Telefarmacia y atención farmacéutica: Una revisión narrativa de la Federación Internacional Farmacéutica

Digital transformation impacts health care through technology. Telepharmacy is set to become one of the most important aspects of Telemedicine in the years to come with its ability to provide patients with increased and more timely access to pharmaceutical care, reduced costs for individuals and health systems, improved patient satisfaction, experience and convenience, and better health outcomes. Telepharmacy has gained increasing importance in the delivery of pharmaceutical care, largely due to the COVID-19 pandemic which has placed enormous pressures on healthcare systems globally. There is a significant amount of published literature from different countries around the world that provide examples of Telepharmacy. There are some innovative models of Telepharmacy services aimed at optimizing and improving access to pharmaceutical care, resulting in improved patient safety and outcomes. The benefits of Telepharmacy include increased value for pharmacies and pharmacists and adapting to patients´ needs, enhanced interprofessional care and increased efficiency of health systems and increased provision of patient- centred services, among others. However, despite these benefits, major barriers for implementation of Telepharmacy remain such as patient confidentiality and privacy of health information. These barriers to the implementation of Telepharmacy have been identified and can be divided into four different environments: technological, organizational, human and economic. Delivering pharmaceutical care and services through digital media is identified as a key priority for the International Pharmaceutical Federation. Digital health is one of the 21 Development Goals launched by International Pharmaceutical Federation in 2020. The International Pharmaceutical Federation Digital Health in Pharmacy Education report in 2021, describes the readiness, adaptability and responsiveness of pharmacy education and knowledge and skill needs of pharmaceutical workforce on digital health. Amongst other digital health tools, telehealth/Telepharmacy has been reported as one of the most preferred tools to teach and learn about by respondents. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved. La tecnología surgida de la transformación digital ha traído consigo cambios en la asistencia sanitaria. En los próximos años, la Telefarmacia previsiblemente se convertirá en uno de los aspectos más importantes de la Telemedicina, ya que ofrece a los pacientes un acceso más inmediato a la atención farmacéutica, supone una reducción de costes tanto para los pacientes como para los sistemas sanitarios, y deriva en una mayor satisfacción, experiencia y comodidad de los pacientes, mejorando así los resultados clínicos. Debido en gran medida a la pandemia de COVID‑19, la Telefarmacia ha adquirido gran importancia en el ámbito de la atención farmacéutica, ya que esta crisis ha provocado una enorme presión sobre los sistemas sanitarios de todo el mundo. Se pueden encontrar multitud de experiencias publicadas en la literatura científica sobre modelos de Telefarmacia en diferentes países del mundo. Existen algunos modelos innovadores de servicios de Telefarmacia orientados a optimizar y mejorar el acceso a la atención farmacéutica, lo que se traduce en una mejora de la seguridad y los resultados de los pacientes. Entre las ventajas de la Telefarmacia se incluye el aumento del valor para las farmacias y los farmacéuticos y la adaptación a las necesidades de los pacientes, la mejora de la atención interprofesional, el aumento de la eficiencia de los sistemas sanitarios y la mayor prestación de servicios centrados en el paciente, entre otras. Sin embargo, a pesar de presentar múltiples ventajas, siguen existiendo importantes barreras para la implantación de la Telefarmacia, como la confidencialidad del paciente y la privacidad de la información clínica. Estas barreras para la implantación de la Telefarmacia pueden dividirse en cuatro ámbitos: tecnoló ico, organizativo, humano y económico. La prestación de atención y servicios farmacéuticos a través de medios digitales es una prioridad clave de la Federación Internacional Farmacéutica. La salud digital es uno de los 21 Objetivos de Desarrollo lanzados por la Federación Internacional Farmacéutica en 2020. El informe de la Federación Internacional Farmacéutica sobre salud digital en la formación farmacéutica en 2021 describe la preparación, adaptabilidad y capacidad de respuesta de la formación farmacéutica y las necesidades de conocimientos y habilidades de los farmacéuticos sobre la salud digital. Entre otras herramientas de salud digital, la Telemedicina/Telefarmacia ha sido señalada como una de las herramientas preferidas por los encuestados para formar y aprender.

Considering equity in priority setting using transmission models: Recommendations and data needs.

OBJECTIVES: Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS: We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS: We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS: Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.

