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1.
Artigo em Inglês | MEDLINE | ID: mdl-31430841

RESUMO

PURPOSE: In contemporary pharmacy, the role of pharmacists has become more multifaceted as they now handle a wider range of tasks and take more responsibility for care provision for patients than 20 years ago. Such an evolution in the pharmacist's responsibilities is accompanied by the need for pharmacists to display high-quality patient-centred care and counselling, and to demonstrate professionalism, which now needs to be taught and assessed are part of pharmacy education and practice. This workaimed at identifying definition of professionalism in pharmacy practice and critically evaluatingpublished instruments for assessing professionalism in pharmacy practice. METHODS: We searched the medical literature listed in Scopus, Medline, andPsycINFOdatabasesfrom 1 January 2000 to 31 December 2018. All papers meeting our selection criteria, were reviewed and summarised into a clear review of professionalism requirements in pharmacy practice. Details of the instruments measuring professionalism were reviewed in detail. RESULTS: There is no accepted simple definition of professionalism, although we identified several theoretical and policy frameworks required for professional pharmaceutical practice. We identified 4 instruments (Behavioural Professionalism Assessment Instrument (BPAI), Lerkiatbundit's Instrument, Pharmacy Professionalism Instrument (PPI) and Professionalism Assessment Tool (PAT) that build on these frameworks and measure professional practice in pharmacy students. These were found to be reliable and valid but had only been used and tested in student populations. CONCLUSION: Given the increasing role of community pharmacisits there is a need for assessment of professionalism in practice. Professionalism is a complex concept that is challenging to measure because it has no standardised definition and existing literature related to the topic is limited. Current instruments available focus on measuring the development of the elements of professionalism among pharmacy students rather than pharmacists.


Assuntos
Serviços Comunitários de Farmácia/normas , Farmacêuticos/normas , Papel Profissional , Profissionalismo , Humanos , Relações Profissional-Paciente , Inquéritos e Questionários
2.
J Manag Care Spec Pharm ; 25(9): 995-1000, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31456493

RESUMO

The shift to a value-based health care system has incentivized providers to implement strategies that improve population health outcomes while minimizing downstream costs. Given their accessibility and expanded clinical care models, community pharmacists are well positioned to join interdisciplinary care teams to advance efforts in effectively managing the health of populations. In this Viewpoints article, we discuss the expanded role of community pharmacists and potential barriers limiting the uptake of these services. We then explore strategies to integrate, leverage, and sustain these services in a value-based economy. Although community pharmacists have great potential to improve population health outcomes because of their accessibility and clinical interventions that have demonstrated improved outcomes, pharmacists are not recognized as merit-based incentive eligible providers and, as a result, may be underutilized in this role. Additional barriers include lack of formal billing codes, which limits patient access to services such as hormonal contraception; fragmentation of Medicare, which prevents alignment of medical and pharmaceutical costs; and continued fee-for-service payment models, which do not incentivize quality. Despite these barriers, there are several opportunities for continued pharmacist involvement in new care models such as patient-centered medical homes (PCMH), accountable care organizations, and other value-based payment models. Community pharmacists integrated within PCMHs have demonstrated improved hemoglobin A1c, blood pressure control, and immunization rates. Likewise, other integrated, value-based models that used community pharmacists to provide medication therapy management services have reported a positive return on investment in overall health care costs. To uphold these efforts and effectively leverage community pharmacist services, we recommend the following: (a) recognition of pharmacists as providers to facilitate full participation in performance-based models, (b) increased integration of pharmacists in emerging delivery and payment models with rapid cycle testing to further clarify the role and value of pharmacists, and (c) enhanced collaborative relationships between pharmacists and other providers to improve interdisciplinary care. DISCLOSURES: This article was funded by the National Association of Chain Drug Stores. The authors have no potential conflicts of interest to report.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Serviços Comunitários de Farmácia/normas , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Farmacêuticos/organização & administração , Farmacêuticos/normas , Organizações de Assistência Responsáveis/organização & administração , Organizações de Assistência Responsáveis/normas , Redução de Custos/normas , Planos de Pagamento por Serviço Prestado/normas , Custos de Cuidados de Saúde/normas , Humanos , Medicare/organização & administração , Medicare/normas , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Papel Profissional , Estados Unidos
3.
BMC Health Serv Res ; 19(1): 285, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053122

