Resúmenes del XIII Congreso Nacional de Atención Farmacéutica. Santa Cruz de Tenerife, 2023 / Summaries of the XIII National Congress of Pharmaceutical Care. Santa Cruz de Tenerife, 2023

Del 2 al 4 de noviembre de 2023 tenemos una cita irrenunciable con la FARMACIA, en Santa Cruz de Tenerife. En esta ciudad celebraremos el XIII Congreso Nacional de Atención Farmacéutica bajo un doble lema: “Sé protagonista. Responde a los nuevos desafíos” y “Dos Continentes, más soluciones”. Nuestros congresos siempre se han basado en la participación de todos los que queremos mejorar los resultados en salud con el uso adecuado de los medicamentos, a través de un desarrollo excelente de nuestra actividad profesional y desde luego, disfrutar de esos buenos momentos que se generan en las reuniones de compañeros que compartimos retos profesionales. En este Congreso, desde la Fundación queremos que prime el debate y el intercambio de experiencias, por lo que el protagonismo lo tendrán los compañeros que presentan comunicaciones dentro de un marco temático que aborda desde la digitalización de procesos de AF, la recertificación profesional, la humanización de la práctica asistencial, la educación a los pacientes y la formación continuada y de postgrado entre otros temas. Dentro de nuestro congreso pondremos un especial foco en conocer la realidad de la formación de grado en el marco de la atención farmacéutica, teniendo un espacio dedicado a los mejores trabajos de fin de grado nacionales en esta materia, así como la formación de postgrado actual y su adecuación a las necesidades de los profesionales. Santa Cruz de Tenerife será también el marco del Encuentro Iberoamericano de Atención Farmacéutica, en el que los compañeros de ambos lados del Atlántico podremos compartir experiencias, similitudes y diferencias de nuestros modelos de práctica asistencial y el común problema de accesibilidad a los tratamientos en cada sistema sanitario. ... (AU)

Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo / Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit

Objetivo: evaluar la contribución del farmacéutico mediante el análisis de la prescripción potencialmente inapropiada y la conciliación del tratamiento domiciliario en la unidad de pacientes crónicos complejos de un hospital terciario. Métodos: estudio observacional, prospectivo y multidisciplinar de los pacientes de la unidad de pacientes crónicos complejos de un hospital durante febrero de 2019 - junio de 2020. El equipo multidisciplinar del crónico complejo elaboró un checklist con una selección de fármacos no recomendados basado en los criterios STOPP/START, Beers y PRISCUS y fármacos susceptibles de desprescripción según los criterios LESS-CHRON. El farmacéutico aplicaba el checklist diariamente en los pacientes que ingresaban en la unidad, además de realizar la conciliación del tratamiento domiciliario revisando el tratamiento prescrito con el detallado en la receta electrónica domiciliaria. Por eso, se recogieron las siguientes variables: edad, sexo y número de fármacos al ingreso como variables independientes, y variables dependientes: número de fármacos al alta, tipo de prescripción potencialmente inapropiada, motivos de conciliación, fármacos implicados y grado de aceptación de la recomendación por parte del médico prescriptor para evaluar la contribución farmacéutica. El análisis estadístico se realizó con IBM® SPSS® Statistics22. Resultados : se revisaron 621 pacientes con una mediana de edad de 84 años (56,4% mujeres), y se intervino en 218 (35,1%). La mediana del número de fármacos fue de 11 (2-26) al ingreso y de 10 (0-25) al alta. Se realizaron 373 intervenciones: 235 por conciliación de la medicación (78,3% aceptadas), 71 por medicamentos no recomendados (57,7% aceptadas), 42 por desprescripción (61,9% aceptadas) y 25 por otros motivos. ... (AU)

Objective: To assess the pharmacist’s contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital.MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22.Results: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). ...(AU)

Assessment of knowledge, attitude and practice of Lebanese pharmacists in providing patient counseling on urinary tract infection and its treatment

