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1.
J Oncol Pharm Pract ; 26(1): 13-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832554

RESUMO

PURPOSE: To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. METHODS: Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. RESULTS: The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). CONCLUSIONS: Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.


Assuntos
Afatinib/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Educação de Pacientes como Assunto/tendências , Farmacêuticos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Serviços Comunitários de Farmácia/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Receptores ErbB/genética , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Estudos Retrospectivos
2.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
3.
Isr J Health Policy Res ; 8(1): 62, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300035

RESUMO

In a recent IJHPR article, Schwartzberg and colleagues report on clinical and other specialty services offered by pharmacists in the community in Israel and in the international arena. The article covers examples of activities recently introduced due to legislative changes which expanded the pharmacist's scope of practice, along with obstacles that are serving to slow broader expansion and availability of these services. This commentary details the success of clinical pharmacy services being provided by the United States Veterans Health Administration, and offers a framework of elements that support clinical pharmacy practice expansion.


Assuntos
Serviços Comunitários de Farmácia/tendências , Humanos , Israel , Sistemas de Medicação , Papel Profissional/psicologia
4.
Yakugaku Zasshi ; 139(4): 529-532, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30930382

RESUMO

The primary pharmacy system and health support pharmacy system were established in 2016. However, local pharmacies need to get closer to the community. To this end, each pharmacy is making efforts to contribute locally. Here, we introduce various initiatives in our region. Akakabe Pharmacy has 66 stores in Osaka Prefecture, mainly in the northeastern part of Osaka, where the elderly population is growing. We are implementing a dominant strategy: cooperation with the city and administration is strong, and we hold many related events directed towards the public. For example, two thousand participants gathered in an event sponsored by the city aimed at the improvement of beauty and health. At such events, participants can easily consult with pharmacists. Dispensing pharmacy stores-pharmacies that combine the features of a convenience store with care consulting services-were established in 2016. Care consultations are potentially highly advantageous to the users. In the consultation space of a pharmacy, a care worker conducts various events every month, such as on dementia prevention, body composition measurement, and more. We believe that this type of combined pharmacy and convenience store has the potential to become a regional comprehensive care center. We intend to share the possibility of a new pharmacy system, centered on this pharmacy/store/consultation model, as a basis to revamp the pharmacy industry.


Assuntos
Comércio , Serviços Comunitários de Farmácia , Assistência Integral à Saúde , Assistência à Saúde/métodos , Farmácia , Encaminhamento e Consulta , Centros Comunitários de Saúde/tendências , Serviços Comunitários de Farmácia/tendências , Assistência Integral à Saúde/métodos , Assistência Integral à Saúde/tendências , Assistência à Saúde/tendências , Fast Foods , Humanos , Japão
5.
Yakugaku Zasshi ; 139(4): 539-543, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30930384

RESUMO

For becoming a talented pharmacist at a health support pharmacy, the practitioner must obtain ability in two significant skill sets: "Technical skill" and "Non-technical skill". Technical skills are that required for a pharmacist's specialty/expertise, such as a wide variety of specialized knowledge and techniques. Non-technical skills are those required for effective communication and cooperation with patients, as well as with professionals from multiple fields, and also leadership/problem-solving ability within a team. Therefore, technical skill and non-technical skill go hand-in-hand like the two wheels on an axle. In a community-based integrated care system, medical professionals are expected to support a patient's overall health more effectively, even extending into his/her private life. In order to enable pharmacists to expand their scope of activity and fully execute their expertise, Yakugaku Seminar Lifelong Learning Center supports pharmacists from the standpoint of education with various themes, for example: the simulated experience of doctor conducting patient education and formulation on a daily basis, learning a basic way of thinking when clinical decisions are made for a patient nearby, mature decision making by combining vital signs, communication that takes into consideration a patient's background, and improved communication or problem-solving abilities within a broader team.


