Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study.

Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0-24.7; p = 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient's (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.

Perceptions of Pharmacy students about their competences for professional practice in community pharmacy

Abstract Pharmaceutical education should enable the development of competences for community pharmacy practice, which is an important field for the pharmacist workforce. The aim of this study was to evaluate the competences perceived by pharmacy interns from a Brazilian pharmacy school for community pharmacy practice. This study adopted a combined quantitative and qualitative approach. The study cohort included undergraduate students who undertook internships in community pharmacy in the final year of the pharmacy course. Students responded to an 11-item structured questionnaire according to a five-point Likert scale that included perceptions of their competences for community pharmacy practice. Among the 693 possible answers, 605 (87.3%) agreed that the course promoted the development of competences for professional practice in community pharmacy. Less than 70% of students perceived themselves as prepared to respond to symptoms and provide non-prescription medicines. Qualitative analysis of the comments revealed three themes: the need to improve patient information skills, improve practice as a member of a health care team, and improve dispensing according to legal requirements. These findings may support improvements in undergraduate pharmacy programs, such as the inclusion of experiential learning, active learning methods, interprofessional education, and development of clinical skills.

Mapping community pharmacy services in Brazil: a scoping review

Abstract The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient's health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists' interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists' interventions as well as reporting results and measuring fidelity in future research.

Challenges for Polish Community Pharmacists in Provision of Services to Immigrants and Non-Polish-Speakers in 2018.

BACKGROUND International patient services in community pharmacies are becoming increasingly common. The growing number of immigrants, as well as the developing trend of medical tourism, make it necessary to provide these people with access to healthcare services, including pharmaceutical services in generally accessible pharmacies. Serving non-Polish-speaking patients, however, requires both fluent specialist knowledge of a foreign language and interpersonal skills. These skills can greatly influence the proper use of medications by patients. This study aimed to investigate the reported challenges for Polish community pharmacists in the provision of services to immigrants and non-Polish-speakers in 2018. MATERIAL AND METHODS The study included 98 pharmacists and pharmaceutical technicians from community pharmacies in Poland. The research tool was a questionnaire sent to pharmacy staff in cooperation with pharmacy councils in 2018. RESULTS Analysis of the data gathered using a 5-point Likert scale showed that the participants rated the preparedness for international patient services in pharmacies as medium (mean 2.76±1.33). The mean foreign language knowledge score was 2.99±1.29. The participants indicated a low possibility of acquiring these language skills (mean 2.53±0.91), and emphasized that patients from abroad rarely asked about the use of the medications (mean=2.20±1.06). CONCLUSIONS This study showed that in 2018, pharmacy staff in Poland did not feel adequately prepared to provide comprehensive pharmacy services for immigrants and non-Polish-speakers, with concerns of non-compliance with medications due to poor communication.

Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study.

BACKGROUND: The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. OBJECTIVES: To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. METHODS: Community pharmacists' across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. RESULTS: Six hundred and sixty-four pharmacists' responded to the online survey. Seventy-five percent of pharmacists' reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. CONCLUSIONS: This study provides baseline data for policy makers on pharmacists' readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

Management of common minor ailments in Qatar: Community pharmacists' self-perceived competency and its predictors.

Studies focused on comprehensive assessment of self-perceived competency of community pharmacists to manage minor ailments are scanty despite that self-perceived competency is a valid determinant of task performance. The objectives of the study were to assess community pharmacists' self-perceived competency to manage fourteen common minor ailments in Qatar, and identify its significant predictors. A cross-sectional assessment of 307 community pharmacists was conducted with a pre-tested 20-item questionnaire. Self-perceived competency was assessed with nine elements on a scale of 1-10 (Maximum obtainable score: Each minor ailment = 90; each element = 140). Mann-Whitney U and bivariate logistic regression were used for data analyses. The response rate was 91.9% (282/307). The majority of the respondents were males (68.1%; 192/282), within the age range of 31-40 years (55.3%; 156/282). The minor ailments with the highest median competency score were constipation (76), and cold/catarrh (75) while travel sickness (69), and ringworm (69) had the lowest. The two condition-specific competency elements with the highest median score were recommendation of over-the-counter (OTC) medicines (115), and provision of instructions to guide its use (115). Ability to differentiate minor ailments from other medical conditions had the lowest median competency score (109). The significant predictors self-perceived competency were female gender (OR = 2.39, 95%CI: 1.34-4.25, p = 0.003), and working for chain pharmacies (OR = 2.54, 95%CI: 1.30-4.96, p = 0.006). Overall, Community pharmacists' self-perceived competency was adequate for majority of the common minor ailments, and it was highest for constipation and cold/catarrh, and specifically for the recommendation of OTC medicines and provision of instructions to guide its use. However, diagnostic ability to differentiate minor ailments from other medical conditions with similar features had the lowest median competency score. Female gender and working in chain pharmacies were the significant predictors of self-perceived competency to manage minor ailments.

