The Pharmaceutical Care Network Europe (PCNE) was established in 1994 by a number of European pharmaceutical care researchers. It became an official association (under Dutch law) in 2004.
4-7 March 2009
The 6th Working Conference of the Pharmaceutical Care Network Europe
Dear friends, dear colleagues,
It has been a pleasure to see many of you at the Sixth International Working Conference of the Pharmaceutical Care Network Europe entitled “Innovation in Pharmaceutical Care research”.
PCNE strongly believes that to develop high quality research, you need to continually update yourself, exchange expertise and experience with colleagues in the same research field. This conference was developed for you to do so, whether you work in education, in industry, as a practitioner or as a researcher.
Many changes have been happening in Europe, which affect, directly and indirectly, pharmaceutical care practice, education and research. The implementation of the Bologna declaration made the change from passive education to a competency-based system compulsory; however, it is still unknown if such a shift will improve fitness to practice.
The deregulation of pharmacy in some countries has made pharmacists react by creating new and more advanced services, available to the overall population or to special patient groups. It is expected that these will constitute new areas of interest for pharmaceutical care research. These are just a few of the innovations in the pharmaceutical care arena that have been debated over these four days of conference.
A range of first-class experts enriched the conference, with interests in the qualitative and quantitative research methods, education, deregulation, added-value of pharmaceutical care, and new services offered to the patient, among others.
The format of the PCNE working conferences always prioritises the workshops, since PCNE believes that this is a unique occasion for open discussion to flourish, and for new projects to emerge, which will ultimately contribute to maximising the networking capacity of this organization. The poster-discussion session proved to be a great forum for novice and more experienced researchers, this year more than 30 posters were exposed. The Glintt award for best poster was won by Dr. Janet Krska and her team from the Liverpool John Moores University, for a poster entitled: Developing a medicines-related quality of life measure. The ABDA award for the best oral presentation was won by Dr.Peter Tenni and his team, from the University of Tasmania (Australia), with the oral communication about Clinical Interventions in Australian Community Pharmacies. In this websection you will find the results of our hard work in March 2009.
Select what yu want to see in the Tabs above. If you need additional information, please contact the PCNE professional secretariat.
On behalf of the organising committee:
Dr. Filipa Alves da Costa and Dr. Mara Guerreiro
Workshop facilitators: Dr. Cecilia Bernsten (Sweden), Ms. Suzete Costa (Portugal)
Description: In this workshop the participants looked at the evaluation of new types of services, such as point of care testing, transfer of care between hospital and community pharmacy, and care to vulnerable patient groups. A study protocol was developed.
Workshop facilitators: Dr. Martin Helman (Ireland), Dr. Pilar Modamio (Spain) and Prof. Dr. David Graham (UK)
Description: To deliver pharmaceutical care, researchers and practitioners usually decide that education is required. However, much of this focuses on knowledge of the conditions and drug therapy being addressed and on the processes of the research or health service programme. Although some of the barriers to the implementation of pharmaceutical care research and practice are being researched, little attention has been paid to education. Research and Practice competencies have been described but experience with Continuing Professional Development suggests that competence under 'test' conditions is no guarantee of performance in practice. This workshop has explored these issues from the undergraduate to the lifelong learning stages and from the research and practice perspectives.
Workshop facilitators: Dr. Margaret Watson (United Kingdom) , Dr. Afonso Cavaco (Portugal)
Description: The purpose of this workshop was to provide an overview and discussion of the use of observation as a research method in general and in pharmaceutical care research in particular. The aim of the workshop was for participants to gain an understanding of the use of observation as a research method, and its application to pharmaceutical care research. The workshop also provided an environment where participants could discuss their experience of this method and qualitative research in general, the strengths and limitations associated with its use, and developped protocols and frameworks for the use of this method for forthcoming studies.
Workshop facilitators: Dr. Tracey Farragher (United Kingdom), and Dr. R. Holland (United Kingdom)
Description:Longitudinal studies are those in which data are measured repeatedly over time. These studies are playing an increasing role in the health and medical sciences as well as in pharmaceutical studies. This workshop introduced the design, analysis and interpretation of two of the most common types of longitudinal studies using real-life published examples and the statistical package SPSS. The workshop explored modelling the change over time, not only of the individuals but also the differences in change across people. The workshop also explored how to summarise this type of data as well as the modelling of the different aspects of change using multi-level models - fixed and random effects. The workshop also looked at survival studies, which are concerned with studying the time between entry to a study and a subsequent event (e.g. death, treatment discontinuation or clinical outcome/success). A number of methods such as life table, Kaplan-Meier survival curves as well as comparison and modellling of survival (log rank test and Cox regression) were studied.
With Support from:
Cecilia Bernsten has a PhD in pharmaceutical science and is currently associated professor Public Health at Uppsala University. She is presently working as Senior researcher at the National Corppration of Swedish Pharmacies. Her professional interests lies within the area of social pharmacy. This includes the application of sociological and social psychological theories and research methods to the study of pharmaceutical problems and drugs. She laso has an interest in in the area of administrative pharmacy (Pharmaceutical policy) including the legal, historical and economical aspects of the use of medicines and pharmacy services. My main work is at present focusing on drug use quality , and drug policy issues. Academic degrees:
Suzete Costa received a degree in Pharmacy from the Faculty of Pharmacy, University of Lisbon in 1993 and a Master's degree in Public Health (MPH) at the Faculty of Medical Sciences, New University of Lisbon in 2001 (Title of Master Thesis: "The impact of a pharmacy-based disease management programme in a group of hypertensive patients"). She became certified in Medication Therapy Management (MTM) by the American Pharmacists' Association (APhA) in May 2008, after completing the MTM Certification Program of APhA.
Graham is Head of Programmes for the Joint Programmes Board for London, East and South East England (2 days a week), with overall responsibility for delivering the key educational strategy and for ensuring that programme development is in line with patient safety and employer need. In addition, he is also Professor of Clinical Pharmacy and Therapeutics at the Department of Pharmacy King's College, London having previously held a personal chair at the School of Pharmacy, University of Brighton. He has a keen interest in developing career structures within the profession, in particular as they relate to the competence of pharmacists, and in designing both undergraduate and postgraduate curricula which embrace novel clinical teaching and assessment methods to promote the acquisition of competencies. Graham is on the editorial board of the Pharmacy Education journal and serves as a reviewer for other journals. His main clinical research area is in the study of novel artificial kidney systems to treat renal failure. He graduated from the Welsh School of Pharmacy (University of Wales; Cardiff) in 1980, was awarded an MSc in Clinical Pharmacy from the School of Pharmacy (University of London) in 1987 and a PhD, from the University of Brighton, in 1997.
Membership of Professional Bodies:
Graham is a member of the Royal Pharmaceutical Society of Great Britain and UKCPA.
Inger Lise Eriksen was born in 1947. She received a MSc in Pharmacy at the University of Oslo in 1971. She became a specialist in hospital pharmacy in 1991. She currently works as a community pharmacist During her career in pharmacy she did different kinds of work, such as for the pharmaceutical industry in drug information (1972-76), and then in hospital pharmacy (drug information 1976-82, administration 1987-92). She also worked at the University of Oslo in the Dept. of Pharmacotherapy between 1982 and 1986. From 1992 to 1996 she was the Director of Pharmacy Business at the Norwegian Pharmacy Association (pharmacy owners). Since 1996 she is the owner of Frogner Apotek in Oslo . She played several roles in the Norwegian pharmacy world, such as:
Membership of Professional Bodies:
Graham is a member of the Royal Pharmaceutical Society of Great Britain and UKCPA.
She currently is the President of the Board of the Nordic Pharmacy Association.
Afonso Miguel Cavaco was born in March 1966 and has one son. He graduated from the University of Lisbon (Portugal) as a pharmacist in 1990, obtained a MSc in Community Pharmacy from the same University and a PhD in Pharmacy Practice and Policy from the University of London (UK) in 2006, under the supervision of Prof Ian Bates. In the last trimester of 2007, he was a post-doctoral Fulbright fellow at Jonhs Hopkins Bloomberg School of Public Health (USA), working with Prof Debra Roter. Afonso holds a position as Assistant Professor at the Faculty of Pharmacy, University of Lisbon. He is responsible for the undergraduate teaching unit Pharmacy Lab, as well as cooperates in the organization of the pharmacy students 6 months internship. He is also involved in post-graduate courses related to Communication Skills for Pharmacists and Pharmacy Management. His main research interest at the moment is patient-provider interaction studies, using the Roter Interaction Analysis System (RIAS), in particular for medical and pharmaceutical consultations.
Following graduation from Liverpool University in Mathematical Sciences I was a statistician within the National Health Service (NHS) in the UK - firstly on hospital waiting times in England and then on the development of new information systems at the Information Statistics Division (ISD) in Scotland. While at ISD I undertook an MSc in Epidemiology at Edinburgh University, which led me into epidemiology research, firstly to coordinate a population study of male reproductive health in Scotland. I then applied and was successful in obtaining a MRC Training Fellowship, so giving me the opportunity to study for a PhD. My PhD, still based at Edinburgh University, described the geographical variation of male reproductive health in Scotland and identified factors that might explain any variations. On completion of my PhD I took up my current post as epidemiologist on the Norfolk Arthritis Register (NOAR) based at Manchester University. NOAR is the world's first true primary care based inception cohort study of new onset cases of inflammatory polyarthritis (including rheumatoid arthritis patients). I am currently analysing the long-term outcome of this cohort; whether these outcomes can be predicted from biomarkers, genetics and other clinical factors; and patients' response to treatment.
Mara Pereira Guerreiro obtained her degree in Pharmaceutical Sciences from the University of Lisbon, Faculty of Pharmacy (1991-97). Since then she has practiced as a community pharmacist, where she has been active in patient-oriented services and training of pharmacy students. Her interest in research led her to pursue a PhD at the University of Manchester (2003-07); in her doctoral research she investigated the feasibility and acceptability of using validated medication safety indicators in Portuguese community pharmacy. Her current research interests include patient safety in primary care, especially in the field of health informatics and health economics. She has published more than 20 research papers and conference abstracts. She has also run several workshops for practitioners and researchers, both in Portugal and abroad.
Dr Martin Henman is Senior Lecturer in the Practice of Pharmacy and Co-ordinator of the Centre for the Practice of Pharmacy in Trinity College Dublin. After completing his Pharmacy degree in the UK, Dr Henman practised as a hospital pharmacist before undertaking a PhD in Pharmacology. He then started in University practice where he has remained ever since. His main research interests are Pharmaceutical Care, Evidence-Based Practice and Competency frameworks. Dr Henman has been a member of Pharmaceutical Care Network Europe since its formation and in September 2003 and he became its Chairman. Dr Henman worked on the Pharmaceutical Care Task Force of the European Association of Faculties of Pharmacy in order to introduce Pharmaceutical Care in the undergraduate syllabus. He has acted as workshop leader at previous PCNE conferences. He is also Medical Editor of 'The Over the Counter Directory', a guide to non-prescription medicines in Ireland and of its web version 'yourmedicines.ie'.
Date of birth 18/5/67 Nationality British
Currently works at the School of Medicine, Health Policy & Practice, University of East Anglia, Norwich NR4 7TJ. Tel: (01603) 593574 01603) 593574, Fax: (01603) 593604, Email: firstname.lastname@example.org
May 1988 BA, Cambridge University (2.1)
July 1991 BM BCh, Oxford University
Oct 1997 Diploma in Anaesthetics, Royal College of Anaesthetists
Nov 1998 Diploma in Public Health (Cambridge) - distinction
Jan 2003 Membership of the Faculty of Public Health Medicine (now Fellow, from Nov 2006)
Jan 2003 Membership of the Institute of Learning and Teaching (by assessment)
July 2005 PhD, University of East Anglia
Current post: Reader in Public Health Medicine, University of East Anglia & Hon. Consultant in Public Health Medicine, Norwich Primary Care Trust.
Previous post: MRC Health Services Research Fellow & Lecturer/Senior Lecturer in Public Health Medicine, University of East Anglia.