Assuntos
Competência Clínica , Serviços de Saúde Comunitária/tendências , Serviços Comunitários de Farmácia/tendências , Assistência Integral à Saúde/tendências , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Educação Continuada em Farmácia/métodos , Educação Continuada em Farmácia/tendências , Farmacêuticos/tendências , Competência Profissional , Papel Profissional , Comunicação , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Relações Profissional-Paciente
6.
J Oncol Pharm Pract ; 25(1): 140-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28942724

RESUMO

Administration of chemotherapy is moving into the community as more and more therapies to treat cancer are being developed as oral medications. Patients taking these oral medications still require support, as many of these agents can be toxic. This support could be simple side effect management, compliance issues or even reassurance with regards to their diagnosis as examples. Community pharmacies are ideally placed within the community to help these patients. The purpose of this review is to determine what support community pharmacies are currently providing for patients taking oral anticancer medication and if there is a model that can be adopted or adapted to be used elsewhere. Searches were undertaken using two databases, Medline and Embase. Other evidence-based articles were discovered from other sources. The different services currently available from community pharmacies were largely varied. There are some key aspects to each which could be used in the development of a new model. Further research is required to determine the views of the patients, carers and community pharmacy staff.


Assuntos
Antineoplásicos/administração & dosagem , Serviços Comunitários de Farmácia , Modelos Teóricos , Farmacêuticos , Relações Profissional-Paciente , Administração Oral , Serviços Comunitários de Farmácia/tendências , Humanos , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Farmacêuticos/tendências
7.
Isr J Health Policy Res ; 7(1): 59, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30501624

RESUMO

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients' health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients' and the healthcare system's needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist's scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.


Assuntos
Serviços Comunitários de Farmácia/provisão & distribução , Farmacêuticos/estatística & dados numéricos , Serviços Comunitários de Farmácia/tendências , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Israel , Papel Profissional , Mecanismo de Reembolso
8.
Curr Pharm Teach Learn ; 10(8): 1013-1021, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30314535

RESUMO

INTRODUCTION: Prior to the Michigan naloxone standing order legislation, a sample of Michigan pharmacists was surveyed to (1) identify gaps in knowledge regarding naloxone: (2) assess supportive attitudes towards the standing order and; (3) determine perceived pharmacist roles when providing naloxone. METHODS: A 37-item survey was emailed to Michigan Pharmacist Association members (n = 2757), July to August 2016. Responses to knowledge, supportive attitude, and perceived roles items were analyzed using descriptive statistics and logistic regression. Significance set at p < 0.05. RESULTS: The useable response was 8% (n = 211), 92% white, 54% female, aged 46.5 ± 14.6 years. Knowledge: Eighty-five percent (179/211) agreed laypersons can administer naloxone. Sixty-four percent could identify an opioid overdose and 74% agreed with required pharmacist naloxone education; yet 20% had education. Supportive attitude: Eighty-seven percent (184/211) supported the standing order. Perceived role: Fifty-six percent agreed with responsibility for following patients after providing naloxone. Predictors of agreement were rural practice location (OR = 2.5; 95% CI 1.2-5.0, p = 0.01), and requiring naloxone education (OR = 3.0; 95% CI 1.3-6.8, p = 0.007). Having a Doctor of Pharmacy versus a Bachelor of Science Pharmacy degree decreased odds of agreement by 43.5% (OR = 0.435; 95% CI 0.221-0.857, p = 0.016). DISCUSSION: Timing of survey may explain the low number of trained respondents. The increased willingness of BS Pharmacists to follow patients may reflect longer practice and closer community ties. Limitations include low generalizability and small sample. CONCLUSION: A small representative sample of Michigan pharmacists is knowledgeable regarding naloxone and has supportive attitudes towards the standing order.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Naloxona/uso terapêutico , Farmacêuticos/psicologia , Papel Profissional/psicologia , Adulto , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/tendências , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Percepção , Farmacêuticos/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/normas , Inquéritos e Questionários
9.
Curr Pharm Teach Learn ; 10(8): 1041-1047, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30314539

RESUMO

INTRODUCTION: Evidence-based health and medication information (HMI) sources and databases have a growing importance in daily professional practice in community pharmacies. Previous research suggests that students learn practical skills at the workplace through self-directed learning and practical experience rather than formal training. Thus, pharmacy internship is a key in ensuring pharmacy students' competency to use HMI sources and databases. This study assessed what HMI sources pharmacy students had used and accessible during their first internship in community pharmacies in Finland. METHODS: The data were collected as part of the obligatory assignments of the second year pharmacy students at the University of Helsinki during their first three-month internship in a community pharmacy in 2013 (n = 152, response rate 100%). RESULTS: The most commonly used HMI sources during the first internship period were electronic product-specific databases assisting in medication counselling, such as the checklist type generic prescription medication information database integrated into pharmacy prescription processing system, used daily by 74% of the students having access to the database (n = 121). Databases assisting in medication reviews were less commonly used although they were available in the majority of the pharmacies. DISCUSSION AND CONCLUSION: Although the majority of students had access to a wide range of HMI sources and databases during their internship, the actual use of sources other than product-specific medication information was limited, particularly the use of databases in assisting in medication reviews. It is important to facilitate their use in the second internship to acquire competences needed for their further use after graduation.