Minimally Invasive Glaucoma Surgery WetLab: A Follow-Up Needs Assessment Survey for Ophthalmology Residents

Purpose : In 2012 Saheb and Ahmed found that minimally invasive glaucoma surgeries (MIGS) lower intraocular pressure, decrease dependence on medications, and have an excellent safety profile. In 2017 75.5% of glaucoma surgeries performed in the US on Medicare patients 65 years or older in the US were MIGS. A 2020 study surveyed US program directors and found that both didactics and wet labs are used for resident training in MIGS. However, 37% of program directors did not feel that the experience was adequate for independent practice and only 27% felt that MIGS should be an ACGME requirement.<span style='font-size:10.8333px'> </span>Since 2017 Loyola's citywide annual microsurgical wet lab for six Chicago residencies has focused on hands-on training in MIGS to meet the increasing interest amongst residents. During COVID-19, Loyola continued to host our annual wet lab, providing MIGS training virtually. The purpose of this study was to assess residents' perspectives of their current MIGS training and how residents' perspectives have changed since 2017. Methods : In 2017 and 2020 respectively, 31 and 44 residents of 6 Chicago programs attended our wet lab. Residents were given a pre-wet lab survey regarding their interest in MIGS and training satisfaction. The data collected was anonymous and de-identified. In 2017 data was collected in-person on iPads using RedCap software and in 2020 the data was collected remotely using Qualtrics data collection platform. In both wet labs residents performed various MIGS and intraoperative gonioscopy. Results : In 2017 and 2020 respectively, 77% and 81% of residents reported that they were interested or very interested in MIGS. In 2017 32% of residents were satisfied by their MIGS training. In 2020, still only 25% of residents were satisfied by their current MIGS training. Conclusions : Despite widespread use of MIGS in the US and growing interest amongst graduating ophthalmologists, there continues to be a gap between resident interest in MIGS and satisfaction with training during residency. Over the four years, this gap has remained unchanged. A MIGS-based hands-on wet lab experience is one way to improve MIGS training for residents and close the gap between interest and satisfaction with current MIGS resident training.

The role of package design typicality on a hand sanitizer purchase

This descriptive research uses multiple methods to understand consumers' interactions with hand sanitizer packaging at the point of purchase during the coronavirus pandemic. An analysis of common visual codes within the product category defines a typical hand sanitizer package at the time of the study. Eye-tracking biometrics systematically describe consumers' attention to hand sanitizer products while shopping. Finally, quantitative and qualitative survey data capture participants' perceived typicality of hand sanitizer packaging, package element preferences and their attitude towards the product. A multiple regression analysis found that visual appeal, brand confidence and packaging have a significant positive relationship to participants' perceived typicality. Packages perceived as typical were best described as transparent with non-pigmented products and few graphical elements included on the principal display panel (PDP). Form, dispensing method and active ingredient were the most important considerations in hand sanitizer purchases. Participants indicated that brand was not an important factor when shopping for hand sanitizer, but biometrics suggested that it was more important than most other text. Findings contribute to the growing research around package design typicality with a novel product category and offer a baseline understanding of expectations for hand sanitizer packaging. Attention towards 11 hand sanitizer packaging stimuli and survey responses of 61 human subjects located in the southeast United States during the coronavirus pandemic were collected and analysed. Further research is needed to understand consumer interaction with hand sanitizer packaging outside this context.

A Feasibility Cluster Randomised Controlled Trial of Paramedic- Administered Breathlessness Management Intervention for Acute- On-Chronic Breathlessness (BREATHE): Study Findings