Background: Urinary tract infection (UTI) is the second most common type of infections, accounting for about 7 million annual visits to health-care providers. Pharmacists have an important role in counseling patients about this disease. Objectives: The study explored the Lebanese pharmacists’ knowledge, attitudes and counseling practices (KAP) around UTI. The aim was to provide a better understanding on the pharmacist role in this context, and improve the patient care process and the health of the public. Methods: A cross-sectional knowledge attitudes practice study was conducted and enrolled pharmacists who were practicing in the community setting. The questionnaire collected data about the sociodemographic characteristics, pharmacist’s knowledge about UTIs, their attitudes and practice in providing patient counseling. Results: A sample of 450 pharmacists was reached, the majority (>90%) of which had good knowledge about UTIs. Moreover, greater than 90% of pharmacists believe that UTIs are serious, and that being unhygienic is one of its causes (93.6%). The majority reported educating patients about the most common causes (90.4%), risk factors (88.4%) and preventive measures (95.1%) of UTIs. A mean score of 8.44 was reported for the knowledge score and multivariable linear regression has shown that female pharmacists have higher knowledge score than males. A significant association between having a PhD degree and believing that men are more prone to UTI. Furthermore, the province of the pharmacists’ practice, being in Beirut, was positively and significantly correlated with better practice. (AU)

Pharmaceutical care during COVID-19 pandemic: challenges and perspectives

Abstract COVID-19 (SARS-CoV-2) pandemic is raising many questions about the future of face-to-face interactions. The possible changes on healthcare delivery may provoke a long term disruption on pharmaceutical assistance requiring new approaches to provide pharmaceutical services. The proposal of pharmaceutical care is patient oriented, and its activities include different forms of interaction. The emergence of COVID-19 puts to the test all the efforts to reposition pharmaceutical care in the set of clinical activities. Now, the pharmaceutical consultations and group activities, which played a fundamental role in the reformulation of pharmacy practices, must be revised in order to reduce the risk of patient agglomeration and contamination. Several researchers suggest technology use to intermediate health care assistance. However, few studies had rigorously analyzed the effectiveness of virtual health care on the pharmaceutical field. Innovating the pharmacy workflow, during the course of a crisis like COVID-19, is the current challenge addressed to all pharmacists. This unforeseen situation requires us to reconsider our plans and actions. It will be necessary resilience, courage and creativity to achieve a consistent attitude, which provides a quick response to the health care needs in this time of crisis.

Pharmacogenomic testing to support prescribing in primary care: a structured review of implementation models.

The application of pharmacogenomics could meaningfully contribute toward medicines optimization within primary care. This review identified 13 studies describing eight implementation models utilizing a multi-gene pharmacogenomic panel within a primary care or community setting. These were small feasibility studies (n <200). They demonstrated importance and feasibility of pre-test counseling, the role of the pharmacist, data integration into the electronic medical record and point-of-care clinical decision support systems (CDSS). Findings were considered alongside existing primary care prescribing practices and implementation frameworks to demonstrate how issues may be addressed by existing nationalized healthcare and primary care infrastructure. Development of point-of-care CDSS should be prioritized; establishing clinical leadership, education programs, defining practitioner roles and responsibilities and addressing commissioning issues will also be crucial.

Dosage adjustment recommendations of drugs in non-nephrology units with kidney disease / Recomendaciones de ajuste posológico de fármacos para enfermedad renal en unidades no nefrológicas

Purpose: Kidney disease (KD) is defined as an abnormality of the kidney in the structure or function with implications for the health, which can occur abruptly, and either resolve or become chronic. This status use to require medication dosage adjustment. Inappropriate prescribing is a common drug-related problem. The aim of this study is to evaluate the acceptance rate through pharmaceutical interventions with implementation of a daily cross-validation procedure in electronic prescription in patients with KD, susceptible to suffer a drug-related problem (DRP). Methods: A nine month-prospective study, in renal insufficiency inpatients (serum creatinine >1.7 mg/dl) treated with drugs that require dosage adjustment.Results: 539 patients with renal failure were identified, 135 of them needed any adjust in their prescription. We performed 179 dosage recommendations, 104 of which were accepted. Most of the recommendations were done in patients with G4 renal damage. Dose modification was the adjustment most widely required. 25 active ingredients were analyzed and the drugs with higher number of interventions were spironolactone, ranitidine, meropenem and allopurinol. General Internal Medicine was the unit with most interventions and acceptance rate. Conclusions: Pharmaceutical intervention stands out as a strategy to improve the population’s pharmacotherapeutic quality taking into account the integration of assisted electronic prescription systems to facilitate a fast and immediate intervention in decision-making in these situations. (AU)