Assuntos
Serviços Comunitários de Farmácia/normas , Acesso aos Serviços de Saúde/normas , Disseminação de Informação/métodos , Estudantes de Farmácia/estatística & dados numéricos , Serviços Comunitários de Farmácia/tendências , Educação em Farmácia/métodos , Finlândia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Residências em Farmácia/métodos , Residências em Farmácia/normas
11.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174808

RESUMO

Background: Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients' self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. Objectives: This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients' medication(s) self-selection behaviour. Methods: A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants' medication self-selection behaviour. Results: Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were >40 years of age, 64.9% had a doctor's diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727). Conclusions: The factors associated with AR patients' self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management


No disponible


Assuntos
Humanos , Assistência Farmacêutica/tendências , Pesquisa em Farmácia/tendências , Serviços Comunitários de Farmácia/tendências , Comercialização de Medicamentos , Desenvolvimento Tecnológico , Comportamento Competitivo , Inovação Organizacional
12.
J Manag Care Spec Pharm ; 24(9): 896-902, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30156453

RESUMO

BACKGROUND: Medication therapy management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who received MTM versus those who did not. One possible reason for outcomes variability is differences in delivery of MTM programs. The Chronic Care Model (CCM) provides a framework for how health care organizations can improve care for the chronically ill through 6 elements: organization of health care, delivery system design, clinical information systems, decision support, self-management, and linkages to community resources. OBJECTIVE: To apply the CCM to understand variation in MTM delivery and formulate policy recommendations. METHODS: This study used a mixed-methods descriptive analysis of MTM delivery. Investigators conducted visits to a purposeful sample of MTM practices to observe MTM and interview participants. The pharmacists and staff of these practices completed a modified Assessment of Chronic Illness Care (ACIC). Pairs of investigators analyzed interview transcripts to identify themes. Demographics and ACIC scores were summarized using descriptive statistics. After analysis, investigators discussed overarching themes and policy implications organized by CCM elements. RESULTS: Seven practices participated, and 87 participants were interviewed. Based on ACIC scores, MTM patient volume, and payer mix, practices were categorized as Early Maturity Level or Later Maturity Level. From the model, organization of health care themes included whether MTM was the practice's core competence, belief/confidence in the MTM process, lack of formal rewards, and the influence of organizational goals and external environment. Delivery system design themes pertained to the extent that MTM processes were formalized. Clinical information systems themes were the extent to which systems were influenced by payers, efficiency strategies, and the accuracy and availability of information. In considering clinical decision support themes, alert design limitations and variation in user approaches to alerts based on experience were noted. We observed strong support for patient self-management; when present, barriers were attributed to the patient, MTM provider, or payer. Referral to community resources was minimal. Numerous policy implications were identified. CONCLUSIONS: Our research identified numerous ways by which MTM delivery varies, particularly by MTM practice maturity level. These findings provide evidence for several policy changes that could be considered to optimize MTM delivery, encourage alignment with the CCM, and promote practice maturation. DISCLOSURES: This research and a portion of Snyder's salary were supported by grant number K08HS022119 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Snyder reports consulting fees from Westat for an evaluation of the CMS Enhanced MTM program. The other authors have nothing to disclose. Portions of this research have been presented as abstracts at the following conferences: (a) 2017 Academy Health Annual Research Meeting; June 25-27, 2017; New Orleans, LA; (b) 2015 American Society of Health-System Pharmacists Clinical Midyear Meeting; December 4-8, 2015; New Orleans, LA; and


Assuntos
Serviços Comunitários de Farmácia/normas , Política de Saúde , Medicare Part D/normas , Conduta do Tratamento Medicamentoso/normas , Adulto , Serviços Comunitários de Farmácia/tendências , Feminino , Política de Saúde/tendências , Humanos , Masculino , Medicare Part D/tendências , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde/métodos , Avaliação de Programas e Projetos de Saúde/normas , Estados Unidos/epidemiologia
13.
Am J Pharm Educ ; 82(4): 6577, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29867246

