Programa "I-Valor": la indicación farmacéutica protocolizada, consensuada y registrada en la farmacia comunitaria / The "I-VALOR" program: standardized, protocolized, and registered drug indications for community pharmacy

La indicación farmacéutica (IF) es el servicio prestado ante la demanda de un paciente o usuario que llega a la farmacia sin saber qué medicamento debe adquirir y solicita al farmacéutico el remedio más adecuado para un problema de salud concreto. Es un servicio demandado frecuentemente en la farmacia y necesita ser protocolizado para garantizar la seguridad del paciente. Se pretende diseñar un programa de actuación (I-VALOR: el valor de la indicación farmacéutica) que facilite su implantación en la farmacia comunitaria. Material y métodos: Desarrollo de un programa informático en formato web que incluye un programa de formación, un listado de criterios de derivación consensuados entre sociedades científicas médicas y farmacéuticas, un sistema de registro y otro de información a los pacientes. El programa permite emitir informes elaborados de manera semiautomática dirigidos bien a los pacientes bien al médico al que se deriva el paciente. Además el programa pretende conseguir su implantación y generalización en la farmacia comunitaria. Resultados: Participaron 1.022 farmacéuticos, 520 titulares y 502 adjuntos, en 846 farmacias de todas las provincias de España. El 50,4% de las farmacias se declaraban como "de barrio" y el 34,4% rurales. Se recogieron 37.701 registros de 5 problemas de salud: erosiones cutáneas, resfriado, pirosis, sequedad ocular y alergias. No se apreciaron diferencias en cuanto a tipo de farmacia ni de comunidad autónoma. Conclusiones: El programa I-VALOR incorpora una herramienta informática que facilita el ejercicio profesional en el servicio de IF. Por la elevada participación de farmacéuticos se puede afirmar que es útil y aplicable a la práctica de la farmacia comunitaria (AU)

The minor ailment service (MAS) is the professional service offered upon demand from a patient or user who visits the community pharmacy without knowing which medicine to acquire, and wishes the pharmacist to provide the best remedy for his or her specific health problem. It is a service frequently demanded in the pharmacy and needs to have an action protocol developed to guarantee the safety of the patient. The aim is to develop an action plan (I-VALOR: "the value of drug indications") to help embed the program into community pharmacy. Material and methods: A software program in a web format which includes an educational program, a list of referral to the physician criteria after a consensus agreed within medical and pharmaceutical scientific societies, a record system and a patient information system, has been developed. The program allows issuing pre-elaborates documents oriented both to the patients and physicians in a semiautomatic way. Also, the program is intended to be fully implemented thorough Spanish community pharmacies. Results: 1,022 pharmacists, 520 owners and 502 assistant pharmacists, participated in 846 pharmacies distributed in all Spanish provinces. 50.4% of the pharmacies were situated in a "neighborhood" and 34.4% in "rural" areas. 37,701 records on 5 health problems; skin erosions, colds, heartburn, ocular dryness and allergies were registered. There were no differences in relation to the type of pharmacy or geographical region. Conclusions: The I-VALOR program includes a software tool which helps the community pharmacist to provide the minor ailment service in a more professional way. Due to the high rate of participants it can be said that the tool is useful and suitable to be used in community pharmacy practice (AU)

Dispensación de antibióticos en Oficina de Farmacia: demanda con receta / No disponible

Mejorar el uso de los antibióticos mediante la protocolización de la dispensación. Diseño: Estudio observacional transversal. Emplazamiento: Oficinas de Farmacia del Estado Español convocadas por Correo Farmacéutico. Participantes: Farmacéuticos comunitarios (titulares, adjuntos, sustitutos). Población diana: Personas que demandan antibióticos con receta médica para inicio o continuación de tratamiento. Intervenciones: Formación de los farmacéuticos participantes. En los pacientes: detección y resolución de carencias de información y Problemas Relacionados con Medicamentos (PRMs) en relación con la prescripción de antibióticos. Mediciones principales: Número de pacientes en los que se sospecha falta de información. Tipo de información de la que carecen en tratamientos inicio y continuación. Cuantificación y descripción de los PRMs, sus causas en tratamiento inicio y continuación. PRMs y causas por grupos terapéuticos. Resultados: 1.788 farmacéuticos participantes, 971 farmacias (4,8% de las farmacias de España). Se obtuvieron 52.753 registros válidos; 40.854 (77%) fueron de demandas de antibióticos con receta. En 33.352 ocasiones fue el propio paciente o cuidador quien realiza la demanda. En inicio tratamiento el 2% los pacientes no conocían la indicación, 12% no conoce la posología, 13% no conocía la duración y 17% tenía otras carencias de información. El 24,5% tenían alguna carencia. En continuación tratamiento los pacientes no conocen posología el 4%, duración de tratamiento 5% y 7% tenía otras carencias de información. El 34% de los demandantes tenía alguna carencia de información. En 3.001 (9%) ocasiones se detectó algún PRM, un 37% por problema de dosis, un 16% por interacción con otro medicamento, el 4% contraindicación, el 15% RAM y un 28 % por otras causas. En 87 ocasiones (0,26% del total de registros válidos) el paciente refirió ser alérgico al antibiótico que le habían prescrito. Conclusiones: La tercera parte de los pacientes a los que se les dispensó antibióticos por vía oral con receta se detectó alguna carencia de información. En un 9% de las ocasiones se detectaron problemas de seguridad o efectividad relacionados con ese antibiótico. En la farmacia comunitaria puede detectarse y corregirse esta situación, contribuyendo al uso correcto de los antibióticos (AU)

