The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach.

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

A communication procedure between community pharmacists and primary care professionals resolves medication errors and other administrative issues.

OBJECTIVES: The aim of this study was to implement a communication procedure, with agreed-upon protocols, to resolve daily medication errors and other administrative issues that require communication between community pharmacists (CPs) and primary healthcare professionals (PHCPs). METHODS: A 6-month pilot study followed by a year-length principal study was carried out in the Donostialdea Integrated Healthcare Organisation (IHO). Afterwards, the project was extended to other IHOs. The CPs identified medication errors or other administrative issues that required communication with PHCPs, contacting the customer service staff by telephone for urgent problems and by email for non-urgent problems. KEY FINDINGS: In total, 49 community pharmacies participated in the study. A total of 1179 medication errors and other administrative issues were detected, and over 90% of problems were solved in less than 24 h (n = 1079, 91.5%). Email was the more frequently used communication method (n = 874, 74.1%), and the most prevalent problems were due to absent (n = 766, 65.0%) and expired (n = 226, 19.2%) electronic prescriptions. Most of the participants were satisfied with the programme. CONCLUSION: The present communication procedure between CPs and PHCPs is an efficient tool to resolve a variety of challenges that occur in community pharmacies.

Defining and characterising age-friendly community pharmacies: a qualitative study.

INTRODUCTION: The Global Network of Age-friendly Cities is a project promoted by the World Health Organization as a response to demographic ageing and urbanization process. San Sebastian, Spain, is one of these Age-friendly Cities and community pharmacies of the city joined the initiative. OBJECTIVE: To define and implement the Age-friendly Pharmacy concept to promote active ageing, optimize the contribution of community pharmacies of San Sebastian to the friendliness of the city and to the improvement of quality of life of the ageing population. METHOD: A bottom-up participative approach was undertaken. A focus group was conducted to determine elderly people's opinions and expectations of community pharmacy. The information obtained was analysed using content analysis and validated for reliability, usefulness and applicability through three expert groups of community pharmacy owners and staff. KEY FINDINGS: Fifteen requirements were agreed, covering four main areas: relationships, pharmacy layout, pharmaceutical services and communication of services. Initially, 18 community pharmacies committed to become Age-friendly Pharmacies by pledging to these requirements and the Official Pharmacist Association of Gipuzkoa supported pharmacies in the implementation of the initiative. CONCLUSION: This study suggests that there is demand for a patient-centred community pharmacy to support older people, in which pharmaceutical care services are required. The 18 Age-friendly Pharmacies together with the Official Pharmacist Association of Gipuzkoa have publicly committed to actively work on social and patient-centred care to meet the needs of the ageing population.

Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial.

OBJECTIVE: To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING: Forty-six community pharmacies and 50 primary care centers of Spain. STUDY DESIGN: Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention-to-treat (ITT) analysis was performed with multiple imputation to replace the missing data. DATA COLLECTION: Adherence, total cholesterol levels, and lifestyle behaviors. FINDINGS: The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30-1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81-3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). CONCLUSIONS: The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.

Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain.

BACKGROUND: In 1999, the Pharmacists Association of Gipuzkoa, a Spanish province with a population of 700,000, initiated a campaign to reduce the common practice in community pharmacies of dispensing antibiotics without prescription. OBJECTIVE: The study was designed to assess the ongoing effectiveness of this program in reducing nonprescription dispensing of antibiotics. METHODS: In March 2009, 2 young women posed as simulated patients and visited each of the 280 operating community pharmacies in Gipuzkoa. In 139 of these pharmacies, randomly selected, the simulated patients feigned the symptoms of an uncomplicated urinary tract infection and requested an unspecified antibiotic. In the remaining 141, the actress requested a specific antibiotic, only describing her symptoms upon request by the dispensing staff. The rate of nonprescription dispensing had previously been estimated at 70.5% in 2000 and 42.2% in 2004. Univariate and multivariate analyses were performed, based on a number of variables related to the pharmacy and staff. RESULTS: In the current study, antibiotics were dispensed without prescription by 49 of 280 pharmacies (17.5%). The product- and symptom-based scenarios had similar rates of 16.3% and 18.7%, respectively. The only variables which appeared to affect the nonprescription dispensing rate were the gender of the dispenser, being males more likely to dispense (OR=3.135, 95%CI [1.286, 7.646]), and the number of previous antibiotic-awareness campaigns in which the pharmacy had participated (OR=1.057, 95% CI [1.008, 1.107]). The community population, its number of pharmacies, the years in business of each pharmacy, or its revenue, did not appear to influence the nonprescription dispensing rate. CONCLUSIONS: A long-term multifactorial program set up by the pharmacists association of Gipuzkoa, Spain, appears to have been effective in reducing the rate at which antibiotics are dispensed without a prescription in community pharmacies.