Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.300
Filtrar
1.
BMJ Open Qual ; 10(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33455910

RESUMO

BACKGROUND: Quality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area. OBJECTIVES: This study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice. METHODS: Details of the HEI-LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data. RESULTS: The study found that a HEI-LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI-LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team's organisational culture with potential to improve service quality for patients. CONCLUSIONS: With the increased adoption of new pharmacist's roles and recent changes to governance associated with the COVID-19 pandemic, a HEI-LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.


Assuntos
Serviços Comunitários de Farmácia/normas , Educação Continuada em Farmácia , Farmacêuticos/normas , Comitê de Farmácia e Terapêutica , Desenvolvimento de Programas , Melhoria de Qualidade , Faculdades de Farmácia , Adulto , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Currículo , Educação de Pós-Graduação , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Pandemias , Competência Profissional , Papel Profissional , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
2.
Ann Pharmacother ; 55(1): 123-126, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32536291

RESUMO

Acute care pharmacists play an integral role in identifying drug-drug interactions that may predispose patients to QT prolongation. Although most pharmacists are equipped with a baseline understanding of drug interactions and the risks of QTc prolongation, few understand the limitations of QTc calculation and interpretation. In this commentary, we put forth the notion that at times health care providers, including pharmacists, place an overemphasis on the QTc interval. In the context of using the QTc to guide pharmacotherapy decisions, unintended consequences may include a cascade of effects leading to delays in treatment, suboptimal medication selection, alert fatigue, and overutilization of resources.


Assuntos
Eletrocardiografia/efeitos dos fármacos , Síndrome do QT Longo/diagnóstico , Farmacêuticos/normas , Torsades de Pointes/prevenção & controle , Sistemas de Apoio a Decisões Clínicas , Interações Medicamentosas , Feminino , Humanos , Síndrome do QT Longo/induzido quimicamente
3.
Ann Pharmacother ; 55(1): 25-35, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32578433

RESUMO

BACKGROUND: Numerous equations are used for estimation of renal function, and many electronic medical records report multiple clearance estimates to assist with drug dosing. It is unknown whether the presence of multiple clearance estimates affects clinical decision-making. OBJECTIVE: To determine whether the presence of multiple renal clearance estimates affects pharmacist drug dosing decisions. METHODS: A randomized trial in the form of an electronic survey including 4 clinical vignettes was delivered to hospital pharmacists. Vignettes consisted of a patient presenting with an acute pulmonary embolism requiring enoxaparin therapy. Pharmacists were randomized to receive a single estimate of renal function or multiple estimates for all vignettes. The primary outcome was deviation from approved recommendations on at least 1 vignette. The χ2 test was used to detect differences in deviation rates between groups. Logistic regression was performed to adjust for the effects of potentially confounding variables. RESULTS: A total of 154 studies were completed (73 in the multiple-estimate group and 81 in the single-estimate group). Pharmacists presented with multiple renal estimates were significantly more likely to deviate from recommended dosing regimens than pharmacists presented with a single estimate (54.7% vs 38.2%; P = 0.04). The results were driven primarily by the 2 vignettes that included discordance among Cockcroft-Gault equation creatinine clearance estimates. Logistic regression identified multiple estimates as the only independent predictor of deviation (P = 0.04). CONCLUSION AND RELEVANCE: Pharmacists provided with a single renal clearance estimate were more likely to adhere to approved dosing recommendations than pharmacists provided with multiple estimates.


Assuntos
Enoxaparina/administração & dosagem , Farmacêuticos/normas , Guias de Prática Clínica como Assunto/normas , Doença Aguda , Idoso , Tomada de Decisão Clínica , Creatinina/urina , Registros Eletrônicos de Saúde , Enoxaparina/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Farmacêuticos/psicologia , Embolia Pulmonar/tratamento farmacológico
4.
Ann Pharmacother ; 55(1): 44-51, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32578446