RESUMO

Progressive pharmacy laws do not always lead to progressive pharmacy practice. Progressive laws are necessary, but not sufficient for pharmacy services to take off in practice. Pharmacy schools can play critical roles by working collaboratively with community pharmacies to close the gap between law and practice. Our experiences launching pharmacy-based point-of-care testing services in community pharmacy settings illustrate some of the roles schools can play, including: developing and providing standardized training, developing template protocols, providing workflow support, sparking collaboration across pharmacies, providing policy support, and conducting research.


Assuntos
Serviços Comunitários de Farmácia/legislação & jurisprudência , Educação em Farmácia/legislação & jurisprudência , Legislação Farmacêutica , Faculdades de Farmácia/legislação & jurisprudência , Serviços Comunitários de Farmácia/tendências , Educação em Farmácia/tendências , Humanos , Legislação Farmacêutica/tendências , Faculdades de Farmácia/tendências
14.
Sociol Health Illn ; 40(6): 1019-1036, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29671885

RESUMO

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed.


Assuntos
Serviços Comunitários de Farmácia/tendências , Prescrições de Medicamentos , Adesão à Medicação , Farmacêuticos , Atitude do Pessoal de Saúde , Política de Saúde , Humanos , Papel Profissional , Teoria Social
15.
Pediatrics ; 141(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29610400

RESUMO

BACKGROUND AND OBJECTIVES: Variability in primary medication nonadherence (PMN), or failure to fill a new prescription, influences disparities and widens equity gaps. This study sought to evaluate PMN across 1 metropolitan area and assess relationships with underlying zip code-level measures. METHODS: This was a retrospective observational study using data extracted from 1 regional community pharmacy market-share leader (October 2016-April 2017). Data included patient age, sex, payer, medication type, and home zip code. This zip code was connected to US census measures enumerating poverty and vehicle access, which were treated as continuous variables and within quintiles. The prescription-level outcome was whether prescriptions were not filled within 30 days of reaching the pharmacy. The ecological-level outcome was PMN calculated for each zip code (numerator, unfilled prescriptions; denominator, received prescriptions). RESULTS: There were 213 719 prescriptions received by 54 included pharmacies; 12.2% were unfilled. Older children, boys, and those with public insurance were more likely to have prescriptions not filled. Prescriptions originating from the highest poverty quintile were significantly more likely to not be filled than those from the lowest poverty quintile (adjusted odds ratio 1.60; 95% confidence interval 1.52-1.69); a similar pattern was noted for vehicle access (adjusted odds ratio 1.77; 95% confidence interval 1.68-1.87). At the ecological level, there were significant, graded relationships between PMN rates and poverty and vehicle access (both P < .0001); these gradients extended across all medication classes. CONCLUSIONS: Poverty and vehicle access are related to significant differences in prescription- and ecological-level PMN across 1 metropolitan area. Pharmacists and pharmacies can be key partners in population health efforts.


Assuntos
Serviços Comunitários de Farmácia/economia , Acesso aos Serviços de Saúde/economia , Adesão à Medicação , Pobreza/economia , Medicamentos sob Prescrição/economia , Transportes/economia , Adolescente , Criança , Pré-Escolar , Serviços Comunitários de Farmácia/tendências , Prescrições de Medicamentos/economia , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Pobreza/tendências , Estudos Retrospectivos
16.
Yakugaku Zasshi ; 138(2): 243-250, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-29386438

RESUMO

 While the community-based integrated care systems are in the process of being structured currently, more and more community pharmacists want to learn physical assessment skills. However, no large-scale survey focusing on present implementation status and problems of physical assessment by community pharmacists has been conducted yet. Osaka has the 2nd highest number of community pharmacies in Japan now, and the population aged ≥65 years will be expected to become the 3rd highest in 2025. Thus, Osaka can become a national leading model case for community pharmacists' activity in future home medical care. Therefore, this study aimed to reveal the present implementation status and problems of physical assessment by community pharmacists in Osaka, especially focusing on vital-signs. The questionnaires were sent to all the 3571 insurance pharmacies belonging to the Osaka Pharmaceutical Association and 871 pharmacies responded. Many pharmacists recognized the necessity for vital-signs measurement by pharmacists in home medical care (81.5% of pharmacies that offered home medical care and 75.4% of pharmacies that did not offer one). However, the proportion of pharmacies that conduct vital-signs measurement in home medical care was 18.7%, therefore, it was suggested that the present problem is "many pharmacists cannot conduct vital-signs measurement, although they think it should be conducted". Moreover, the most common reason for not measuring vital-signs was the lack of instruments, such as stethoscopes and sphygmomanometer (43.2%). This is the latest report with a large-scale sample, thus, it can serve as valuable knowledge in considering what pharmacists do for the future.


