Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study.

RATIONALE, AIMS AND OBJECTIVES: Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. METHOD: This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. RESULTS: We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2) and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. CONCLUSION(S): This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Evaluation of process indicators of a medication review service between pharmacists and physicians.

RATIONALE, AIMS AND OBJECTIVES: Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD: This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS: A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. CONCLUSION: The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.

Development and content validation of an instrument to document the dispensing of prescribed medicines.

WHAT IS KNOWN AND OBJECTIVE: Qualified dispensing is fundamental for the promotion of the rational use of medicines. Documentation is an indicator of quality and one of the essential steps in the care process. However, in Brazil, there are no models of clinical documentation applicable to dispensing practices. Thus, the objective of this study was to develop and validate an instrument to document the dispensing process of prescribed medicines. METHODS: A methodological development study was carried out from February 2017 to October 2017 in two stages, which were (i) the development of the instrument and (ii) content validation of the proposed instrument. The development phase comprised three stages, which were (i) the elaboration of the prototype based on a previously performed systematic review, (ii) academic brainstorming and (iii) a pre-Delphi consensus. The content validation process was performed using the Delphi technique. The instrument was sent to 40 experts with experience in dispensing, and the consensus among them was calculated using the content validity index (CVI). The study was approved by the Ethics Committee, and all participants signed an informed consent document detailing the terms of the study. RESULTS: In the development stage, three versions of the instrument were generated, which were the prototype, version 1 (changed after academic brainstorming) and version 2 (changed after the pre-Delphi). In the content validation process of version 2 of the instrument, 23 experts returned their evaluation in the first round of the Delphi process and 17 in the second. All the items obtained a CVI >0.83, which resulted in the validation of the instrument. The final instrument comprised the following sections: general information, the identification of technical and legal problems of prescriptions, the conduct for the resolution of the technical and legal problems of prescriptions, medication dispensed, suspected drug-related problems, verbal guidance, written guidance, referral and the referral result. WHAT IS NEW AND CONCLUSION: The developed and validated instrument presents the main variables that should be documented during the dispensing process.

Evaluation of students' attitudes towards pharmacist-physician collaboration in Brazil.

OBJECTIVE: To measure undergraduate pharmacy and medical students' collaborative attitudes regarding Pharmacist-Physician collaboration. METHODS: A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP2C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p<0.05. RESULTS: Three hundred seventy students completed the SATP2C. Overall, the students had positive attitudes towards physician-pharmacist collaboration. There was no significant correlation between age and score (p=0.79). Women showed a more positive collaborative attitude than men (53.1, SD=6.8 vs. 55.1, SD=6.3). Pharmacy students had a higher score than medical students (57.5, SD=4.7, vs. 51.1, SD=6.4). The first-year medical students had a higher score than last-year medical students (52.3, SD=6.0 vs. 49.5, SD=6.6; p<0.007). There was no significant difference in the attitudes between the first and last year pharmacy students (p<0.007). CONCLUSIONS: Pharmacy and medical students showed positive attitudes towards physician-pharmacist collaboration. However, pharmacy students presented more collaborative attitudes than medical ones. Additionally, the first-year medical students had more collaborative attitudes than last-year medical students. Studies should be conducted to provide recommendations to improve interprofessional education efforts to further enhance the positive attitudes toward physician-pharmacist collaboration.