Objectives: To improve the use of the antibiotics in the population, offering a dispensing process with a structured interview and defined interventions. Design: Observational cross-sectional Study. Location: Community pharmacies of Spain summoned by the weekly edition of «Correo Farmacéutico». Participants: Community pharmacists (owners and employees). Setting: People asking for antibiotics with a prescription, at the onset of treatment or for the continuation of a treatment already in use. Interventions: 1. Training of participant pharmacists. 2. For patients: identifying and solving: a) lack of essential information and b) Drugs Related Problems (DRP) in connection with the antibiotics prescribed. Measures: Number of patients that were identified with lack of information. Type of information needed in the beginning or continuation treatments. Quantification and classification of DRP and their causes in the onset or continuation treatments. Type of DRP and its causes within each therapeutic group of antibiotics. Results: 1.788 participant pharmacists from 971 pharmacies (4,8% of the pharmacies of Spain) obtained 52.753 valid registrations of dispensing process of antibiotics. Of this total, 40.854 (77%) were antibiotic demand with a doctor prescription. In 33.352 cases the demand was done by the patient himself or the caregiver. In the onset of treatments: 2% the patients didn't know the indication; 12% doesn't know the dosage regimen; 13% he/she didn't know the length of the treatment and 17% he/she had other lacks of information. In treatment's continuation, the patients didn't know dosing or dosage regimen by 4%; duration of treatment by 5% and he/she had other lacks of information by 7%. In all, 34% of the patients had some lack of information. In 3.001 prescriptions (9%) some DRP was identified; 37% was a dosing problem, 16% was an interaction with another medication, 4% had contraindications, in 15% an Adverse Drug Reaction (ADR) was identified and 28% were DRP by other causes. In 87 occasions (0,26% of the total of valid registrations) the patient referred to be allergic to the antibiotic that have been prescribed to him/her. Conclusions: Lack of essential information was detected in a third of the patients who came to the pharmacies with an antibiotic prescription. In 9% of the cases, problems of security or effectiveness related with the antibiotic were identified. With an structured interview at the dispensing point in the community pharmacy those situations may be intervened and solved, promoting the appropriate use of the antibiotics (AU)

[Demand for dispensing of medicines without medical prescription]. / Demanda de medicamentos de prescripción sin receta médica.

OBJECTIVES: To study the request for drugs and their dispensing without the necessary prescription form. DESIGN: Cross-sectional, observational study. SETTING: Volunteer community pharmacies in Spain. MAIN MEASUREMENTS: Percentages of request and dispensation of drugs without prescription. Reasons given by people requesting the medicines and pharmacists' reasons for dispensing them. RESULTS: 11.1% of prescription drugs were requested without a prescription form: 69.7% of these requests were for chronic medication or acute treatment and 20% were for self-medication. The drugs without prescription form were dispensed in 10.8% and refused in 0.3% of cases. The reasons given by pharmacists for dispensing without the compulsory prescription form were: "drugs recommended by a doctor" (33.3%), "advance on prescriptions" (24.1%), and "the pharmacist knew the patient's pharmaco-therapeutic record" (17.5%). CONCLUSIONS: Dispensing drugs without the necessary prescription form is a very frequent practice (10.8%) and is not restricted to any particular drug therapy group. Doctors, dentists, nurses, pharmacists, patients and health service management must all assume their share of responsibility if this problem is to be solved. The system of prescription and dispensing of chronic medicine (repeat prescription in long-term treatment) needs to be improved and strengthened.

