The community pharmacists and their practice as health care providers

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Comment. Drug utilization studies. The need to know the indication

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Oral health knowledge, attitudes and practice in 12-year-old schoolchildren.

OBJECTIVE: The objective of this study was to assess the association between knowledge, attitudes and practice of oral health in 12-year-old schoolchildren, and to analyse the findings in terms of the conventional KAP health-education model and of the critical approach. STUDY DESIGN: This study has a cross sectional design. The study participants were 1105 randomly selected 12-year-old children resident in the region of Galicia in Spain. For data collection, five teams of one dentist and one assistant were formed. The dentist carried out the physical examination and the assistant helped the subjects to answer the questionnaire. Knowledge, attitudes and practice were assessed, as well as oral health indicators. Multiple regression analysis was used to identify variables affecting practice (as measured by extent of plaque). RESULTS: The results of this study show how that there is an important association between oral health knowledge, attitudes, and practice in 12-year-old schoolchildren in this region. However, the results also show that attitude is not totally explained by knowledge, so that attitude cannot be understood simply as an intermediate variable in a knowledge practice causal chain. Specifically, the results indicate that sociocultural environment modifies the association knowledge, attitudes and practice. CONCLUSIONS: Within oral health education it is clearly important to increase public knowledge of the risk factors for dental disease. However, the efficacy of such education will be limited if health programs do not directly impinge on attitudes, and take into account factors related to the environment, education, social status and economic level of the targeted population.

Oral health knowledge, attitudes and practice in 12-year-old schoolchildren

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Objective: The objective of this study was to assess the association between knowledge, attitudes and practice of oral health in 12-year-old schoolchildren, and to analyse the findings in terms of the conventional KAP health-education model and of the critical approach.Study design: This study has a cross sectional design. The study participants were 1105 randomly selected 12-year-old children resident in the region of Galicia in Spain. For data collection, five teams of one dentist and one assistant were formed. The dentist carried out the physical examination and the assistant helped the subjects to answer the questionnaire.Knowledge, attitudes and practice were assessed, as well as oral health indicators. Multiple regression analysiswas used to identify variables affecting practice (as measured by extent of plaque).Results: The results of this study show how that there is an important association between oral health knowledge, attitudes, and practice in 12-year-old schoolchildren in this region. However, the results also show that attitude is not totallyexplained by knowledge, so that attitude cannot be understood simply as an intermediate variable in a knowledge¨ practice causal chain. Specifically, the results indicate that sociocultural environment modifies the association knowledge, attitudes and practice.Conclusions: Within oral health education it is clearly important to increase public knowledge of the risk factors for dental disease. However, the efficacy of such education will be limited if health programs do not directly impinge onattitudes, and take into account factors related to the environment, education, social status and economic level of the targeted population

Factors associated with the pharmacist counselling without dispensing.

PURPOSE: To describe the pharmacist counselling without dispensing and to analysed the characteristics of pharmacies and pharmacists that provide this type of counselling, and the characteristics of customers that receive it to a greater extent. METHODS: We carried out a cohort study on a sample of 166 pharmacists in North West Spain. Different characteristics of pharmacists and clients and other variables related to counselling were measured (who initiates the consultation; type of consultation; whether or not the patient consulted with a doctor previously and who is the receptor of the counselling) were included in the models as independent variables. Pharmacist Counselling without dispensing (PhCwD) were included as dependent variable. We constructed logistic regression models. RESULTS: The response rate to the first questionnaire was 98.8% and the participation rate in the follow-up was 60%. Out of 7010 registered pharmacist counselling, 6034 were included in the final analysis (86.1%). The proportion of PhCwD is 26.3% (95%IC: 25.2-27.4). CONCLUSIONS: Our results show the number of working hours of the pharmacist and the amount of customers are associated with PhCwD. So working hours and amount customers should be reduced. Other factor that should be taken into account is the fact that pharmacists with less experience should give less counsels. Thus during the university period pharmacist counselling should be studied. Finally, our results show that an important proportion of counselling is given regardless the dispensation process, and this should be taken into account when defining the pharmacists remuneration system.

Factors related to dental health in 12-year-old children: a cross-sectional study in pupils.