Background/aims: One-fifth of conveyances to the emergency department (ED) are due to acute-on-chronic breathlessness. Paramedic breathlessness management may ease distress quicker and/or reduce ED conveyances. We evaluated the feasibility of a full trial of a paramedic delivered intervention to reduce avoidable conveyances (recruitment, randomisation, consent, training and intervention acceptability, adherence, data quality, best primary outcome, sample size estimation). The intervention comprised evidence-based non-drug techniques and a self-management booklet. Methods: This mixed-methods feasibility cluster randomised controlled trial (ISRCTN80330546) with embedded qualitative study about trial processes, training and intervention delivery, randomised paramedics to usual care or to intervention + usual care. Retrospective patient consent to use call-out data and prospective patient/carer consent for follow-up was sought. Potential primary outcomes were breathlessness intensity (numerical rating scale) and ED conveyance. Follow-up included an interview for patients/carers and questionnaires at 14 days, 1 and 6 months and paramedic focus groups and survey. Results: Recruitment was during the COVID-19 pandemic, leading to high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics;9 withdrew. Randomisation and trial procedures were acceptable. Paramedics recruited 13 patients;8 were followed up. Data quality was good. The intervention did not extend call-out time, was delivered with fidelity and no contamination and was acceptable to patients, carers and paramedics. There were no repeat call-outs < 48 hours. Recruitment stop-go criteria were not met. We had insufficient data for sample size estimation. Conclusions: A full trial in the same circumstances is not feasible. However, valuable information was gained on recruitment, attrition, consent, training and intervention acceptability and adherence, and patient-reported data collection.

COVID-19 Pandemic Impact on US Childhood Caries and Potential Mitigation.

Non-Hispanic Black (NHB) and Hispanic and low-income US children have a higher prevalence of untreated caries than their higher-income and non-Hispanic White (NHW) counterparts. Due to the COVID-19 pandemic, many dental offices and school sealant programs closed beginning March 2020. We examine the effect of reduced access to restorative care and sealants on the oral health of children from low-income households overall and by race/ethnicity and how increased sealant delivery in September 2022 could mitigate these effects. We used Markov chain Monte Carlo simulation to model COVID-19's impact on first permanent molar (1M) caries incidence and loss in quality of life (disability-adjusted life years [DALYs]) due to time lived with 1M untreated caries. Our model followed a cohort of children aged 7 y in March 2020 until February 2024. Model inputs were primarily obtained from published studies and nationally representative data. Excess DALYs per 1,000 children attributable to reduced access to care during the pandemic were 1.48 overall and greater for Hispanic (2.07) and NHB (1.75) children than for NHW children (0.94). Excess incidence of 1M caries over 4 y was 2.28 percentage points overall and greater for Hispanic (2.63) and NHB (2.40) children than for NHW (1.96) children. Delivering sealants to 50% of eligible 1Ms in September 2022 would not completely mitigate COVID-19's health access impact: overall excess DALYs would decrease to 1.05, and absolute disparities in excess DALYs between NHW children and Hispanic and NHB children would remain but decrease by 0.38 and 0.33, respectively. Sealing 40% of eligible 1Ms, however, would bring overall 4-y caries incidence down to pre-COVID-19 levels and eliminate the differential effect of the pandemic on children from minority groups. The pandemic's negative impact on the oral health of children from low-income households and increased disparities could be partially mitigated with increased sealant delivery.

Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study.

BACKGROUND: Child with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically have mild symptoms that do not require medical attention, leaving a gap in our understanding of the spectrum of SARS-CoV-2-related illnesses that the viruses causes in children. METHODS: We conducted a prospective cohort study of children and adolescents (aged <21 years) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time polymerase chain reaction assay. RESULTS: Of 382 children, 293 (77%) were SARS-CoV-2-infected. SARS-CoV-2-infected children were more likely to be Hispanic (P < .0001), less likely to have asthma (P = .005), and more likely to have an infected sibling contact (P = .001) than uninfected children. Children aged 6-13 years were frequently asymptomatic (39%) and had respiratory symptoms less often than younger children (29% vs 48%; P = .01) or adolescents (29% vs 60%; P < .001). Compared with children aged 6-13 years, adolescents more frequently reported influenza-like (61% vs 39%; P < .001) , and gastrointestinal (27% vs 9%; P = .002), and sensory symptoms (42% vs 9%; P < .0001) and had more prolonged illnesses (median [interquartile range] duration: 7 [4-12] vs 4 [3-8] days; P = 0.01). Despite the age-related variability in symptoms, wWe found no difference in nasopharyngeal viral load by age or between symptomatic and asymptomatic children. CONCLUSIONS: Hispanic ethnicity and an infected sibling close contact are associated with increased SARS-CoV-2 infection risk among children, while asthma is associated with decreased risk. Age-related differences in clinical manifestations of SARS-CoV-2 infection must be considered when evaluating children for coronavirus disease 2019 and in developing screening strategies for schools and childcare settings.