RESUMO

BACKGROUND: Community pharmacy Common Ailments Services can ease the considerable workload pressures on primary and secondary care services. However, evidence is needed to determine whether there are benefits of extending such services beyond their typically limited scope. This study therefore aimed to evaluate a new community pharmacy model of a service for patients with ear, nose and throat (ENT) and eye conditions who would otherwise have had to seek primary care appointments or emergency care. METHODS: People with specified ENT or eye conditions registered with General Practitioners in Staffordshire or Shropshire who presented at participating community pharmacies were offered a consultation with a pharmacist trained to provide the service. The service included provision of relevant self-care advice and, where clinically appropriate, supply of non-prescription medicines or specified prescription-only medicines (POMs), including antibiotics, under Patient Group Directions. Patients received a follow up telephone call from the pharmacist five days later. Data were collected on the characteristics of patients accessing the service, the proportion of those who were treated by the pharmacist without subsequently seeing another health professional about the same condition, and patient reported satisfaction from a questionnaire survey. RESULTS: A total of 408 patients accessed the service, of whom 61% received a POM, 15% received advice and medicine supplied under the common ailments service, 9% received advice and purchased a medicine, 10% received advice only and 5% were referred onwards. Sore throat accounted for 45% of diagnoses where a POM was supplied, 32% were diagnosed with acute otitis media and 15% were diagnosed with acute bacterial conjunctivitis. The number of patients successfully followed up was 309 (76%), of whom 264 (85%) had not seen another health professional for the same symptoms, whilst 45 (15%) had seen another health professional, usually their GP. The questionnaire was completed by 259 patients (response rate 63%) of whom 96% reported being very satisfied or satisfied with the service. CONCLUSIONS: The study demonstrates that pharmacists can effectively diagnose and treat these conditions, with a high degree of patient satisfaction. Wider adoption of such service models could substantially benefit primary care and emergency care services.


Assuntos
Serviços Comunitários de Farmácia , Oftalmopatias/diagnóstico , Otorrinolaringopatias/diagnóstico , Satisfação do Paciente/estatística & dados numéricos , Farmacêuticos/normas , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Oftalmopatias/terapia , Humanos , Otorrinolaringopatias/terapia , Encaminhamento e Consulta , Inquéritos e Questionários
4.
Int J Med Inform ; 127: 80-87, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31128835

RESUMO

OBJECTIVES: To assess the impact of electronic prescription on the types and rates of medication errors in prescribing and dispensing phases, and to formulate recommendations on the use of electronic prescriptions in Egyptian outpatient practice. METHODS: Medication errors and correction interventions were collected by reviewing the incident reports obtained from the outpatient pharmacy in a specialized hospital in Egypt. A data collection form was used to classify the errors. The Main outcome measures are prescribing and prescription errors, dispensing errors, error free prescriptions, pharmacy call-backs and phone calls for five months before and five months after the electronic system implementation. RESULTS: 3512 incident reports were reviewed for errors in the hand-written and electronic phases. The use of electronic system led to a minor significant 2% reduction in prescribing errors, significant 1.2% decrease in dispensing errors, and significant 18.2% increase in the error free prescriptions (p < 0.05). Indication and omission prescribing errors were increased significantly (1.7%, p < 0.0001) in the electronic phase. The electronic system failed to significantly decrease some types of dispensing errors like wrong medicine and wrong dosage form. No difference was detected in the volume of communications between pharmacists and prescribers. CONCLUSION: Electronic prescribing is able to reduce prescribing and dispensing errors associated with the use of hand-written prescriptions in the Egyptian outpatient clinic, however, more advanced and trusted systems are likely needed for more efficient effect on error rates and pharmacy workflow.