Assuntos
Serviços Comunitários de Farmácia , Serviços de Assistência Domiciliar , Farmacêuticos , Papel Profissional , Sinais Vitais , Competência Clínica , Serviços Comunitários de Farmácia/tendências , Serviços de Assistência Domiciliar/tendências , Humanos , Japão , Inquéritos e Questionários
17.
Int J Clin Pharm ; 40(2): 480-487, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29453677

RESUMO

Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed. The study population consisted of 126 patients with polypharmacy and with additional risk for drug related problems that underwent a medication review in five community pharmacies. The medication review was performed by the pharmacist in close cooperation with the general practitioner of each corresponding patient. Main outcome measure Number of (potentially inappropriate) drugs, and appropriateness of prescribed medicines. Results The average number of drugs a patient used 1 day before the review was 8.7 (SD = 2.9), which decreased (p < 0.05) to 8.3 (SD = 2.7) 1 week after the review, and to 8.4 (SD = 2.6) 3 months after the review. The average number of PIDs was initially 0.6 (SD = 0.8) per patient and decreased to 0.4 (SD = 0.6, p < 0.05). Twenty-two of the 241 initial drug changes (9%) were deprescribed during follow-up. Registered reasons for continuing PIDs are clinical or patients' preferences. Conclusions Performing medication reviews in polypharmacy patients seems useful to continue at least in high-risk patients in The Netherlands. The time-consuming reviews could be limited to patients who are willing to change their medication.


Assuntos
Prescrições de Medicamentos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/tendências , Reconciliação de Medicamentos/tendências , Polimedicação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Farmácia/tendências , Feminino , Humanos , Estudos Longitudinais , Masculino , Reconciliação de Medicamentos/métodos , Países Baixos/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Int J Clin Pharm ; 40(2): 345-353, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29435911

RESUMO

Background Pharmacists' interventions to improve outcomes of diabetes management have been promising. However, evidence on using telephone-based interventions in pharmacy practice are limited, particularly in developing countries. Objective To evaluate the efficacy of a telephone-based intervention to improve care and clinical outcomes in type-2 diabetes. Setting A referral community pharmacy and drug information center. Method We conducted a two-armed randomized controlled trial on 100 patients with type-2 diabetes. The intervention consisted of 16 telephone calls in 3 month by a trained pharmacist working in an academic drug information center, while the control group received usual care. Before random allocation, patients attended a live education session delivered by pharmacists to learn the basics of diabetes care and to confirm the eligibility criteria. Assessments were performed at baseline, month-3 (after intervention), and month-9 (follow-up). Main outcome measure Hemoglobin A1c (HbA1c). Results Eighty four patient completed the trial. Baseline variables were comparable between the two groups and the baseline value of hemoglobin A1c was 8.00 ± 1.44 in the study population. HbA1c was significantly improved in both groups at month-3 (6.97 ± 1.41 vs. 7.09 ± 1.78) and remained steady at month-9 (6.96 ± 1.44 vs. 7.26 ± 1.85). Lipid profile showed small improvements in the intervention group but was not significant. The adherence score and self-care score improvement was significantly higher in the intervention group at month-3 and were maintained at month-9. Conclusion Medication adherence and self-care significantly improved in the telephone-based intervention group. However, the improvement of clinical outcomes might have been diluted due to the live diabetes education session.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Adesão à Medicação , Farmacêuticos/estatística & dados numéricos , Papel Profissional , Telefone/estatística & dados numéricos , Adulto , Idoso , Serviços Comunitários de Farmácia/tendências , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Farmacêuticos/tendências , Autocuidado/estatística & dados numéricos , Autocuidado/tendências , Telefone/tendências , Resultado do Tratamento
19.
Fundam Clin Pharmacol ; 32(3): 306-322, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29436015

