy system (based on Framingham's study). METHODS: A descriptive, observational study over 15 days in six pharmacies, with patients aged between 25 and 74 years, and with a prescription for medications related to hypertension, dyslipidaemia, CVD prevention or type-2 diabetes. Results of patients' absolute CVDR were assessed and compared using the SCORE system and the Wilson-Grundy method, adapted for Spain. The Chi-square test was used to compare proportions, and the Student t-test was used to compare mean values, including odds ratios (OR) and 95% confidence intervals (95%CI). RESULT: A total of 257 patients [165 women, 92 men; mean (SD) age, 60.9 (10.8) years; percentage of previous medical history of hypertension (70.0%), dyslipidaemia (42.4%), type-2 diabetes (19.5%) and CVD (22.6%)] participated. With the CVDR assessed with SCORE, the distribution was as follows: low 35.8%, intermediate 21.0% and high 43.2%. The corresponding values using the Wilson-Grundy system was low 60.7%, intermediate 8.2% and high 31.1%. CONCLUSION: The cardiovascular risk of patients that attend community pharmacies with prescriptions for cardiovascular medications is significantly higher when assessed using the SCORE system than with the Wilson-Grundy method.

Analysis and quantification of self-medication patterns of customers in community pharmacies in southern Chile.

BACKGROUND: Self-medication refers to using drugs which have not been prescribed, recommended or controlled by a licensed health care specialist. Marketing, in Chile only admitted for over-the-counter medications, influences the practice of self-medication and extends it to prescription drugs. Thus, a complex self-medication process is started, due to reuse of a previous prescription, using drugs purchased directly at the pharmacy or drugs coming from family first-aid kits. The purpose of this study is to determine the frequency of self-medication, the type of medications involved, the dosages used, and the reasons for this practice. METHODS: An observation-based cross-sectional study was carried out at three pharmacies belonging to a pharmacy chain in the city of Valdivia (southern Chile). In addition, a previously validated form was used. Customers who requested over-the-counter medications were surveyed to identify the patterns that foster the self-medication practice. RESULTS: Of 909 surveyed customers, 75% self-medicate. Of these, 31% stated that they commonly self-medicate due to suffering from light symptoms, such as headaches (19%), the common cold (8.8%), sore muscles (6.7%), and bone pains (5.3%). The group of medications most requested in this study was nonsteroidal anti-inflammatory drugs (NSAIDs) (33%), with diclofenac sodium being the most used (14%). Influence from other people did not exceed 20% and reusing prior prescriptions reached 46%. There were significant differences when assessing consumer knowledge, reading of information leaflets, and opinions about self-medication at each surveyed pharmacy (P < 0.001). CONCLUSION: Most consumers at the surveyed pharmacies use medications without proper knowledge of their benefits, treatment method, and duration. Drug dispensing at community pharmacies should include active pharmacist involvement to divulge the sensible use of drugs.

Development and validation of a Spanish language patient satisfaction questionnaire with drug dispensing.

OBJECTIVE: To develop and validate a specific questionnaire about patient satisfaction with drug dispensing at Spanish community pharmacies. METHOD: A self-administered semi-structured questionnaire was designed centered on the perception of the patients with the dispensing service. To validate this questionnaire, it was administered at Spanish community pharmacies, which voluntarily agreed to participate in the study for a period of 2 months (March and April 2006). Patients or caregivers who were able to read and write were included in the study. MAIN OUTCOME MEASURE: Scores of the items related to satisfaction with the dispensing service. RESULTS: The questionnaire consisted of: an introduction, 10 closed questions in an interval scale of five points, an open section to express comments, and finally demographic data of the patients. Twenty-seven community pharmacies participated in the validation, and 561 questionnaires were obtained with a response percentage of 56.5%. A Cronbach's alpha coefficient of 0.91 was obtained. The Kaiser-Meyer-Olkin coefficient was 0.92, and the extraction of the principal components revealed a unique component explaining 55.2% of the total variance. About 15.5% of patients made additional comments that praised the quality of attention received and other aspects of the service such as the amiability and friendliness shown by pharmacy staff. CONCLUSION: The questionnaire developed shows evidence of validity and reliability for evaluating patient satisfaction with the dispensing service in community Pharmacies in Spain.

Questionnaire to assess patient satisfaction with pharmaceutical care in Spanish language.

OBJECTIVE: To develop and validate a questionnaire, in Spanish, for assessing patient satisfaction with pharmaceutical care received in community pharmacies. DESIGN: Selection and translation of questionnaire's items; definition of response scale and demographic questions. Evaluation of face and content validity, feasibility, factor structure, reliability and construct validity. SETTING: Forty-one community pharmacies of the province of Santa Fe. Argentina. PARTICIPANTS: Questionnaire administered to patients receiving pharmaceutical care or traditional pharmacy services. MAIN OUTCOME MEASURE: Pilot test to assess feasibility. Factor analysis used principal components and varimax rotation. Reliability established using internal consistency with Cronbach's alpha. Construct validity determined with extreme group method. RESULTS: A self-administered questionnaire with 27 items, 5-point Likert response scale and demographic questions was designed considering multidimensional structure of patient satisfaction. Questionnaire evaluates cumulative experience of patients with comprehensive pharmaceutical care practice in community pharmacies. Two hundred and seventy-four complete questionnaires were obtained. Factor analysis resulted in three factors: Managing therapy, Interpersonal relationship and General satisfaction, with a cumulative variance of 62.51%. Cronbach's alpha for the whole questionnaire was 0.96, and 0.95, 0.88 and 0.76 for the three factors, respectively. Mann-Whitney test for construct validity did not showed significant differences between pharmacies that provide pharmaceutical care and those that do not, however, 23 items showed significant differences between the two groups of pharmacies. CONCLUSION: The questionnaire developed can be a reliable and valid instrument to assess patient satisfaction with pharmaceutical care in community pharmacies in Spanish. Further research is needed to deepen the validation process.