RESUMO

BACKGROUND: Inappropriate albumin use in clinical practice remains problematic. Health-systems face continued challenges in promoting cost-appropriate use. OBJECTIVE: To evaluate the clinical and economic impact of a clinical pharmacist-led intervention strategy targeting inappropriate albumin use in general ward patients. METHODS: A retrospective cohort study evaluated all adult (≥18 years) general ward patients administered ≥1 dose of albumin at a university medical center over a 2-year period. The intervention consisted of a clinical pharmacist-led strategy intervening on all albumin orders not in accordance with institutional guidelines. The primary end point was to compare inappropriate albumin utilization before and after implementation. Secondary end points compared the rates of inappropriate albumin use adjusted for hospital admission and patient-days as well as associated costs by appropriateness between study periods. RESULTS: A total of 4420 patients were screened, with 1971 (44.6%) patients meeting inclusion criteria. The clinical pharmacist strategy significantly reduced inappropriate albumin (grams) utilization by 86.0% (P < 0.001). A 7-fold reduction of inappropriate albumin administered adjusted for the number of patient admissions was found from the preimplementation period following clinical pharmacist intervention strategy implementation (415.3 ± 83.2 vs 57.5 ± 34.2 g per 100 general ward hospital admissions, respectively; P < 0.001). Also, the adjusted inappropriate albumin rate was reduced from 62.2 ± 12.3 to 8.6 ± 5.2 g per 100 patient-days in the preimplementation and postimplementation periods, respectively (P < 0.001). Annual cost savings were $421 455 overall, with $341 930 resulting from mitigation of inappropriate use. CONCLUSION AND RELEVANCE: Clinical pharmacist-led interventions significantly reduced inappropriate albumin use and costs in hospitalized patients.


Assuntos
Albuminas/economia , Uso de Medicamentos/economia , Prescrição Inadequada/economia , Serviço de Farmácia Hospitalar/normas , Adulto , Albuminas/uso terapêutico , Redução de Custos , Custos de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitais de Ensino/economia , Hospitais de Ensino/organização & administração , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos
5.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194192

RESUMO

The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes


No disponible


Assuntos
Humanos , Atenção Primária à Saúde/normas , Política de Saúde , Farmácias/normas , Farmacêuticos/normas , Assistência Farmacêutica/normas , Farmácias/organização & administração , Portugal , Assistência Farmacêutica/organização & administração , Prática Profissional , Papel Profissional
6.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194193

RESUMO

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the "Smart Use of Medicines" program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice


No disponible


Assuntos
Humanos , Atenção Primária à Saúde , Farmácias/normas , Farmacêuticos/normas , Prática Profissional , Farmácias/organização & administração , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Indonésia , Integração Comunitária
7.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-194196

RESUMO

BACKGROUND: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. OBJECTIVE: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. METHODS: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. RESULTS: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. CONCLUSIONS: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes


No disponible


Assuntos
Humanos , Farmacêuticos/normas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Competência Clínica , Assistência Farmacêutica/normas , Assistência Farmacêutica/organização & administração , Cooperação e Adesão ao Tratamento , Custos e Análise de Custo/métodos , Hemoglobina A Glicada/uso terapêutico , Qualidade de Vida
8.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194198

RESUMO

BACKGROUND: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. OBJECTIVE: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). METHODS: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. RESULTS: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. CONCLUSIONS: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Atenção Primária à Saúde/métodos , Prescrição Inadequada/prevenção & controle , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/epidemiologia , Antidepressivos , Benzodiazepinas , Fatores de Risco , Farmacêuticos/normas , Estudos Transversais , Análise Multivariada
9.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194203

RESUMO

The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges


No disponible


Assuntos
Humanos , Atenção Primária à Saúde , Farmácias/normas , Farmacêuticos/normas , Prática Profissional , Assistência Farmacêutica/normas , Farmácias/organização & administração , Estados Unidos
10.
Public Health Rep ; 135(5): 547-554, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780671

RESUMO

In 2019, President Trump announced a new initiative, Ending the HIV Epidemic: A Plan for America (EHE). EHE will use 3 key strategies-diagnose, treat, and prevent-to reduce new HIV infections at least 90% by 2030, as well as new laboratory methods and epidemiological techniques to respond quickly to potential outbreaks. Partnerships are an important component in the initiative's success. Pharmacists and pharmacies can play important roles in EHE, including dispensing antiretroviral therapy and providing HIV screening, adherence counseling, medication therapy management, preexposure prophylaxis, and nonprescription syringe sales. The objective of this report is to discuss potential roles that pharmacists and pharmacies can play under the key strategies of EHE.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Programas de Rastreamento/normas , Farmácias/normas , Farmacêuticos/normas , Profilaxia Pré-Exposição/normas , Papel Profissional , Adolescente , Adulto , Epidemias/legislação & jurisprudência , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Estados Unidos/epidemiologia , Adulto Jovem
11.
Am J Gastroenterol ; 115(9): 1532-1533, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32694291

RESUMO

INTRODUCTION: To characterize the clinical pharmacists' impact on caring for patients with inflammatory bowel disease during COVID-19. METHODS: A clinical pharmacist's encounters between March 17 and April 14, 2020, were audited to determine encounter frequency and indication. RESULTS: The clinical pharmacist addressed COVID-19 and inflammatory bowel disease treatment concerns with 140 patients, conducted 34 medication education and monitoring visits, reviewed 141 patients' charts and helped rescheduled 18 patients who missed their biologic infusion, transitioned 12 patients to home infusions, and assisted 5 patients with medication access. DISCUSSION: Clinical pharmacists embedded in gastroenterology practices permit for continued optimal patient care during a pandemic.