Objetivos: Evaluar la tasa de aceptación de las intervenciones farmacéuticas con la implementación de un procedimiento diario de validación cruzada en prescripción electrónica de pacientes con IR susceptibles de sufrir un problema relacionado con la medicación (PRM). Material y método: Se trata de un estudio prospectivo de nueve meses de duración realizado en un hospital general universitario de 400 camas en pacientes con insuficiencia renal (creatinina sérica >1,7mg/dl) tratados con medicamentos que pueden requerir un ajuste posológico. La variable principal fue la tasa de aceptaación de las intervenciones farmacéuticas.Resultados: Se identificaron 539 pacientes con insuficiencia renal durante el período de estudio, 135 de ellos necesitaron algún ajuste en su prescripción. Se realizaron 179 recomendaciones farmacéuticas, 104 de las cuales fueron aceptadas. La mayoría de las recomendaciones se realizaron en pacientes con insuficiencia renal G4. Se analizaron 25 principios activos y los fármacos con mayor número de intervenciones fueron: espironolactona, ranitidina, meropenem y alopurinol. El servicio con más intervenciones y tasa de aceptación fue Medicina Interna. (AU)

2021. El año de los retos / 2021. Year of challenges

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Providing pharmacy services in a basketball arena: Reflections on building a pharmacy in a COVID-19 surge facility.

PURPOSE: As Coronavirus disease 19 (COVID-19) has spread globally, hospital systems have seen an increasing strain on their ability to accommodate the growing caseload. This demand has led countries to adopt varying surge-facility or alternate care site (ACS) models to manage patient overflow. This report describes the experience of setting up pharmacy services at a city-run surge facility in Philadelphia. SUMMARY: The COVID-19 Surge Facility at the Liacouras Center (CSF-L) was initially developed to serve as a site for patients convalescing from acute inpatient stays in order to free up healthcare resources in surrounding hospitals. The CSF-L site required a distinct set of services to provide the desired level of care. This report details the preparations and challenges faced by the CSF-L pharmacy team in this endeavor, including identifying a pharmacy location that met regulatory requirements, obtaining proper licenses, coordinating drug procurement, filling staffing requirements, developing a formulary, defining the pharmacy and medication management workflow, and ensuring safety protocols were followed. This report explains the rational for developing certain processes and suggests alternative options and ideal plans for developing future pharmacy services in an ACS. CONCLUSION: Identifying a pharmacy leadership team early in the ACS planning process can lead to more efficient plans for pharmacy services. This report details the important steps taken, decisions made, and challenges faced in setting up pharmaceutical services at a COVID-19 field hospital.

Community Pharmacists: On the frontline of health service against COVID-19 in LMICs.

The COVID-19 outbreak is a global public health crisis which has affected healthcare practice across professions. In the context of this pandemic, there is a need to highlight the roles and responsibilities of pharmacists. Community pharmacists are the most accessible healthcare professionals to the general public and have a lot to offer amid the COVID-19 response. This have led to significant changes in the health systems of many countries. This article seeks to highlight additional roles and activities relating to the public health response that can be undertaken by community pharmacists that could help to reduce pressure on general practice and other areas of the health service.

Community and hospital pharmacists in Europe: encroaching on medicine?

Pharmacy has been historically regarded as a discipline between health and chemistry devoted to drug development, production, and compounding. These tasks have been almost lost with the industrial manufacturing, and dispensing remains the main activity of pharmacists. Hospital pharmacists are usually employees in their workplace, while the professional framework of community pharmacists is very different, being pharmacies predominantly private shops in almost all European countries. In the last years pharmacists have strongly advocated that the focus of their services should switch from 'product' to 'patient'. Clinical pharmacy and pharmaceutical care are the two most cited concepts to support this shift. Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes. The practice of clinical pharmacy should embrace the philosophy of pharmaceutical care. The new wave of pharmacists' patient-centered care in Europe still seems to be a reaction against the loss of their traditional professional role after the drug manufacturing revolution. To depict a realistic scenario for progress, it is worth differentiating between hospital and community. Hospital pharmacists should strengthen their pivotal role of medication gatekeepers to improve among clinicians the appropriateness of drug prescriptions and generate savings in expenditures. Any proposal for clinical services provided by community pharmacists is inevitably affected by the issue of their potential remuneration, especially in countries where the remuneration for reimbursable drugs is still a proportion of the retail price.