Pharmacists' perceptions of the use of internet-based medication information by patients: A cross-sectional survey.

PURPOSE: The credibility and the reliability of Internet webpages to seek medication-related information is questionable. The main objective of the current study was to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. METHODS: This is a cross-sectional descriptive study that was conducted to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. During the study period, 200 pharmacists were approached to participate in the study using a paper-based survey to assess their perceptions and current experience with the use of Internet-based medication information by their patients. Data were analyzed using descriptive statistics (mean/standard deviation for continuous variables, and frequency/percentages for qualitative variables). Also, simple linear regression was utilized to screen factors affecting pharmacists' perception scores of the use of Internet-based medication information. RESULTS: Among 161 recruited pharmacists, the majority (n = 129, 80.1%) reported receiving inquiries from patients about Internet-based medication information within the last year. Among them, only 22.6% (n = 29) of pharmacists believed that Internet-based medication information is somewhat or very accurate. Unfortunately, only 24.2% (n = 31) of them stated that they always had enough time for their patient to discuss their Internet-based medication information. Regarding pharmacists' perception of the use of Internet-based medication information by their patients, more than half of the pharmacists (>50%) believe that Internet-based medication information could increase the patient's role in taking responsibility. On the other hand, 54.7% (n = 88) of the pharmacists believed that Internet-based medication information would contribute to rising the healthcare cost by obtaining unnecessary medications by patients. Finally, pharmacists' educational level was found to significantly affect their perception scores toward patient use of Internet-based medication information where those with higher educational level showed lower perception score (r = -0.200, P-value = 0.011). CONCLUSION: Although pharmacists felt that usage of Internet-based data by patients is beneficial, they also have believed that it has a negative impact in terms of rising the healthcare cost, and it promotes unnecessary fear or concern about medications. We suggest that pharmacists be trained on principles of critical appraisal to become professional in retrieval information on the Internet that might improve their delivery of healthcare information and their recommendations to patients.

E-prescribing and access to prescription medicines during lockdown: experience of patients in Aotearoa/New Zealand.

BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.

Knowledge, attitude and practices of community pharmacists regarding COVID-19: A paper-based survey in Vietnam.

OBJECTIVE: To survey the knowledge, attitude, and practices of Vietnamese pharmacists regarding the COVID-19 pandemic. METHOD: This cross-sectional, paper-based study was conducted from June to August 2020. A validated questionnaire (Cronbach's alpha = 0.84) was used to interview 1,023 pharmacists in nine provinces of Vietnam. Analysis of covariance was employed to identify factors associated with the knowledge of pharmacists. The best model was chosen by using the Bayesian Model Averaging method in R software version 4.0.4. RESULTS: The mean knowledge score was 12.02 ± 1.64 (range: 6-15), which indicated that 93.4% of pharmacists had good knowledge of COVID-19. There was no difference in the average score between males and females (p > 0.05). The multivariate linear regression model revealed that the knowledge was significantly associated with pharmacists' age, education level, and residence (p < 0.001). About attitude and practices, pharmacists daily sought and updated information on the COVID-19 pandemic through mass media and the internet (social network and online newspapers). Nearly 48% of them conceded that they communicated with customers when at least one person did not wear a face mask at the time of the COVID-19 outbreak. At medicine outlets, many measures were applied to protect pharmacists and customers, such as equipping pharmacists with face masks and hand sanitizers (95.0%), using glass shields (83.0%), and maintaining at least one-meter distance between two people (85.2%). CONCLUSION: The pharmacists' knowledge of COVID-19 transmission, symptoms, and prevention was good. Many useful measures against the spread of this perilous virus were applied in medicine outlets. However, pharmacists should restrict forgetting to wear face masks in communication with medicine purchasers. The government and health agencies should have practical remedies to reduce the significant differences in the COVID-19 knowledge of pharmacists among provinces and education-level groups.