Assuntos
Serviços Comunitários de Farmácia/normas , Prescrição Eletrônica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Prescrições de Medicamentos/normas , Egito , Feminino , Humanos , Lactente , Masculino , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Farmacêuticos/normas , Fluxo de Trabalho , Adulto Jovem
5.
Int J Clin Pharm ; 41(3): 677-681, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31011894

RESUMO

Background The effectiveness of pharmaceutical care has already been evidenced in several studies and scenarios; the lack of patient's consultation has been little explored in the literature. Unprovided care is a missed opportunity to offer care to another individual who needs attention to their health. The need for investigation of missed consultations in a Brazilian pharmaceutical care service arises. Objective To evaluate the participation and characteristics of patients in pharmaceutical care consultations in a university outpatient unit in the Brazilian city of Divinópolis. Methods A descriptive study was carried out from a secondary source of information. The socio-demographic profile of the patients who were absent from the pharmacy consultations from January to December 2017 was outlined. Results Of the 832 scheduled appointments from January to December 2017, 501 were not attended by patients, revealing 60.2% missed consultations. The female gender was predominant, corresponding to 67.8% of the patients. A total of 63.8% of the absentees were over 60 years of age. Most of the patients had two comorbidities (32.5%) and came from an active identification by the Outpatient unit pharmacists (86.60%). Furthermore, the patients who were more absent from the consultations had their primary health care units farther away from the outpatient unit, and this could be one of the causes of the high number of absent patients from the pharmaceutical consultations. Conclusion The lack of participation in patient's consultations is high. It is necessary to articulate new strategies aimed at reducing absences from consultations, since this is a source of waste of financial resources and opportunities to improve the patients' health and quality of life.


Assuntos
Serviços Comunitários de Farmácia/normas , Participação do Paciente/métodos , Farmacêuticos/normas , Papel Profissional , Encaminhamento e Consulta/normas , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Int J Clin Pharm ; 41(3): 630-666, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30963447

RESUMO

Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease patients. Aim of the review To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease. Method PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists' involvement in the multidisciplinary team providing care to patients with chronic kidney disease, more high-quality research is warranted.


Assuntos
Serviços Comunitários de Farmácia/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Papel Profissional , Insuficiência Renal Crônica/tratamento farmacológico , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos
7.
Int J Clin Pharm ; 41(3): 700-710, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30963448

RESUMO

Background Patients with advanced cancer commonly experience pain and it is least controlled in community settings. Community pharmacists in the UK already offer medicines optimisation consultations although not for this patient group. Objective To determine whether medicines consultations for patients with advanced cancer pain are feasible and acceptable. Setting Community-dwelling patients with advanced cancer pain were recruited from primary, secondary and tertiary care using purposive sampling in one UK city. Methods One face-to-face or two telephone delivered medicines optimisation consultations by pharmacists were tested. These were based on services currently delivered in UK community pharmacies. Feedback was obtained from patients and healthcare professionals involved to assess feasibility and acceptability. Main outcome measure Recruitment, acceptability and drug related problems. Results Twenty-three patients, (range 33-88 years) were recruited, 19 completed consultation(s) of whom 17 were receiving palliative care services. Five received face-to-face consultations and 14 by telephone during which 47 drug related problems were identified from 33 consultations (mean 2.5). Advice was provided for 34 drug related problems in 17 patients and referral to other healthcare professionals for 13 in 8 patients, 2 patients had none. Eleven patients returned questionnaires of which 8 (73%) would recommend the consultations to others. Conclusion The consultations were feasible as patients were recruited, retained, consultations delivered, and data collected. Patients found the 20-30 min intervention acceptable, found a self-perceived increase in medicines knowledge and most would recommend it to others. Community pharmacists were willing to carry out these services however they had confidence issues in accessing working knowledge. Most drug related problems were resolved by the pharmacists and even among patients receiving palliative care services there were still issues concerning analgesic management. Pharmacist-conducted medicines consultations demonstrate potential which now needs to be evaluated within a larger study in the future.