Pandemic preparedness of community pharmacies for COVID-19.

Background: Community pharmacies provide an important healthcare service, which is broadly established, and constitutes the preferred and initial contact for members of the community. The significant value of community pharmacies was further highlighted during the COVID-19 pandemic crisis. Objective: The assessment of community pharmacies preparedness for the COVID-19 pandemic. Methods: A cross-sectional interview survey of 1018 community pharmacies working in four regions of Egypt (South, East, Centre, and North). Data collection was conducted from 8-19 April 2020. Results: Availability of personal protective equipment (PPE) and medication was better than alcohol (70% conc.). Home delivery services were available in 49.1% of pharmacies. Infection control measures covering interactions between staff were in place in up to 99.5% of pharmacies. Conversely, there was less frequent availability of contactless payment (29.1%), hand sanitizers (62.1%) or masks (86.5%) for customer use, or a separate area for patients with suspected COVID-19 (64%). Verbal customer education (90.4%) was used preferably to written (81.3%). Despite high clinical knowledge and awareness (97.6%-99.2%), only 8.8% of pharmacists had reported suspected COVID-19 cases, however this varied significantly with pharmacist demographics (geographic region P < 0.001; pandemic training p < 0.001; position p = 0.019; age p = 0.046). Conclusions: Government and policymakers strive to mitigate the shortage of PPE and medication. More attention should be given to infection control measures around interactions between staff and customers to ensure community pharmacists are fit and able to provide continuity in their important role. Educating customers using regularly-updated posters, banners or signs will contribute to decreasing contact with patients, and reducing the number and duration of visits to the pharmacy. Pandemic preparedness of community pharmacists must also extend to reporting procedures. By avoiding under-reporting or over-reporting, community pharmacists will contribute to accurate monitoring of the national spread of infection.

Emergency preparedness and response (EP&R) by pharmacy professionals in India: Lessons from the COVID-19 pandemic and the way forward.

The COVID-19 pandemic highlights the importance of Emergency Preparedness & Response (EP&R) education, training, capacity building and infrastructure development in India. During the pandemic, pharmacy professionals (PPs) in India have continued to provide medications, supplies and services. India's public-private healthcare system is complex and of variable quality. Lacunae in pharmacy education, training, and lack of resolution around pharmacist roles present challenges in providing health services to patients. Such lack of differentiation creates challenges around role specifications and appropriate placement of PPs in patient care and on EP&R task forces or representation at the policy level. This study aimed to gain rapid insights from PPs in India regarding their roles and preparedness for the COVID-19 pandemic. An online survey comprising 20 questions regarding EP&R and Operations management was developed using the Qualtrics® survey software and administered to a sample of PPs. Survey results indicate that PPs were actively involved in essential pharmacy services despite minimal EP&R training. Based on lessons learned during COVID-19, lacunae in knowledge, training and regulations were identified and recommendations are provided to broaden PP roles and enable them to be better prepared and actively engaged in EP&R for future emergencies.

COVID-19 pandemic: Response plan by the Johns Hopkins Aramco Healthcare inpatient pharmacy department.