Hydroxychloroquine availability during COVID-19 crisis and its effect on patient anxiety.

OBJECTIVE: To report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic. METHODS: A survey was designed by Lupus Europe's patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0-10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared. RESULTS: 2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively. CONCLUSIONS: The HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients' mind and behaviours.

Naturaleza de las dispensaciones durante el servicio de guardia de fin de semana de las farmacias en la ciudad de Teruel / Nature of dispensations during the weekend guardservice of pharmacies in the city of Teruel

INTRODUCCIÓN: el trabajo que los farmacéuticos y otros profesionales sanitarios realizan durante el servicio de guardia tiene una importancia esencial, ya que asegura la accesibilidad al medicamento, ofreciendo consejo sanitario, seguimiento farmacoterapéutico y apoyo profesional a los pacientes fuera del horario habitual. OBJETIVO: conocer la naturaleza de las dispensaciones en el servicio de guardia de las farmacias de la ciudad de Teruel durante el fin de semana. METODOLOGÍA: estudio observacional descriptivo transversal realizado en tres farmacias comunitarias de la ciudad de Teruel. El primer período analizado comprende desde abril hasta junio de 2019 y el segundo en marzo de 2020, durante los cuatro fines de semana que las farmacias estudiadas estaban de guardia. RESULTADOS: de las 4.245 dispensaciones de los fines de semana analizadas en 2019, 1.059 (26,4 %) fueron medicamentos con prescripción realizada por servicios médicos de urgencia; 965 (21,8 %) de fármacos con prescripción crónica; 655 (15,2 %) no tenían prescripción médica de ningún tipo, pero se consideraron necesarios; 1.067 (25,8 %) no tenían prescripción médica y no se consideraron necesarios, y 499 (10,8 %) fueron dispensaciones no ortodoxas. CONCLUSIONES: el patrón de las dispensaciones durante las guardias de las farmacias es constante, independientemente de que el fin de semana sea ordinario, situación especial (Semana Santa) o situación de alarma ("COVID"). El servicio de urgencias farmacéutico no está siendo bien utilizado por la población, ya que el porcentaje de actuaciones farmacéuticas que tiene su origen en una urgencia médica es muy bajo

INTRODUCTION: The work that pharmacists and other healthcare professionals during the on-call service shades an importance that ensures accessibility to the drug, health advice, pharmacotherapeutic monitoring and profesional support to patients; out of regular hours. OBJECTIVES: Know the nature of the population in the guardservice of the pharmacies in the city of Teruel during the weekends. METHODOLOGY: Cross-sectional observational study conducted in three community pharmacies in the city of Teruel. The first period analyzed ranges from April to June 2019 and the second in March 2020, during the four weekends that the pharmacies studies were on call. RESULTS: Of the 4245 weekend dispensations analyzed in 2019: 1059 (26.4%)were prescription drugs performed by emergency medical services, 965 (21.8%) of chronically prescribed drugs, 655 (15.2%) did not have a prescription of any kind but were considered necessary, 1067 (25.8%) had no prescription and were not considered necessary and 499 (10,80%) were non-orthodox dispensations. CONCLUSIONS: The pattern of dispensing during pharmacy guards is constant, independently of whether the weekend is ordinary, special situation (Easter) or an Alarm Situation ("COVID"). The pharmaceutical emergency service is not being used well by the population, the percentage of pharmaceutical actions that originate from a medical emergency is very low

Self-medication consultations in community pharmacy: an exploratory study on teams' performance, client-reported outcomes and satisfaction

BACKGROUND: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines. OBJECTIVE: The study aimed to describe CPTs' performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients' satisfaction with this service. METHODS: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients' overall satisfaction was explored, using linear regression. RESULTS: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the 'other medication' questioning. Most clients (93%) reported improvement after the consultation. Clients' satisfaction score was 4.70 out of 5. The variables that seem to better explain clients' overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender. CONCLUSIONS: Clients' reported outcomes were favourable, as well as satisfaction with the service. Clients' satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists' clinical role. A larger study is warranted to confirm these findings

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Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors

OBJECTIVES: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon. METHODS: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors. RESULTS: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p < 0.05). CONCLUSIONS: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors

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Assessment of job satisfaction among community pharmacists in Baghdad, Iraq: a cross-sectional study

BACKGROUND: Pharmacists have the unique position of providing safe and effective care. Hence, addressing their feelings about their working life is crucial to provide good pharmacy services. OBJECTIVE: this study aimed to assess job satisfaction among Iraqi community pharmacists and determine the effect of pharmacist characteristics on job satisfaction. METHODS: A cross-sectional study was conducted among community pharmacists in Baghdad, the capital of Iraq. A simple random sample technique was adopted to select community pharmacists. A survey questionnaire using Warr-Cook-Wall satisfaction scale (ranging from extremely dissatisfied to extremely satisfied) was used to assess job satisfaction. RESULTS: Community pharmacists experienced moderate satisfaction with their jobs. The mean satisfaction score for all pharmacists was 20.4 (SD 3.7). The lowest mean scores occurred for recognition (1.4; SD 0.7), public respect (1.8; SD 0.9), and pharmacy regulations (1.9; SD 0.9). Job satisfaction was significantly affected by pharmacist characteristics, including gender (p < 0.001), age (p < 0.001), degree level (p = 0.003), years in practice (p < 0.001), working patterns (p< 0.001), and working hours (p < 0.001). Regression analysis indicated pharmacist gender and age had the highest effect on job satisfaction, while, years in practice, working hours, and working pattern had the lowest effect. CONCLUSIONS: Community pharmacists expressed moderate satisfaction with their jobs with satisfaction levels being affected by gender, age, years in practice, working patterns, and working hours. New strategies will require support for Iraqi pharmacists by the Ministry of Health and Syndicate of Iraqi Pharmacists before being included in extended pharmacy services

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Community pharmacists' use, perception and knowledge on dietary supplements: a cross sectional study

BACKGROUND: Pharmacists are commonly tasked with recommending the appropriate dietary supplement and advising the patients of their correct and safe use. Previous research, conducted on pharmacy students, showed that they did not always use the evidence based sources of information, with personal use identified as a significant predictor influencing the decision to recommend a supplement. OBJECTIVES: To compare use, perceptions and knowledge of dietary supplements of pharmacists with different years of work experience and to explore factors that could influence their recommendation of supplements. METHODS: A questionnaire based cross-sectional study was conducted on Croatian community pharmacists in September 2017. The questionnaire explored pharmacists' demographic characteristics, use, perceptions and knowledge of dietary supplements. Pharmacists (N=102) were divided in two groups based on their work experience: P0 (<10 years) and P1 (≥10 years). RESULTS: All included pharmacists had high knowledge scores without differences between groups (P0=10, IQR 9-12 vs P1=11, IQR 9-12, expressed as median and interquartile range (IQR), p = 0.275). Less experienced pharmacists perceived there was less research conducted on the dietary supplements compared to their more experienced counterparts (P0=1, IQR 1-2 vs P1=2, IQR 2-3, expressed as median and interquartile range, p < 0.001). Groups differed in sources used when choosing the appropriate supplement with P0 using higher quality sources such as systematic reviews in comparison to P1 (32.1% vs 8.7%, p = 0.004). Pharmacists' decision to recommend a dietary supplement was influenced by their personal use (odds ratio 0.216, 95%CI 0.068:0.689, p = 0.01) and work experience (odds ratio 0.154, 95%CI 0.045:0.530, p = 0.003). CONCLUSIONS: Pharmacists did not use the high quality sources when recommending dietary supplements and their decision to recommend the supplement was not based on objective evaluation of evidence. Further education about the practice of evidence-based pharmacy is necessary, with special emphasis on senior pharmacists who might have missed that aspect during their formal education

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Servicio profesional farmacéutico de indicación farmacéutica en sequedad ocular utilizando el programa 'I-VALOR' / Minor ailment service for dry eye syndromes: I-VALOR programme

INTRODUCCIÓN: la labor del farmacéutico comunitario en el Servicio de Indicación Farmacéutica (SIF) es muy importante como primera línea de asistencia a la población, aunque no está suficientemente documentada. OBJETIVOS: evaluar la intervención del farmacéutico comunitario en el SIF ante una consulta sobre enfermedad de ojo seco (EOS) con el uso de protocolos. MATERIAL Y MÉTODOS: estudio descriptivo, observacional realizado dentro del programa I-VALOR (enero-junio 2015). Los participantes fueron farmacéuticos voluntarios y pacientes que solicitaron algún remedio para aliviar la EOS. Se utilizó el protocolo del SIF del Foro de Atención Farmacéutica en Farmacia Comunitaria, un consenso para EOS realizado entre sociedades científicas, una hoja de derivación, un informe para el paciente y una hoja de recomendaciones. RESULTADOS: participaron 6.350 pacientes. 62,7 % consultas fueron realizadas por mujeres (24,3 % 46-65 años). El 60 % de los pacientes no presentaba ningún criterio de derivación. Se detectaron 3.887 criterios de derivación en 2.537 pacientes. Se decidió no derivar al 15,4 %, y del resto, 87,3 % aceptó la derivación. La dispensación de algún tratamiento tuvo lugar en el 80 % de los pacientes: 3.157 con tratamiento farmacológico (89,2 % un único medicamento) y 2.403 con tratamiento no farmacológico. El 35 % recibió consejos higiénico-dietéticos y consejo farmacéutico. Se detectaron 25 reacciones adversas a medicamentos (0,4 %). El 70,5 % de todas las consultas realizadas fueron resueltas sin necesidad de derivar al médico. CONCLUSIONES: el programa I-VALOR para EOS ha permitido evaluar la intervención protocolizada del farmacéutico en EOS mediante el registro de las actuaciones farmacéuticas para demostrar la labor desarrollada desde la farmacia comunitaria

BACKGROUND: Minor ailment service offered in community pharmacist is a key element in patient care. Thought in Spain the service is not properly documented. AIMS: The main objective was to evaluate community pharmacists' interventions through an agreed minor ailment service for dry eye syndromes (DES). METHOD: Descriptive study undertaken alongside I-VALOR programme (January-June 2015). Participants were pharmacists from SEFAC who voluntarily decided to do, and patients were those who consulted about DES in community pharmacy. Pharmacists used the Pharmaceutical Care Forum guideline for the Minor Ailment Service and an agreed consensus between pharmaceutical and medical societies. A patient's form and a referral's form were designed. RESULTS: There were 6,350 patients involved. 62.7% consultations were made by women 24.3% of 46-65 years old). No referral criteria were detected in 60% of patients. The pharmacist detected 3,887 referral criteria in 2,537 patients. Pharmacists decided not to refer 15.4% of those patients. 87.3% of the patients referred accepted the referral. Treatments were dispensed in 80% of patients: 3,157 pharmacological treatment (89.2% a single medication) and 2,403 non-pharmacological treatment (medical device, food supplement or eye cleaning product). 35% received hygienic-dietary advice and pharmaceutical advice. Twenty-five adverse drug reactions were detected (0.4%). 70.5% of all consultations made were managed with no referral to a general practitioner (GP). CONCLUSIONS: I-VALOR programme allowed to evaluate an agreed intervention for DES in community pharmacy through the record of MAS to demonstrate CP contribution to manage minor ailments

The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach / Servicio de detección de discrepancias de la medicación: un estudio multidisciplinar y coste-efectivo

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

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

Time-trend analysis of medicine sales and shortages during COVID-19 outbreak: Data from community pharmacies.

