Clinical pharmaceutical services in primary health care of the Federal District: Performance frequency and conditioning factors

Abstract Pharmaceutical services correspond to a set of actions that aim to guarantee the integral access and rational use of drugs by the population. In this sense, this study aimed to identify the frequency and conditioning factors for clinical services of primary care in the Federal District, Brazil. A quantitative cross-sectional study was conducted, in which 34 pharmacists were interviewed. The most frequently developed clinical pharmaceutical services were dispensing, pharmaceutical guidance for users, and technical-pedagogical activities for the health team. There is a greater frequency of operation of clinical services by pharmacists working in pharmacies with physical infrastructure, with better levels of adequacy, greater support from management and health staff, and the inclusion in Family Health Support Nucleus activities. Although the clinical pharmaceutical services in primary care are incipient, the study raises important data for the reorientation and qualification of these actions.

How pharmacy and medicine students experience the power differential between professions: "Even if the pharmacist knows better, the doctor's decision goes".

Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery of healthcare. Common barriers include negative attitudes, professional stereotypes, professional cultures and power differentials between professional groups. The aim of this qualitative study was to explore how professional hierarchies and power differentials shape interprofessional interactions between preregistration pharmacy and medicine students. Data were gathered via semi-structured interviews and subject to thematic analysis. Four main themes were identified: Reproducing traditional hierarchies; Social norms around respect; Hierarchies in care values and goals; and Challenging the narrative is possible. Students' interactions with and views of the other profession largely reflected traditional stereotypes and power differentials. Hierarchy was evident in how respect was accorded and in how care values and goals were managed. Despite this, students overwhelmingly perceived and reported a sense of agency in changing the status quo. Emerging professional identity and conceptualisation of future roles is heavily influenced by the hierarchical relationship between the professions and can pose a significant barrier to collaborative practice. Greater support for collaborative interprofessional practice is needed at the level of policy and accreditation in health education and healthcare to ensure greater commitment to change.

COVID-19 and Drug Shortages: A Call to Action.

The ever-vulnerable medication supply chain is being further strained by the COVID-19 pandemic. Pharmacists in all settings, including managed care, will need to prepare for a potential exacerbation of existing and new drug shortages in the midst of unprecedented crisis. We summarize the major issues, discuss potential mitigation strategies, and call on our colleagues to respond with the resilience necessary to protect our patients. DISCLOSURES: The authors declare no funding sources nor conflicts of interest.

Prevalence of ethanol and other potentially harmful excipients in pediatric oral medicines: survey of community pharmacies in a Nigerian City.

OBJECTIVE: Excipients are needed in the formulation of oral liquid medicines intended for children; they have however been reported to trigger safety issues. This study evaluated the concentrations and prevalence of ethanol and other potentially harmful excipients in pediatric formulations marketed in South Eastern Nigeria in line with international labeling guidelines and allowable daily limits (ADL). The study sampled oral pediatric formulations offered for sale in registered pharmacies. Those with accessible information leaflets were assessed for the presence and quantity of previously flagged excipients with potential to harm the pediatric population. RESULT: Of the 380 oral pediatric medicines, 140 provided access to list/quantity of ingredients. 47.9% (67) of the formulations contain at least one of the flagged excipients while the remaining only listed the active ingredients. Ethanol had the highest occurrence (62.7%) and was more in cough/cold medicines. A homeopathic cough and cold remedy had concentration of 90% v/v. Ethanol and sucrose in some formulations exhibited concentrations with a potential of crossing their approved daily intake (ADI) (1-90% v/v and 1.7 g-3.7 g/5 ml respectively). Ethanol use in studied pediatric formulations was quite high, with ethanol-containing formulations being prescribed for children 0-6 years and older. Only 26 (38.8%) completely satisfied the labelling requirements for ethanol containing formulations.

Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers

Background: Having a local code of ethics, based on moral obligations and virtues, known to all practicing pharmacists is important in order to guide them in relationships with patients, health professionals, and society. Objective: To investigate pharmacists' attitude and barriers towards applying the ethical principles published by the Jordanian Pharmacists Association in the Jordanian code of ethics. Methods: The study objectives were addressed in a cross-sectional study completed by a convenience sample of community pharmacists, in both cities; Amman and Irbid A questionnaire was used to achieve the study objective. The questionnaire was developed and validated, investigating pharmacists' socio-demographic and practice characteristics, perceived attitude toward certain practice scenarios, and perceived barriers towards applying the locally published ethical principles while dealing with their patients. The questionnaire was self-completed by pharmacists between January and August 2017. Collected data was analyzed using SPSS version 21. Descriptive statistics and parametric tests were used with p<0.05 set a priori as significant. Results: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to the questionnaire, providing completely answered questionnaires with a response rates of 69.4% in Amman and 99.6% in Irbid. Pharmacists from both cities revealed that they use the Internet as their main resource to obtain ethical information when they need it, to help them deal with their patients (34.0% from Amman and 31.5% from Irbid). More pharmacists in Amman (57.0%) had access to resources regarding ethical information at their practice sites compared to pharmacists in Irbid (24.0%). Significant differences in attitude was found between pharmacists practicing in both cities, as significantly less pharmacists from Amman (37.8%) declared that they would sell a medication for an unreported indication according to national and international guidelines, if recommended by the consultant, compared to pharmacists from Irbid (77.7%, p<0.001). Conclusions: Despite having ethical guidance from the Jordanian Pharmacists Association, the majority of pharmacists in Jordan do not use this resource; instead, most choose to access ethical guidance on-line. Pharmacists from the capital, Amman, reported to adhere more with the guidelines when selling a medication for an unreported indication compared to pharmacists from the smaller city, Irbid. Results of this study call for more actions from the authorities in the country responsible for setting and enforcing the pharmaceutical Code of Ethics

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Challenges in Treatment for Fever among School-Age Children and Adults in Malawi.

Prompt and effective treatment is key to malaria control and prevention, as it reduces disease morbidity and mortality and minimizes the number of transmission reservoirs. Transmission reduction may be particularly important among school-age children (SAC, 5-15 years old), who have the highest prevalence of Plasmodium falciparum infection in southern Malawi. We hypothesized that one factor contributing to this difference in prevalence is that SAC are less likely to seek appropriate treatment for fever than children younger than 5 years. In this study, we assessed treatment-seeking behaviors of people of all ages between 2012 and 2014 in Malawi. During each of the five cross-sectional surveys, all members of ∼900 households reported on fever and treatment-seeking in the previous 2 weeks. Multilevel logistic regression was used to analyze predictors of whether febrile people sought treatment and whether they did so at formal (government/private clinics) or informal sources (primarily shops). Twenty-two percent of participants (3,579/16,621) reported fever, and 2,715 of those (75.9%) sought treatment. Seeking treatment exclusively from local shops remains a common practice, although use of recommended diagnostic testing and antimalarial drugs was infrequently reported there. Although SAC were not significantly less likely than children aged < 5 years to seek treatment, SAC and adults (age ≥ 16 years) were significantly less likely to use formal sources. Our results indicate that encouraging treatment at government/private clinics and increasing retail access to appropriate antimalarial testing and treatment, especially among SAC, could help remedy inadequate treatment of symptomatic disease and potentially reduce Plasmodium transmission in Malawi.

Los Riesgos para Mujeres Asociados a la Dispensación de Cyclofem en Droguerías de Bogotá D.C. Revisión de Alcance / The Risks for Women Associated with the Dispensation of Cyclofem in Pharmacies of Bogotá D.C. A Scope Review

La normatividad legal en Colombia exige que la dispensación y administración de Cyclofem en droguerías esté apoyada por una prescripción médica. Cyclofem es un anticonceptivo inyectable de combinación de vía intramuscular (AIC) que contiene medroxiprogesterona acetato y cipionato de estradiol y presenta un 99,7% de efectividad. Este medicamento produce sangrados abundantes, prolongados e irregulares, náuseas, mareos, aumento de peso, dolor de cabeza, osteoporosis y aumenta la tolerancia a la glucosa y la resistencia a la insulina. En la ciudad de Bogotá, D.C. sólo el 0,4% de las droguerías exigen la prescripción médica para la dispensación y administración de dicho medicamento(AU)

The legal regulations in Colombia require that the dispensing and administration of Cyclofem in drugstores be supported by a medical prescription. Cyclofem is an injectable intramuscular combination contraceptive (CCI) that contains medroxyprogesterone acetate and estradiol cypionate with an effectiveness of 99.7%. This medication causes heavy, prolonged and irregular bleeding, queasiness, dizziness, weight gain, headache, osteoporosis and increases glucose tolerance and insulin resistance. Only 0.4% of the pharmacies in Bogotá D.C. demanded the presentation of the medical prescription for dispensing and intramuscular administration (I.M) of Cyclofem in accordance with the current legal regulations(AU)

Pharmacies versus doctors' offices for adolescent vaccination.

PURPOSE: We sought to understand the relative advantage of pharmacies compared to doctors' offices for delivering HPV vaccination to adolescents. METHODS: Participants were a national sample of 1500 U.S. parents of adolescents ages 11-17 recruited in 2014-15. In an online survey, items informed by Diffusion of Innovation Theory assessed parents' perceptions of the relative advantages of HPV vaccine delivery in pharmacies and doctors' offices. PRINCIPLE FINDINGS: Many parents believed doctor's offices offered a better health care environment than pharmacies, with more privacy (77%) and a safer place for vaccination (70%). However, many parents also believed pharmacies were more accessible than doctors' offices, requiring less time for vaccinations (71%) and offering more convenient hours (59%). Parents were more willing to get their children HPV vaccine from pharmacists if they indicated more relative advantages in vaccine delivery in pharmacies (ß = .29; p < .001) and believed patient accessibility more important than health care environment (ß = .20; p < .001). CONCLUSIONS: To be more appealing to parents as HPV vaccine providers, pharmacy providers within community and hospital settings should build on their relative advantage with respect to accessibility and enhance their appeal of their healthcare environment.

Amoxicillin Quality and Selling Practices in Urban Pharmacies and Drug Stores of Blantyre, Malawi.

This study evaluated a newly developed paper analytical device (PAD) for screening amoxicillin samples in Blantyre urban townships. Covert shoppers attempted to buy amoxicillin from a geographically stratified selection of private pharmacies (N = 22 out of 26) and drug stores (N = 23 out of 103) in the township area. According to the PAD results, all 42 samples obtained by the shoppers contained amoxicillin and none contained suspicious filler materials. Next, the products were assayed using high-performance liquid chromatography. Consistent with the PAD results, all samples contained the correct amount of amoxicillin with no unexpected ingredients. However, one sample was purchased as amoxicillin and contained that ingredient, but was packaged in capsules that are normally used to package ampicillin. Almost every sample failed a simple packaging analysis. Nine in 10 samples were missing their original packaging and/or inserts (52.4% repackaged capsules and 35.7% repackaged blister packs). Only 33.3% of the packages had expiry dates, 16.7% had batch numbers, and 47.6% had the manufacturer's name. Dispensing practices were likewise unsatisfactory. Ninety-five percentage of the sellers sold the amoxicillin without a prescription, even though this medicine is regulated as prescription-only in Malawi. Although the chemical analysis showed that amoxicillin quality was good, our market survey revealed poor adherence to prescription-only medicine dispensing of antibiotics, which threatens antimicrobial stewardship efforts. Furthermore, the wide prevalence of repackaging deprives medicines of important information needed during patient's use, regulatory investigations, and pharmacovigilance reporting.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

OBJECTIVE: The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. METHODS: International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. KEY FINDINGS: Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. CONCLUSION: There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey.

Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of "poor-quality" if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment's efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.

Moral dilemmas of community pharmacists: a narrative study.

Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing. Objective To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy. Methods Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure Themes of moral dilemmas. Results Twenty-two themes were identified in 128 narratives. These moral dilemmas arose predominantly during pharmacists' contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators. Conclusion The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.

Dispensación de medicamentos en las grandes farmacias de Chile: análisis ético sobre la profesión del químico farmacéutico / Medicines dispensing in big pharmacies in Chile: ethical analysis about pharmaceutical chemist profession / Dispensação de medicamentos em grandes farmácias no Chile: análise ética acerca da profissão farmacêutica química

Resumen: Sobre la base de una investigación de carácter cualitativo, se describe el contexto de la dispensación de medicamentos en las grandes cadenas de farmacias de Chile, teniendo como protagonista a los profesionales químicos farmacéuticos quienes ocupan la función de directores técnicos de estas entidades. Se considera que el consumo y la economía están incrustados en todos los mecanismos de la vida, incluyendo la salud. Los medicamentos, en este sentido, son un claro ejemplo de un objeto de consumo utilizado cotidianamente por la población chilena, cuestión que hace necesaria una vigilancia política, social y ética al respecto. Se analizan las dimensiones sociales de los saberes técnicos de los químicos farmacéuticos, en base a los intereses de las farmacias en las que están contratados, de un éxito profesional medido en términos individuales y de la consecución de metas pecuniarias por sobre sanitarias, cuestión que incentiva una cultura que promueve el consumo de medicamentos, más que lo restringe. Estos profesionales son parte de un proyecto socioeconómico y sociopolítico particular capaz, incluso, de modificar las bases cognitivas de una profesión.