Current and recent grants:
Selected recent Publications
Martin is an Adjunct Professor at Goethe University, Department of Pharmacology/Clinical Pharmacy, Frankfurt, Germany. In his main job, he is Managing Director Department of Medicine of the ABDA - Federal Union of German Associations of Pharmacists, Berlin. In addition, he is Director Pharmacy of the German Institute for Drug Use Evaluation (www.dapi.de). He graduated as a pharmacist from the University of Hamburg, in 1983. From 1983-1984, he was a hospital pharmacist, and studied Medicine at the University of Hamburg from 1984-1986. In 1988, he obtained his Ph.D. in Pharmacology from the University of Hamburg. In 1989, he was named "Expert in Pharmacology DGPT" by the German Society for Pharmacology and Toxicology (DGPT). He specialized as a Drug Information Pharmacist in 1993. Evaluation and implementation of pharmaceutical care; Promotion of an effective and safe self-medication; Pharmacoepidemiology and -economics; Drug information and drug supply and -usage etc. are some of the areas where Martin has expertise. He has more than 390 publications to his name and has also delivered 250 lectures, seminars and has written some books as well. Prof. Schulz is a member in various committees and commissions like ESCP board; Ministry of Health; FIP BPP Programme Committee, to name a few. He is one of the founding members of PCNE and served as chairman 1999-2001.
Dr Mary Tully is currently a Clinical Senior Lecturer in the School of Pharmacy & Pharmaceutical Sciences, The University of Manchester, in the UK. She also has an honorary contract at Salford Royal NHS Trust Hospital, where she works one day per week. Her main research interests are in hospital prescribing, especially around patient safety, and the measurement of the outcome of this process. She has published over 100 research papers and conference abstracts. She teaches professional ethics to undergraduate pharmacy students and research ethics to postgraduate pharmacists and PhD students across the Faculty of Medical and Health Sciences. She has served on a Research Ethics Committee since 2002 and has chaired the committee since 2007.
Dr Margaret (Mags) Watson is a Senior Research Fellow in the Department of General Practice and Primary Care, University of Aberdeen and a public health pharmacist with NHS Grampian. She has been a registered pharmacist for 21 years, working as a hospital pharmacist for eight years, and as a full-time health services researcher for 14 years. Mags gained her PhD in 1998 from the Faculty of Medicine, University of Bristol. Her research interests are evidence based practice, behaviour change and public health. She leads the SESAME (Safe and Effective Supply And use of MEdicines) research programme. As well as her PhD, Mags has an MSc Epidemiology from the London School of Hygiene and Tropical Medicine and an MSc Clinical Pharmacy. During her career as a health service researcher, commencing 1994, she has been a named applicant on grants totalling over £1.34 million. Of this amount, £548,446 has been generated from awards for which she was lead applicant. Mags has over 34 publications in peer-reviewed journals. She was awarded the Pharmacy Practice Research Trust, Conference Practice Medal Award in 2008 and the ESCP Oral Communication Award in 2007. She is a member of the editorial board for the International Journal of Pharmacy Practice, and the British Pharmaceutical Conference Practice Panel, and is a frequent reviewer for journals and grant applications.
Tommy Westerlund is a researcher at the Research & Development Department of Apoteket AB, the National Corporation of Swedish Pharmacies. His primary research interest is the improvement of medicine use , in particular drug-related problems (DRPs), pharmacy interventions and self-medication with non-prescription products. He has created a DRP classification system and a documentation instrument, that was incorporated into the software of all Swedish pharmacies in 2001 and used ever since. Tommy graduated as a pharmacist from Uppsala University in Sweden, earned a Master of Science Degree at the University of Minnesota in the United States and a Doctor of Philosophy Degree in Social Medicine at the University of Gothenburg, Sweden. He has previously held positions as an information pharmacist and as a pharmacy manager, in both cases for eight years. He has also worked as an assistant professor in Social Pharmacy at the University of Gothenburg in 2007 and 2008. Tommy served as the chairman of the Community Pharmacy Section of the Swedish Academy of Pharmaceutical Sciences for five years and has also been a board member of the Swedish Pharmaceutical Association. He is the immediate past chairman of the PCNE and still a member of the PCNE board.
García-Delgado P, Gastelurrutia MA, Baena MI, Martínez-Martinez F., Pharmaceutical Care Research Group. University of Granada, Spain
Relevance of the work: The knowledge of the patients about their medicines is most related to a better rational use of drugs and so, to the achievement of better health outcomes from this use. It seems important to have a validated tool to allow measuring patients' knowledge about medicines in any setting.
Aim To design and validate a questionnaire to assess the knowledge degree of the patients about their medicines.
Methods 1) Questionnaire: Literature review, some qualitative techniques (expert panel, brainstorming, Delphi method)and some pilot testing. And 2) Questionnaire validation. The discriminant capacity of the items was assessed. Content and construct validity were analyzed through the Spearman’s Rho coefficient and Factor Analysis. Reliability was assessed through the internal consistency measure, equivalence (inter observer concordance) and test-retest reliability.
Result: The final questionnaire, with 11 items explaining the different dimensions of knowledge found, was completed by 102 patients (answer rate of 95.3%) with an average age of 46.6 years (SD 16.70). Filling time average was 4.9 minutes (SD 2.2). Factor analysis showed a probable structure of 4 factors explaining the 67% of the total variance. The Spearman-Brow's Rho coefficient was 0.30 (p<0.05). Cronbach's alpha was 0.677, Kappa's coefficient = 0.99 and intraclass correlation coefficient = 0.74 (CI 95%: 0.49 - 0.87). Conclusion The designed questionnaire is agile, valid and reliable, being able to measure the knowledge degree of the patients about the medicines they use.
Hunter TA1,2 and Henman MC2
1Primary Care HSE West, JFK parade, Sligo, Ireland. 2Centre for the Practice of Pharmacy, The School of Pharmacy, Trinity College Dublin, Dublin 2, Ireland.
Relevance of the work: In Ireland Patients with type 2 diabetes mellitus are cared for in primary care. This project examined the potential of the Community Pharmacist to review the medication of patients with type 2 diabetes and recommend changes.
Aim To determine the medication problems of patients with type 2 diabetes, to perform a medication use review and to document interventions.
Methods Medication usage reviews were conducted across the Co-operation And Working Together area in Northern Ireland and in the Republic of Ireland. Community Pharmacists identified patients with type 2 diabetes and those who gave consent attended a consultation. The pharmacist resolved or referred any medication problems and advised the GP and patient of the consultation outcomes. Pharmacists recorded changes in the patient’s medication records at follow up. Results 244 patients completed the medication usage review in 31 pharmacies A substantial proportion of patients were receiving either monotherapy or no drug therapy – among hypoglycaemic, antiplatelet, lipid lowering and antihypertensive drugs. Changes to therapy in each of the groups were recommended but the need for therapy was the main recommendation made by pharmacists. At 3 month follow up, changes to prescribed medication were made for 24% of patients on pharmacists’ recommendations. However, in 53% of cases, GPs did not give any feedback to pharmacists about their recommendations.
Discussion The pharmacist’s brief intervention was successful in increasing the percentage of patients on evidence based medication. The response by general practitioners to the pharmacists’ recommendations did not differ in the two jurisdictions.
Conclusion This programme demonstrated the feasibility, value and potential of brief pharmaceutical care interventions around a structured medication use review in patients with type 2 diabetes mellitus.
Salmiah Mohd Ali, Faculty of Pharmacy, University Technology MARA, Malaysia
Relevance of the work: With growing number of people diagnosed with diabetes, there is a lack of diabetic control among people with diabetes in Malaysia and we need to understand why this is.
Aim: This study set out to explore the perspectives of pharmacists with regards to patients’ management of type 2 diabetes and provide recommendations that aim to enhance adherence to treatment and help patients to improve their self-management skills.
Methods: In-depth interviews were carried out on a purposeful sample of patients and their health care professional (HCPs). Interviews were recorded, transcribed and audiotapes were analysed using NVivo software to identify emerging themes and code according to categories. Interviews were conducted in an Endocrinology clinic in Malaysia with 18 Malay patients (15-75 years, 9 males and 9 females) and 13 HCPs.
Results: Themes that emerged from interviews with pharmacists included patients’ problems with integrating the treatment regimen and difficulty developing coping skills to achieve the desired blood glucose level. Patients lacked knowledge about their medicines, dietary control, medicine taking, complexities of treatment, and side effects of medications. They needed to integrate many treatment requirements such as diet, medications, blood glucose monitoring and exercise into their daily routine posed problems. Other barriers such as ethnicity, beliefs (culture and financial) proved to be the constraints that limited their ability to good control diabetes. Education and knowledge related to diabetes that influenced understanding of the disease were also reasons for non-adherence to treatment regimen. According to pharmacists, patients’ ethnicity and education level played a substantial role in their attitudes toward diabetes management.
Discussion: Their beliefs, cultural and social needs shaped their attitudes in controlling or adherence to treatment management. Patients were willing to discuss their problems about self-managing diabetes if these barriers were addressed during consultations with the pharmacists.
Conclusion: More positive approaches are needed in self-management of diabetes and pharmacists involved in the management of diabetes need to understand their patients’ beliefs about their diabetes and their constraints to promote more awareness and to foster greater control of diabetes and improve health outcomes.
Fernando Fernandez-Llimos, Teresa A. Silva, Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon.
Relevance of the work: Estimated prevalence of diabetes in Portugal1 is 8.2%, what means about 830,000 people with diabetes. On September 2003, a collaborative protocol was established in Portugal for the intervention of pharmacists in diabetes care at two levels: basic and advanced. Up to 5,000 diabetic patients could be followed, being reimbursed by the National Health System.
Aim To assess the implementation of the level II (advanced) in the Collaborative Protocol on Pharmaceutical Care in diabetes in Portugal from 2004 to 2008.
Methods: Data of pharmacies included in the diabetes protocol were obtained from INFARMED webpage.2 Data from September months were used for each representing year. Numbers of pharmacies and patients were analyzed at a municipality level.
Results: INFARMED data showed that the number of pharmacies in Protocol level II has increased very slightly: 258 in 2004, 356 in 2005, 370 in 2006, 378 in 2007, and 379 in 2008. Mean (CI95%) number of patients followed per pharmacy was 3.39 (3.0-3.8) in 2004, 3.63 (3.2-4.0) in 2005, 2.96 (2.6-3.3) in 2006, 3.03 (2.7-3.4) in 2007, and 3.12 (2.7-3.5) in 2008. Proportion of pharmacies reporting zero patients followed was 30.6% in 2004, 29.2% in 2005, 38.6% in 2006, 39.7% in2007, and 39.1% in 2008. The highest number of diabetic patients followed was reached in 2005 with 1,294. In 2008, in 96 (34.5%) municipalities in Portugal (out of the 278 existing) pharmacies reported following any patient. Mean percentage of estimated diabetic patients followed per municipality in 2008 was 0.12% (CI95%: 0.08-0.15).
Discussion Although positive effects of the pharmaceutical care program in diabetes were shown3, after 5 years, implementation is too low. This protocol should have overcome two of the commonly mentioned barriers for implementation, because service was established under an official agreement, and it was reimbursed. Additionally, Associations made a considerable effort to achieve the implementation of this Protocol. A new analysis on implementation barriers and facilitators should be done.
Conclusion Despite several of the commonly mentioned facilitators for service implementation were included in the development of the Collaborative Protocol on Pharmaceutical Care in diabetes in Portugal, this service cannot be considered as implemented. Pharmacists’ reported barriers and facilitators may not be real.
Tenni PC, Peterson GM, Williams M, Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Australia
Relevance of the work: This is the first major study of community pharmacists’ involvement in the detection and resolution of drug-related problems (clinical interventions; CIs) in Australia. Over 2,000 interventions from more than 50 pharmacies have been analysed for problem type, recommendations made, and clinical and economic significance.
Aim To determine the nature, frequency and value of clinical interventions in Australian community pharmacies.
Methods: Pharmacists at 52 pharmacies in Melbourne, Australia electronically documented details of situations where drug-related problems were identified and resolved, for 8 weeks. Information concerning the drug involved, the type of problem, the action taken to investigate it, the recommendation made, and the outcome were centrally collated. Analysis also involved an expert panel assessment of the potential clinical consequences of a sample of interventions.
Result Over the eight week study, 435,520 prescriptions for 258,979 patients were dispensed and information concerning 2,385 CIs was documented (0.55 CIs per 100 prescriptions and 0.92 CIs per 100 patients). The majority of CIs were one of three categories: drug selection problems (22.7%), dosage problems (19.4%) or education or information problems (17.4%). Drug groups commonly associated with clinical interventions were antibiotics, drugs for diabetes, cardiovascular drugs and drugs for respiratory disorders. In one-third of cases, the pharmacist contacted the prescriber in order to clarify the problem. Recommendations for changes in therapy were made in 67%, and information or education was provided in over 50% of CIs.
Discussion The clinical and economic analysis indicated that the value of Australian community pharmacy interventions related to prescription medication is in the order of $200M each year in direct costs avoided. In addition, around 170,000 hospital bed-days are avoided and 25M days of adverse health impact are avoided each year. As a result of each CI by a pharmacist, there is a mean reduction of: 34 days in a lowered health status (3.7 days of severe poor health, 16.6 days of moderate poor health and 13.4 days of mild poor health); 0.13 days in hospital; 0.7 GP consultations and 0.14 specialist consultations; and a total of $150 in total direct costs.
Conclusion: Australian community pharmacists undertake approximately one CI every 200 prescriptions. The estimated average value of each CI was $150 in direct costs, which extrapolates to approximately $0.5M in savings daily across Australia.
Salmiah Mohd Ali, Nor Hidayah bt
Harun Faculty of Pharmacy, University Technology MARA, Malaysia (Email: email@example.com)
Relevance of the work: Medicines have led to major improvement in the treatment and control of diseases. However, medicines also affect millions of people through its adverse reactions and will continue to harm when used if not properly documented. According to Ministry of Health Malaysia, there were 2,363 cases of ADRs reported in 2005 an increased nearly 42% compare to the 2004. Thus, there is a need to assess the knowledge and attitudes of pharmacists and to evaluate the factors that might act as deterrent in reporting of ADRs.
Methods: In order to assess community pharmacists’ knowledge and attitudes, a prospective, cross-sectional study is use to collect the data from the participants around Klang Valley areas from August till October 2008 and data collected were analyzed using SPSS version 12. Questionnaires comprise five hypothetical cases (jaundice with frusemide, nausea with montelukast, headache with venlafaxine, thrombocytopaenia with heparin and cold extremities with -adrenoceptor blockers) were used to evaluate the knowledge of community pharmacists.
Results: Overall the attitude of most community pharmacists in Selangor was good though in some cases the results showed poor attitude among pharmacists. They did not identify the ADRs in their care and did not report ADR whenever they suspected it. 55% of pharmacists sent ADR reports to the drug authority. 47.5% of the community pharmacists in Selangor preferred to use email instead of telephone or facsimiles to report ADRs. Qualifications did not determine the different knowledge of ADRs reporting among pharmacists.
Discussion: Pharmacists were found to have limited knowledge of ADRs reporting and some issues in this study needed to be addressed so that they would be able to promote better used of medicines through good ADRs reporting practices.
Conclusion: Community pharmacists need to have the right knowledge and attitudes in reporting ADRs which could enhance their role in pharmaceutical care in the community.
Krass I, Armour CL, Hughes J, Mitchell B, Peterson G, Smith L, Stewart K, White L.
Relevance of the work: The implementation of DMAS, a pharmacy disease management program for type 2 diabetes, exemplifies the translation of earlier research1 into mainstream pharmacy practice at a national level. This abstract presents results of the first stage of DMAS implementation.
Methods: A national quota sample of 90 pharmacies was recruited and randomly allocated into Group 1: the 6 month service (5 visits); and Group 2 the 12 month service (7 visits). Each pharmacy recruited up to 10 type 2 diabetes patients. Data collection comprised clinical indices, surveys and focus groups.
Results: 548 patients (Group 1; 279; Group 2; 269) were recruited. Key facilitators of implementation included adequate staffing and infrastructure support and prior professional relationships with local GPs. Barriers included lack of infrastructure support and difficulties with recruitment. 158 patients have completed 5 visits (66 Group 1 / 75 Group 2). Mean blood glucose levels have decreased from 8.97mmol/L at baseline to 8.23mmol/l at 6 the month visit (p<0.001) with no difference between Groups (p=0.32).
Conclusion: The results to date suggest that the DMAS is a clinically effective pharmacy delivered disease management program which may be implemented in diverse community pharmacy settings provided they have adequate staff and infrastructure to support service provision.
Reference: I Krass, C Armour, B Mitchell et al. The Pharmacy Diabetes Care Program: Evaluating the impact of a diabetes service model delivered by community pharmacists in Australia Diabetic Medicine 2007; 24:677-683
Acknowledgements: The Diabetes Pilot Program has been developed in collaboration with the Pharmacy Guild of Australia and the Department of Health and Ageing and is funded as part of the Fourth Community Pharmacy Agreement.
Cassimjee M, Suleman F
Relevance of the work: The province of KwaZulu-Natal, South Africa, embarked on the Essential Drugs Programme (EDP) consisting of standard treatment guidelines and essential drug lists (EDL) in May 1999. The use of these tools was aimed at promoting rational drug use.
Aim: This study sought to determine the percentage of compliance to the standard treatment guidelines (STGs) of the EDP in the treatment of hypertension in patients in the district of eThekwini.
Methods: A retrospective cross-sectional randomized sampling of a 100 prescriptions for hypertension per 21 health facility was conducted for the period of 3 months in 2007. Each prescription was assessed against modified WHO indicators to determine compliance to STGs.
Results: The mean age of the sample was 55.235 years (±0.62). Hypertension featured as the most common diagnosis in the sample (57.5%). The mean result of compliance to the STGs for the eThekwini District was 22.05% (±20.03). The results of the multiple linear regression equation suggest that the variables selected in this study explain 86.79% of the variables impacting on treatment guideline adherence.
Discussion: With the most common diagnosis being solely hypertension in 14 of the 21, facilities, the overall TND mean of 4.045 (?1.29) signifies polypharmacy prevalent at all levels of care. This point is further substantiated by the fact that 9 items were prescribed for a diagnosis of hypertension alone and 14 for hypertension with more than one comorbidity at a DH level. Analgesics, NSAIDS, antihistamines, vitamins, mineral supplements, antacid preparations and antidepressants were the common categories co-prescribed with the hypertensive agents mainly for unspecified diagnoses/indications. There was an absence of diagnoses on 10% of prescriptions, and a number of prescriptions recorded diagnoses as hypertension, but the drugs prescribed were for other conditions. A complete diagnosis enhances the use of drugs appropriately for the clinical indication of the patient.
Conclusion: The low mean results for compliance to the STGs was due mainly to the absence of a diagnosis recorded on the prescription, and the addition of a new drug for each symptom without due consideration of polypharmacy, drug-disease and drug-drug interactions.
Jurgita Dauksiene, PhD student Kaunas Medical University, Social Pharmacy Department, Raimondas Radziunas, Assoc Prof. Kaunas Medical University, Social Pharmacy Department
Relevance of the work: Pharmacists are health care professionals who are ideally positioned to perform primary health care role. Pharmacies become not only the place of purchasing medication or getting medical advice. In recent years pharmacies have adopted some additional services such as blood pressure measurement (BPM).
Aim: The aim of our study was to determine if BPM services are popular in Kaunas city pharmacies and if pharmacies use this service as opportunity to screen patients at hypertension risk and provide information about lifestyle changes.
Methods: The investigation consisted of 2 parts: phone survey of Kaunas city pharmacies and secret customer visit. Firstly, all Kaunas city pharmacies that have valid Pharmacy Practice Licence were contacted by phone enquiring, if they provide BPM services. Secondly, the pharmacies, which reported providing such services, were visited by young (32 years) male patient with blood pressure 140/90 mm Hg. After every visit the patient filled in a special form.
Result: The results were obtained from 216 pharmacies (96%) out of 225. 83(38.4%) of them do provide BPM services. In 26(31.33%) cases this service was charged with special fee. The level of fee varied depending on pharmacy from 0.20 LTL (about 0.06 €) to 1 LTL about 0.30 €). In 8 (15%) pharmacies no help of pharmacy staff was offered. In 78.31%(n=65) consultation pharmacists advised to check blood pressure regularly, 61.44%(n=51) recommended to consult a GP, 18,07%(n=15) informed the patient about high blood pressure complication risk, 36,14%(n=30) gave some lifestyle and diet recommendations. These recommendations were given in 27%(n=12) cases at the pharmacies with free of charge services and in 69%(n=18) charged (P< 0.001).
Discussion: Additional pharmacy services could be an opening statement in new kind of relationship with pharmacy patients. This could be part of some monitoring programs and help to detect risk patients and educate them.
Conclusion: Even 38.4% of pharmacies in Kaunas area provide some extra services such as BPM. Regrettably these services are not always provided by the pharmacy staff and connected with pharmacists’ advice. Pharmacies do not always use the enquiry about these services as the opportunity to provide information about lifestyle changes or further treatment actions. Deeper consultations were observed in the pharmacies where this service was charged.
Relevance of the work: Following studies1 on the facilitators and barriers to change in pharmacy practice, this studyi analysed the business models pharmacies used to implement PCS in practice. It became evident that business models used for implementing PCS were altered when the focus shifted to sustainability. Sustaining service delivery may require different strategies to those used to achieve implementation.
Aim The aim is to investigate the strategies that have assisted Australian community pharmacies sustain PCS delivery.
Method: Semi-structured interviews were conducted with a purposive sample of 30 pharmacy owners. Questions were based on operational issues and PCS being offered, covering themes such as staff management, decision making, service intensity and success of the pharmacy. The analysis was done through an inductive coding process of constant comparison using NVivo2.
Result: Strategies used by pharmacy owners to sustain PCS were based on creating networks, using technologies and differentiating their businesses. Most community pharmacies rely on remuneration to begin a service but those with a focus on health, supported by effective retailing models, sustain PCS in their daily practice through the creation of cross-synergies and building on their existing healthcare capacity.
Discussion: Pharmacies able to sustain PCS in their daily practice were led by pharmacy owners focused on integrating their pharmacy in the healthcare system. They saw their retail outlet as an opportunity to broaden their health offering to customers both in product and service provision. Overall, sustained change was more evident when the concepts of retailing and healthcare were seen as equally important and integrated in the pharmacy.
Conclusion: Pharmacies implementing PCS differentiate their businesses to become focused healthcare providers. This healthcare focus has influenced the sustainability of PCS suggesting that healthcare focused, not cost cutting, pharmacy models are best suited to sustain PCS.
References: 1. Roberts et al (2004), van Mill et al (2001) 2. Kvale, S. Sage 1996 i. This program is funded by the Australian Government Department of Health and Ageing as part of the 4th Community Pharmacy Agreement through the 4th CPA Grants Program managed by the Pharmacy Guild of Australia.
T Dreischulte, SA Hudson
Relevance of the work: Effective prevention and treatment of chronic cardiovascular diseases requires systematic approaches to ensure evidence based drug treatments are provided to all eligible patients and optimal control of risk factors is achieved. We have developed and validated Medication Assessment Tools for chronic cardiovascular conditions (MATCVC), which detect apparent gaps in guideline implementation at population and individual patient levels.
Aim: To explore the reliability and feasibility of MATCVC in different practice settings in Scotland, the Netherlands and Germany Methods: Evidence based guidelines relevant to the respective settings were identified. Guideline recommendations addressing long term medication use in primary and secondary prevention of cardiovascular events or treatment of coronary heart disease (CHD), chronic heart failure (CHF) or atrial fibrillation (AF) were used to generate a set of assessment criteria (MATCVC), which were validated by local clinicians. We have conducted MATCVC based cross sectional surveys in settings in Scotland (single general practitioner/community pharmacist collaboration), the Netherlands (two community pharmacies/ six general practitioners) and in a teaching hospital in Germany (three cardiology wards at discharge). Relevant patient data were abstracted from routine clinical documentation. The survey results were fed back to practitioners.
Result: The survey samples comprised patients with risk factors for and/or manifest diseases of the circulatory system (Scotland: n=285; Germany: n=204 and the Netherlands: n=1,879). Data on the following outcome measures will be presented: Inter-rater reliability (Cohen’s kappa) and prevalence of insufficient data as measures of feasibility; population measures of adherence (%) to MATCVC; frequency distribution of apparently unmet drug therapy needs (care issues) per patient; proportion of care issues judged to require clinical action (checks or changes) and the nature of checks/changes required; prevalence of (clinically) justified deviations from guideline recommended treatments.
Discussion: Adherence to evidence based guidelines is an important dimension of quality in medication use. Improving guideline implementation using assessment against explicit criteria requires (a) valid and reliable assessment criteria (b) meaningful ways of feedback of findings and (c) strategies for multidisciplinary collaboration in addressing care issues detected in individual patients.
Conclusion: The results of this study will inform the development of multidisciplinary quality assurance systems for chronic medication use in primary care and at the primary/secondary care interface.
M. Dziehan1, Wong Yee Cheat2, Kobu a/l Thiruvanackan3, Nur Azmiah4, Chan Beow Hui5, Norazlina Sariam6, Umi Syafinaz7,Dr Azmi Hassali8, Dr Salmiah Mohd Ali9.
1KK Telok Panglima Garang, PKD Kuala Langat 2KK Ampang, PKD Hulu Langat 3KK Shah Alam, PKD Petaling 4KK Anika, PKD Klang 5KK Sg Pelek, PKD Sepang 6KK Bukit Kuda 7PKD Klang 8KK Pandamaran 9PKD Klang Universiti Sains Malaysia - University Technology MARA. Email: firstname.lastname@example.org
Relevance of the work: Besides improvement of treatment outcome, Home Medication Review (HMR) also can reduce incident of unscheduled appointment, reduce cost due to wastage of unused medication at home, and increase patient empowerment to manage their disease at home more effectively, reduce repeated admission to hospital emergency dept due to disease progression/complication, Improve patient’s Quality Of Life, and reduce cost on treatment for disease complication in future, improve patient’s perception towards the service provided by Ministry of health Malaysia (MoH) and HMR allowed pharmacists to contribute to some clinical activities at healthcare centre.
Aim: The aim of this study is to evaluate treatment outcome, enhanced patient understanding on drug use and reduce need for the costly medical services to treat complication in future from ‘Medication Therapy Management’ (MTM) program initiated by pharmacist at primary health clinic in Selangor.
Method: This is a prospective study performed in five clinics examining the implications of pharmacist’s interventions. Patient recruited (FMS/MO referred patient based on selection criteria) and the data collected are from August 2007 until May 2008. This program focuses on uncontrolled Diabetes Mellitus and or uncontrolled Hypertension patient which will be followed up by pharmacist at every doctor’s appointment.
Result: There is a significant result after comparing monitored parameter before and after MTM program using statistical analysis Paired T-Test (P=0.001). There is a reduction on BP systolic P=0.01, BP diastolic P=0.0005, FBS P=0.0005, HbA1C P=0.0005, Total Cholesterol P=0.01 and complexity of regimen P=0.0005.
Other interesting results are
Discussion: This study proves that MTM program is a good preventive program which can benefit in terms of; 1) saving cost of medication for treating complication of the disease and 2) cost of treatment complication of uncontrolled DM and or HPT in future.
Conclusion: The program promotes involvement of pharmacists at healthcare centres in Clinical Pharmacy activities which bring new image of pharmacy services at primary healthcare level. This could enhance recognition and motivation for pharmacy career & development.
Fernando Fernandez-Llimosa, Yolanda Aguasb, Rafael Marquezc, Amelia Villanuevac, Jose Pavonc, Pilar Sanchez-Mohinoc, Javier Rojasc, Jose M. Lopez de Lermad. a Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon / b Drug Information Center, Badajoz Pharmacists Association / c Community Pharmacist, AIPaFaC-PBRN member / d AIPaFaC-Farmalog designers. Eurosof
Relevance of the work: Adverse drug reaction under-reporting has been estimated1 between 82% to 99%. Factors associated to under-reporting are: not serious ADR, forgetting the report, and lack of time.2
Aim: To evaluate the contribution of the AIPaFaC Practice Based Research Network (PBRN) to the National Pharmacovigilance Network through the voluntary adverse drug reaction (ADR) reporting system.
Method: Descriptive analysis of the database of the Extremadura Pharmacovigilance Center, containing ADRs voluntarily reported for non-hospital healthcare professional. ADRs from 2007 and 2008 (reported until Dec. 11, 2008) were included.
Result: Community pharmacies in Extremadura evolved from 3 ADRs reported in 2005, and 11 ADRs in 2006, to 160 in 2007, and 172 in 2008, representing 13.6%, 13.3%, 74.4%, and 68.0% of the total reported, respectively. AIPaFaC-PBRN members contributed with 0 in 2005, 0 in 2006 (PBRN not created yet), 89 (41.4%) in 2007, and 116 (45.8%) in 2008. Although in Extremadura there exist 676 pharmacies, AIPaFaC-PBRN ADRs reported constituted 55.6% of the total pharmacist’ reports in 2007 (with 5 pharmacies), and 67.4% in 2008 (with 9 pharmacies). ADRs reported by AIPaFaC-PBRN members were less serious (chi-square: p<0.001 in 2007 and in 2008), but with no differences in causality assignment (chi-square: p=0.230 in 2007 and p=0.358 in 2008). But ADRs reported by PBRN members contained significantly more medicines (Mann-Withney: p<0.001 in 2007 and in 2008)
Discussion: Practice-based research network members, because of their better attitudes and motivation, and because of the more advanced working tools (namely, computational systems) may be performing with higher quality standards than the average community pharmacist, at least on reporting ADRs to the National Pharmacovigilance System.
Conclusion: AIPaFaC-Practice Based Research Network members contribute by reporting ADRs to the National Pharmacovigilance System more intensively than other pharmacies. This contribution inverted the usual proportions of reports by professional in Spain, making the pharmacists being the top reporters.
References 1. Hazell L, Shakir SAW. Under-reporting of adverse drug reactions. Drug Saf 2006;29:385-96. 2. Irujo M, et al. Factors that influence under-reporting of suspected adverse drug reactions among community pharmacists in a Spanish region. Drug Saf 2007;30:1073-82.
Fernando Fernandez-Llimos1, Yolanda Aguas2, Beatriz Fernandez-Ruano3, Ana Nieto3, Ana Garcia Pineda3, Isabel Delgado3, Enrique de Miguel3, Jose M. Lopez de Lerma4.
1Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon / 2Drug Information Center, Badajoz Pharmacists Association / 3Community Pharmacist, AIPaFaC-PBRN member / 4AIPaFaC-Farmalog designers. Eurosof
Relevance of the work: Different barriers were identified by community pharmacies that theoretically difficult the implementation of cognitive services. Lack of computational tools is not one of the highest weighted barriers.
Aim: To evaluate the contribution of a clinical documentation computerized system on the implementation of a pharmacotherapy follow-up service in the community pharmacies of the AIPaFaC Practice Based Research Network (PBRN).
Method: Descriptive analysis of the evolution of implementation of pharmacotherapy follow-up in AIPaFaC pharmacies after the adoption of a common computerized documentation system included in the general management computer application. Computerized system was started on January 2007. Data were obtained on April, 20th 2007 and on December, 11th 2008.
Result: On April 2007, AIPaFaC-PBRN was constituted by 5 community pharmacies in Western Spain. They had registered 5,493 patients (mean=1,099 SD=474). A complete medication record existed for 3,196 patients (mean=639 SD=428). For 763 patients the medication record was not updated (mean=153 SD=134). Medication records contained 33,171 drugs (Mean=6,634 SD=4,572). Pharmacies had performed 405 pharmacotherapy outcome assessments (mean=81 SD=20). These assessments correspond to 305 patients (mean= 61 SD=12). On December 2008, AIPaFaC-PBRN was constituted by 9 community pharmacies in Western Spain. They had registered 18,830 patients (mean=2,092 SD=1,204). A complete medication record existed for 12,995 patients (mean=1,443 SD=874). For 1,939 patients the medication record was not updated (mean=215 SD=188). Medication records contained 81,914 drugs (Mean=9,101 SD=4,722). Pharmacies had performed 5,228 pharmacotherapy outcome assessments (mean=581 SD=257). These assessments correspond to 2,978 patients (mean= 331 SD=135).
Discussion: Although lack of computational tools is not frequently reported as one of the top barriers for the implementation of cognitive services in community pharmacies, these tools can simplify administrative tasks associated to these services, facilitating their implementation. Obviously, other factors related to motivation and attitudes, will not be overcome by adopting these tools.
Conclusion: Inclusion of a computerized documentation system allowed pharmacies in AIPaFaC-Practice Based Research Network to advance in the implementation of the pharmacotherapy follow-up service.
Castrillon CC(1), Faus MJ(2), Gastelurrutia MA(1,2). (1)Community Pharmacy in San Sebastian (Spain) (2).Pharmaceutical Care Research Group of the University of Granada (Spain)
Relevance of the work: In Spain, medicine management services (MMS) (including follow-up) are not well implemented yet. One of the facilitators to its implementation is “patient demand for the service”. However it seems difficult for this demand to happen while the service is not universally implemented and patients don’t expect to have it delivered in their pharmacies. In a project to broadly implement the service in a Spanish community pharmacy, now having around 100 patients on MMS, it seems important to know the opinions of patients receiving this new service and their perceived differences with the previous product delivery service they use to receive.
Aim: To assess the perceptions of patients about a new service aimed to evaluate and improve medicine outcomes.
Methods: A Focus Group was performed including 10 patients receiving MMS in one Spanish Community Pharmacy. Discussed issues included satisfaction with the service, perceived differences between this new service and the ordinary delivery service they’re used to receive. Also, their opinions about communication with other health care professionals such as physicians and nurses were discussed. Finally other topics such as the possibility of recommending relatives and friends to demand the new service and the importance of more pharmacies delivering it were dealt with. Content analysis using N-vivo® software was carried out.
Result: Results will be presented in a poster on PCNE Working Conference, in Lisbon.
Gastelurrutia MA, Larrañaga B, Garay A, Echeveste FA. (Gipuzkoa Local Professional Association. Spain)
Relevance of the work: Dependent people can join Municipal Domiciliary Care Services (MDCS), and receive help with some daily activities such as cooking, cleaning, etc. Community pharmacies can help these people to use their medicines better through this collaborative program with the MDCS.
Aim: To improve the use of medicines on people enrolled in MDCS.
Method: This program is based on a pilot collaborative action of the Gipuzkoa local professional association and MDCS in two towns: Legazpi and San Sebastian, both located in Gipuzkoa (Spain). It is focused on people enrolled in the MDCS of these cities who accept to participate and to follow the program procedures by signing an informed consent form. They can choose the pharmacy to get the service provided. Pharmacies must be accredited by the professional association. The pharmacist, after a broad evaluation of the whole medication, prepare Dose Administration Aids (DAA) which are given in the pharmacy to the patient or carer fortnightly at the time he gives back the DAA used the previous fortnight. Participant Pharmacies send a data sheet which includes all the information about the development of the program to the local association, monthly.
Result: First semester of 2008. 12 pharmacies attending 23 patients. 92.5% polymedication (? 5 drugs) Total DAA prepared was 567, with an average of 4.4 DAA filled per patient/month. Filling time was 1hour 37 minutes patient/month. 79% of the used medicines could be included in the DAA devices. 48 blisters containing “not taken pills” were returned (8.5% of the total) which meant non compliance or hospital admissions. 293 prescriptions were taken away from the health system because they were identified as not necessaries (3794.76€ of saving).
Conclusion: This program helps dependent patients included in MDCS to improve the use of their medicines. It leads to savings to the NHS because non necessary prescriptions are identified and taken away from the system.
Gastelurrutia MA on behalf of the Forum on Pharmaceutical Care Consensus Committee.
Relevance of the work: As in Spain there have been different approaches and terminologies about Pharmaceutical Care (PC), making it difficult for PC to be implemented, the agreement on a Consensus defining the meaning of the common words and services, and their procedures, related to PC Practice can be considered as a great step towards the implementation of PC services.
Aim: To reach a consensus on PC definitions and services. Also, to describe the education needs for pharmacists and dissemination approaches for PC to be implemented and to develop some recommendations for software companies to help pharmacists to implement PC services in their pharmacies.
Method: A Consensus committee including representatives from all the organizations related to PC was set up: (General Board of Pharmacy and Health Care Products of the Ministry of Health and Consumer Affairs, General Council of Professional Associations, National Royal Academy of Pharmacy, Spanish Society of Primary Care Pharmacists, Spanish Society of Community Pharmacy, Spanish Society of Hospital Pharmacy, Pharmaceutical Care Foundation, Spain, Pharmaceutical Care Research Group of the University of Granada).
Result: A Consensus document was produced and issued to all participant organizations to be disseminated to all Spanish pharmacists. Dispensing, OTC prescription and Medicine Management (including follow-up) were defined and presented as being the most important PC services. Also the Committee reached a consensus on definitions of Drug Related Problems (being possible causes for non expected outcomes, such as interactions, non adherence, duplicities, etc.) and Negative Outcomes related to the use of Medicines (being these categorised in three domains: indication, effectiveness and safety). Also as a result of a functional analysis that was carried out by the Committee some recommendation on procedures were agreed and proposed to Spanish software companies for its implementation in Spanish software programs for pharmacies.
Conclusion: With such an agreement and all the pharmaceutical organizations working together trying to reach the same objectives it seems easier to get PC services implemented in Spain in the medium term.
Casado de Amezúa MJ(1), Martínez-Martínez F(1), Gastelurrutia MA(1) (2) (1) Pharmaceutical Care Research Group. University of Granada (Spain) (2) Community pharmacy
Relevance of the work: Opinions on how pharmacists delivering Cognitive Services (CS) overcame barriers to CS implementation can be very important for the design of implementations actions. Also, opinions about why their Spanish colleagues don’t act as they do can bring deep insights into the explanation of the behaviour of community pharmacists.
Aim: To analyse ordinary Spanish community pharmacists’ reasons for no CS implementation, according to the opinion of pharmacists who successfully did it. To explore perceived rewards from the implementation of CS in routine, by pharmacists delivering advanced CS.
Method: A focus group was performed with 10 “expert pharmacists” (5 men, 5 women) who deliver Medicine Management services (including follow-up) as a routine service in their pharmacies. Content analysis using N-vivo® software was carried out.
Result: Participants think that among ordinary pharmacists there is a lack of knowledge and understanding about the meaning of Pharmaceutical Care (PC) and the different services involved. It is said that “the expression PC has been prostituted (adulterated)” and that “the word is distorted”. These ordinary pharmacists don’t know what they are supposed to do in the future. It is said that two main groups of factors act as barriers for their colleagues to start implementing PC: economic and professional factors. In the first group the most important discussed barrier was the lack of payment for this kind of services, not included in the margin of medicines sold. Among professional factors, identified barriers were the lack of professional reward and the fear about the future in relation to obtaining less money and loads of work; also a lack of self-efficacy of doing this new practice was identified.
I Feletto E, Wilson LK, Roberts AS & Benrimoj SI
Relevance of the work: Community pharmacy has been challenged over recent times with the introduction of pharmaceutical care services. Organizational flexibility increases business capacity to adapt in a changing external environment1. Developing a tool to measure this capacity in pharmacies may assist the profession in developing strategies to accelerate response to change.
Aim: To develop and validate a quantitative tool based on organisational flexibility theory to assess the capacity of community pharmacies to implement PCS.
Method: A qualitative study involving face-to-face interviews (n=57) was undertaken to contextualise organizational flexibility for community pharmacies2. The development adapted two validated instruments testing organizational flexibility, the relationship to the external environment1 and analysing organisational practices to understand culture3. The resulting tool was pretested (n=9) prior to a planned pilot and national study.
Result: The tool to be tested for reliability and validity consists of five parts including constructs such as: * pharmacy needs when implementing a service, e.g. staffing, external support, changes to physical space and relationships to customers * the culture of the pharmacy measured through 7 constructs – process-results, employee-job, organizational-professional, open-closed, loose-tight, social responsibility-self interest & market-internal * types of flexibility: steady-state, operational, structural and strategic * perceptions of the external environment: i.e. understanding changes in legislation * demographic information.
Discussion: The tool will enable pharmacies to be typed based on their flexibility, their culture and their needs allowing for the development of strategies to promote their responsiveness to change and their implementation of PCS.
Conclusion: The tool could be adopted for international and national comparison to test the capacity for change and increase the speed of change.
References 1. Verdu-Jover AJ et al. (2006) JSBM 44(3): 334-349 2. Feletto E et al (2008) AJP 89(Nov 08): 68-69 3. Verbeke W (2000) JOB 21:587-602 i.
This program is funded by the Australian Government Department of Health and Ageing as part of the 4th Community Pharmacy Agreement through the 4th CPA Grants Program managed by the Pharmacy Guild of Australia.
Marianne Agergaard, Pernille Dam, Bente Frøkjær, Hanne Herborg, Claus Møldrup, Charlotte Rossing.
Relevance of the work: Compliance technologies constitute a rapidly growing market where several actors are interested in acting as distribution channels. Pharmacies can offer independence from product interests to health care administrators. The community pharmacy has an opportunity to become the chosen channel of delivery for compliance technology services in primary health care.
Aim: To identify and categorize relevant compliance technologies suited for a pharmacy product selection. To test selected compliance technologies with medicine users in order to gain qualitative experience about the devices outline which type of medicine users they may be suited for identify counselling needs.
Method: A search was made in Pubmed and Google for compliance technologies/medication reminders/aids and similar terms. A selection of electronic medication reminders were field-tested on 20 voluntary medicine users for 2 weeks as part of a pilot study. A semi-structured questionnaire was used to collect data.
Result: Available technologies were located, mapped and categorised in terms of mobility, communication and technology level. Five medicine users failed to implement the medication reminder. Seventeen medicine users returned the questionnaire. Eight medicine users reported an improvement, seven reported no change, and none reported a decrease in compliance after implementing the medication reminder.
Discussion and Conclusion: When field-tested, the electronic medication reminders alone does not necessarily implement well. The matching of product and medicine user as well as motivation, counselling, follow-up and the possibility of exploring more than one solution seem to be crucial. The market of compliance technologies is large and the available products vary in terms of quality and level of technology. Some of these products may be suitable for pharmacy supply. Quality standards need to be outlined in order to select suitable products for pharmacy product range.
J Krska, C Morecroft, H Poole, P Rowe, R Auckland. School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool UK
Relevance of the work: Pharmaceutical care is aimed at enhancing patients’ quality of life. However many studies involving patients with polypharmacy show no benefit of pharmaceutical care interventions using standard generic quality of life measures, such as SF-36 and Euro-QoL. A generic measure specifically focused on quality of life related to medicines use may be more sensitive to change, enabling it to be used in pharmaceutical care studies to demonstrate the impact of pharmacist interventions.
Aim: To develop and validate a novel generic tool for measuring quality of life related to long-term medicines use.
Method: A three-stage study is in progress, involving patients in primary care taking multiple medicines for at least one year. Stage 1 involves in-depth interviews to identify issues arising from medicines use which patients perceive to affect their quality of life. Qualitative analysis of the interviews has led to key themes being identified from which a questionnaire will be developed. In Stage 2, patients complete the questionnaires in the context of a cognitive interview, to validate the questionnaire and allow further refinement. Stage 3 involves testing and re-testing of the refined questionnaire in a larger sample of patients alongside the Beliefs about Medicines Questionnaire (BMQ) and SF-12 to assess stability and concurrent validity.
Result: To date 20 in-depth interviews have been completed and the initial themes identified are: relationships/communication with health professionals, practicalities in obtaining and using medicines, information about medicines, control over medicines taking, efficacy, side effects, coping with medicines, attitudes towards medicines and overall impact of taking medicines. Quotations representing each theme are being used to formulate questionnaire items for testing in Stage 2.
Discussion: All themes currently identified have the potential to be affected by pharmacist intervention. They are not collectively covered by any other individual outcome measure currently available.
Conclusion: The measure may prove more sensitive to the small changes in quality of life which pharmacist intervention can effect than current measures.
Pieters K., Verstraeten A., Foulon V.
Research Centre for Pharmaceutical Care and Pharmacoeconomics Faculty of Pharmaceutical Sciences K.U.Leuven O&N 2, Herestraat 49, B3000 Leuven, Belgium. Karen.Pieters@pharm.kuleuven.be
Relevance of the work: During education, pharmacy students spend a substantial amount of time in the community pharmacy fulfilling their internship. This practice experience is considered crucial to their professional development. However, as there are no competences requirements for pharmacists training the students (further called tutors), there is no guarantee for the quality of this internship experience.
Aim: In order to develop training programs to increase competences among pharmacist tutors, two main questions need to be answered: 1. Which competences are essential for tutors? 2. What kind of support do pharmacists want in becoming a tutor?
Method: Two different approaches were used, involving about 50 tutors of Katholieke Universiteit Leuven (Belgium). 1. In focus groups with tutors who trained a maximum of two students in the past five years, characteristics of a good tutor, and expected support and education for tutors were discussed. 2. During visits at the internship sites, tutors were asked their opinion on didactic support, using four open-ended questions. Content analysis was performed on transcripts of the focus groups and interviews.
Result: Novice tutors expect substantial support from the university to train their interns. As experience grows, the current initiatives (information session, visit at internship site, newsletter and website) seem to be sufficient. Novice as well as experienced tutors would like to have the opportunity to communicate with other tutors. There is no general consent on the frequency, timing and location of support sessions. Most tutors prefer workshops, some prefer online education. Most tutors would prefer extra guidance to assess their students, as this is experienced as a difficult task. In general, a need for quality standards for tutors was urged. However, fulfilment of these criteria should be compensated with recognition or rewards.
Discussion: The methodology used particularly generated answers on the kind of support pharmacists want in becoming a tutor. Required competences of tutors were less clearly revealed.
Conclusion: According to a provisional analysis of the data, pharmacists seem to be open for extra support and guidance in becoming a tutor. Furthermore, pharmacists are not reluctant to quality standards for tutors, but ask recognition for their efforts.
Yousef Mousa*, Reem Kayyali*, Chris Goldsmith**, Louise Coughlan**, Chris Cairns* and Chris Evans**
*Kingston University, Penrhyn Road, London KT1 2EE **St. George’s Hospital, Blackshaw Road, London SW17 0QT
Nearly 900,000 people in the UK currently have heart failure. St. George’s Hospital NHS Trust took part in a programme aimed to increase the effectiveness of medicines for people with long term conditions and to reduce re-admissions to hospital due to problems with medicines. As part of this, St. George’s Hospital and Wandsworth Primary Care Trust have recently developed and published two shared-care guidelines to treat and manage patients with heart failure. One outlines the initiation and dose titration of angiotensin-converting enzyme (ACE) inhibitors and the other beta blockers. This study aimed to evaluate the need and satisfaction of GPs and community pharmacists within the area with these guidelines. Questionnaires consisting of 10 closed questions and 2 open questions were designed and sent to 60 local general practitioners (GPs) and 50 community pharmacists to gauge opinions regarding the content and layout of the heart failure shared-care guidelines. 20 GPs and 38 pharmacists responded to the questionnaire generating a 33% and 76% response rate respectively. The guidelines were rated highly by both the GPs and community pharmacists with 95% of the GPs agreeing that all the necessary information was included in the guidelines. 95% of respondent GPs and pharmacists thought the guidelines were user-friendly. Pharmacists were more positive with 89% (34) finding them clear and concise compared to 65% (13) of GPs respondents. There was an overwhelming support in both groups that the guidelines were useful in their practice; 85% GPs and 92% pharmacists. 35 (92%) of the community pharmacists expressed their desire to receive information about similar guidelines. This project highlighted the need for shared-care guidelines for chronic conditions to be developed to ensure the uniformity of care across primary and secondary care. Although, these guidelines were designed primarily for the use of GPs, it was interesting to note the high percentage of community pharmacists (92%) who thought that the guidelines would be useful to their practice and who wished to receive similar guidelines in the future.