OBJECTIVE: The aim of this study was to identify factors related to the prevalence of caries in 12-year-old schoolchildren. METHODS: A cross-sectional study was carried out using a representative sample (n = 1217) of the population of 12-year-old schoolchildren in Galiza (northwest Spain). Independent variables were measured through a questionnaire, and dependent variables were determined through oral examination. Multiple and logistic regression were applied. RESULTS: The decayed, missing and filled permanent teeth/decayed, filled primary teeth (DMFT-dft) value in the sample was 1.83 (95% confidence interval [CI], 1.67-1.98), the DMFT value was 1.53 (95% CI, 1.37-1.67), and the prevalence of caries was 61% (95% CI, 57.7-64.5). The prevalence of caries was directly related to a low frequency of brushing, greater use of toothpaste, and a higher consumption of sweets. The prevalence of caries was higher in rural than in urban areas. In contrast, the higher the mother's level of education and the greater the subject's knowledge of dental health, the lower the prevalence of caries. CONCLUSIONS: The main goals of dental health programmes should be to achieve quality brushing every day in children, to reduce the consumption of sweets, and to increase knowledge of dental health.

Factors related to dental health in 12-year-old children: a cross-sectional study in pupils

Objetivo: Identificar los factores asociados a la prevalencia de caries en escolares de 12 años. Métodos: Estudio transversal sobre una muestra (n = 1.217) de escolares de 12 años de Galicia. Las variables independientes se midieron mediante un cuestionario y las dependientes, a través de exploración bucal. En el análisis estadístico se aplicaron regresión logística y regresión lineal múltiple. Resultados: El índice CAO-co en la muestra fue 1,83 (intervalo de confianza [IC] del 95%, 1,67-1,98), el índice CAO 1,53 (IC del 95%, 1,37-1,67), mientras que la prevalencia de caries se situó en el 61% (IC del 95%, 57,7-64,5). La prevalencia de caries estuvo directamente asociada a la baja frecuencia del cepillado, al mayor uso de pasta y al elevado consumo de golosinas. La prevalencia de caries determinada en el medio rural fue más alta que en el medio urbano. Por último, el mayor nivel de estudios de la madre y los mayores conocimientos sobre salud oral de los individuos se asocian a una menor prevalencia de caries. Conclusiones: A pesar de la moderada afectación por caries, los principales objetivos de los programas de salud oral para este grupo de edad deben ser: lograr el cepillado dental diario, reducir el consumo de golosinas e incrementar los conocimientos sobre salud oral. Por último, los programas de salud oral deben estar dirigidos principalmente a la población del medio rural y de menor nivel sociocultural

Objective: The aim of this study was to identify factors related to the prevalence of caries in 12-year-old schoolchildren. Methods: A cross-sectional study was carried out using a representative sample (n = 1217) of the population of 12-year-old schoolchildren in Galiza (northwest Spain). Independent variables were measured through a questionnaire, and dependent variables were determined through oral examination. Multiple and logistic regression were applied. Results: The decayed, missing and filled permanent teeth/decayed, filled primary teeth (DMFT-dft) value in the sample was 1.83 (95% confidence interval [CI], 1.67-1.98), the DMFT value was 1.53 (95% CI, 1.37-1.67), and the prevalence of caries was 61% (95% CI, 57.7-64.5). The prevalence of caries was directly related to a low frequency of brushing, greater use of toothpaste, and a higher consumption of sweets. The prevalence of caries was higher in rural than in urban areas. In contrast, the higher the mother's level of education and the greater the subject's knowledge of dental health, the lower the prevalence of caries. Conclusions: The main goals of dental health programmes should be to achieve quality brushing every day in children, to reduce the consumption of sweets, and to increase knowledge of dental health

Influence of pharmacists' opinions on their dispensing medicines without requirement of a doctor's prescription.

OBJECTIVE: To assess the influence of pharmacists' opinions on their dispensing medicines with a "medical prescription only" label without requiring a doctor's prescription. METHODS: We performed a cross-sectional study of 166 community pharmacies in northwest Spain. The opinions of pharmacists on the following were collected as independent variables through personal interview: a) physicians' prescribing practices; b) the pharmacist's qualifications to prescribe; c) the responsibility of the pharmacist regarding the dispensed drugs; d) the customer' qualifications for self-medication; and e) the pharmacist's perception of his or her own work. The dependent variable was the pharmacist's demand for a medical prescription for 5 drugs, which in Spain require a prescription. Multiple linear regression models were constructed. RESULTS: The response rate was 98.8%. A total of 65.9% of pharmacists reported dispensing antibiotics without a prescription. This percentage was 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for angiotensin-converting enzyme inhibitors, 13.4% for benzodiazepines, and 84.8% for oral contraceptives. Further results showed that pharmacists with a heavier workload and those who underestimated the physicians' qualifications to prescribe but overestimated their own qualifications to prescribe less frequently demanded medical prescriptions. In contrast, pharmacists who stressed the importance of their duty in rationalizing the consumption of drugs more frequently demanded medical prescriptions. CONCLUSION: Our results suggest that to increase the quality of dispensing: a) the importance of the pharmacist's duty in controlling drug consumption should be stressed; b) pharmacies' workload should be optimized; and c) perceptions of physicians' prescribing practices among pharmacists should be improved.