Assuntos
Dor do Câncer/diagnóstico , Dor do Câncer/tratamento farmacológico , Serviços Comunitários de Farmácia/normas , Farmacêuticos/normas , Papel Profissional , Estudo de Prova de Conceito , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Int J Clin Pharm ; 41(3): 719-727, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30937694

RESUMO

Background Older persons living alone have been associated with poorer health outcomes and higher mortality rate. However, little is known about the drug related problems (DRPs) faced by this population group in Singapore. Objectives This study aims to elucidate the prevalence and type of DRPs associated with older persons living alone. Setting Eleven Senior Activity Centers in Singapore. Method Individuals aged above 55 years, taking at least one oral chronic medication and living in the housing estate served by the Senior Activity Centers were recruited to participate in an individual interviewer-administered cross-sectional survey. Those who were unable to comprehend the survey or communicate their responses fully were excluded. DRPs were identified by the interviewers and reported using a modified DOCUMENT system. Main outcome measure The main outcome measure was the difference in prevalence and types of DRPs between survey participants with different living arrangements. Results Among 360 respondents, 152 (42.2%) were older persons living alone. A higher prevalence (61.2% vs. 47.6%, adjusted OR = 1.86 [1.12-3.10], p = 0.016) and mean number of DRPs (1.23 ± 1.4 vs. 0.95 ± 1.33, p = 0.018) were observed among older persons living alone in comparison with those who were not living alone. Specifically, those living alone were more likely to have DRP related to the category 'Taking too little' (adjusted OR = 2.32 [1.28-4.20], p = 0.006) and which involved the use of HMG-CoA reductase inhibitors (adjusted OR = 2.78 [1.16-6.69], p = 0.022). Conclusion Besides having a significantly higher prevalence of DRP, older persons living alone were more likely to be non-adherent to their medications, particularly statins. Targeted interventions to reduce these DRPs and ensure appropriate management of chronic conditions should be derived, especially for those who lack the ability to help themselves.


Assuntos
Serviços Comunitários de Farmácia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Vida Independente , Adesão à Medicação , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Farmácia/normas , Estudos Transversais , Feminino , Humanos , Vida Independente/normas , Masculino , Pessoa de Meia-Idade , Singapura/epidemiologia
9.
Int J Clin Pharm ; 41(3): 672-676, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30997622

RESUMO

Background Handling of unavailable prescriptions, i.e. prescriptions missing on the online server, is considered troublesome and time-consuming by community pharmacy staff and may result in both patient dissatisfaction and non-compliance. Objective To describe the occurrence and reasons for unavailable prescriptions at Danish community pharmacies as well as the types of drugs involved. Method An online 11-item questionnaire was developed and distributed to 24 community pharmacies across Denmark which each collected data on unavailable prescriptions handled within a 3-week period. Results Out of 194,358 prescriptions dispensed during the study period, a total of 2765 (1.4%) unavailable prescriptions were registered. Of these, 51.1% (n = 1412) occurred when a patient expected a new prescription after having consulted a physician, most often the patient's general practitioner (75.6%; n = 1067). Of all unavailable prescriptions, 68.1% (n = 1882) concerned prescriptions on regular drugs for treatment of a chronic condition, with the patient not having any medication left in 27.9% (n = 526) of these cases. Unavailable prescriptions most frequently concerned cardiovascular drugs (15.8%; n = 437) followed by nervous system drugs (14.4%; n = 399). Conclusion Unavailable prescriptions occur in approximately 1% of all dispensing at Danish community pharmacies. Miscommunication between the patient and general practitioner seems to be the primary source of unavailable prescriptions.