Solidarity Matters: Prototypicality and Minority and Majority Adherence to National COVID-19 Health Advice

The effectiveness of measures introduced to minimise the spread of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2 or COVID-19) depends on compliance from all members of society. The Irish response to COVID-19 has been framed as a collective effort, fostering national solidarity. However, dominant representations of the national community often unreflexively reaffirm the prototypicality of majority group members, implicitly marginalizing minority group members. This may have implications for adherence behaviours. We propose that majority/minority membership of the national community predicts adherence to COVID-19 health advice via prototypicality and national solidarity. In Study 1, we collected data online from Irish residents (N = 1,185) during the first wave of restrictions in Ireland's response. In Study 2, we collected data from Irish residents (N = 537) during the second wave of restrictions, with more targeted sampling of minority groups. Based on these two studies, there is no difference between minority and majority group members' adherence behaviours. However, mediation analysis showed that greater adherence to COVID-19 health advice is shown when group members perceive themselves to be prototypical of the Irish national community, and thereby show greater national solidarity. In Study 3, we manipulated an appeal to adhere to restrictions (N = 689) and show that an inclusive solidarity appeal increased reported intentions to adhere to COVID-19 restrictions compared to an exclusive solidarity appeal among minority group members. These findings suggest that appeals to national solidarity in response to COVID-19 will be most successful when they reference the diversity of the nation.

Implementation and Effectiveness of a CSPAP-Informed, Online Secondary Methods Course With Virtual Field Experiences During the COVID-19 Pandemic

This study examined the implementation and effectiveness of a comprehensive school physical activity program (CSPAP)-informed, 15-week physical education secondary methods course, adapted from its previous in-person format to be completely online for fall 2020 during the COVID-19 pandemic. The participants were 15 preservice physical education teachers (PPETs) and three course instructors. Each PPET taught six virtual physical education lessons to middle and high school students learning at home. Multiple data sources including focus groups, individual interviews, and course artifacts were analyzed to address research questions centered on the fidelity of course delivery, adaptations made to the course during implementation, and the PPETs' approach to lesson planning and teaching. The findings showed a high level of implementation fidelity, and few adaptations were made to the course. Three themes were identified with respect to the PPETs' pedagogical approach: personalization, inquiry-based instruction, and resilience. This study provides a case example of trying to prepare PPETs for professional roles in the COVID era.

Supporting Weight Management during COVID-19 (SWiM-C): A randomised controlled trial of an acceptance-based behavioural intervention to prevent weight gain during the pandemic

Introduction: The social distancing and isolation measures imposed during the COVID-19 pandemic mean that adults with overweight and obesity in the UK are at increased vulnerability to weight gain and the associated negative impacts on physical and mental wellbeing. There is growing evidence that interventions based on Acceptance and Commitment Therapy (ACT) are more effective for weight management compared with standard behavioural treatment. In collaboration with patient and public representatives and other stakeholders, we developed an ACT-based behavioural intervention to support adults with overweight and obesity to prevent weight gain during the COVID-19 pandemic (SWiM-C). This study evaluated whether SWiM-C reduced weight and achieved greater improvements in eating behaviour, physical activity and mental wellbeing compared with standard advice, over four months during the pandemic. Methods: We randomised adults (BMI≥25kg/m2) to the SWiM-C intervention or to a standard advice wait list control group. SWiM-C is an ACT-based guided self-help intervention consisting of weekly webbased sessions for 12 consecutive weeks, with two remote contacts (by telephone and email) from a trained non-specialist coach. The control group received standard advice from the European Association for the Study of Obesity (EASO) on diet, physical activity, and mental wellbeing during the COVID-19 pandemic. The planned sample size was 360 to give us 90% power to detect a 1kg difference between groups at the 5% level. Participants completed outcome assessments online at baseline and 4 months follow-up. The primary outcome was change in self-measured weight from baseline to four months;secondary outcomes included depression, anxiety, stress, psychological flexibility, eating behaviour (cognitive restraint, uncontrolled eating and emotional eating), physical activity, and health-related quality of life. Analysis was based on the intention-to-treat principle. We estimated baseline-adjusted differences between the study groups in change in weight (and secondary outcomes) from baseline to 4 months using linear regression models, also adjusting for randomisation stratifiers (sex, BMI group). Results: We recruited and randomised 388 participants (196 standard advice, 192 SWiM-C). 187 (97%) SWiM-C participants started the intervention, 167 (87%) completed the coach call, 161 (84%) were sent tailored coach emails, and 93 (48%) completed at least 8 sessions. Follow-up for the primary outcome was completed by 325 (84%) participants. Analysis of the effectiveness of SWiM-C is currently underway and will be completed before the conference. Conclusion: There is a need for user-friendly and remotely delivered weight management interventions to support adults with overweight and obesity during the COVID-19 pandemic. SWiM-C has demonstrated excellent uptake and engagement levels for a predominantly digital intervention, and we will report on the effectiveness of this approach. Findingswill inform the evidence base on digital interventions for weight management and can be used to inform existing services which are currently transitioning from face-to-face to online delivery.