Sharmeen Ajaz1, Reem Kayyali1, Chris Goldsmith2, Louise Coughlan2, Chris Cairns1 and Chris Evans2
1Kingtson University, Penrhyn Road, London KT1 2EE 2St George’s Hospital, Blackshaw Road, London SW17 0QT
Increasing the incidence of face-to-face medication reviews can enhance patient concordance and understanding of their medication. This study at St. George’s hospital aimed to improve the effective use of medicines in heart failure patients. The aim was divided into the following objectives; to develop a heart failure educational tool to facilitate medication reviews; to pilot and survey the opinions of hospital and community pharmacists within the area regarding the tool. Following an interview with 6 pharmacists to identify their perceptions of medication reviews and their expectations of educational tools, a five page educational tool for heart failure was designed. The tool gave a background to heart failure and its diagnosis. It listed the drug treatment for heart failure. For each treatment; the dosing regimen including the dose titration steps, if applicable, the monitoring parameters, corresponding action plan and important side effects were listed. A questionnaire was developed to assess the clarity, content and usefulness of the tool using a Likert scale. The questionnaire together with the tool was given to all 40 St. George’s hospital pharmacists and was posted to 50 local community pharmacists. The response rate of the community pharmacists was 62% (31) compared to 55% (22) from hospital pharmacists. The results showed that the mode rating of the content of the tool was good with a range from excellent to fair. 28 (90%) of the responding community pharmacists and 15 (68%) hospital pharmacists stated that they would be using the tool with 95% of the responding pharmacists demanding the development of similar tools for other chronic conditions. This study has emphasised the need for educational tools for chronic conditions to facilitate medication reviews by pharmacists in primary and secondary care. The optimum design of such tools has been highlighted, enabling more tools for other chronic conditions to be developed. Such tools should help a high standard and more uniform patient care to be provided in different care settings. By improving the effective use of medicines in chronic conditions, heart failure in this case, the readmission rates for such patients in hospitals would be expected to decrease.
Mahmathi Karuppannan, Helen Boardman, Ting Kang Nee, Salmiah Mohd. Ali, Wong Kok Thong
Relevance of the work: Adverse drug events (ADEs) are a major concern among the health care professionals. They are thought to greatly impact patients’ quality of life and result in increased health care expenditure. In order to prevent and reduce the impact of ADEs, it is important to determine the extent and nature of the problem. Research in this area in Malaysia is limited, although studies have investigated ADR reporting and made suggestions as to how this might be improved.
Aim: To detect and categorize ADEs in patients admitted to medical wards in one public hospital in Malaysia.
Method: The medical charts of patients admitted to two medical wards (one each for men and women) were reviewed over 4 weeks. Demographic data, reason for admission, current medicines, medical and drug histories, laboratory test results and any diagnoses were noted on the data collection form. All suspected ADE cases were then categorized into five different event types: adverse drug reactions (ADRs), medication errors, therapeutic failures, adverse drug withdrawal events and overdoses. Data analysis consisted simple frequencies for event type and medicines implicated.
Result: A total of 136 cases were reviewed of which 37 (27%) patients were categorized as being admitted to the hospital due to an ADE. Failure of treatment, due to lapses in taking medicines, was the most common type of ADE detected (84%; n=31/37). Diabetes (n=17) and hypertensive (n=9) therapy were the largest contributors to non-adherence. The next largest area of ADEs was ADRs (n=5), followed by overdoses (n=1). The medicines most frequently implicated were hypoglycaemic agents and beta-blockers.
Discussion: The method tested has enabled the detection of ADEs in a Malaysian hospital. Non-adherence to therapy and diabetes appear to be primary targets for potential interventions, however the small scale of this study means further investigation is needed.
Conclusion: The high prevalence of ADEs appears to be a major contributor to hospital admissions in our pilot study. During 2009 we will be conducting a large scale study which will determine if these early indications about ADEs in a Malaysian hospital are correct.
Rouault A1,Beaussier H1, Houot M1, Bézie Y1, Zuber M2
1Department of Pharmacy, 2Department of Neurology, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand 75674 Paris cedex 14
Relevance of the work: Hypertension (HT) increases arterial stiffness that contributes to generate ischemic events. Medication adherence and lifestyle factors are the main identified contributors of uncontrolled blood pressure under antihypertensive medication. Therapeutic education (TE) focused on antihypertensive medication may be of primary importance in stroke patients considering the major causal role of HT in cerebrovascular events.
Aim: To assess stroke patients’ experience of HT and their motivation to undergo TE sessions, in order to consequently develop a standardized TE program adapted to such patients.
Method: A three months preliminary survey was conducted in hypertensive patients prospectively hospitalized in a stroke unit for an acute cerebral ischemic event and treated for HT before or following stroke. The support was an « open and short questions » questionnaire divided into three parts: the medical patient abilities to participate, the patient knowledge about HT and the TE patient approach. Students in pharmacy achieved this survey.
Result: Concerning the patients, 28 participated in the survey (14 women, 14 men; age: 50 to 85 years). 17 patients were treated for HT before hospitalization. Two patients were excluded because of medical inability and 9 patients had minor attention troubles. 35% of patients had a good knowledge about HT, while 30% and 35% had few or no notion, respectively. One third of the patients ignored their HT. Half of patients was motivated to undergo TE sessions, 23% were undecided and 27% were not interested. Most motivated patients asked for more information about the disease, its complications and treatment management. Among them, 54% had a good knowledge about HT whereas among undecided and uninterested patients, 85 % had few or no notion about HT. Concerning clinical pharmacy, this survey was the opportunity to develop a multidisciplinary cooperation notably between nurses, physicians and pharmacists.
Conclusion: To prevent cardio- and cerebrovascular risks in stroke patients, it may be firstly important to motivate patients, in order to secondly improve their knowledge and cooperation using TE programs.
Shubashini Gnanasan1, Ting Kang Nee2, Wong Kok Thong2, Salmiah Mohd Ali3, Abdul Razak Abdul Muttalif4, Claire Anderson1
1University of Nottingham, United Kingdom, 2University of Nottingham, Malaysia Campus, 3Universiti Teknologi MARA, Malaysia, 4Penang Hospital, Malaysia
Relevance of the work: A preliminary study in a public hospital in Malaysia revealed that almost 50% of TB patients with co-morbidites were presented with diabetes mellitus. Little is known about how TBDM patients are being managed especially issues related to their medications. Currently, TBDM patients are mainly managed by doctors and nurses with limited involvement of pharmacists.
Aim: To explore health care professionals’ views on the need for PC management in TBDM patients
Method: A qualitative study employing semi-structured interviews with two doctors and two nurses were carried out. A focus group discussion was conducted with four clinical pharmacists. Interviews and discussion were audiotaped and transcribed verbatim. The general themes that were discussed included experiences in managing TBDM, drug related issues, health-system barriers, issues related to Directly Observed Treatment, Short-course (DOTS) and any potential involvement of pharmacists.
Result: The general experience in managing TB patients by doctors and nurses include adherence problem, difficulties in educating elderly patients, language barriers, overcoming stigma, lack of awareness and non-acceptance of the disease. High pill loads especially for those with multi-morbidity poses an issue with many patients. TBDM patients reported to have more episodes of nausea and vomiting compared to TB patients. The barriers in the current health-system in Malaysia include limited workforce and time to provide patient- centered care, long waiting time, and restricted facilities for proper patient counselling. DOTS is viewed positively for ensuring compliance, detection of adverse drug reactions and prevention of multi drug-resistance TB. Conversely, DOTS is perceived to be troublesome for causing financial burden and patients’ inconvenience. Both doctors and nurses interviewed welcome the involvement of pharmacist, particularly in managing drug related issues in these patients.
Discussion: All expressed that provision of PC will benefit TBDM patients. Information gathered indicated the need for better sharing of the concept of PC to other health care professionals.
Conclusion: This small study indicates the need to initiate PC to TBDM patients. Insights obtained will help to inform the development of a PC intervention with the involvement of pharmacists.
John M. Lonie, Ed.D, R.Ph
Relevance of the work: Research has shown that health professionals that are empathic have patients who tend to have better health outcomes. This is a learning (developmental) process which develops in certain individuals as a result of various factors (social, developmental, cognitive, and professional). Pharmacy educators both entry-level and continuing education, may benefit from knowing how to best foster empathic development in pharmacists and pharmacy students.
Aim: Using a model of reflective practice, this study aims to form a connection between pharmacists’ ability to be highly empathic and their tendency to be self-reflective and introspective. If this connection is valid, it may prove to be the foundation of educational programs geared toward enhancing pharmacist (and other health professionals) empathic development.
Method: A grounded theory multiple case study qualitative design, peer-nominated highly empathic community pharmacists was used. Twenty-four pharmacists completed a critical incident questionnaire. The questionnaire was intended to encourage participants to reflect on, and respond to, specific questions dealing with aspects of pharmacy practice which stirred them emotionally. The critical incidents dealt with responding to a patient in distress. The data was analyzed first through an open coding qualitative approach, then through computerized qualitative analysis software.
Result: The critical incident yielded several major themes regarding pharmacists’ empathic responses to a patient(s) in distress. (i) When asked what about the patient moved them emotionally, the majority indicated that it was the patient needing help; (ii) Pharmacists felt concern and sympathy when interacting with the patient; (iii) Pharmacist behaviour during the patient interaction included actively listening to patients concerns/problems and/or taking some kind of action to help the patient; (iv) when asked if they would behave that way again if faced with a similar situation, all the pharmacists indicated they would.
Discussion: The results of this pilot study indicate that highly empathic pharmacists, who later completed the critical incident, apparently elicit observable empathic behaviours in practice (as indicated by the fact that they were peer-nominated). There appears to be congruence between real life empathic behaviour and the ability to be self-reflective, thoughtful, introspective, and empathic regarding past professional events which were emotionally charged.
Conclusion: The need to better understand the connections between behaviour and cognition (self-reflection, introspection) is critical when making decisions on admission criteria for pharmacy students as well as curricular development in pharmacy education.
Laura Monzona1, Silvia Guerreiro2, Claudia Milheiro2, Fernando Fernandez-Llimos2
1GIFPV, Valencian Pharmacy Practice Research Group, Valencia (Spain), 2Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon (Portugal).
Relevance of the work: Several disease-targeted instruments to assess health-related quality of life in patients with osteoporosis have been created. The different characteristics of these questionnaires make them useful in different situations. This variety produced the lack of a standard recommended by osteoporosis guidelines.
Aim: To assess the frequency of use of the osteoporosis-targeted health-related quality of life instruments in published studies.
Method: A search in Pubmed was performed using the query <&lOsteoporosis[mh] AND “quality of life”[mh] AND questionnaires[mh] AND has abstract AND English[la]>>. Papers retrieved were independently analyzed by two reviewers to find those mentioning a specific questionnaire. Papers creating, validating or comparing questionnaires were excluded.
Result: A total of 161 papers were retrieved and analysed. 93 papers did not mention any specific questionnaire. 6 were reviews, 16 papers published creation or validation studies and 5 were cross-cultural validations. In the remaining 41 papers, those reporting having used a specific osteoporosis-targeted questionnaire, the use of QUALEFFO-41 was referred 19 times (46.3%), whereas the use of its short version (QUALEFFO-36) is not referred. The use OQLQ and mini-OQLQ was mentioned in 6 (14.6%) and 3 (7.3%) studies respectively. The Japanese JOQOL was used in 4 papers (9.8%). OPAQ-1 was used 4 times (9.8%) whereas OPAQ-2 was used only once (2.4%). The use of OPAQ-SV was not mentioned in any article. QUALIOST, and OPTQoL were referred twice (4.9%). The ECOS-16, was not used at all.