BACKGROUND: COVID-19 is a worldwide public health concern. Disruptions in the drug market are expected and shortages might worsen. Community pharmacies can contribute to early identification and report of medicines' supply and demand issues. OBJECTIVE: The aim of this study is to characterize the impact of the COVID-19 outbreak on outpatient medicines' sales and shortages. METHODS: A retrospective, time-trend analysis of medicine sales, shortages and laboratory-confirmed COVID-19 cases was performed from February 1st to April 30th, 2020, and its homologous period (regarding sales only). A detailed analysis of 6 pharmaceutical substances was performed. All data were subjected to rescaling using the min-max normalization method, in order to become comparable. Data analysis was performed using Microsoft® Excel. RESULTS: The pandemic resulted in an increase in medicines' demand and reported shortages during the early stage of the outbreak. The maximum proportion of medicine sales was registered on March 13th, 2020, 4 days after the WHO declared COVID-19 a pandemic. By the end of March, sales have already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period were below those recorded in the pre-COVID-19 period. The analyzed drugs were paracetamol, ascorbic acid, dapagliflozin plus metformin, rosuvastatin plus ezetimibe, formoterol, and hydroxychloroquine, as these pharmaceutical substances registered the highest growth rate in sales and shortages when compared to the same period in the previous year. Hydroxychloroquine showed the most different pattern trends on sales and shortages of these medicines. CONCLUSIONS: Pharmacies can provide timely and real-world data regarding sales and shortages. The adopted measures to guarantee the continuous supply of the medicine market seem to have worked. The long-term impacts of this pandemic are unknown and should continue to be closely monitored.

Dispensing errors in community pharmacies in the United Arab Emirates: investigating incidence, types, severity, and causes

BACKGROUND: Medication dispensing is a fundamental function of community pharmacies, and errors that occur during the dispensing process are a major threat to patient safety. However, to date there has been no national study of medication dispensing errors in the United Arab Emirates (UAE). OBJECTIVE: The study aimed to investigate the incidence, types, clinical significance, causes and predictors of medication dispensing errors. METHODS: The study was conducted in randomly selected community pharmacies (n=350) across all regions of UAE over six months using a mixed-method approach, incorporating prospective disguised observation of dispensing errors and interviews with pharmacists regarding the causes of errors. A multidisciplinary committee, which included an otolaryngologist, a general practitioner and a clinical pharmacist, evaluated the severity of errors. SPSS (Version 26) was used for data analysis. RESULTS: The overall rate of medication dispensing errors was 6.7% (n=30912/ 464222), of which 2.6% (n=12274/464222) were prescription-related errors and 4.1% (n= 18638/464222) pharmacist counselling errors. The most common type of prescription-related errors was wrong quantity (30.0%), whereas the most common pharmacist counselling error was wrong drug (32.1%). The majority of errors were caused by medicine replaced with near expire one (24.7%) followed by look-alike/sound-alike drugs (22.3%). The majority of errors were moderate (46.8%) and minor (44.5%); 8.7% were serious errors. Predictors of medication dispensing errors were: grade A pharmacies (dispensing  60 prescriptions a day (OR 2.1; 95%CI 1.4-3.6; p = 0.03) and prescriptions containing ≥4 medication orders (OR 2.5; 95%CI 1.7-4.3; p = 0.01). CONCLUSIONS: Medication dispensing errors are common in the UAE and our findings can be generalised and considered as a reference to launch training programmes on safe medication dispensing practice

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An interactive website to aid young women's choice of contraception: feasibility and efficacy RCT.