Development of an acceptance-based guided self-help behavioural intervention for weight loss maintenance: An evidence-, theory-and person-based approach

Introduction: The long-term impact and cost-effectiveness of weight management interventions depends on post-treatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioural therapy (3wCBT), specifically Acceptance and Commitment Therapy (ACT), could improve long-term weight management. However these interventions are typically delivered face-to-face by clinical psychologists, which limits their scalability. We used an evidence-, theory-and person-based approach to develop an ACT-based intervention for weight-loss maintenance that uses digital technology and non-specialists to minimise resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in healthcare, Intervention Mapping Protocol, and the person-based approach for enhancing the acceptability and feasibility of interventions. Two phases of work were conducted: phase one consisted of collating and analysing existing and new primary evidence, and phase two consisted of theoretical modelling and intervention development, including development of guiding principles, a logic model and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development. Results: This process resulted in a guided self-help intervention called SWiM (Supporting Weight Management). SWiM is a 4-month programme, consisting of weekly web-based sessions for 13 consecutive weeks, followed by a 4-week break for participants to reflect and practice their new skills, and a final session at week 17. Each session consists of psycho-educational content, reflective exercises, and behavioural experiments. SWiM includes specific sessions on key determinants of weightloss maintenance, including developing skills to identify and manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight-management. A trained, non-specialist coach supports participants through the programme with four scheduled 30-minute telephone calls and three further optional calls, which are guided by scripts. Conclusions: This comprehensive and iterative approach facilitated the development of an intervention that is based on scientific theory and evidence to support people with weight loss maintenance, and is grounded in the experiences of the target users and the context in which the intervention is intended to be delivered. The development of SWiM is prudent given the novel coronavirus pandemic, and the increased need for remote delivery of weight management interventions. The intervention will be refined based on findings of a planned pilot randomised controlled trial.

Enhancing postgraduate skills in paediatric critical care physiotherapy via simulation-based education: A collaborative approach

AIMS & OBJECTIVES: Cardiorespiratory physiotherapy within the paediatric critical care unit requires specialist knowledge and postgraduate training to ensure safety and clinical competency. Within the United Kingdom, simulationbased education (SBE) is primarily used for treatment skills and updates for cardiorespiratory on-call physiotherapists (Gough et al, 2013). The availability and accessibility of high-fidelity resources and specialist education is variable. A collaboration between Great Ormond Street Hospital and the Royal Brompton Hospital, London, was established with the aim of providing a comprehensive SBE course to paediatric physiotherapists nationally. There are currently no other paediatric SBE programmes within the region. METHODS: During May 2018, 2 courses were run with a combination of pre-simulation lectures, simulation scenarios and peer group discussion. Following an international peer review from Queensland Children's Hospital and anonymised candidate feedback (N=23), the course content was divided into 2 separate study days (October 2018 and May 2019). This allowed targeted, specific SBE to both a critical care group and a high dependency care group of paediatric physiotherapists. RESULTS: 15 candidates attended the SBE paediatric critical care (N=8) and high dependency care (N=7) courses. Of the 14 anonymised electronic feedback responses, 96.5% rated the 4 simulation scenarios as extremely useful or very useful. Feedback themes were collated to guide future course content. CONCLUSIONS: The targeted SBE programme for paediatric critical care physiotherapists demonstrated improved confidence in managing highly complex scenarios alongside an opportunity for shared peer learning and reflective practice. In the current COVID-19 pandemic, the course is being modified for teaching via a virtual platform.