Assuntos
Serviços Comunitários de Farmácia/normas , Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Satisfação do Paciente , Inquéritos e Questionários , Dinamarca/epidemiologia , Feminino , Humanos , Masculino
10.
Int J Clin Pharm ; 41(3): 813-819, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31028597

RESUMO

Background The model of community pharmacy practice is changing remarkably not only in the West but also in developing countries, which has led retail pharmacies to transform into chain community pharmacies. However, very little is known about consumers' expectations and experiences with chain community pharmacies in developing countries. Objective This study aims to assess the expectations and experiences of consumers with services provided by chain community pharmacies in Lahore, Pakistan. Setting Four random chain community pharmacies. Methods A qualitative study design was employed and face-to-face, audio-recorded, interviews were conducted with 12 consumers attending 4 randomly selected chain community pharmacies. All interviews were transcribed verbatim and the interview data were analysed thematically using NVivo® software. Main outcome measure Consumers' expectations and experiences with chain community pharmacies. Results The results contributed to a deeper understanding of the consumers' expectations and experiences with the services provided by chain community pharmacies. Six themes emerged from interview data including; access to pharmacists, quality use of medicines, range of distinct services, staff's behaviour, inventory management, and scope of services. The consumers reported that pharmacists working in chain community pharmacies were building trusting relationships and encouraging them to take an active role in healthcare. Pharmacists working there were providing them medication information and counselling services, which they normally do not expect from traditional pharmacies. Consumers mentioned that they had access to pharmacists and quality services, but the inventory of pharmacies was limited. Conclusions This exploratory study provides preliminary evidence that some of the consumers' expectations and experiences were aligned. However, some deficiencies were highlighted by the consumers that need to be addressed by relevant stakeholders. Further research is needed to assess the expectations and experiences of pharmacists working in the chain community pharmacy sector.


Assuntos
Serviços Comunitários de Farmácia/normas , Comportamento do Consumidor , Farmacêuticos/normas , Papel Profissional , Pesquisa Qualitativa , Adulto , Humanos , Masculino , Paquistão/epidemiologia , Farmacêuticos/psicologia , Papel Profissional/psicologia
11.
Int J Clin Pharm ; 41(3): 741-750, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006832

RESUMO

Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.


Assuntos
Serviços Comunitários de Farmácia/normas , Revisão de Uso de Medicamentos/normas , Reconciliação de Medicamentos/normas , Farmacêuticos/normas , Papel Profissional , Varfarina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Seguimentos , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/normas , Masculino , Malta/epidemiologia , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Varfarina/administração & dosagem
12.
BMC Health Serv Res ; 19(1): 186, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898124

RESUMO

BACKGROUND: Worldwide community pharmacies are shifting their role in the healthcare system from simple medication dispensers to health care providers. High levels of satisfaction with pharmacy services were found in previous studies. This study has two main goals. The primary goal is to describe the levels of satisfaction and knowledge regarding pharmacy services in Portugal. The secondary goal is to explore the perceptions and the utilisation of pharmacy services by the Portuguese. This statement includes exploring the impact of a set of variables on both perceptions and uses of pharmacies in regard to services that are currently offered as well as to new services that may be provided in the future. METHODS: A face-to-face survey of closed-ended questions was applied to a nationwide representative sample of the Portuguese population in September 2015. The sample was weighted based on population distribution across regions, habitat, age and gender. Data analysis comprises descriptive statistics and Multiple Correspondence Analysis to explore different typologies of respondent's orientation toward community pharmacy. RESULTS: A total of 1114 interviews comprised the study. Of the respondents, 36% used the pharmacy as a first resource when seeking to treat a minor ailment, and 54% reported that they use the pharmacy as a first resource when seeking answers about medicines. Of those who visited their pharmacy at least once in the previous year, 94% were either globally satisfied or very satisfied. The level of acknowledgement of pharmacy services' was also high among the Portuguese. Of the participants, 29% considered there could be more services available in pharmacies that are currently provided by other health care facilities. The construction of a typology of orientations towards community pharmacy practice resulted in three outcome groups: "Motivated" (63%), those with a connection to a pharmacy; "Settled" (23%), mainly those who had a pharmacy nearby; and "Demobilised" (14%), those who are weakly tied to a pharmacy. CONCLUSIONS: The vast majority of the Portuguese population has a strong positive attitude towards their community pharmacy, as expressed by the high levels of satisfaction with, and positive evaluation of, the pharmacy's services.