Assuntos
Betacoronavirus , Auditoria Clínica , Infecções por Coronavirus/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Equipe de Assistência ao Paciente/normas , Assistência ao Paciente/métodos , Farmacêuticos/normas , Pneumonia Viral/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Pandemias , Pneumonia Viral/epidemiologia , Papel Profissional , Estudos Retrospectivos
12.
Ann Hematol ; 99(7): 1615-1625, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32483668

RESUMO

Ibrutinib treatment has been shown to increase survival in patients with B cell malignancies. Real-life data suggest a large part of discontinuations are due to toxicities, impairing ibrutinib efficacy. We aimed to assess the impact of a pharmaceutical care program on the efficacy and safety of ibrutinib. This single-center, cohort, observational study enrolled patients with B cell malignancies. Patients were either assigned to the program or to receive usual care, based on physician decision. The program was conducted by clinical pharmacists specializing in oncology and included patient education for management of toxicities, adherence monitoring, interventions to reduce drug-drug interactions, and follow-up of transition from hospital to community. Between February 2014 and May 2017, we enrolled 155 patients, including 42 (27%) who were allocated to the program group and 113 (73%) to the usual care group. The effect of the program was beneficial in terms of time to treatment failure (p = 0.0005). The 30-month progression-free and overall survivals were significantly superior in the program group (respectively p = 0.002 and p = 0.004). Grade 3 or higher adverse events occurred more frequently for patients in the usual care group (15%) than program group (8%). A pharmaceutical care program provides a personalized environment for outpatient monitoring and control of the key risks associated with oral anticancer agents. This study shows evidence that management of ibrutinib treatment by clinical pharmacists results in significant improvement in survival and better tolerance than usual care.


Assuntos
Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Assistência Farmacêutica/normas , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Melhoria de Qualidade , Tempo para o Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eficiência Organizacional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/organização & administração , Assistência Farmacêutica/tendências , Farmacêuticos/organização & administração , Farmacêuticos/normas , Análise de Sobrevida , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/tendências , Falha de Tratamento
13.
Anesthesiology ; 133(2): 332-341, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32541549

RESUMO

BACKGROUND: While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room. METHODS: The authors completed a systems theoretic process analysis for the medication use process in the operating room at their institution. First, the authors defined medication-related accidents (adverse medication events) and hazards and created a hierarchical control structure (a schematic representation of the operating room medication use system). Then the authors analyzed this structure for unsafe control actions and causal scenarios that could lead to medication errors, incorporating input from surgeons, anesthesiologists, and pharmacists. The authors studied the entire medication use process, including requesting medications, dispensing, preparing, administering, documenting, and monitoring patients for the effects. Results were reported using descriptive statistics. RESULTS: The hierarchical control structure involved three tiers of controllers: perioperative leadership; management of patient care by the attending anesthesiologist, surgeon, and pharmacist; and execution of patient care by the anesthesia clinician in the operating room. The authors identified 66 unsafe control actions linked to 342 causal scenarios that could lead to medication errors. Eighty-two (24.0%) scenarios came from perioperative leadership, 103 (30.1%) from management of patient care, and 157 (45.9%) from execution of patient care. CONCLUSIONS: In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.


Assuntos
Anestesiologia/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Erros de Medicação/prevenção & controle , Salas Cirúrgicas/normas , Melhoria de Qualidade/normas , Teoria de Sistemas , Anestesiologistas/normas , Humanos , Salas Cirúrgicas/métodos , Farmacêuticos/normas , Estudos Prospectivos , Cirurgiões/normas
14.
Lancet Gastroenterol Hepatol ; 5(9): 809-818, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32526210

