Importance of heat therapy in the treatment of pain in the daily clinical practice.

BACKGROUND: Musculoskeletal (MSK) pain includes a wide variety of causes and conditions. Despite the heterogeneity of MSK pain, it is possible to identify some common clinical features and treatments. Heat therapy (HT) is one of the most common and could be a suitable non-pharmacological approach. OBJECTIVE: To obtain a European overview on the use of non-pharmacological approaches and the role of heat therapy in the treatment of MSK pain. METHODS: Through a two-cycle Delphi-like method, an international board of experts reached a consensus on 13 questions for a survey to healthcare professionals who provide direct patient care. Between November 2021 and January 2022, the resulting web survey was distributed to professionals with the collaboration of ten European scientific societies and associations. Univariate and bivariate analyses were performed on collected data. RESULTS: Two hundred eighty-two answers were validated. Most of the respondents had extensive professional experience. Participants were widely distributed throughout Europe. HT is administered to about 50% of patients, with a higher percentage administered to those affected by low back pain (92%) and neck pain (84%). The choice of exogenous HT is based on both personal clinical experience and scientific evidence. HT is primarily chosen due to its relaxation effect, high safety profile and enhancement of tissue perfusion. The use of HT is recommended by 86.5% of respondents. CONCLUSION: Experts indicate that exogenous HT represents a valid therapeutic choice and is widely used in Europe. Patients should be informed about the use of heat therapy as a valuable self-management therapy option.

European community pharmacists practice in tackling influenza.

Background: In many European countries, flu vaccination coverage rates are below the 75% target. During the COVID-19 pandemic, many pharmacists around Europe were involved as vaccine administrators and demonstrated positive results in improving vaccine uptake. This paper explores the challenges, accomplishments, and best practices of various European pharmacists' associations in administering vaccines and positively contributing to public health. Methods: Eight pharmacists representing various associations from different countries across Europe (Italy, Belgium, Poland, Portugal, France, and Germany) convened to discuss their role as vaccination providers, the advantages, and strategies for improvement, and to identify barriers and gaps in the vaccination administration process, especially focusing on the administration of seasonal flu vaccines. Results: Currently, 15 European countries allow community pharmacists to dispense and administer flu vaccines. Among the ones that attended the meeting, Portugal initiated the flu immunization program at the pharmacy earliest, before the COVID era, but in other countries, the process started only in the last couple of years. Initial hesitancy and reluctance by other HCPs or institutions were overcome as the pilot projects showed positive and cost-effective public health results. Today, pharmacists are considered crucial professional figures to provide immunization services against COVID-19, the flu, and other vaccine-preventable diseases, and pursue important public health goals.Key takeaways to enhance the pharmacist's role in providing immunization services against vaccine-preventable diseases include improving interaction with policymakers and the public, generating real-world evidence highlighting public health benefits, and ensuring ongoing professional education and training for pharmacists. Conclusion: Vaccinating pharmacists are gaining recognition of their role and the benefits derived from their broader involvement in the healthcare system, including immunization programs. Further efforts are needed in each country for an adequate recognition of the profession and a broader utilization of pharmacy services to exploit the benefit of immunization, especially against the flu.

Role of Portuguese community pharmacy and pharmacists in self-care.

Portugal recognizes the importance of self-care in its policies and has been actively engaging in health literacy and citizen empowerment. The current National Health Plan for the period 2021-2030 clearly mentions the need to "take greater advantage of the network of community pharmacies throughout the national territory, in favour of the health of the community, from the protection and promotion of health, through health literacy, to the prevention and early detection of disease, and the aggravation of chronic disease, among others". There is recognition of the role of pharmacists and community pharmacies. However, more needs to be done to promote intersectoral collaboration, particularly as community pharmacies are private entities but can nonetheless support the public national health service. Community pharmacies assisted many individuals during the pandemic to test suspect cases free of charge. The fight to end AIDS and viral hepatitis is another example where community pharmacies promote self-testing and ensure efficient screening and referral to diagnosis and treatment. Portugal has already moved to reimburse community pharmacies for services with some of them in areas of self-care including COVID-19 testing. Nevertheless, future challenges include making community pharmacies sustainable. Taking into account that community pharmacies are private entities that can supplement the public health service just as any other provider, it is essential to review payment models, referral mechanisms and access and integration of information from other partners in primary and secondary care.

Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery.

The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.

Management of allergic rhinitis symptoms in the pharmacy Pocket guide 2022.

Background: Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Methods: Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence-based, integrated care approach. Results: This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence-based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician. Conclusion: This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation.

Using an online nominal group technique to determine key implementation factors for COVID-19 vaccination programmes in community pharmacies.

Background One vital strategy to fight the COVID-19 pandemic is the rapid roll-out of vaccination programmes. In a number of countries pharmacists are joining the vaccination programme workforce, including plans to involve community pharmacies. Objectives (1) to determine key implementation factors for rapid roll-out of COVID-19 vaccination programmes in European community pharmacies and (2) to trial an online nominal group technique to generate ideas and reach consensus on the first aim. Setting In February 2021, during a workshop at the 12th Working Conference of the Pharmaceutical Care Network Europe. Method An online nominal group technique workshop over 10 hours was conducted. Identified implementation factors were mapped to the Framework for the Implementation of Services in Pharmacy and assessed in terms of importance and changeability. Main outcome measure Consensus of key implementation factors. Results In total, 85 implementation factors were identified. The top 3 factors were the same for both criteria: "(Regular) Staff training on correct vaccination procedure/to perform hands-on injection technique"; "Training in basic life support/first aid (Cardiopulmonary resuscitation)", and; "Definition of process, roles and responsibilities in the team". Conclusion An online nominal group technique enabled international collaboration to gather diverse perspectives on the implementation of COVID-19 vaccination programmes in a time and cost-efficient manner. "Staff training on correct vaccination procedure", "training in basic life support" and "definition of process, roles and responsibilities in the team" were deemed the most important and changeable implementation factors. Online nominal group technique may be a suitable method for other implementation problems.

A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review.

Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient's quality of life, limits their daily living activities, and reduces their work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of superficial heat therapy in the management of non-specific mild-to-moderate LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LBP), and finally review the published evidence regarding the impact of superficial heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is relevant for the management of non-specific mild or moderate low back pain in current clinical practice.

Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study.

Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists' success; technology enhanced engagement amongst patients and increased pharmacists' confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF.

Measurement of arterial stiffness and vascular aging in community pharmacies-The ASINPHAR@2action project.

The ASINPHAR@2action project aims at raising awareness to arterial stiffness (AS) and early vascular aging (EVA) through a community pharmacy-based intervention. This preliminary analysis is focused on the analysis of the proportion of participants with increased AS and the identification of its main determinants. We performed an observational cross-sectional study of participants enrolled in 11 community pharmacies in Portugal, between April and November 2017. Blood pressure (BP) and arterial function parameters were measured with a validated device. Clinical and demographic information was gathered, as well as the estimation of global cardiovascular risk, health-related quality of life, and dietary profile. Cholesterol and glycaemia were taken from a recent laboratory bulletin. The cohort includes 658 participants with a mean age of 57.3 ± 16.3 years, 66% women. Brachial BP was 126.6 ± 16.4 mm Hg and 79.9 ± 11.5 mm Hg, and central BP was 115.8 ± 15.4 mm Hg and 81.2 ± 11.6 mm Hg, respectively, for systolic and diastolic BP. Mean pulse wave velocity (PWV) was 8.5 ± 2.3 m/s, and the augmentation index was 23.6 ± 15.6%. The proportion of participants with increased AS was 19.8%. The overall best-fitting model for AS included age, gender, aortic PP, visceral fat, HDL cholesterol, AIx@75, total vascular resistance, hypertension, and diabetes, corresponding to an AUC of 0.910 (CI: 0.883, 0.937; P < 0.001) in the ROC curve analysis. The preliminary results of this pioneering large-scale study measuring arterial function in community pharmacies provide the grounds for the operationalization of subclinical target organ damage screening in pharmacies, as a strategy to improve cardiovascular risk monitoring and to promote adherence to treatment.

ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project.

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.

The social value of pharmaceutical interventions, the Portuguese contribution to sustainable development.

This commentary focuses on a description of solidarity initiatives developed by pharmacists in different practice areas. These are varied initiatives which contribute to improve the life of human beings in a wide range of formats with one common vector, the pharmacist's involvement. Each of the initiatives described is related to the sustainable development goal it contributes to, whilst also referring to its link to international health policy documents, mostly issued by FIP. We expect this commentary further contributes to boost such initiatives in other parts of the world.

Structured Multi-Stakeholder Workshops to Advance a Global Transformative Roadmap for Pharmaceutical Workforce.

In November 2016, the International Pharmaceutical Federation (FIP) endeavored to create an environment to foster a shared vision to lead a transformative pharmaceutical workforce roadmap. Three milestone documents were developed and presented at the Global Conference on Pharmacy and Pharmaceutical Education. Workshops with the key themes and connecting Pharmaceutical Workforce Development Goals (PWDG) were conducted and analyzed. This Note serves to summarize the key aspects of these workshops, reporting on the innovative approaches used to generate guidance for stakeholders regarding implementation. INNOVATION: Seven workshops with a uniform structure were developed. These were designed to improve communication, harmonise outcome-generation, and allow for aggregate analysis. A team of seven conducted each workshop, each team consisted of: a Chair, a facilitator, one rapporteur, and four speakers purposively selected from FIP member organisations and other key stakeholders with expertise for sharing a variety of perspectives. Guidelines and templates were developed for all roles and each team was briefed in advance. KEY FINDINGS: Approximately 200 personnel participated in the seven workshops, with around 20 country representatives per workshop, covering all six World Health Organisation regions. Three key aspects of workforce transformation, using the PWDGs, were explored in each workshop: drivers for implementation; challenges to implementation; and ways of encouraging implementation. Drivers for implementation mentioned were enhancing collaboration and engagement. Challenges to implementation were identified as variance in terminology. Several ways of encouraging implementation were acknowledged, such as communication strategies, advocating for workforce development and sharing best practices to foster partnerships. NEXT STEPS: The unique format of the workshops, the innovative approach to include stakeholders across an array of settings and the parallel structure in all the seven workshops, aided in creating reliable findings. The achievability of the PWDGs depends on several factors. Engagement with stakeholders and engagement from and between professional associations are important factors to achieving workforce development goals.

Social and economic value of Portuguese community pharmacies in health care.

BACKGROUND: Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal. METHODS: The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: "with service" versus "without service". RESULTS: It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (M€), including 342.1 M€ in non-remunerated pharmaceutical services and 448.1 M€ in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 M€: 120.3 M€ in non-remunerated services and 24.5 M€ in potential savings with health resource consumption. CONCLUSIONS: Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society.

Drug related problems identified by European community pharmacists in patients discharged from hospital.

INTRODUCTION: Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Community pharmacists' interventions to detect, prevent and solve DRPs in this population are scarcely studied. OBJECTIVE: To examine the nature and frequency of DRPs in community pharmacies among patients discharged from hospitals in several countries, and to examine several variables related to these drug related problems. METHOD: The study was performed in 112 community pharmacies in Europe: Austria, Denmark, Germany, The Netherlands, Portugal and Spain. Community pharmacists asked patients with a prescription after discharge from hospital between February and April 2001 to participate in the study. A patient questionnaire was used to identify drug related problems. Pharmacists documented drug related problems, pharmacy interventions, type of prescriber and patient and pharmacy variables. RESULTS: 435 patients were included in the study. Drug related problems were identified in 277 patients (63.7%). Uncertainty or lack of knowledge about the aim or function of the drug (133; 29.5%) and side effects (105; 23.3%) were the most common DRPs. Practical problems were reported 56 times (12.4%) by patients. Pharmacists revealed 108 problems (24.0%) concerning dosage, drug duplication, drug interactions and prescribing errors. Patients with more changes in their drug regimens (drugs being stopped, new drugs started or dosage modifications) and using more drugs were more likely to develop DRPs. Community pharmacists recorded 305 interventions in 205 patients with DRPs. Pharmacists intervened mostly by patient medication counselling (39.0%) and practical instruction to the patient (17.7%). In 26.2% the intervention was directed towards the prescriber. In 28 cases (9.2%) the pharmacists' intervention led to a change of the drug regimen. CONCLUSION: This study shows that a systematic intervention by community pharmacists in discharged patients, or their proxies, is able to reveal a high number of DRPs that might be relevant for patient health outcomes. There should be more initiatives to insure continuity of care, since DRPs after discharge from hospital seem to be very common.