Assuntos
Serviços Comunitários de Farmácia/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Farmácia/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Percepção , Farmácias/normas , Farmácias/estatística & dados numéricos , Portugal , Opinião Pública , Inquéritos e Questionários , Adulto Jovem
13.
J Int Med Res ; 47(5): 2018-2025, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30885078

RESUMO

OBJECTIVE: To investigate the level of counselling regarding the effects of sedating antihistamines on driving skills provided by private community pharmacies in Madinah, Saudi Arabia. METHODS: This study randomly selected private community pharmacies. Mystery shoppers following a similar scenario individually visited these pharmacies. These clients asked for a commonly used brand of sedating antihistamine and noted the counselling offered by the pharmacist. If spontaneous counselling was not offered, necessary information regarding the medication's use was requested. Finally, the content of counselling was documented. RESULTS: Of the 100 pharmacies selected, 12 were excluded for various reasons and 88 pharmacies were included in the study. Only 23 pharmacies offered spontaneous counselling. Although 73.9% of pharmacists (65 of 88), spontaneously or upon request, mentioned sedation as a side-effect, only one pharmacist warned the client against driving after taking the medication, and three other pharmacists warned against dealing with hazardous machinery. Other side-effects were almost ignored. CONCLUSION: A life-threatening insufficiency in the quality of counselling at Saudi Arabian private community pharmacies exists. Traffic accidents, secondary to the side-effects of sedating antihistamines, may be avoided if proper counselling is offered. Saudi Arabian authorities should take appropriate actions to ensure optimal practice in community pharmacies.


Assuntos
Serviços Comunitários de Farmácia/normas , Aconselhamento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Educação de Pacientes como Assunto/métodos , Farmacêuticos/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Qualidade de Vida , Arábia Saudita/epidemiologia , Inquéritos e Questionários
14.
Br J Gen Pract ; 69(680): e190-e198, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30745357

RESUMO

BACKGROUND: Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process. AIM: To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK. DESIGN AND SETTING: Analysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017. METHOD: Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically. RESULTS: In total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work. CONCLUSION: Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais/normas , Conduta do Tratamento Medicamentoso , Farmacêuticos/normas , Serviços Comunitários de Farmácia/normas , Medicina Geral/métodos , Medicina Geral/normas , Humanos , Conduta do Tratamento Medicamentoso/normas , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Polimedicação , Pesquisa em Sistemas de Saúde Pública , Melhoria de Qualidade , Reino Unido
15.
Int J Clin Pharm ; 41(1): 244-250, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30610541

RESUMO

Background Many tools exist to document drug-related problems (DRP), such as the Pharmaceutical Care Network Europe (PCNE) classification. However, none have been adapted and published for French-speaking Belgian community pharmacies. Settings French-speaking Belgian Community pharmacies. Objective The objective was to translate and adapt the PCNE V6.2 classification to the Belgian pharmacy practice and legal setting and to assess the content validity, daily use and inter-rater reliability of this classification. Main Outcome Measure Validation of the French-language adapted PCNE v6.2 classification in Belgium. Method The first step translated and adapted the PCNE V6.2 classification to the Belgian setting. Thereafter academic and community pharmacists evaluated the content validity, which involved six criteria and concerned the instruction manual (clarity, helpfulness) and the registration form (representativeness, logical design, completeness and uniqueness). The next step was the DRP collection, using the PCNE tool daily. Compliance with the instructions and the time needed to solve a DRP were evaluated. Finally, the inter-rater reliability was evaluated by comparing DRP codings done by pharmacist volunteers. Results The classification was translated into French and adapted by adding 16 items. The classification showed a high content validity for the academics and the community pharmacists. A total of 109 DRP forms were coded, with an average resolution time of 5 min. Regarding the inter-rater reliability, 74 tool items out of the set of 83 showed high consistency in coding. Conclusion This study showed that the tool adaptation to a French-speaking Belgian context was reliable and has adequate validity for daily use.