RESUMO

Diversion of prescription drugs is difficult to assess in quality and quantity. This study aimed to characterize diversion of prescription drugs in France through a comparative analysis of falsified prescriptions collected during three periods from 2001 to 2012. The data recorded in a national program which records all falsified prescriptions presented to community pharmacies were studied. Included data regarded: subjects, prescription forms, and drugs. Description of the dataset in three periods (2001-2004, 2005-2008, and 2009-2012) was completed with clustering analyses to characterize profiles of prescriptions and subjects associated with the most reported drugs. The 4469 falsified prescriptions concerned most often females (51.6%). Average age was 46.5 years. Zolpidem, bromazepam, and buprenorphine were the most frequent drugs. Alone, 13 drugs (1.7%, 13/772) represented more than 40% of the total reports (3055/7272). They were associated with three diversion profiles: (i) buprenorphine, flunitrazepam, and morphine were mentioned on overlapping secure prescription forms presented by young men; (ii) alprazolam, bromazepam, zolpidem, codeine/acetaminophen were mentioned on simple prescription forms presented by experienced women; and (iii) acetaminophen and lorazepam were mentioned on modified prescription forms presented by elderly subjects. Clonazepam, clorazepate, dextropropoxyphene, zopiclone moved between those profiles. The patterns of falsified prescriptions provided in this study contribute to enhance the scientific knowledge on the most diverted prescription drugs. The latter follow distinct trajectories across time depending on their pharmacology (including their abuse/addiction potential) and on their regulation's history. The close and continuous analysis of falsified prescriptions is an excellent way to monitor prescription drug diversion.


Assuntos
Serviços Comunitários de Farmácia/tendências , Prescrições de Medicamentos , Fraude/tendências , Pacientes/psicologia , Desvio de Medicamentos sob Prescrição/tendências , Uso Indevido de Medicamentos sob Prescrição/tendências , Programas de Monitoramento de Prescrição de Medicamentos/tendências , Adulto , Fatores Etários , Análise por Conglomerados , Feminino , França , Fraude/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Desvio de Medicamentos sob Prescrição/psicologia , Uso Indevido de Medicamentos sob Prescrição/psicologia , Avaliação de Programas e Projetos de Saúde , Fatores Sexuais , Fatores de Tempo
20.
Int J Clin Pharm ; 40(2): 458-463, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29442280

RESUMO

BACKGROUND: Patient satisfaction is an important determinant of the feasibility and sustainability of community pharmacy screening services. However, few studies have evaluated this, with no such study performed for a chronic kidney disease risk assessment service. OBJECTIVE: The aim was to determine patient satisfaction with a chronic kidney disease risk assessment service performed in community pharmacies. SETTING: Community pharmacies in the state of Tasmania, Australia. METHOD: An anonymous nine-item satisfaction survey, with Likert-type scales, was developed following a literature review of existing surveys. Reliability of the nine-item scale was determined using Cronbach's alpha. Patients were asked an additional question on willingness to pay, with choices of amount from $5 to $25. The satisfaction survey was mailed to 389 patients who participated in the chronic kidney disease risk assessment study. MAIN OUTCOME MEASURE: Patient level of satisfaction with and willingness to pay for the chronic kidney disease service. RESULTS: Responses from 143 participants were included in the final analysis. Cronbach's alpha for the nine-item satisfaction scale was 0.87. The majority of participants agreed that the time required to undergo the risk assessment process was justified (90.2%); overall, they were satisfied with the chronic kidney disease risk assessment service (90.0%) and they felt comfortable with the pharmacist referring their results to their doctor (88.9%). Of 136 participants who answered the question on willingness to pay, 62.9% indicated that they would pay for the chronic kidney disease service. Of these, 29.2, 25.8 and 19.1% were willing to pay $20, $10 and $5, respectively. CONCLUSION: Patient satisfaction with the community pharmacy-based chronic kidney disease risk assessment was high. These findings provide support for the implementation of the service within community pharmacy practice.


Assuntos
Serviços Comunitários de Farmácia/tendências , Satisfação do Paciente , Farmacêuticos/tendências , Papel Profissional , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/psicologia , Idoso , Serviços Comunitários de Farmácia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Medição de Risco , Tasmânia/epidemiologia
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