Influence of pharmacists’ opinions on their dispensing medicines without requirement of a doctor’s prescription

Objetivo: Evaluar la influencia de las opiniones de los farmacéuticos que no solicitan receta médica para dispensar fármacos que la requieren para su venta. Métodos: Se ha llevado a cabo un estudio transversal sobre una muestra de 166 farmacéuticos de oficina de farmacia en la provincia de A Coruña. Las opiniones de los farmacéuticos, variables e independientes, fueron medidas mediante entrevista personal. Se valoraron las opiniones siguientes: a) prácticas prescriptoras de los médicos; b) cualificación de los farmacéuticos para prescribir; c) la responsabilidad de los farmacéuticos sobre los medicamentos dispensados; d) la cualificación de los clientes para automedicarse, y e) la percepción de los farmacéuticos sobre su trabajo. La exigencia de receta por parte del farmacéutico para 5 fármacos, que en España deben dispensarse con receta, fue la variable dependiente que se tuvo en cuenta. Se construyeron modelos de regresión múltiple. Resultados: La participación fue del 98,8%. Un total del 65,9%de los farmacéuticos afirmaron dispensar antibióticos sin receta. Este porcentaje fue del 83,5% para los antiinflamatorios no esteroideos, 46,3% para los inhibidores de la enzima de conversión de la angiotensina, 13,4% para las benzodiazepinas y 84,8% para los anticonceptivos orales. Además, los resultados muestran que los farmacéuticos con mayor carga de trabajo y los que califican peor la prescripción de los médicos, y que en mayor medida consideran que ellos mismos están capacitados para prescribir, exigen menos recetas médicas. Por el contrario, los farmacéuticos que otorgan mayor importancia a la racionalización en el consumo de fármacos exigen receta más frecuentemente. Conclusión: Nuestros resultados indican que para el incremento en la calidad de la dispensación el sistema debería lograr: a) incrementar la importancia que los farmacéuticos otorguen al control y la racionalización del consumo de fármacos; b) adecuar la carga de trabajo de las farmacias, y c) mejorar la percepción que los farmacéuticos tienen de las pautas prescriptoras de los médicos

Objective: To assess the influence of pharmacists’ opinions on their dispensing medicines with a «medical prescription only» label without requiring a doctor’s prescription. Methods: We performed a cross-sectional study of 166 community pharmacies in northwest Spain. The opinions of pharmacists on the following were collected as independent variables through personal interview: a) physicians’ prescribing practices; b) the pharmacist’s qualifications to prescribe; c) there sponsibility of the pharmacist regarding the dispensed drugs; d) the customer’ qualifications for self-medication; and e) the pharmacist’s perception of his or her own work. The dependent variable was the pharmacist’s demand for a medical prescription for 5 drugs, which in Spain require a prescription. Multiple linear regression models were constructed. Results: The response rate was 98.8%. A total of 65.9% of pharmacists reported dispensing antibiotics without a prescription. This percentage was 83.5% for non-steroidal anti-inflammatory drugs, 46.3% for angiotensin-converting enzyme inhibitors, 13.4% for benzodiazepines, and 84.8% for oral contraceptives. Further results showed that pharmacists with a heavier workload and those who under estimated the physicians’ qualifications to prescribe but overestimated their own qualifications to prescribe less frequently demanded medical prescriptions. In contrast, pharmacists who stressed the importance of their duty in rationalizing the consumption of drugs more frequently demanded medical prescriptions. Conclusion: Our results suggest that to increase the quality of dispensing: a) the importance of the pharmacist’s duty in controlling drug consumption should be stressed; b) pharmacies ’workload should be optimized; and c) perceptions of physicians’ prescribing practices among pharmacists should be improved

Socio-demographic factors related to the prevalence of adverse drug reaction at hospital admission in an elderly population.