Assuntos
Serviços Comunitários de Farmácia/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Multilinguismo , Assistência Farmacêutica/normas , Tradução , Bélgica/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Farmacêuticos/normas , Reprodutibilidade dos Testes
16.
Int J Clin Pharm ; 41(1): 215-227, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30659491

RESUMO

Background Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective To determine community pharmacists' training, experiences and behavioural determinants in counselling and management of homeless population. Setting UK community pharmacies. Method A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures Pharmacists' perspectives, pharmacists' training, pharmacists' experiences and behavioural determinants. Results A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists' knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy.


Assuntos
Atitude do Pessoal de Saúde , Pessoas em Situação de Rua/psicologia , Percepção , Farmacêuticos/psicologia , Papel Profissional/psicologia , Inquéritos e Questionários , Adulto , Idoso , Serviços Comunitários de Farmácia/normas , Aconselhamento/métodos , Aconselhamento/normas , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Pessoas em Situação de Rua/educação , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/normas , Reino Unido/epidemiologia
17.
Int J Pharm Pract ; 27(2): 140-148, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30338875

RESUMO

OBJECTIVES: The aim was to recognise the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customise the descriptions of these values for community pharmacy practice. METHODS: The narratives of 128 moral dilemmas, collected from Dutch PharmD students and early career pharmacists who experienced these dilemmas in practice, were qualitatively analysed. An expert panel deductively coded relevant portions of these narratives with the core values as formulated by the Royal Dutch Pharmacists Association. Other values that emerged were inductively coded and if possible used to further customise the respective core values. KEY FINDINGS: The expert panel identified all four professional core values, that is, commitment to the patient's well-being (117, 91.4%), reliable and caring (116, 90.6%), pharmaceutical expertise (72, 56.2%) and responsibility to society (30, 23.4%) in the 128 moral dilemma narratives. Thirteen other values that emerged in the analysis could all be used for the customisation of the professional core values in descriptions that better reflect community pharmacy practice. CONCLUSIONS: Professional core values were identified in moral dilemma narratives of pharmacists in community pharmacy and customised for their practice. These customised core values can enable pharmacists to better recognise moral dilemmas in practice. This can add to the advancement of the profession as a pharmaceutical care practice.


Assuntos
Serviços Comunitários de Farmácia/ética , Ética Farmacêutica , Princípios Morais , Farmacêuticos/ética , Serviços Comunitários de Farmácia/normas , Feminino , Humanos , Masculino , Países Baixos , Farmacêuticos/normas , Estudantes de Farmácia/estatística & dados numéricos
18.
J Oncol Pharm Pract ; 25(3): 674-688, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30200843

RESUMO

PURPOSE: To create a set of consensus-based and evidence-informed recommendations to provide guidance around the safe dispensing and handling of oral anti-cancer drugs in low-volume settings unique to the community pharmacy setting. METHODS: A review of published and grey literature (published in non-commercial domains such as national organizations and associations) documents and nine key informant interviews were conducted and a modified Delphi approach was taken to achieve consensus. The final list of 47 candidate recommendations was reviewed by a task force and validated by multi-disciplinary stakeholders. A draft of the statements was circulated broadly within the community pharmacy community in an effort to assess relevance and implementation feasibility. RESULTS: The final report included 44 recommendations that addressed 11 key areas germane to the safe handling of oral anti-cancer drugs in community pharmacies. Mean agreement increased from 70% to 95%. Early feedback from community pharmacy leaders during the external review suggests that many of the proposed recommendations can be feasibly implemented within a reasonable timeframe when released with appropriate education and resource materials. CONCLUSIONS: A modified-Delphi approach supplemented by key informant interviews and a comprehensive external review resulted in a set of evidence-informed, community-driven recommendations for community pharmacies. The recommendations address a gap in existing literature to improve understanding of the risks associated with handling and dispensing oral anti-cancer drugs for both community pharmacy staff and management and offer mitigating strategies to reduce those risks. Incorporating feasibility assessment actions early (through the key informant interviews) and late (through the external review) ensures recommendations are grounded in practicality and support broad and early knowledge translation strategies.


