Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease

© 2016 Elsevier Inc. Background Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system. Objectives The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia. Methods An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis. Results The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Secondary results of the workshop included: a list of needs and gaps in cardiovascular care (n = 6), a list of roles for community pharmacists in cardiovascular prevention (n = 12) and a list of potential factors (n = 7) that can hinder the integration of community pharmacy services into practice. Conclusions This stakeholder analysis provided a detailed picture of the wide range of stakeholders across the entire health care system that have a stake in the development of a community pharmacy service aimed at preventing CVD. Of these, a core group of key stakeholders, with complementary roles, can then be approached for further planning of the service. The results of this analysis highlight the relevance of establishing multilevel stakeholder groups for CPS planning

Effect of pharmaceutical intervention on medication adherence and blood pressure control in treated hypertensive patients: Rationale, design and methods of the AFenPA pilot study.

Objetivo: Evaluar el efecto de una intervención farmacéutica protocolizada sobre el control de la presión arterial y la adherencia al tratamiento farmacológico en pacientes usuarios de farmacias comunitarias.Material y métodos: Estudio cuasi-experimental con grupo control en el que se comparará el efecto de una intervención farmacéutica (grupo intervención) con el proceso de atención habitual (grupo control), sobre la presión arterial y la adherencia al tratamiento de pacientes hipertensos tratados farmacológicamente en farmacias comunitarias. Los pacientes serán distribuidos de forma equitativa en ambos grupos (n control = n intervención) y serán seguido durante 6 meses. El programa de la intervención farmacéutica constará de tres partes fundamentales: 1) educación/información al paciente sobre aspectos relacionados con la hipertensión y adherencia al tratamiento farmacológico, 2) automonitorización de la presión arterial y, 3) interacción con el médico mediante informes personalizados cuando la media de las cifras de presión arterial realizadas en el domicilio superen el objetivo terapéutico acorde con la situación clínica del paciente. Para evaluar el efecto de la intervención farmacéutica sobre la adherencia terapéutica y la presión arterial se obtendrán medidas de presión arterial en la farmacia y porcentaje de cumplimiento terapéutico mediante recuento de comprimidos en ambos grupos al principio y al final del estudio.Discusión: Según nuestros conocimientos, éste es el primer estudio que se realiza en farmacia comunitaria en España para probar la efectividad de una intervención farmacéutica conjuntamente con la automedida de la presión arterial sobre el control de la presión arterial. Además, la intervención farmacéutica se ha diseñado de forma que pueda integrase como práctica habitual enmarcada dentro de la Atención Farmacéutica.Objective: To assess the effect of a protocol-based pharmacist intervention on blood pressure control and medication adherence among treated hypertensive patients who are users of community pharmacies.Methods: A quasi experimental study design with control group has been designed to compare the effect of pharmaceutical intervention (intervention group) versus the standard healthcare procedure (control group) on blood pressure and medication adherence among hypertensive patients receiving drug therapy in community pharmacies. The patients will be allocated evenly between the two groups (ncontrol = nintervention), with a 6-month follow-up. The pharmaceutical intervention program will comprise three main parts: 1) patient education / information on issues relating to hypertension and medication adherence; 2) self-monitoring of blood pressure; and 3) interaction with the physician through personalized reports when the mean blood pressure values recorded at home exceed the treatment goal according to the clinical condition of the patient. In order to evaluate the effect of the pharmaceutical intervention upon medication adherence and blood pressure, blood pressure recordings will be made in the pharmacy, while percent medication adherence will be established based on pill count in both groups at the start and end of the study.Discussion: To our knowledge, this is the first study in the community pharmacy setting in Spain to evaluate the effectiveness of pharmaceutical intervention in combination with home blood pressure monitoring on blood pressure control. In addition, the pharmaceutical intervention has been designed for inclusion as standard practice in the context of Pharmaceutical Care

