A holistic and integrated approach to implementing cognitive pharmaceutical services

La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentrasometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidorescomo de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su prácticahacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estosservicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en susdefiniciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellospueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisionesclínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión estánrelacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a laspolíticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes delcambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y lainvestigación en práctica farmacéutica que se ha venido realizando con anterioridad han sidosintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamientoholístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puedeenmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organizaciónprofesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con laimplantación de servicios ha mostrado la aplicación de programas de implantación que han incluidouno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrolladoun modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado yholístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) quepretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, elservicio de seguimiento farmacoterapéutico.Community pharmacy is part of the health care system which is currently under economic pressureand facing changes in demands from consumers and government. In response, the pharmacy profession is becoming more patient orientated and implementing cognitive pharmaceutical services(CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels andusing different tools. However, they can be classified using a broad hierarchical model based onclinical decision making and the extent of change required (Box 1). The challenges faced by theprofession are related the development of a new patient orientated model of pharmacy which affectshealth care policy, education and research, the evolution of the market, the individual andorganisational approaches to change and the implementation of CPS. These issues and previousresearch conducted in pharmacy practice have been synthesised to provide a platform for change thatcan guide a holistic and integrated approach to CPS implementation. Implementation can beconceptually framed in six levels: clinical, service provision, community pharmacy, professionalorganisation, government and stakeholder (Figure 1). Past experience with service implementation hasseen the application of programs that include one or two of these levels in practice rather than aholistic approach. A concentric model was developed to illustrate the implementation of CPS and theholistic and integrated approach required to support change. A program (conSIGUE) being conductedin Spain has attempted to integrate all six levels to support the implementation and evaluation of amedication management service (Seguimiento Farmacoterapéutico

From "retailers" to health care providers: Transforming the role of community pharmacists in chronic disease management

© 2015. Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes

Progress in patient couselling practices in Finnish community pharmacies

Access restricted by publisherObjective The aim of this study was to assess progress in patient counselling practices in Finnish community pharmacies during a national four-year program (TIPPA) from 2000–2003 promoting enhanced pharmacist–customer communication about medicines. Method A pseudo customer method was applied. Four visits with four different scenarios were conducted in a convenience sample of 60 Finnish community pharmacies of different size and geographic location. In total there were 240 visits during each time point measured (baseline in 2000 and three annual follow-ups, n = 960). The pseudo customers presented three scenarios related to self-medication and one related to a prescription medicine with a new prescription (baseline and the second follow-up) or a repeat prescription of the same medication (the first and the third follow-up). A structured data form customised to each scenario was used to record the interaction. Key findings Baseline scores were generally low. In two of the four scenarios (one self-medication and one prescription) a statistically significant improvement (P < 0.05) was found in total scores between the baseline and the third follow-up. Aggregation of the scores of the three self-medication scenarios did not show any change in counselling practices between the baseline and the third follow-up, measured as mean total scores (P = 0.439). Conclusions Some improvements were found in pharmacists' counselling performance in relation to customers' requests for advice about nasal products and also when prescription scenarios were presented. However, pharmacists' counselling rates were low in relation to a repeat prescription or when a request was made to buy a specific medicine. Further attention needs to be paid to the latter two types of consultation

Serviços Farmacêuticos em Doentes com Insuficiência Renal Crónica

O papel dos farmacêuticos na assistência a doentes com insuficiência renal crónica tem sido documentado na literatura internacional e este estudo teve como objetivo compilar os serviços farmacêuticos prestados para que possam vir a ser considerados para eventual adaptação à realidade Portuguesa.Conduziu-se uma busca nas fontes secundárias Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts e The Cochrane Library para recolher estudos descrevendo intervenções farmacêuticas em doentes com insuficiência renal crónica. No final, e após aplicação dos critérios de inclusão e exclusão, foram incluídos e analisados 37 estudos (correspondendo a 38 artigos). As intervenções farmacêuticas reportadas nos estudos foram: revisão do perfil farmacoterapêutico para identificação de problemas relacionados com a medicação, ajuste e otimização da terapêutica, identificação e correção de discrepâncias nos processos clínicos, avaliação da adequação da terapêutica durante a admissão e alta hospitalares, monitorização de parâmetros laboratoriais, implementação de protocolos de atuação na anemia, hiperparatiroidismo secundário, e hiperlipidemia, educação dos doentes, promoção da adesão à terapêutica, participação nas visitas médicas e reuniões multidisciplinares, comunicação e interação com outros profissionais de saúde, e fornecimento de informação sobre a escolha de fármacos e regimes terapêuticos.Em conclusão, a análise da literatura internacional revelou uma multiplicidade de potenciais intervenções farmacêuticas em doentes com insuficiência renal crónica que evidenciam o potencial de atuação do farmacêutico no processo de uso de medicamentos destes doentes e na melhoria dos resultados clínicos.The role of pharmacists caring for patients with chronic kidney disease has been documented in the international literature. This study aims at compiling all pharmaceutical services provided to these patients in order to adapt them to the Portuguese reality. Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts and The Cochrane Library were searched for studies describing pharmacist interventions in patients with chronic kidney disease. Ultimately, and after applying the inclusion and exclusion criteria, 37 studies (corresponding to 38 articles) were included and analysed. Pharmacist interventions reported were: performing medication reviews to identify drug-related problems, adjusting and optimising drug therapy, identifying and correcting drug records discrepancies, evaluating admission and discharge medication appropriateness, performing laboratory monitoring of specific parameters, implementing anaemia-managing, phosphate-managing and lipid-managing protocols, performing patient education, improving compliance, participating in medical rounds and multidisciplinary patient care meetings, communicating and interacting with other health care professionals, and providing information about drug selection and therapeutic regimes. In conclusion, a multitude of potential pharmacist interventions in patients with chronic kidney disease was reported in the literature, where pharmacists played a key role in contributing to improve the process of use of medicines and clinical outcomes in these patients.