Demanda de medicamentos de prescripción sin receta médica / Demand for dispensing of medicines without medical prescription

Objetivo. Estudiar la demanda y la dispensación de medicamentos de prescripción sin la correspondiente receta. Diseño. Estudio observacional, transversal. Emplazamiento. Farmacias comunitarias voluntarias de España. Mediciones principales. Porcentajes de demanda y dispensación de medicamentos de prescripción sin la receta; razones alegadas por los usuarios para la demanda; motivos del farmacéutico para dispensar. Resultados. De los medicamentos que necesitan receta, el 11,1% se solicitó sin ella, correspondiéndose en el 69,7% de los casos con tratamiento crónico o tratamiento médico urgente. El 20% fue automedicación. Se dispensaron sin receta el 10,8% y se negó el 0,3%. Los motivos alegados por el farmacéutico para dispensar sin la receta obligatoria fueron: recomendado por un médico (33,3%), adelantos de recetas (24,1%) y conocimiento previo de la historia farmacoterapéutica del paciente en el 17,5%. Conclusiones. La dispensación de medicamentos que precisan receta sin cumplir este requisito es un hecho frecuente (10,8%) en las farmacias españolas. Afecta a todos los grupos terapéuticos y no es característica de un grupo de pacientes determinados. Para resolver este problema es necesario que todos los implicados (médicos, odontólogos, personal de enfermería, farmacéuticos, pacientes y la propia administración) asuman su parte de responsabilidad. Se debe mejorar y potenciar el sistema de prescripción y dispensación de los medicamentos crónicos (prescripción repetida en tratamientos de larga duración)

Objectives. To study the request for drugs and their dispensing without the necessary prescription form. Design. Cross-sectional, observational study. Setting. Volunteer community pharmacies in Spain. Main measurements. Percentages of request and dispensation of drugs without prescription. Reasons given by people requesting the medicines and pharmacists' reasons for dispensing them. Results. 11.1% of prescription drugs were requested without a prescription form: 69.7% of these requests were for chronic medication or acute treatment and 20% were for self-medication. The drugs without prescription form were dispensed in 10.8% and refused in 0.3% of cases. The reasons given by pharmacists for dispensing without the compulsory prescription form were: "drugs recommended by a doctor" (33.3%), "advance on prescriptions" (24.1%), and "the pharmacist knew the patient's pharmaco-therapeutic record" (17.5%). Conclusions. Dispensing drugs without the necessary prescription form is a very frequent practice (10.8%) and is not restricted to any particular drug therapy group. Doctors, dentists, nurses, pharmacists, patients and health service management must all assume their share of responsibility if this problem is to be solved. The system of prescription and dispensing of chronic medicine (repeat prescription in long-term treatment) needs to be improved and strengthened

[Pharmaceutical care in people who have had acute coronary episodes (TOMCOR study)]. / Atención farmacéutica en personas que han sufrido episodios coronarios agudos (Estudio TOMCOR).

BACKGROUND: This study evaluates the effects on coronary patients of a new practice in community pharmacies called Pharmaceutical Care (PhC) as compared to the traditional pattern of pharmacy practice. It attempts to ascertain whether pharmaceutical care is feasible in addition to ascertaining differences in effectiveness for coronary patients' pharmacotherapeutic health outcomes, potentially attributable to PhC. METHODS: A randomized prospective controlled-intervention study was conducted in 83 community pharmacies in the provinces of Asturias, Barcelona, Madrid and Biscay in a one-year monitoring of the drug-use of 735 patients at the start of the study (330 intervention patients and 405 control) and 600 at the end. RESULTS: Differences were fund in favor of the intervention group in: a) the use of health care services as a morbidity indicator such as frequency of hospital emergency room visits 1.27 I (CI95%; 1.10-1.44) and 1.63 C (CI95%; 1.36-1.90) or average length-of-stay in Intensive Care Units 2.46 I (CI95%; 1.56-3.36) and 5.87 C (CI95%; 3.57-8.17), both due to coronary causes; b) health-related quality of life score (physical functioning dimension difference of 4.7 (p < 0.05); c) average patient knowledge of coronary heart disease risk factors having improved by 10% (p < 0002-0.007 depending on dimension); d) patient knowledge of the name and identification of their drugs having improved by 10% (p < 0.001) along with their subjective perception of the antiagregans drugs relative importance having improved by 12% (p < 0.009) and effects of beta-blockers having improved by 25% (p < 0.02); e) average satisfaction with pharmaceutical care service and perception of pharmacist's professional competence having improved by 2% (p < 0.000 to 0.05 depending on dimension). CONCLUSIONS: A decrease in emergency health care demand due to coronary causes, a fewer number of patient hospitalizations and a shorter length-of-stay in Coronary Intensive Care Units due to hospitalization regarding coronary patients on pharmaceutical care would suggest that patients who suffered an acute coronary heart episode made a better use of drugs and would tend to be less ill. Furthermore, coronary patients who received pharmaceutical care services showed a better knowledge of the reasons for their pharmacotherapy and therefore took better advantage of health care resources and improved their health condition.