Scielo RSS http://scielo.isciii.es/rss.php?pid=1885-642X20170003&lang=pt vol. 15 num. 3 lang. pt http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300001&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Adverse Drug Reactions (ADRs) are a major public health problem. Prompt reporting of suspected ADRs is fundamental in the post-marketing surveillance of medicines and helps in ensuring medicine safety. However, fewer ADRs are reported in general and in particular by community pharmacists. There is limited knowledge about the factors which are preventing community pharmacists in the UK from reporting an ADR. Objectives: To identify the barriers to ADR reporting among community pharmacists practicing in the UK. Methods: A cross sectional study using a 25-items questionnaire (both online and paper based) including 10 barriers to ADR reporting was conducted from 1st April 2012 to September 2012. Community pharmacists practicing in the West Midlands, UK, were approached for the participation in this study. Chi-Square and regression were applied to identify covariates for the barriers to ADR reporting. A significant value of 0.05 was assigned for analysis. Results: Of the 230 invited community pharmacists, 138 pharmacists responded (response rate 60%). The median age of respondents was 31 years. All pharmacists reported that they would report both serious and mild ADRs from drugs with black triangle among children as well as adults. About 95% (n=131) of the pharmacists were familiar with the paper based ADR reporting system. Store-based pharmacists were more likely to be more confident about which ADRs to report [0.680, 95% Confidence Interval 0.43-3.59]. Lack of time 46.4% (n=64), and pharmacists perception that ADR is not serious enough to report (65.2%; n=90) were identified as barriers to ADR reporting. Majority 63.0% (n=87) of the pharmacists identified training and information about what to report and access to Information Technology (IT) (For example access to internet connection) 61.6% (n=85) as facilitators to ADR reporting process. Conclusion: Lack of time and ADRs considered not serious enough by pharmacists to report were barriers to ADR reporting. Further training and education about the types of ADRs to be reported can help to improve the reporting of ADRs. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300002&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB). Objective: Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST. Methods: A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests. Results: Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively). Conclusion: Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300003&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Private general practitioners in Malaysia largely operates as solo practices – prescribing and supplying medications to patients directly from their clinics, thus posing risk of medication-related problems to consumers. A pharmacy practice reform that integrates pharmacists into primary healthcare clinics can be a potential initiative to promote quality use of medication. This model of care is a novel approach in Malaysia and research in the local context is required, especially from the perspectives of pharmacists. Objective: To explore pharmacists’ views in integrating pharmacists into private GP clinics in Malaysia. Methods: A combination of purposive and snowballing sampling was used to recruit community and hospital pharmacists from urban areas in Malaysia to participate either in focus groups or semi-structured interviews. A total of 2 focus groups and 4 semi-structured interviews were conducted. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10. Results: Four major themes were identified: (1) Limited potential to expand pharmacists’ roles, (2) Concerns about non-pharmacists dispensing medicines in private GP clinics, (3) Lack of trust from consumers and private GPs, (4) Cost implications. Participants felt that there was a limited role for pharmacists in private GP clinics. This was because the medication supply role is currently undertaken in private GP clinics without the need of pharmacists. The perceived lack of trust from consumers and private GPs towards pharmacists arises from the belief that healthcare is the GPs’ responsibility. This suggests that there is a need for increased public and GP awareness towards the capabilities of pharmacists’ in medication management. Participants were concerned about an increase in cost to private GP visits if pharmacists were to be integrated. Nevertheless, some participants perceived the integration as a means to reduce medical costs through improved quality use of medicines. Conclusion: Findings from the study provided a better understanding to help ascertain pharmacists’ views on their readiness and acceptance in a potential new model of practice. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300004&lng=pt&nrm=iso&tlng=pt ABSTRACT Objective: 1) To evaluate the relationship between physician-pharmacist agreement about the off-label drug use and 2) and to identify the most common off-label medication category/indications and prescriber clinical disciplines in private settings in Baghdad area, Iraq Methods: This study evaluated 980 off-label use requests in the private clinical settings within Baghdad area, Iraq from October 2013 to September 2015. The efficacy, safety, and convenience of each drug request and its alternative options were evaluated according to the patient health and demographic characteristics and standard guidelines. Results: Of the 980 physician off-label requests, only 22.7% were approved by the pharmacists. Rheumatology and Nephrology accounted for the highest ratio of off-label use requests for adults (30.3% and 26.3%). The pharmacist rejection ratio of off-label use was comparable between the two groups (p>0.05). Most of the issued requests were attributed either to unapproved indication or to combination of more than one drug (38% and 35.3%). A low acceptance rate was reported in the requests issued for treatment in different clinical lines to the authorized one (11.9%). The lowest rate of acceptance was reported in the requests that had very low evidence level (9.1%). The mostly prescribed medications were musculoskeletal agents (28.9%). Finally, 78.2% of the requests came from clinical branches for adults. Although the agreement rate for requests in adults was higher than that in pediatrics, the two rates were not significantly different. Conclusion: Community pharmacists should effectively take responsibility for assessing off-label drug requests in Iraqi private settings. The quality of evidence does not represent the major factor influencing the approval rate of off-label drug use. The availability of safer and/or affordable alternatives and prescribing for a different patient age category highly impacted the pharmacists’ approval rate. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300005&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Patients’ behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. Objectives: This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. Methods: A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. Results: This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. Conclusion: Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300006&lng=pt&nrm=iso&tlng=pt ABSTRACT Objective: to evaluate physicians and clinical pharmacists’ awareness and practices regarding use of aldosterone antagonists in heart failure (HF) and post-myocardial infarction (MI). Methods: First, we reviewed the prescription of aldosterone antagonists among 408 patients presenting to the cardiology clinic at a major hospital in Jordan. Second, physicians and pharmacists working in cardiovascular departments completed a questionnaire related to use of aldosterone antagonists in HF and post-MI. Results: Thirty patients (7.59%) were eligible for aldosterone antagonist; only 4 received them at discharge (13.3%). The survey was completed by 153 professionals (response rate 76.12%). About 72.1% of participants were aware of studies regarding use of aldosterone antagonists post-MI and in HF. Moreover, 10.45%/53.6% of participants strongly agreed/agreed that these agents are useful in normotensive post-MI and HF patients. Spironolactone was the most prescribed drug by 92.1% of participants. About 41.8% of participants reported use of spironolactone in post-MI and HF. With respect to guidelines, only 39.2% of participants agreed that adding spironolactone to standard therapy in HF is recommended, and 48.3% agreed on adding it directly post-MI. Clinical pharmacists and cardiologists were generally more aware of guidelines than pharmacists, cardiac surgeons and residents/fellows. Conclusions: there is an under-use of aldosterone antagonists in HF and post-MI patients, and a lack of detailed awareness of current guidelines among health care providers. Dissemination of evidence-based guidelines and usage protocols may improve management of post-MI and HF. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300007&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs) on the health-related quality of life (HRQOL) among hypertensive patients. Objectives: The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients. Methods: A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients’ data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach. Results: 200 hypertensive patients (mean age 59.7 years (SD=10.2)) were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3). Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all). On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both). Conclusion: Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify, prevent and resolve DRPs, which may improve patients HRQOL. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300008&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: The concept of customer engagement and devotion has been applied in various service businesses to keep the customers with business However, a limited number of studies were performed to examine the context of customer engagement and devotion in pharmacy business which focus on the impact of customer perceptions about pharmacists, perceived quality of pharmacy structure, medication price strategy on pharmacy engagement and pharmacy customer devotion in a pharmacy providing pharmaceutical care to the customers. Objective: This study aimed to assess a conceptual model depicting the relationships among customer perceptions about pharmacists, pharmacy quality structure, medication price, customer engagement, and customer devotion. And also aimed to assess and measure if there is a direct or indirect relationship between these factors. Methods: A quantitative study was conducted by using self-administered questionnaires. Two hundred and fifty three customers who regularly visited the pharmacy were randomly recruited from a purposively selected 30 community pharmacies in Bangkok. The survey was completed during February to April 2016. A structural equation model (SEM) was used to assess the direct and indirect relationships between constructs. Results: A total of 253/300 questionnaires were returned for analysis, and the response rate was 84%. Only perceptions about pharmacist in customers receiving professional pharmacy services was statically significant regarding relationship with pharmacy engagement (beta=0.45). Concurrently, the model from empirical data fit with the hypothetical model (p-value = 0.06, adjusted chi-square (CMIN/DF)=1.16, Goodness of Fit Index (GFI)=0.93, Comparatively Fit Index (CFI)=0.99, and Root Mean Square Error Approximation (RMSEA)=0.03). Conclusion: The study confirmed the indirect positive influence of customer perceptions about pharmacist on pharmacy customer devotion in providing pharmacy services via pharmacy engagement It was customer perceptions about pharmacist that influenced customer retention, positive word of mouth and constructive advice to pharmacies, not quality of pharmacy structure and medication price. To create a long term impact on community pharmacy business, pharmacist is the key success factor. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300009&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01). Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001). Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300010&lng=pt&nrm=iso&tlng=pt ABSTRACT Objective: To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait. Methods: A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p<0.05. Results: The response rate was 82.4%. Respondents had overall positive attitudes towards physician-pharmacist collaboration. Pharmacy students expressed significantly more positive attitudes than medical students (p< 0.001). Medical students rated the three most significant barriers to collaboration to be: pharmacists’ separation from patient care areas (n=100, 70.0%), lack of pharmacists’ access to patients’ medical record (n=90, 63.0%) and physicians assuming total responsibility for clinical decision-making (n=87, 60.8%). Pharmacy students’ top three perceived barriers were: lack of pharmacists’ access to patients’ medical record (n=80, 84.2%), organizational obstacles (n=79, 83.2%), and pharmacists’ separation from patient care areas (n=77, 81.1%). Lack of interprofessional education was rated the fourth-largest barrier by both medical (n=79, 55.2%) and pharmacy (n=76, 80.0%) students. Conclusions: Medical and pharmacy students in Kuwait advocate physician-pharmacist collaborative practice, but both groups identified substantial barriers to implementation. Efforts are needed to enhance undergraduate/postgraduate training in interprofessional collaboration, and to overcome barriers to physician-pharmacist collaboration to advance a team approach to patient care. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300011&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known. Objective: This study aims to a) Identify community pharmacists’ current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists’ objectives and ideas for discharge optimisation. Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient’s care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. Conclusion: Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist’s opinions, appropriate pharmaceutical care is therefore impeded. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2017000300012&lng=pt&nrm=iso&tlng=pt ABSTRACT Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known. Objective: This study aims to a) Identify community pharmacists’ current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists’ objectives and ideas for discharge optimisation. Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient’s care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. Conclusion: Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist’s opinions, appropriate pharmaceutical care is therefore impeded.