Abstract: Based on qualitative research, is described the context of dispensing drugs in "big pharmacy chains" in Chile, starring pharmaceutical chemists who have the role of technical directors of these entities. It is considered that the consumption and the economy are embedded in all the mechanisms of life, including health. Drugs in this sense, are a clear example of an everyday consumer object used by the chilean population, an issue which calls for a surveillance political, social and ethical about it. The social dimensions of the technical knowledge of pharmaceutical chemists are analyzed, based on the interests of pharmacies in which they are employed, a professional success measured in individual terms and achieving financial goals on health, an issue that encourages a culture that promotes the consumption of drugs, rather than restricting it. These professionals are part of a particular socio-economic and socio-political project capable even to modify the cognitive foundations of a profession.

Resumo: Com base em uma pesquisa de caráter qualitativo, descreve-se o contexto da dispensação de medicamentos em grandes cadeias de farmácias no Chile, tendo como protagonista os profissionais farmacêuticos químicos que ocupam a função de diretores técnicos dessas entidades. São considerados o consumo e a economia como incorporados em todos os mecanismos da vida, incluindo a saúde. Os medicamentos, nesse sentido, são um claro exemplo de um objeto de consumo cotidiano pela população chilena, questão esta, que exige a necessidade de um acompanhamento político, social e ético a este respeito. Analisou-se as dimensões sociais do conhecimento técnico dos farmacêuticos químicos, com base nos interesses das farmácias onde eles estão contratados, de um êxito profissional, medido em termos individuais e do cumprimento de metas monetárias, sobre as de saúde, uma questão que incentiva uma cultura que promove o consumo de medicamentos, mais que os restringir. Estes profissionais fazem parte de um projeto socioeconômico e sociopolítico particular capaz, até mesmo, de alterar as bases cognitivas de uma profissão.

Adherencia terapéutica: solos no se puede / No disponible

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Consulta farmacéutica por somnolencia en un lactante / Pharmaceutical enquiry by drowsiness in breastfed baby

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El papel de las farmacias comunitarias en el tratamiento de la tuberculosis / The role of community pharmacies in the treatment of tuberculosis

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Protocolo de actuación ante la rosácea en la farmacia comunitaria / Course of action for rosacea in community pharmacy

La rosácea es una dermatosis facial inflamatoria, recidivante y crónica, que con frecuencia demanda consulta en la farmacia comunitaria. Orientado hacia la práctica clínica del farmacéutico comunitario, este artículo revisa y sintetiza los conceptos clásicos y los avances más recientes en la comprensión y el tratamiento de esta enfermedad cutánea. Finalmente, propone un protocolo para la asistencia de pacientes con rosácea en la farmacia comunitaria (AU)

Rosacea is a chronic relapsing inflammatory facial dermatosis that demands often attention in the Community Pharmacy. Keeping in mind what could be useful in the clinical practice for the community pharmaceutist, this paper reviews and synthesizes clasical concepts and the most recent advances in the understanding and management of this skin disease. Finally, a protocol for the assistence of patients with rosacea in the Community Pharmacy is proposed (AU)

Vacunación en neumococo. Actuación en la farmacia comunitaria / Pneumococcal vaccination. Community pharmacy procedure

En la elaboración del documento han participado SEFAC, semFYC, SEMERGEN y SEPAR. El objetivo principal era definir los perfiles de paciente susceptibles prioritariamente de la vacunación frente al neumococo considerando los grupos de riesgo, las patologías concomitantes, las posibles consecuencias de una infección neumocócica y la elaboración, a su vez, de un algoritmo de vacunación en el adulto. Se han definido igualmente las indicaciones de la vacuna así como la propuesta de entrevista por parte de la farmacia comunitaria. El documento, avalado por las principales sociedades científicas médico-farmacéuticas, será de gran utilidad para el farmacéutico comunitario de cara a abordar a pacientes con mayor factor de riesgo de contraer enfermedad neumocócica. Será también una manera muy gráfica para conseguir detectar, asesorar y, llegado el caso, derivar al facultativo médico a todo este tipo de paciente (AU)

SEFAC, semFYC, SEMERGEN and SEPAR were involved in the production of the document. The primary objective was to define the patient profiles most susceptible to be vaccinated against pneumococcus, considering the risk groups, the associated pathologies and the possible consequences of a pneumococcal infection and in turn, to develop a vaccination program in adults. The vaccine indications were also defined, as well as the proposed consultation by the community pharmacy. The document, backed by the main medico-pharmaceutical science companies, will be very useful to community pharmacies with regards to handling patients with a greater degree of risk of contracting pneumococcal disease. This will also be a very explicit way of detecting, assessing and, as necessary, diverting medical staff to this type of patients (AU)