BACKGROUND: Effective use of contraception can reduce numbers of unintended pregnancies, but misunderstandings and concerns about contraception abound. Increasingly, women seek health-care information online. OBJECTIVES: To develop an interactive website to aid informed choice of contraceptive method, including long-acting reversible contraception (Phase I), and test its effectiveness in a parallel, single-blind randomised trial (Phase II). Approval came from London - Camden & King's Cross Research Ethics Committee (reference 17/LO/0112). SETTING AND PARTICIPANTS: For both phases, women aged 15-30 years were recruited from general practice, sexual health services, maternity services, community pharmacies and an abortion service. DESIGN: In Phase I, we conducted three systematic literature reviews, a review of YouTube (YouTube, LLC, San Bruno, CA, USA) videos about contraception, and focus groups and interviews with young women to explore barriers to and concerns and misperceptions about contraception. We then iteratively co-designed an interactive website, Contraception Choices [URL: www.contraceptionchoices.org (accessed June 2020)], with young women and a software company. In Phase II, we evaluated the website through a randomised trial that began as a feasibility trial. Early demand for Contraception Choices stimulated a design change from a feasibility to an efficacy trial, with follow-up for clinical outcomes at 3 and 6 months. A randomisation list was incorporated into the trial software program to allocate participants to the intervention (website) or control group (standard care). INTERVENTION: Contraception Choices is a co-designed, evidence-based, interactive website to aid informed choice of contraception. It provides information about different methods, addresses common concerns and offers tailored contraceptive options in response to individual preferences. MAIN OUTCOME MEASURES: Qualitative - participant views and experience of the intervention, assessed through qualitative interviews. Quantitative primary outcomes - follow-up rate at 6 months in the initial feasibility trial, using a long-acting reversible contraception method, and satisfaction with contraceptive method at 6 months in the efficacy trial. RESULTS: A total of 927 women were randomised online to the website (n = 464) or control group (n = 463), of whom 739 (80%) provided follow-up data at 6 months [786 women (85%) provided data at 3 and/or 6 months that were included in the analysis of primary outcomes]. There was little difference between groups in the proportion using long-acting reversible contraception at 6 months [30.4% intervention vs. 31.0% control, adjusted odds ratio after imputation 0.87 (95% confidence interval 0.60 to 1.27)] or in satisfaction with contraceptive method [proportion being 'satisfied' or 'very satisfied', 82.6% intervention vs. 82.1% control, adjusted odds ratio 0.93 (95% confidence interval 0.69 to 1.25)]. Qualitative evaluation indicated highly positive views about the website and increased knowledge of contraceptive methods that could dispel misperceptions. Women appreciated having information tailored to their specific needs and felt better prepared before consultations. LIMITATIONS: We did not include intermediate measures, such as knowledge of contraceptive methods, intention to change method or confidence in discussing contraception with a health-care professional, which may have indicated other benefits of using the website. In future, the website should be studied in different settings (e.g. schools and in routine practice) to see whether or not it improves the quality or efficiency of contraceptive consultations. CONCLUSIONS: Our systematic review indicated wide-ranging influences on women's use of contraception globally. The website, Contraception Choices, was very popular with young women and contraception service providers. It was not associated with statistically significant differences in use of long-acting reversible contraception or satisfaction with contraceptive method at 6 months. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13247829. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 56. See the NIHR Journals Library website for further project information.

WHAT WAS THE QUESTION?: Choosing between types of contraception can be challenging, so can a website help women make the right choice for them? WHAT DID WE DO?: We asked women what they think about contraception. We looked at other studies and YouTube (YouTube, LLC, San Bruno, CA, USA) videos. We then designed the Contraception Choices website with young women [URL: www.contraceptionchoices.org (accessed January 2020)]. The website describes each type of contraception and compares them side by side. When users answer questions about what matters to them, the website suggests three types of contraception they might like. A total of 927 women helped us test the website in an online trial. We asked everyone what contraception they were using and how satisfied they were with it 6 months later. WHAT DID WE FIND?: Women really liked the website. Ninety-seven per cent of participants found it helpful or very helpful for 'getting useful information about contraception' and 87% responded that it was helpful or very helpful for 'finding a method of contraception that is right for you'. Comments included: However, seeing the website did not mean that women used a more reliable type of contraception. Women were just as satisfied with their contraception whether or not they had seen the website. We think that this is because many other factors are involved; for example, some women found it difficult to access long-acting contraception methods from health services. WHAT DOES THIS MEAN?: Young women liked the Contraception Choices website and found it useful. Women can be put off by contraception side effects and the views of partners, friends, family and others. On its own, the Contraception Choices website was not enough to help more women use the most reliable contraception methods.