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic having caused a major health care crises across the globe. Pharmacy professionals are considered vital in preparation for optimal response to the COVID-19 pandemic. Therefore, in response to the estimated potential impact of COVID-19 on Johns Hopkins Aramco Healthcare (joint venture between Saudi Aramco and Johns Hopkins Medicine International), several initiatives were taken by the hospital's inpatient pharmacy department with focus on infection control, staffing, meeting clinical operational challenges, ethics, increased utilization of automation, and maintenance of employee wellness to prepare for this challenge. The plan implemented by the inpatient pharmacy department was prepared while incorporating information and recommendations from leading pharmacy organizations, ministry of health, institute's experience in battling another similar coronavirus (the Middle East respiratory syndrome-coronavirus) previously, and updated scientific research. The key focus areas include development of an institutionalized COVID-19 protocol, measures to improve infection control when handling and dispensing medications, modified staffing plan, system changes in peri-operative areas, keeping pharmacy professionals updated about new and scientific researches, increased utilization of automation, clinical interventions by pharmacist ensuring appropriate utilization of medications while monitoring for drug-drug interactions, adverse drug event prevention, and preparing for handling drug shortages. By implementing a robust plan, pharmacy professionals continue to show that they are an integral member of inter-professional health care teams.

Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond.

Background: Pharmacists have long been involved in public health and emergency preparedness and response (EP&R), including through preventive measures such as screening, vaccinations, testing, medical and pharmaceutical countermeasures, as well as ensuring medication safety and access during natural disasters and pandemics. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Community and hospital pharmacies are expanding services and hours to provide essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve public health. In addition, pharmacy professionals are increasingly integrating into global, national, state and local EP&R efforts, including into interprofessional teams, such as Medical Reserve Corps (MRCs). However, lacunae exist for further integration of pharmacists into public health and safety initiatives. There are increasing opportunities and recommendations that should be expanded upon to provide improved patient care and population health interventions, and to ensure healthcare worker and public health safety. Objective: Develop a Pharmacy Emergency Preparedness and Response (PEPR) Framework and recommendations for pharmacy professional pathways towards full integration within public health EP&R efforts (such as the COVID-19 pandemic), and enhanced recognition of pharmacists' skills, roles and contributions as integral members of the interprofessional healthcare team. Methods: This paper draws on the American Society of Health-System Pharmacists (ASHP) 2003 Statement on the Role of Health-System Pharmacists in Emergency Preparedness and lessons learned from previous and current public health emergencies, such as the 2009 H1N1 pandemic and the current COVID-19 pandemic, to provide expanded guidance for pharmacists and pharmacy professionals across all practice settings in EP&R. The proposed PEPR framework also incorporates information and recommendations from The Pharmacy Organizations' Joint Policy Recommendations to Combat the COVID-19 Pandemic (March 2020), CDC-NIOSH, International Pharmaceutical Federation (FIP) Guidance, health departments and emergency preparedness guidance and resources, Boards of Pharmacy, and other pharmacy professional organizations and educational institutions. Results: Based on methods and resources utilized in developing this proposed PEPR Framework, five key focus areas were identified, as follows:1)Emergency preparedness and response2)Operations management3)Patient care and population health interventions4)Public health pharmacy education and continuing professional education5)Evaluation, research, and dissemination for impact and outcomes. Conclusion: Pharmacists and pharmacy professionals have been at the frontlines in responding to the COVID-19 pandemic. Yet, challenges remain, such as limited availability of personal protection equipment, high risk of infectious exposures inherent in healthcare professions, and legislative hurdles resulting in lack of provider status and related reimbursements. Recommendations to enhance pharmacy's scope as public health professionals involved in EP&R include targeted training and education on key framework areas and policymaking. Pharmacy professionals should further integrate with interdisciplinary public health teams. Additional research and dissemination on impacts and outcomes of EP&R can enhance recognition of pharmacy professionals' contribution and value during public health emergencies. The proposed PEPR Framework can be utilized to develop, implement, evaluate, and disseminate results in order to strengthen existing efforts and to establish new initiatives in EP&R.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Pharmacists' Patient Care Process: State "Scope of Practice" Priorities for Action.

To fully engage in the Pharmacists' Patient Care Process, pharmacists must be able to (1) participate in a Collaborative Practice Agreement, (2) order and interpret laboratory tests, (3) prescribe certain medications, (4) adapt medications, (5) administer medications, and (6) effectively delegate tasks to support staff. Each of these activities is dependent on state scope of practice laws, but these laws are not binary. Various state-level restrictions allow us to view these activities on a continuum from more restrictive to less restrictive. This continuum will allow pharmacy and public health stakeholders to identify priorities for action in their states.