Discussion: This utilization scattering impedes comparison of the studies. After analyzing strengths and weaknesses of the different instruments, development of a new international osteoporosis-targeted instrument should be considered. Osteoporosis associations should consider including recommendations in their guidelines on what humanistic outcome assessment tool should be used.
Conclusion: The results suggest that the actual use of available osteoporosis-targeted health-related quality of life instruments varies, but some instruments were not used at all after their creation. Instruments short versions are scarcely used.
Clara Sequeira1, Ana Cristina Rama1, Odete Isabel1, Alfredo Mota2, Carlos Fontes Ribeiro3
1Pharmacy Department & 2Renal Transplantation Unit, Coimbra University Hospitals; 3Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra. Portugal
Relevance of the work: In renal transplantation, noncompliance to immunosuppressive therapy is an insufficiently studied problem and not well defined, although it can cause devastating clinical consequences.
Aim: Measure and compare the extent of noncompliance to tacrolimus (FK) and sirolimus (SRL) in renal transplantation, through four different methods.
Method: Observational, open and prospective study (FK:125±20 days; SRL:140±32 days) of 49 patients (FK:18; SRL:31). Compliance measures: pills/capsules counting (PC/C); monitoring of blood levels (MBL); electronic monitoring (EM); compliance self-reporting (CSR). Operational definitions depended on applied methods and investigators criteria. Compliance rate (CR) expressed by median (Percentile25-Percentile75), except for MBL. Adherents/non-adherents classification using “cut-off” level 80% CR. Statistical analysis: Student’s t and Mann-Whitney U tests (p?0.05).
Result: Groups’ baseline characteristics were similar, predominating male patients and age being comparable (mean age 47). Compliance for FK and SRL was comparable (p>0.05) with the four methods. EM: FK- CR “according to dose” 98.8% (92.4%-100.1%), “according to doses interval” 88.9% (75.0%-96.5%) and “according to days” 91.7% (82.0%-97.0%); 66.7% adherents; SRL- CR “according to dose” 99.3% (97.7%-100.7%), “according to doses interval” 89.7% (83.9%-97.6%) and “according to days” 95.0% (88.6%-99.2%); 83.9% adherents; PC/C: FK- CR 99.4% (97.5%-101.9%); 100.0% adherents; SRL- CR 99.7% (97.7%-100.5%); 93.5% adherents; MBL: FK- CR 46.6±28.5%; 11.1% adherents (CR) and 50.0% (mean concentrations); SRL- CR 50.3±26.7%; 9.7% adherents (CR) and 58.1% (mean concentrations); CSR: FK- 94.4% adherents; SRL- 93.5% adherents.
Discussion: In each group, non-compliance estimates were variable as mentioned on literature, in face of different methods and compliance operational definitions used. According to EM, considered the closest to gold standard, we found high CRs that could be explained by prospective study design (“Hawthorne Effect”), but mostly, by patients’ fear of negative consequences of non-compliance. Total percentage of non-adherent patients measured by EM was 22.4%, value close to the ones presented by other authors in renal transplant patients. Results confirmed that combination of methods is the ideal way of measuring compliance, as they gave different and complementary information, although having their own limitations, with comparable compliance results.
Conclusion: Compliance was not associated specifically to one or other studied drug, although the groups were different regarding daily drug intake and FK and SRL`s side effects.
Raimundo Pastor-Sánchez, Carmen Alberola Gómez-Escolar, Flor Álvarez de Toledo Saavedra, Nuria Fernández de Cano Martín, Ana Dago Martínez
Relevance of the work: It shows the outcomes of a coordination strategy between community-pharmacists and family-doctors about pharmacotherapeutic referrals from pharmacy to clinic.
Aim The main objective was to measure difficulties in and achievements of the coordination strategy between pharmacists and doctors when this strategy was jointly applied.
Method: Phase A: Joint preparation and edition of two guidelines about asthmatic and hypertensive clinical situations that may give rise to a referral .The classification of situations was done following criteria of need, safety and health education deficit. Phase B: a pilot test of (a) the adherence to these guidelines in 32 pharmacies and (b) the level of coordination achieved with doctors working at the 13 healthcare centres nearest to those pharmacies
Result: From 361 clinical situations identified by the pharmacists, referral to the patient’s family-doctor was needed in 190 (52%). Good professional coordination was achieved in 114 of these (60%). The level of coordination was dependent on the kind of clinical situation that prompted the intervention.
Discussion: Selecting only two diseases seemed easier in order to cooperate with doctors regarding the procedures and opportunity of pharmacotherapeutic referrals. We chose two of the most common diseases found at Primary Care level: Asthma and Hypertension. From this we obtained enough positive feedback from both the doctors and the pharmacists to be able to understand the pharmacotherapy failure in those patients whose care was shared.
Conclusion: It seems a good strategy to make frame agreements between pharmacists and doctors establishing the most frequent reasons to refer patients from one service to the other. The guidelines about asthma and hypertension patients were tested in the MEDAFAR study and showed to be useful
References: Aparicio G, Castro J and al. Coordinación de servicios sociosanitarios para la mejora de la prescripción y dispensación farmacológica en una residencia de ancianos. Rev Esp Geriatr Gerontol. 2007;42:333-41. García Cebrián F. La seguridad del paciente y la colaboración entre médicos y farmacéuticos. SEMERGEN. 2006; 32(2): 55-7.
Assist Nejc Horvat, MPharm/Prof Ales Mrhar, PhD, MPharm/Assist Prof Mitja Kos, PhD, Mpharm - University of Ljubljana- Faculty of Pharmacy
Relevance of the work: Several instruments have been developed to assess patient satisfaction with pharmacy services. However, most of the questionnaires have failed to test or provide data about questionnaire’s reliability and validity. Additionally, the content of these questionnaires was not necessarily assured to represent patients’ perceptions, needs and culture. A new questionnaire is proposed that aims to overcome the disadvantages of previously published instruments.
Aim: To develop a psychometrically valid, multi-dimensional, self-administered, generally scoped questionnaire measuring patient satisfaction with pharmacy performance for outpatients.
Method: A multi-phase development process was used to develop the questionnaire. In Phase I questionnaire’s content was generated using interviews with pharmacy users regarding their experiences and expectations relating to pharmacies. In Phase II the content and format of the questionnaire was defined in a two-round modified Delphi study where an expert panel estimated importance of generated items for patient satisfaction. Members of the expert panel also rated items’ wording and suggested additional items to include. In Phase III initial validation of the questionnaire took place. Questionnaires were distributed among pharmacy visitors. Mailed-back questionnaires were analysed, factorial structure of the questionnaire was established and tests of its reliability and validity were performed.
Result: Five hundred thirty four questionnaires were mailed-back eligible for further analysis (48.1% response rate). Factor analysis extracted 4 factors which accounted for 48% of the variance. All Cronbach’s ? coefficients exceeded 0.7. Content validity was established through appropriate questionnaire construction methodology involving pharmacy visitors. Construct validity was identified through examination of item and factor correlations: all item-factor correlations were greater than 0.3, all factor-factor correlation coefficients were below 0.7. Support for criterion validity was indicated by statistically significant correlation between age and satisfaction. Most of the items demonstrated poor response variability in terms of significant ceiling effect.
Discussion: The developed questionnaire takes into account patient priorities and focuses on issues that have a potential to impact patients’ perception of a pharmacy. Included items are connected with the performance of a pharmacy in question. The questionnaire also exhibits consistency with the Donabedian’s theoretical framework for assessing health care quality. Further validation studies will concentrate on gaining response variability by relating the questionnaire’s content to a single pharmacy visit and focusing on patients who picked up a prescription medicine for themselves.
Conclusion: A questionnaire measuring patient satisfaction with pharmacy performance was developed. The questionnaire focuses on issues expressed as important by patients, takes into account services as well as the supporting structure of pharmacy, includes items relevant to an individual pharmacy and demonstrates satisfactory psychometric properties.
Margarida Marques1; Ana Cristina Ribeiro Rama1; Odete Isabel1: Salvador Massano Cardoso2.
1Pharmacy Department, Coimbra University Hospitals & 2Faculty of Medicine, University of Coimbra. Portugal
Relevance of the work: The increased use of medications result from: the higher incidence of chronic medical conditions, adoption of unhealthy lifestyles and behaviours, the emergence of new drugs and is a consequence of aging population and longevity. Polypharmacy has become useful in many areas, improving patients’ health and quality of life. But, the use of multiple medications is associated with an increased risk for adverse drug reactions, drug-drug interactions, noncompliance to treatment, hospitalizations. The knowledge of the drug-use patterns is an important tool in promoting the rational use of drugs, and minimizing the potential risk associated with polypharmacy.
Aim: Quantify and characterize polypharmacy in outpatients of Diabetology, Dyslipidemia and Rheumatology Department.
Method: Descriptive cross sectional study in outpatients aged more than 18. The pharmacist performed an interview, collecting data on medication, morbidity and demographic characteristics. Polypharmacy was defined as the concurrent use of five or more drugs. Statistics analysis performed with SPSS 16.0.
Result: From the 253 studied subjects, 153 (60.5%) were women and 100 (39.5%) men; the mean age was 55.49±14.31; 153 (62.3%) subjects had elementary education; 102 (42.7%) were retired. The mean number of chronic disease was 1.74±1.0, being the most frequent the endocrine, osteoarticular and cardiovascular diseases. The majority of population had hypertension and hypercholesterolemia. Mean drug use per patient was 5.3 (men 4.42±3.0; women 5.87±3.23). Polypharmacy was observed in 61% of the population, with 45% of it having more than 65 years. The most commonly used drug groups were from the cardiovascular system (35.8%), Drugs used in Diabetes (14.2%), Nervous System (12.0%), and Muscle-skeletal System (11.1%).
Discussion: These results provide evidence of high frequency of polypharmacy. Predictors of higher number of drug use were found to be female gender and oldest people. The results are in line with national and international trends regarding the higher medicine use in women and elderly, as well as, for the most consumed drug groups.
Conclusion: A frequency of polypharmacy of 61% in the studied outpatients, indicate the need for further investigation, to assess potential consequences of multiple medication use in specific group of patients.
Bradley, C. T. – Boots the Chemist & The School of Pharmacy, Trinity College Dublin, Ireland. Henman, M.C. – The School of Pharmacy, Trinity College Dublin, Ireland
Relevance of the work: The pharmacy profession is increasingly focussed on developing pharmacy-led services, particularly in the area of pharmaceutical care. In order to develop such services the co-operation of a number of stakeholders will be required. It would be useful to understand how these stakeholders currently view the role of the community pharmacist.
Aim: To explore the views of key stakeholders regarding the current role of community pharmacists.
Method: Key stakeholder groups were identified from a series of pharmacist focus groups. These included leaders of the profession, policy makers, other healthcare professions, the Health Service Executive and patients. A purposive sample of eleven stakeholder representatives was selected. Semi-structured interviews were conducted to ascertain the views of stakeholders regarding the role of community pharmacists. Interviews were transcribed and validated. Thematic analysis was conducted using NVivo 8 with double coding for validation purposes. Ethics approval was obtained.
Result: Most stakeholders saw pharmacists as healthcare professionals with responsibility for dispensing medicines and providing advice. However the advice-giving role was seen to be compromised by the fact that pharmacists were largely hidden in the dispensary, unseen by patients. There was a low level of awareness of extended services, including pharmaceutical care, amongst non-pharmacists although some did mention that there might be a role for pharmacists in disease management and medicines management. Pharmacists were also seen to have a commercial role. Whilst some stakeholders accepted that a certain amount of commercialism was required to sustain a viable business, others felt that this compromised the professional role. This was particularly evident amongst other healthcare professionals who suggested that pharmacists were less “evidence-based” than other healthcare professionals. Many stakeholder groups raised questions as to why pharmacists were not considered part of the primary care team within the healthcare strategy and suggested that this should be addressed if pharmacists were to develop professional services. One policy maker stated that she did not fully understand what pharmacists did.