To identify and to measure the association between socio-demographic factors and the prevalence of adverse drug reaction at hospital admission in an elderly population, we carried out a cross-sectional study on a sample of 19,070 patients of the Gruppo Italiano di Farmacoepidemiologia nell'Anziano data base (Italy). The following socio-demographic variables were considered as independent variables: gender, age, education, living arrangement, widowhood/widowerhood, and alcohol and tobacco habit. We estimated the association of these variables with diagnosis of any adverse drug reaction at hospital admission. We used a logistic regression model to obtain estimates of this association, taking into account hepatic and renal diseases, number of diseases, number of drugs used, albumin index (indicator of nutritional condition) and cognitive function. Out of the 19,070 patients included in our study, 878 (4.3%) were diagnosed with an adverse drug reaction at admission. The multivariate analysis shows that none of the socio-demographic variables and health habits considered are associated with adverse drug reactions at admission. A worse nutritional condition of the subject (OR = 1.39; 95% CI: 1.17-1.64), the number of drugs consumed in the month previous to the admission (OR = 1.74; 95% CI: 1.47-2.08) and the presence of renal disease (OR = 1.76; 95% CI: 1.41-2.55) are associated with ADR at hospital admission. Our results suggest that special attention should be paid to avoid adverse drug reactions in elderly people with nutritional problems, renal failure or those who are using two drugs or more. Additional precautions should be taken with people with cognitive impairment, because of their reduced capacity to report their symptoms.

Influence of commercial information on prescription quantity in primary care.

BACKGROUND: In the last few years we have witnessed many publicly-financed health services reaching a crisis point. Thus, drug expenditure is nowadays one of the main concerns of health managers, and its containment one of the first goals of health authorities in western countries. The objective of this study is to identify the effect of the perceived quality stated in commercial information, its uses, and how physicians perceive the influence it has on prescription amounts. METHODS: A cross-sectional study of 405 primary care physicians was conducted in Galicia (north-west Spain). The independent variables physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice, and number of patients were collected, through a postal questionnaire. Environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators of prescription volume. RESULTS: The response rate was 75.2%. Prescription amounts was found to be associated with perceived credibility of information provided by medical visitors, regulated physician training, and environmental characteristics of the practice (primary care team practice, urban environment). CONCLUSIONS: The study results suggest that in order to decrease prescription amounts it is necessary to limit the role of pharmaceutical companies in physician training, improve physician education and training, and emphasize more objective sources of information.

Interaction between aspirin and ACE Inhibitors: resolving discrepancies using a meta-analysis.

BACKGROUND: Recently, studies have attempted to explore the interaction between ACE inhibitors and aspirin (acetylsalicylic acid) when both drugs are used concomitantly to reduce mortality in patients with coronary artery disease. Results have been conflicting due, in part, to sub-optimal methods used to explore this interaction. METHODS: We reviewed systematically all studies on mortality in patients treated with ACE inhibitors and aspirin and conducted a meta-analysis in order to explore the interaction between both drugs and resolve discrepancies. To be included, each study had to provide data on mortality of patients who received both drugs, either drug and no drug. These data were necessary to calculate the synergy index (S) and its 95% confidence interval (CI) that we used to quantify the effect due to interaction between ACE inhibitors and aspirin. After testing for heterogeneity of effects, we pooled the S values from the individual studies into one summary measure. Subsequently, we compared our results with those obtained through the most common but incorrect method of evaluating interaction. This method uses significance testing of the relative risk of mortality when a 'product term' between ACE inhibitors and aspirin is entered in a logistic regression model. RESULTS: Eight studies met the inclusion criteria. The pooled synergy index S indicates slight but precise antagonism between ACE inhibitors and aspirin (S = 0.91; 95% CI 0.80 to 1.03). In contrast, the pooled 'product term' is not significant and would have lead to the conclusion of absence of interaction (p = 0.15). CONCLUSION: There seems to be an antagonistic interaction between ACE inhibitors and aspirin. Former discrepancies were due to inadequate assessment of interaction. Results from the Studies on Left Ventricular Dysfunction (SOLVD) and Heart Outcome Prevention Evaluation (HOPE) trials that assessed the effect of combined administration of ACE inhibitors and aspirin were not included in this meta-analysis because those trials did not provide enough data to compute the S statistic. It is possible that results from on-going trials such as Women's Atovarstatin Trial on Cholesterol (WATCH) will shed more light on ACE inhibitor and aspirin interaction in the future.

Data collection methods for analyzing the quality of the dispensing in pharmacies.

OBJECTIVE: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. METHODS: A bibliographic search was carried out in MEDLINE (1980-2000). Articles with Medical Subject Heading (Mesh) "pharmacies" written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected. RESULTS: Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, self-completed records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. CONCLUSIONS: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.