RESUMO

BACKGROUND: Highly effective direct-acting antiviral drugs provide the opportunity to eliminate hepatitis C virus (HCV) infection, but established pathways can be ineffective. We aimed to examine whether a community pharmacy care pathway increased treatment uptake, treatment completion, and cure rates for people receiving opioid substitution therapy, compared with conventional care. METHODS: This cluster-randomised trial was done in Scottish community pharmacies. Before participants were recruited, pharmacies were randomly assigned (1:1) to refer patients with evidence of HCV antibodies to conventional care or offered them care in the pharmacy (pharmacist-led care). Pharmacies were stratified by location. All pharmacies were trained to offer dried blood spot testing. All eligible participants had received opioid substitution therapy for approximately 3 months, and those eligible to receive treatment in the pharmacist-led care pathway were HCV PCR positive, were infected with HCV genotype 1 or 3, and were willing to have a pharmacist supervise their antiviral drug administration. Neither pharmacists nor patients were masked to treatment allocation. In both groups, assessment blood samples were taken, infection with HCV was confirmed, and daily oral ledipasvir-sofosbuvir (90 mg ledipasivir plus 400 mg sofosbuvir) for 8 weeks for genotype 1 or daily oral sofosbuvir (400 mg) plus oral daclatasvir (60 mg) for 12 weeks for genotype 3 was prescribed by a nurse (conventional care group) or pharmacist (pharmacist-led care group). In the conventional care group, the patient received care at a treatment centre. Once prescribed, medication in both groups was delivered as daily modified directly observed therapy alongside opioid substitution therapy in the participants' pharmacy where treatment was observed on 6 days per week. The primary outcome was the number of patients with sustained virological response 12 weeks after completion of treatment (SVR12) as a proportion of the number of people receiving opioid substitution therapy at participating pharmacies. Participants were monitored at each visit for nausea and fatigue; other adverse events were recorded as free text. Secondary outcomes compared key points on treatment pathway between the two groups. These key points were the proportion of patients having dry blood spot testing, the proportion of patients initiating HCV treatment, the proportion of patients completing the 8 or 12 week HCV course of treatment, and the proportion of patients with sustained virological response at 12 months. This study is registered with ClinicalTrials.gov, NCT02706223. FINDINGS: 56 pharmacies were randomly assigned (28 to each group; one pharmacy withdrew from the conventional care group). The 55 participating pharmacies included 2718 patients receiving opioid substitution therapy (1365 in the pharmacist-led care group and 1353 in the conventional care group). More patients met the primary endpoint of SVR12 in the pharmacist-led care group (98 [7%] of 1365) than in the conventional care group (43 [3%] of 1353; odds ratio 2·375, 95% CI 1·555-3·628, p<0·0001). More users of opioid substitution therapy in the pharmacist-led care group versus the conventional care group agreed to dry blood spot testing (245 [18%] of 1365 vs 145 [11%] of 1353, 2·292, 0·968-5·427, p=0·059); initiated treatment (112 [8%] of 1365 vs 61 [4%] of 1353, 1·889, 1·276-2·789, p=0·0015) and completed treatment (108 [8%] of 1365 vs 58 [4%] of 1353, 1·928, 1·321-2·813, p=0·0007). The data for sustained virological response at 12 months are not reported in this study: patients remain in follow-up for this outcome. No serious adverse events were recorded. INTERPRETATION: Using pharmacists to deliver an HCV care pathway made testing and treatment more accessible for patients, improved engagement, and maintained high treatment success rates. The use of this pathway could be a key part of an integrated and effective approach to HCV elimination at a community level. FUNDING: Partnership between the Scottish Government, Gilead Sciences, and Bristol-Myers Squib.


Assuntos
Antivirais/uso terapêutico , Benzimidazóis/uso terapêutico , Fluorenos/uso terapêutico , Hepatite C/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Uridina Monofosfato/análogos & derivados , Adulto , Idoso , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Benzimidazóis/administração & dosagem , Benzimidazóis/efeitos adversos , Quimioterapia Combinada , Feminino , Fluorenos/administração & dosagem , Fluorenos/efeitos adversos , Hepacivirus/efeitos dos fármacos , Hepacivirus/genética , Hepatite C/sangue , Hepatite C/epidemiologia , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Imidazóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Farmacêuticos/normas , Escócia/epidemiologia , Sofosbuvir/administração & dosagem , Sofosbuvir/efeitos adversos , Sofosbuvir/uso terapêutico , Resposta Viral Sustentada , Resultado do Tratamento , Uridina Monofosfato/administração & dosagem , Uridina Monofosfato/efeitos adversos , Uridina Monofosfato/uso terapêutico
15.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194055

RESUMO

BACKGROUND: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. OBJECTIVE: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. METHODS: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th, 2019, and June 14th, 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines' recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. RESULTS: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%CI 4.79-72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. CONCLUSIONS: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increased adherence to guidelines and may reduce the number of preventable bleeding cases


