Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care: a systematic literature review and international consensus development

Background Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general defnition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. Aim This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. Method A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modifed Delphi technique to develop the definition of QIs for PhC. Results A total of 182 QI definitions were identifed from 174 articles. Of these, 63 QI definitions (35%) cited one of fve references as the source. Sixteen aspects that construct QI definitions were derived from the identifed definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence defnition of QIs for PhC: “quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists”. Conclusion Building upon existing defnition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC

Drug-related problems. Identification, characteristics and pharmacy interventions

Introduction: Drug-related morbidity and mortality represent a major problem to patients, public health and society. Hence, there is a need to do more research in patients' medication practices and to find ways to improve the use of drugs. Pharmacy practitioners are in a unique position to identify, correct and prevent the occurrence of drug-related problems (DRPs) because of their training and regular contacts with patients. Objectives: To (1) develop instruments for the documentation of DRPs in pharmacy clients; (2) examine the frequency and characteristics of DRPs identified in community pharmacy practice and resulting interventions; (3) analyze relationships among the number and types of problems and patient characteristics, class of drug and symptoms; (4) explore pharmacy personnel and work site factors influencing the DRP identification and detection rates; (5) study pharmacy practitioners' views on computerized documentation of DRPs; and (6) develop, apply, and follow-up a pharmacy OTC counseling model, aimed at an improved management of problems related to symptoms and drug use in dyspepsia clients.Methods: (1) Development and application of (a) a manual and (b) a computerized systemfor the documentation of DRPs, patient variables and pharmacy interventions; (2) examination of pharmacy practitioners' views and experiences by the use of different attitudinal instruments; (3) development and application of a pharmacy OTC counseling model; and (4) telephone follow-up interviews of dyspepsia clients.Results: The developed documentation instruments worked well in daily practice according to the majority of the participating practitioners. Uncertainty about the aim of the drug, various dosage problems and therapy failure belonged to the most frequently identified DRPs. Several patient groups were significantly over-represented among the problems. The educational level of the pharmacy personnel and their commitment had significant effects on the DRP documentation rates. Patient drug counseling and switch of OTC drugs were common interventions. Pharmacy practitioners reported positive experiences of a developed IT-based DRP documentation system. Patients appreciated the pharmacy OTC counseling model used and complied with given self care advice. However, most referred patients did not see a physician. Conclusions: The research leading to this thesis has demonstrated a need for professional attention and intervention by pharmacy staff to identify, prevent and resolve DRPs in pharmacy clients. Education, experience, IT-based documentation and commitment favor DRP identification.A developed pharmacy OTC counseling model had a positive impact on outcomes in dyspepsia clients

Use of an electronic expert support system in a Swedish community pharmacy to identify and resolve drug-related problems

Background The Lund Integrated MedicinesManagement model offers a systematic approach forindividualising and optimising patient drug treatment.Clinical, economical and humanistic outcomes havebeen shown as well as results from the medicationreconciliation process. There is a need also to describethe medication review process.Objective To describe the frequency and types of drug-relatedproblems (DRPs) identified during medicationreviews and to evaluate the actions of the pharmacistsand the physicians regarding the identified DRPs.Method Structured medication reviews were conductedby a multi-professionalteam on top of standard care for719 patients in two internal medicine wards in a SwedishUniversity Hospital. The medication reviews were studiedretrospectively to classify DRPs and actions taken.Results A total of 573 (80%) of patients had at leastone actual DRP; an average of three DRPs per patientand in total 2164. Wrong drug and adverse drug reactionwere the most common types of DRPs. The most frequentmedication groups involved in DRPs were drugs forthe cardiovascular system and the nervous system andthe most frequent substances were warfarin, digoxin,furosemide and paracetamol. The 10 most commonmedications accounted for 27% of the actual DRPs. Ofthe identified DRPs, a total of 1740 (80%) were actedon. The three most common types of adjustments madewere withdrawal of drug therapy, change of drug therapyand initiation of drug therapy. When the pharmacistsuggested an adjustment, the physician implemented88% (1037/1174) of the recommendations.Conclusion DRPs are common among elderly patientswho are admitted to hospital. Systematic identificationof high-riskmedications and common DRP types enablestargeting of prioritised patients for medication reviews..</p

Community pharmacy and primary health care in Sweden - at a crossroads

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business

Community pharmacy and primary health care in Sweden : at a crossroads

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital ("online doctors") and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digiphysical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business

Role of community pharmacy and pharmacists in self care in Sweden

Background: Self care is an important concept, which is increasingly being applied by policy makers on a large scale. It is associated with improved health literacy and technological advances. Community pharmacy practitioners are easily accessible for self care counselling, purchase of non-prescription products and for referrals to other healthcare providers. Objective: To describe self care policies and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy. Methods: A search was conducted to retrieve self care policy documents and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy on respective websites, as well as personal contacts with key persons in pharmaceutical organizations and community pharmacy practice. Results: A new law on self care was adopted by the Swedish Parliament becoming effective in 2023. The law defines self care as a healthcare measure that has been assessed by a treating licenced healthcare practitioner to be possible to be performed by the patient him/herself. The law includes a wide range of measures. According to a Government Commission that followed Sweden's the National Pharmaceutical Strategy's Action Plan in 2018, the Medical Products Agency (MPA) was assigned to establish requirements of qualifications in self care counselling. In its report in late 2022, the MPA stated that self care counselling by community pharmacy practitioners plays an important role in society. The new requirements are expected to become effective in mid-2023. None of the four community pharmacy chains operating 97% of Sweden's community pharmacies have developed any specific self care policies, although self care counselling and sales of non-prescription products, as well as provision of some primary healthcare services, constitute important components of their operations. Furthermore, all Swedish pharmacies offer several digital self care solutions, supporting people to manage their own health. Neither the Swedish Pharmacy Association, representing most pharmacies, nor the Swedish Pharmacists Association, the trade union, have developed any self care policies. However, the Swedish Association of the Pharmaceutical Industry is promulgating Swedish self care reform using a systematic review of self care and which medicines should be over-the-counter. Conclusions: Self care is not currently established as a core pillar of a Swedish national health strategy. There are further opportunities to enable pharmacists to fulfil their potential in supporting individual wellbeing and promoting self care interventions. A new system needs to be created which fully integrates the promotion of everyday wellbeing, self care for self-treatable conditions and the management of long-term conditions

Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden : after re-regulation of the pharmacy market

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden &gt;= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden