Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months' follow-up.

BACKGROUND: This study evaluated the cost-effectiveness of an intervention based on a training course for community pharmacists and a smoking cessation service (CESAR©), using limited societal and the health provider perspectives. METHODS: Non-randomized controlled trial of 12-months' follow-up. Spanish community pharmacists who were previously trained with CESAR© formed the intervention group (n = 102), and control group delivered usual care (n = 80). CESAR Patients were smokers identified by the community pharmacists when they attended the pharmacy. Data were self-reported. Outcomes were smoking cessation and quality-of-life (EQ-5D-3L) and were collected at baseline, 6, and 12 months. Costs data included direct health costs, work loss, and intervention costs. Smoking cessation was analyzed through logistic regression models. Generalized linear models were carried out for quality-adjusted life year (QALY) and costs. Incremental cost-effectiveness ratio (ICER) and cost-utility ratio (ICUR) were calculated. RESULTS: In total, 800 smoking patients were included in the intervention group and 278 in the control group. Of these, 487 and 151 patients completed the study, respectively. Costs were lower in the intervention group compared to the control group in both perspectives. At 12 months, 54.3% and 37.1% patients from the intervention and the control groups reported smoking cessation, respectively. The difference in probability of cessation in the intervention compared to the control group was 17.6% (CI:0.05; 0.25). The mean QALY was higher in the intervention group [0.03(CI: 0.01; 0.07)]. The ICER and the ICUR were dominant for the intervention group. CONCLUSION: This intervention for smoking cessation showed that the CESAR© intervention, that combined a training for community pharmacists with a smoking cessation service was efficient for smoking cessation and QALY at 12 months' follow-up. TRIAL REGISTRATION: NCT05461066, retrospectively registered (July 15, 2022).

Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions.

Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.

La indicación farmacéutica, un servicio profesional farmacéutico para reforzar la vertiente clínica y asistencial de la farmacia / The pharmaceutical indication, a professional pharmaceutical service to strengthen the clinical and care aspect of the pharmacy

El Consenso del Ministerio de Sanidad de 2001 y posteriormente el Foro de Atencion Farmacéutica definieron la Indicación Farmacéutica como un servicio en el que el farmacéutico desarrolla un papel fundamental en la mejora de problemas de salud autolimitados, derivando al médico si fuera necesario. ¿Pero es lo mismo efectuar una indicación farmacéutica que tener en la farmacia un servicio de indicación farmacéutica?SEFAC, el Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada y el Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia pusieron en marcha para responder a esta pregunta el estudio INDICA+PRO, en el que se demostró que había diferencias entre las farmacias que aplicaban el sistema tradicional y las que estaban formadas con protocolos consensuados con sociedades científicas.Con los datos obtenidos en ese trabajo se ha puesto en marcha el estudio de implantación del Servicio de Indicación Farmacéutica con mas de 700 investigadores y mas de 13.000 registros recogidos hasta la fecha y fruto de todo este esfuerzo, a partir de febrero los farmacéuticos que lo deseen podrán capacitarse en el Servicio Profesional Farmacéutico de Indicación Farmacéutica de SEFAC (SIFAC), que cuenta con el aval de las principales sociedades científicas médicas de atención primaria.

Impacto del servicio profesional farmacéutico asistencial de cesación tabáquica en la farmacia comunitaria. Protocolo del estudio y características de los investigadores y los pacientes / Impact of the professional pharmaceutical care service for smoking cessation in community pharmacies. Study protocol and characteristics of researchers and patients

Introducción:  el tabaquismo es un grave problema de salud pública, el 23 % de los españoles mayores de 15 años fuma a diario y el 2,4 % es fumador ocasional. El farmacéutico comunitario (FC) es un profesional sanitario accesible y cercano a la población que puede desempeñar una importante labor en cesación tabáquica. Es fundamental realizar estudios de investigación que demuestren el impacto de la intervención del FC en tabaquismo y ayuden a definir un protocolo de actuación que pueda implantarse de manera generalizada en cualquier farmacia comunitaria de nuestro país.Material y métodos:  el protocolo se utilizó en un estudio prospectivo controlado no aleatorizado de 12 meses de seguimiento en paciente fumador mayor de 18 años que acudía a la farmacia comunitaria con una prescripción médica para dejar de fumar, haciendo una consulta para dejar de fumar o paciente que se detecta como fumador. El estudio se diseñó para desarrollarse en 100 farmacias con farmacéuticos capacitados a través del programa CESAR (grupo intervención) que realizaban una intervención estructurada y 100 farmacias con farmacéuticos no capacitados (grupo control) que realizaban una intervención habitual. Cada una de las farmacias debía reclutar un total de 5 pacientes, lo que supondría un total de 1.000 casos.Resultados:  en el estudio participaron 182 FC (grupo intervención: 102, grupo control: 80), la mayoría de los cuales desarrollaban su actividad profesional en farmacias de barrio. Se incorporaron 1.078 pacientes (grupo intervención: 800, grupo control: 278), con una distribución homogénea por sexos y una edad media de 49 años.

A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy.

BACKGROUND: Minor ailments are "self-limiting conditions which may be diagnosed and managed without a medical intervention". A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). METHODS: The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists' training, practice change facilitators and patients' educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals' consultation time, medication costs, pharmacists' training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. RESULTS: A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. CONCLUSIONS: Expanding community pharmacists' scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. TRIAL REGISTRATION: ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered.

Effectiveness of a Patient-Centered Weight Management Model in a Community Pharmacy: An Interventional Study.

PURPOSE: The aim of this study was to evaluate the provision of a professional pharmaceutical patient-centered model in a weight management program and optimization of the medication in a Spanish community pharmacy. PATIENTS AND METHODS: This was a single-group intervention study with a mean follow-up period of 8.2 months (sd 2.3). Patients ≥18 years old seeking to lose weight or improve eating habits were recruited. On the first visit, the pharmacist collected patients' sociodemographic and anthropometric variables, dietary history and lifestyle habits, biochemical measurements and other clinical and therapeutic data. The intervention was based on the Spanish Society of Community Pharmacy recommendations for diet and exercise and for pharmacotherapy management. The follow-up included a two-month visit and a final visit. RESULTS: A total of 330 patients were included (80% women; mean age 51.3 years old (sd 15.3)). A statistically significant reduction in anthropometric measurements (weight, BMI, and waist circumference) and a statistically significant increase in the number of patients with normal cholesterol and LDL-cholesterol (p<0.001) were observed at two-month visit compared with first visit (p<0.001). The number of patients with normal triglyceride levels at final visit compared with first visit also increased significantly (p=0.04). A total of 186 (56.4%) patients had drug-related problems at first visit and 31 (9.4%) patients at two-month visit. CONCLUSION: The implementation of a patient-centered weight management model had a positive impact on the improvement of anthropometric, clinical and therapeutic parameters.

Colaboración farmacéutico-médico en la elaboración de protocolos consensuados para el tratamiento de síntomas menores: programa 'INDICA+PRO' / Collaborative care protocols for the management of minor ailments agreed between pharmacists and medical practitioners: INDICA+PRO Study

Introducción: la colaboración entre médicos y farmacéuticos es necesaria en el manejo de los síntomas menores, ya que el paciente acude a ambos profesionales sanitarios para su tratamiento. El objetivo del estudio fue elaborar protocolos de trabajo consensuados entre farmacéuticos comunitarios y médicos de atención primaria para el Servicio de Indicación Farmacéutica (SIF). Material y método: se utilizaron dos metodologías: revisión bibliográfica y grupo de expertos para el consenso. Estos protocolos se actualizaron y diseñaron a partir de un documento previo de 2008. En el grupo de expertos se incluyeron cuatro farmacéuticos comunitarios de SEFAC (2), MICOF (2) y cuatro médicos de atención primaria de semFYC (2) y SEMERGEN (2). Resultados: se consensuaron protocolos de trabajo para 31 síntomas menores distribuidos en cinco grupos: respiratorios, dolor moderado, digestivos, dermatológicos y otros. Se añadieron cinco síntomas nuevos al documento de partida. Respecto a la estructura de cada síntoma se consideró: concepto, causas más frecuentes, criterios de derivación al médico (edad, síntomas de alarma, duración de los síntomas, otros problemas de salud y/o medicamentos y situaciones especiales), recomendaciones para la prevención y tratamiento (no farmacológico y farmacológico). Conclusión: el documento desarrollado mediante colaboración entre profesionales de la medicina y la farmacia es una herramienta que contribuye a la mejora de la actuación del farmacéutico en el manejo de los síntomas menores desde la farmacia comunitaria, con énfasis en la definición de indicadores que señalan la necesidad de derivar el paciente al médico de atención primaria

Background: To increase the collaboration between community pharmacists and medical practitioners working in primary care it is critical to have collaborative protocols in place. Minor ailments could be a good example where this collaboration would benefit patient care as patients are seeking treatment in both settings. These collaborative protocols would assist in diminishing the variability of treatments in both settings. The aim of the study was to develop care protocols for minor ailments agreed between medical practitioners and pharmacists Methods: Two different methodologies were used to arrive at a consensus for the proto-cols: literature review and expert group. Some of the clinical protocols were updated from a previous document created in 2008. Expert group was composed of four community pharma-cists (SEFAC, MICOF) and four medical practitioners (SemFyC y Semergen). Results: Thirty-one protocols for minor ailments were agreed and allocated to five groups (five new minor ailments protocols were added: respiratory tract-related conditions, gastrointestinal disturbance, pain, dermatological problems and others.Protocols were structured following: definition, more frequent causes, referral criteria (pa-tient’s age, red flags, symptom’s duration, patient’s health problems and treatments and physiological situations), recommendations for management (prevention, non-pharmacological and pharmacological treatment) and references used. Conclusions: Clinical protocols agreed between health professionals of medicine and phar-macy are a tool that contribute to better management of minor ailments in community pharmacy