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies

Background: Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service’s impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient’s outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. Methods: A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. Results: The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on costeffectiveness outcomes. Conclusions: There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed

Percepción de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria

Objetivo: Explorar la percepción de Formadores Colegiales con experiencia previa sobre su formación y sus funciones futurasen la implantación y sostenibilidad del servicio de Seguimiento Farmacoterapéutico en el ámbito de la farmacia comunitariaespañola. Método: Estudio cualitativo mediante la técnica del grupo focal. El coordinador de la reunión focal utilizó un guión temáticopreviamente elaborado que permitía explorar la opinión de los Formadores Colegiales sobre sus experiencias y percepciones acercadel futuro de esta nueva figura profesional. El contenido de la conversación fue registrado en una grabadora, transcrito en su totalidady posteriormente analizado mediante análisis de contenido. Resultados: La reunión grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmacéuticos, en Madrid, tuvo unaduración de 95 minutos. Participaron seis Formadores Colegiales. En función de los temas tratados se identificaron dos dimensiones;una primera que abarca las funciones que debe desempeñar un Formador Colegial (resaltando la función de motivador, facilitadorde la comunicación y formador metodológico y clínico) y una segunda en las que se describen las características que ese profesionaldebe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio deFarmacéuticos correspondiente, con lugar físico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otrascaracterísticas). Conclusiones: El presente artículo aporta información relevante sobre la figura innovadora del Formador Colegial, describiendo lascaracterísticas intrínsecas necesarias para desarrollar su labor y las funciones a desempeñar. Dicha información debería ser utilizadapor aquellos Colegios Oficiales de Farmacéuticos provinciales que deseen implantar Servicios Profesionales Farmacéuticos, talescomo el servicio de Seguimiento Farmacoterapéutico

Percepción de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria

Objetivo: Explorar la percepción de Formadores Colegiales con experiencia previa sobre su formación y sus funciones futurasen la implantación y sostenibilidad del servicio de Seguimiento Farmacoterapéutico en el ámbito de la farmacia comunitariaespañola. Método: Estudio cualitativo mediante la técnica del grupo focal. El coordinador de la reunión focal utilizó un guión temáticopreviamente elaborado que permitía explorar la opinión de los Formadores Colegiales sobre sus experiencias y percepciones acercadel futuro de esta nueva figura profesional. El contenido de la conversación fue registrado en una grabadora, transcrito en su totalidady posteriormente analizado mediante análisis de contenido. Resultados: La reunión grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmacéuticos, en Madrid, tuvo unaduración de 95 minutos. Participaron seis Formadores Colegiales. En función de los temas tratados se identificaron dos dimensiones;una primera que abarca las funciones que debe desempeñar un Formador Colegial (resaltando la función de motivador, facilitadorde la comunicación y formador metodológico y clínico) y una segunda en las que se describen las características que ese profesionaldebe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio deFarmacéuticos correspondiente, con lugar físico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otrascaracterísticas). Conclusiones: El presente artículo aporta información relevante sobre la figura innovadora del Formador Colegial, describiendo lascaracterísticas intrínsecas necesarias para desarrollar su labor y las funciones a desempeñar. Dicha información debería ser utilizadapor aquellos Colegios Oficiales de Farmacéuticos provinciales que deseen implantar Servicios Profesionales Farmacéuticos, talescomo el servicio de Seguimiento Farmacoterapéutico

Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis

Abbreviations: BCT, Behavioural change techniques taxonomy; BCW, Behavioural change wheel; CFIR, Consolidated framework for implementation research; EPOC, Cochrane effective practice and organisation of care; FISpH, Framework for the implementation of services in pharmacy; GIF, Generic implementation framework; KPI, Key performance indicator; TDF, Theoretical domains frameworkBackground: Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published. Methods: Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation. Results: Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking. Conclusions: The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.The study was funded as part of a University of Technology Sydney (UTS) Research Excellence Scholarship (RES), comprising of an Australian Postgraduate Award (APA) Scholarship funded by the Australian Government, plus a Top-up funded by the University of Technology Sydney, received from the primary author (JCM)

Migration as a form of workforce attrition: a nine-country study of pharmacists

Background There is a lack of evidence to inform policy development on the reasons why health professionals migrate. Few studies have sought to empirically determine factors influencing the intention to migrate and none have explored the relationship between factors. This paper reports on the first international attempt to investigate the migration intentions of pharmacy students and identify migration factors and their relationships. Methods Responses were gathered from 791 final-year pharmacy students from nine countries: Australia, Bangladesh, Croatia, Egypt, Portugal, Nepal, Singapore, Slovenia and Zimbabwe. Data were analysed by means of Principal Components Analysis (PCA) and two-step cluster analysis to determine the relationships between factors influencing migration and the characteristics of subpopulations most likely and least likely to migrate. Results Results showed a significant difference in attitudes towards the professional and sociopolitical environment of the home country and perceptions of opportunities abroad between those who have no intention of migrating and those who intend to migrate on a long-term basis. Attitudes of students planning short-term migration were not significantly different from those of students who did not intend to migrate. These attitudes, together with gender, knowledge of other migrant pharmacists and past experiences abroad, are associated with an increased propensity for migration. Conclusion Given the influence of the country context and environment on migration intentions, research and policy should frame the issue of migration in the context of the wider human resource agenda, thus viewing migration as one form of attrition and a symptom of other root causes. Remuneration is not an independent stand-alone factor influencing migration intentions and cannot be decoupled from professional development factors. Comprehensive human resource policy development that takes into account the issues of both remuneration and professional development are necessary to encourage retention