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/normas , Inibidores da Agregação de Plaquetas/administração & dosagem , Guias de Prática Clínica como Assunto/normas , Farmacêuticos/normas , Doença da Artéria Coronariana/tratamento farmacológico , Estudos Prospectivos , Fibrinolíticos/administração & dosagem , Erros de Medicação/prevenção & controle , Fatores de Risco
16.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194057

RESUMO

BACKGROUND: Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience. OBJECTIVE: This study aimed to: 1) Assess general practice pharmacists' self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience. METHODS: All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants' responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences. RESULTS: The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson's r=0.284, p = 0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods. CONCLUSIONS: General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists' effectiveness in general practice


No disponible


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Serviços Comunitários de Farmácia , Educação em Farmácia , Autoeficácia , Competência Clínica , Assistência Farmacêutica/normas , Inquéritos e Questionários , Farmacêuticos/normas , Papel Profissional
17.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194068

RESUMO

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government's Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists' roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia's Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia's future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government's 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles


No disponible


Assuntos
Humanos , Farmácias , Atenção Primária à Saúde , Farmacêuticos/normas , Prática Profissional , Serviços de Saúde Comunitária , Austrália , Sociedades Farmacêuticas/normas , Cooperação e Adesão ao Tratamento
18.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194069

RESUMO

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced


No disponible


Assuntos
Humanos , Atenção Primária à Saúde , Farmácias , Farmacêuticos/normas , Serviços Comunitários de Farmácia/normas , Espanha
19.
Int J Med Inform ; 137: 104119, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32172184

RESUMO

BACKGROUND: 'Look-alike, sound-alike' (LASA) medicines may be confused by prescribers, pharmacists, nurses and patients, with serious consequences for patient safety. The current research aimed to develop and trial software to proactively identify LASA medicines by computing medicine name similarity scores. METHODS: Literature review identified open-source software from the United States Food and Drug Administration for screening of proposed medicine names. We adapted and refined this software to compute similarity scores (0.0000-1.0000) for all possible pairs of medicines registered in Australia. Two-fold exploratory analysis compared: RESULTS: Screening of the Australian medicines register identified 7,750 medicine pairs with at least moderate (arbitrarily ≥0.6600) name similarity, including many oncology, immunomodulating and neuromuscular-blocking medicines. Computed similarity scores and resulting risk categories demonstrated a modest correlation with the manually-calculated similarity scores (r = 0.324, p < 0.002, 95 % CI 0.119-0.529). However, agreement between the resulting risk categories was not significant (Cohen's kappa = -0.162, standard error = 0.063). CONCLUSIONS: The software (LASA v2) has potential to identify pairs of confusable medicines. It is recommended to supplement incident reports in risk-management programs, and to facilitate pre-screening of medicine names prior to brand/trade name approval and inclusion of medicines in formularies.


Assuntos
Algoritmos , Rotulagem de Medicamentos/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Preparações Farmacêuticas/análise , Farmacêuticos/normas , Software , Austrália , Humanos , Segurança do Paciente
20.
PLoS One ; 15(3): e0229855, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126121

RESUMO

Medication dispensing performed without the necessary information on proper use can result in harmful effects to the individual, and therefore providing this service with quality for the users is necessary to promote the rational use of medication; however, in a developing country this activity is performed largely by unqualified people and in an inappropriate way. This study aims to develop and validate a study instrument that measures the knowledge of medication dispensing for the professionals involved in this practice (pharmacist, pharmacy technician in the pharmacy, and clerk/assistant). The study has methodological design and is characterized by the development and validation of an instrument to measure the knowledge of dispensation. A questionnaire denominated CDM-51 was elaborated and divided in two parts: the first collects the socio-demographic characteristics of the participants, and the second has 51 questions to assess the knowledge construct regarding dispensation. The validity of content was realized through the evaluation by seven experts regarding the relevance and clarity of the items. A pretest and main validation study with 30 and 79 pharmacy professionals respectively, from the city of Ribeirão Preto in the Brazilian state of São Paulo were carried out, and questions presented to the respondents were corrected. The analysis of the internal consistency of the KR-20 (Kuder-Richardson) was 0.837, and validity construct evidence was found (p value: 0.001) that participants with formal education have greater knowledge of medication dispensing. This work contributes to increasing the quality of services provided by dispensing pharmacies and points out the importance of training for formal education to perform this service, thus promoting the rational use of medication.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Farmacêuticos/normas , Técnicos em Farmácia/normas , Qualidade da Assistência à Saúde/normas , Adulto , Feminino , Humanos , Masculino , Assistência ao Paciente , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...