Assuntos
Antineoplásicos , Serviços Comunitários de Farmácia/normas , Farmácias , Canadá , Consenso , Humanos
19.
J Pharm Pract ; 32(4): 428-433, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29486666

RESUMO

OBJECTIVE: To identify opportunities to improve safe and effective immunization delivery in community pharmacies. METHODS: Pharmacy managers from chains in Michigan were interviewed about their company's immunizations programs. A survey regarding immunization training, quality assurance measures, pharmacist comfort level immunizing different patient populations, and resources used in practice was distributed to community pharmacists throughout Michigan. RESULTS: Most pharmacists (88.8%) confirmed they received American Pharmacists Association immunization training and felt they followed the guidelines outlined in that training course very well. No routine reassessment of immunization technique was reported. In a minority of respondents, some issues were identified: (1) not being up-to-date on cardiopulmonary resuscitation certification as required by state law (7.1%), (2) lack of awareness of location of emergency kit (4.2% for epinephrine, 13.5% for diphenhydramine), and (3) feeling uncomfortable immunizing children (51% for children <7 years). CONCLUSION: To address quality control issues identified in the survey, we recommend chain pharmacies incorporate credential checks into annual pharmacy training requirements. Pharmacists may benefit from immunization-related continuing education requirements. State pharmacy organizations may want to take the lead in developing the material to ensure that it is timely and abides by state and federal laws.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Programas de Imunização/organização & administração , Imunização/métodos , Farmacêuticos/organização & administração , Adulto , Serviços Comunitários de Farmácia/normas , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Imunização/efeitos adversos , Programas de Imunização/normas , Masculino , Michigan , Farmacêuticos/normas , Papel Profissional
20.
Res Social Adm Pharm ; 15(5): 558-567, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30031695

RESUMO

BACKGROUND: Community pharmacy practice in the Kingdom of Saudi Arabia (KSA) faces many challenges. In KSA, there is a lack of empirical research about medication safety in this setting. OBJECTIVE: To explore the safety problems associated with medication supply from community pharmacies in KSA and compare different stakeholder perspectives. METHODS: Four focus groups and individual interviews were conducted in Riyadh, KSA, in February-May 2013. All group discussions were recorded, transcribed and translated from Arabic into English, except the professional group, which was conducted in English. Thematic analysis was performed using the Human Factors Framework (HFF). RESULTS: The groups comprised "professionals" (n = 8; one female), community pharmacists (n = 4; all male) and two pharmacy user groups (females, n = 11 and males, n = 8). Medication safety problems identified were categorised into nine categories representing the HFF. Seven main themes were identified from these categories: commercial pressure on community pharmacy; illegal supply of prescription medication; lack of enforcement of regulations; the healthcare system; self-medication; patient trust in pharmacists: and communication failure. Themes that emerged only from the "professionals" and community pharmacists were the different role of the regulatory organisations and the reasons behind lack of enforcement, while the community pharmacist group focused on the relationship between owners and managers. Pharmacy users expressed a need for information about medication and that the primary role of the pharmacist should be as an information provider. Furthermore, they perceived pharmacists to be vendors rather than healthcare professionals. CONCLUSION: Many medication safety problems were identified, attributable to individuals (patient, pharmacist), pharmacy and organisational factors. These results will be used to develop interventions to improve medication safety.


Assuntos
Serviços Comunitários de Farmácia/normas , Segurança do Paciente , Medicamentos sob Prescrição , Adulto , Serviços Comunitários de Farmácia/organização & administração , Feminino , Grupos Focais , Fraude , Comunicação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos , Papel Profissional , Relações Profissional-Paciente , Pesquisa Qualitativa , Arábia Saudita , Automedicação , Adulto Jovem
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