Discussion: These interviews demonstrated a lack of clarity about the role of community pharmacists amongst stakeholders, with particular confusion articulated over the dichotomy of the commercial and professional roles.
Conclusion: Whilst the role of the community pharmacist as a healthcare professional was acknowledged it was clear that some stakeholders believed that this role was compromised by other factors. These views may affect stakeholder engagement in the development of extended pharmacy services.
Wouters M, Foulon V
Research Centre for Pharmaceutical Care and Pharmaco-economics Faculty of Pharmaceutical Sciences KULeuven, Belgium
Relevance of the work: Depressive disorders have a global impact on health-related quality of life as well as on socio-economic parameters. Treatment with antidepressant drugs has shown to be effective if executed correctly for an appropriate period of time. However, recent data suggest that only a minority of patients taking antidepressant drugs adhere to treatment recommendations. Therefore, it seems obvious to develop interventions that might have a positive impact on adherence and health outcomes.
Aim: I. The overall aim of this project is to study the impact of medication counselling by the community pharmacist on the use of antidepressant drugs. The counselling will focus on new users and the impact will be measured on clinical, economic and humanistic parameters. The project will also investigate II. the patterns of clinical use of antidepressant drugs in Belgium III. the attitudes and stigma of community pharmacists towards patients with mental disorders IV. the impact of an education program involving consumer educators on stigma and attitudes.
Method: To answer the main research question, a randomized controlled trial will be set up. Pharmacists in the intervention arm will be trained to counsel patients with a new prescription for an antidepressant drug. Pharmacists in the control arm will deliver standard care. All patients in the study will be called 4 times in 6 months to gather information on the different parameters using appropriate questionnaires. The database of a pharmacy-network, containing patient-level data, will be used to address the second research question. To investigate stigma and attitudes of pharmacists and the impact of an education program, a survey instrument will be used that was previously tested on pharmacy students.
Result: The analysis of the dataset of the pharmacy-network is the first step in the realisation of this project. This analysis is still on-going. Some provisional results will be presented at the conference.
Discussion: The project described in this abstract is set up to investigate the impact of community pharmacy counselling on the use of antidepressant drugs. The authors would greatly appreciate any suggestions on the design of this project as well as on the proposed methodology.
Conclusion: So far, no conclusions can be drawn.
Lloret M**, Pérez-Rodríguez MT*, Modamio P**, Mariño EL** *Primary Care Centres. Consorci Sanitari Integral **Clinical Pharmacy and Pharmacotherapy Unit. Faculty of Pharmacy. University of Barcelona(http://www.ub.es/farcli/wp0.htm).
Relevance of the work: This study shows the need for pharmacist intervention in order to improve the safety of elderly primary care patients with chronic disease medication, above all when medications, such as benzodiazepines, entail a greater potential risk in this population.
Aim: To determine the prevalence of chronic benzodiazepine (BZD) use in elderly primary care patients and their profile. Methods * Environment: Basic Health Area in Barcelona, Spain (23,881 patients). * Population: Patients ? 85 years old, with chronic disease medication and with at least one chronic BZD prescription (n=256). * Period of study: October- December 2007 * Data source: Electronic medical records (OMI-AP) Study variables: Age, sex, medical history number, institutionalized or not, risk of falls, falls and fractures during the last year, chronic disease medication and for BZD prescription: number, type, length and the reason for prescription.
Result: The final sample included 244 patients. Profile: average age 89 years, 82.4% (n=201) women, 45% (n=110) institutionalized, the rest (n=130) lived at home. 41% of the total patients (n=100) presented risk of falls. During the last year 31% (n=76) had fallen and 9% (n=22) had suffered a fracture. The institutionalized elderly received an average of 8.5 medicines/patient (1.2 BZD/patient) and the non-institutionalized 6.6 medicines/patient (1.1 BZD/patient). 86.1% (n=210) were taking only one BZD, mainly lorazepam (35.1%, n=104). 28.7% (n=70) of BZD prescriptions were to treat insomnia and depression. The average length of treatment was 20 months.
Discussion: More than 50% of the patients had at least one BZD prescription for a chronic use. The institutionalized elderly received more medications in general and BZD in particular than those who were not institutionalized. In general, we detected an inadvisable chronic BZD use, according to the available evidence.
Conclusion: Regular review of BZD prescription in elderly primary care patients is recommended in order to avoid inadequate chronic use and promote patient safety.
Esperança Silva, Margarida Caramona, Emanuel Ponciano
Relevance of the work: It is generally known that adherence with chronic treatment is low, and is a major problem with huge cost implication. However there is less knowledge on the reasons for non adherence and this study shows different reasons for this.
Aim: The aim of this study was to identify the problems that may led to non adherence to prescribed therapy in order to find out some ways in which adherence could be best improved by pharmacists
Method: The study was performed in 201 community pharmacies from Portugal. Patients 18 years or older were selected during 2006-2007. As inclusion criteria patients had to be under antihypertensive therapy. The reasons for not taking their medication as prescribed were self-reported by patients in the applied questionnaire. (Haynes-Sackett method Batalla Test, Morisky-Green Test).
Result: From the 1005 hypertensive patients selected, the mean age was 61,12 years, 57,51% were women, 41,9% had blood pressure out of control and 63,28% had the body mass índex over 25. Most of them showed dyslipidemia and had previous cardiovascular problems The mean number of chronic medications taken per patient was 4,5. The most frequently reported reasons for not following the treatment were: forgetfulness ran out of pills, being away from home, having problems with taking pills at specified times problems with taking more than one pill at the same time, the lack of knowledge or information and their mistrust or beliefs.
Discussion: Non adherence to drug treatment was most influenced by patients’ behavioural issues. Gender, educational level, and age are important factors influencing non adherence but can’t be changed.
Conclusion: The pharmacist is in a privileged position to give more advice about the drugs, therapy and disease. However, these health professionals need to understand the main reasons for the low adherence and try to improve this rate.
Veerle Foulon, Katrien Bosseloo, Marijke Buekenhoudt, Valérie Deliën, Debby Geeraerts, Marijke Housen, Veerle Liebaut, Tine Peeters, Sofie Pylyser, Annelies Van den Berge, Lies Volkaerts, Jan De Lepeleire
Relevance of the work: A recent study, performed on behalf of the Belgian Health Care Knowledge Centre, showed that medication use by Belgian nursing home residents is high and that the quality of the drug regimens is rather poor. The study further showed that there is a huge need for amelioration of the medication management as well as for redefining the role of doctors, pharmacists and nurses.
Aim: The aim of this project was to identify the bottlenecks in the medication management of selected nursing homes and to list the solutions that were proposed by the people involved. Design of strategies to encompass the bottlenecks, as well as measurement of the impact of these strategies, will be part of a follow-up project.
Method: For three nursing homes, a process diagram was developed through careful observation of the medication management. Further analysis on the identified bottlenecks was performed by semi-structured interviews with directors, doctors, pharmacists and nurses. Interviews were transcribed verbatim and content analysed.
Result: The bottlenecks that were identified through observation and qualitative interviews are 1) lack of communication; 2) errors in drug therapy execution; 3) lack of money, time and personnel; 4) lack of organisation; 5) prescription-related problems and 6) storage difficulties. Directors as well as nurses and doctors asked for more training in pharmacotherapy; people involved put great expectations in the automation of medication management and electronic prescribing systems. The introduction of multidisciplinary consults was proposed as a possibility to encompass the lack of structure and to ameliorate the quality of the drug regimens.
Discussion: The demand for automation of the medication management, as well as the question for more training in pharmacotherapy and for multidisciplinary consults should be taken by the pharmacists as an opportunity to profile themselves as members of the care team rather than as suppliers of medicines.
Conclusion: This study allowed the identification of the bottlenecks in the medication management of three selected nursing homes. The solutions that were suggested by the people involved open up perspectives for the pharmacist to take up new roles. The establishment of these new roles, however, will be dependent on the organisation of multidisciplinary consults.
1SY Olave Quispe, 2ML Traverso, 3E García Bermúdez, 3T Díaz Carmona, 1M Machuca González, 1MJ Martín Calero, 1MC Pérez Guerrero
1Research Group on Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, University of Seville, Spain; 2Clinical Pharmacy Department, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Argentine; 3Seville Pharmacists Council, Spain
Relevance of the work: The measure of patient’s satisfaction with healthcare is an important outcome of increasing use in the Health Services.
Aim: To describe the preliminary psychometric properties (validity and reliability) of a patient’s satisfaction questionnaire (PSQ) with pharmaceutical care services.
Method: A cross-sectional study was assessed in community pharmacies of Seville (every pharmacy provides attention to 2000 patients). Pharmacist had previously received training in pharmaceutical care. This PSQ was adapted by experts on pharmaceutical care and was self-administered by personal surveys. It contents 27 items, structured, multidimensional, answers of the type of the Likert scale of five continuous categories. Subsequently, the viability was evaluated, the validity of criterion was determined upon establishing the spread of items and dimensions of the PSQ, through factorial analysis, and the reliability was evaluated by Cronbach Alfa coefficient (?). Patient’s satisfaction with the community pharmacies was also analyzed.
Result: An Eighteen community pharmacies participated in this study. 223 heterogeneous patients in terms of age, sex, level of education were included in the analysis. The factorial analysis with rotation varimax establishes the 24 items on two dimensions: Managing Therapy (MT) and Friendly Explanation (FE) that extracted the 63.5% of the variance. The internal consistency by ? was 0.964 for the PSQ and 0.959 and 0.916 for the two dimensions, respectively. The mean (±SD) score on the MT scale was 4.6 (±0.6) and on the FE scale it was 4.2 (±0.8). A paired t test indicated the difference between these scores was statistically significant (P < .001).
Discussion and Conclusion: Our results suggest that PSQ is an instrument on patient’s satisfaction with two dimensions, with adequate psychometric properties for its use in community pharmacies of Seville that have received some training in pharmaceutical care. It must be used cautiously until it will be tested among different pharmacies, able to know how to provide different levels of care. Thus, it could be a preliminary point to develop more trials to know more about this new health care service, in different settings, pathologies and groups.
Mónica Condinho, Margarida Cavaco, Cristina Camões, Fernando Fernandéz-Llimós, Fernando Miranda, Carlos Sinogas. ACF – Acompanhamento Farmacoterapêutico Lda (email@example.com)
Relevance of the work: In Portugal, where pharmaceutical care services are not compulsory or reimbursed, the implementation of cognitive services is residual. Official data1 indicate that specialized pharmaceutical care in Diabetes provided by some 300 Pharmacies over more than 2800 in the country, involves an average of 1.7 patients per Pharmacy, covering less than 0.05% of the estimated diabetic population. A survey, within Community Pharmacies in Évora2, reports the intensive administrative workload of pharmacists, insufficient clinical pharmacology background and knowledge on the follow-up methodology, as the more relevant factors for its low implementation.
Aim: To show the viability of the provision of Pharmacotherapy follow-up in Community Pharmacies, through a new strategy involving the sharing of external pharmacists, with appropriate training and expertise, performing exclusively this work.
Method: Patients, who accept the invitation of the local pharmacist to join the program, receive the pharmacotherapy follow-up service provided by the specialized pharmacists on behalf of the Pharmacy where the work is performed. Pharmacotherapy follow-up is provided in a comprehensive approach, not in a disease-based approach. Pharmacist interventions are written, either when only directed to the patient or to the physician (through the patient). Evaluation of clinical outcomes is performed by measuring relevant parameters related with the disease or with the therapy involved.
Result: During the first two months 9 Community Pharmacies with 30 patients were enrolled and 91 negative clinical outcomes were identified. A total of 162 pharmacist’s interventions were done, 140 patient’s addressed and 22 physician’s addressed. There are no rejected interventions and 31 negative clinical outcomes could be resolved, remaining 29 unresolved, for the moment. All but two of the other negative clinical outcomes have ongoing pharmaceutical interventions.
Conclusion: Data available do show the viability of pharmacotherapy follow-up performed by a specialized external pharmacist shared between different Community Pharmacies.