Identifying masked uncontrolled hypertension in the community pharmacy setting

© 2015 Wolters Kluwer Health, Inc. Masked uncontrolled hypertension (MUCH) is associated with an increased cardiovascular risk. This condition is frequent in the community pharmacy (i.e., CP-MUCH), but there is no evidence on the factors associated with its presence in that setting. The aim of this analysis was to explore these factors. A sample of 98 treated hypertensive patients from the MEPAFAR study, with normal community pharmacy blood pressure (CPBP <135/85 mmHg), were analyzed. Blood pressure (BP) was also measured at home (4 days) and monitored for 24 h. CP-MUCH was identified when either ambulatory (daytime) or home BP averages were equal to or higher than 135/85 mmHg. A multivariate logistic regression analysis was carried out to identify the factors associated with CP-MUCH. The prevalence of CP-MUCH tends to be higher as systolic and diastolic CPBP increase, reaching 47% in patients with both systolicand diastolic CPBP equal to or higher than 123 mmHg and 79 mmHg, respectively.The multivariate regression analysis showed only systolic CPBP as an independent factor of CP-MUCH [≥123 mmHg: odds ratio=16.46 (P=0.012); from 115 to 122.9 mmHg: odds ratio=10.74 (P=0.036); systolic CPBP <115 mmHg as the reference]. Further assessment, using ambulatory and/or home BP monitoring, is recommended in patients with normal CPBP, but systolic CPBP equal to or higher than 115 mmHg. A more feasible approach would be evaluating patients with systolic CPBP equal to or higher than 123 mmHg and diastolic CPBP equal to or higher than 79 mmHg

Métodos de medida de la presión arterial disponibles en la farmacia comunitaria para el cribado y seguimiento de la hipertensión arterial

La medida de la presión arterial (PA) en la consulta médica (PAC) ha sido durante muchos años el método de referencia para realizar el diagnóstico, seguimiento y tomar las decisiones clínicas en el manejo de la hipertensión arterial (HTA). Por otra parte, la medida de la PA en la farmacia comunitaria es un método poco estudiado y su utilidad en la práctica clínica es, cuando menos, desconocida. La aparición de la automedida domiciliariade la PA (AMPA) y de la monitorización ambulatoria de la PA (MAPA) ha permitido superar muchas de las limitaciones inherentes a la medida de la PAC, principalmente al proporcionar múltiples medidas de PA exentas del efecto de bata blanca. Además, estos métodos han demostrado relacionarse más estrechamente que la medida de la PAC con el pronóstico cardiovascular y la lesión de órganos diana. En definitiva, la AMPA y la MAPA proporcionan una evaluación más precisa (p. ej., del riesgocardiovascular o del efecto de los tratamientos antihipertensivos) y un mejor manejo del paciente con HTA. El presente artículo ofrece una visión actualizada sobre el interés de los distintos métodos de medida de la PA disponibles en la farmacia para el cribado y seguimiento del paciente hipertenso

Métodos de medida de la presión arterial disponibles en la farmacia comunitaria para el cribado y seguimiento de la hipertensión arterial

La medida de la presión arterial (PA) en la consulta médica (PAC) ha sido durante muchos años el método de referencia para realizar el diagnóstico, seguimiento y tomar las decisiones clínicas en el manejo de la hipertensión arterial (HTA). Por otra parte, la medida de la PA en la farmacia comunitaria es un método poco estudiado y su utilidad en la práctica clínica es, cuando menos, desconocida. La aparición de la automedida domiciliariade la PA (AMPA) y de la monitorización ambulatoria de la PA (MAPA) ha permitido superar muchas de las limitaciones inherentes a la medida de la PAC, principalmente al proporcionar múltiples medidas de PA exentas del efecto de bata blanca. Además, estos métodos han demostrado relacionarse más estrechamente que la medida de la PAC con el pronóstico cardiovascular y la lesión de órganos diana. En definitiva, la AMPA y la MAPA proporcionan una evaluación más precisa (p. ej., del riesgocardiovascular o del efecto de los tratamientos antihipertensivos) y un mejor manejo del paciente con HTA. El presente artículo ofrece una visión actualizada sobre el interés de los distintos métodos de medida de la PA disponibles en la farmacia para el cribado y seguimiento del paciente hipertenso

Available measurement methods of blood pressure at the community pharmacy for the screening and follow up of hypertension

The blood pressure (BP) measurement in the physician's office has been for many years the gold standard for diagnosis, monitoring and making clinical decisions in the management of hypertension. On the other hand, few studies analyze the usefulness of the community pharmacy BP measurement method, which remains unknown in clinical practice. Home and ambulatory BP monitoring (HBPM and ABPM, respectively) have overcome many of the inherent limitations of the BP measurement at the physician's office, mainly providing multiple BP readings exempt from the white coat effect. Additionally, these methods have shown to be better predictors of end-organ damage and cardiovascular outcome than BP measured in the physician's office. Finally, the use of HBPM or ABPM enables a more accurate assessment and an improved management of hypertension. This article provides an overview update on the interest of the different BP measurement methods available in the community pharmacy for the screening and monitoring of hypertensive patients

Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies

© 2016 Elsevier España, S.L.U. Objectives To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. Design Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. Location Spanish Community Pharmacies. Participants There were 323 patients in the control group, from the 640 who completed the study. Main measurements Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. Results For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). Conclusions According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity