Cross-sectional description of hospital pharmacy services in Puerto Rico in 2022 using the Practice Advancement Initiative 2030 Self-Assessment Tool.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. SUMMARY: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. CONCLUSION: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Development, validation and measurement of patient satisfaction questionnaire in Spanish in drive thru services adapted to hospital pharmacies during COVID-19 pandemic.

Background: There are no validation studies on patient satisfaction surveys in Spanish that can evaluate a hospital pharmacy drive-thru service. Objective: To develop and apply a pharmacy drive-thru satisfaction survey in Spanish during the COVID-19 pandemic with an analysis of the instrument validation. Methods: This was a qualitative study for developing, validating, and measuring patient satisfaction who used the drive-thru pharmacy during the COVID-19 pandemic. Content validity was obtained by a two-round Delphi and patient interview for apparent validity. The questionnaire was administered to 110 patients. The researchers made an item reduction by inter-item and item-total correlation analysis, stability validation by a test-retest, a test of reliability by Cronbach's alpha, and extraction of factors by an exploratory factorial analysis. Likewise, confirmatory factor analysis was developed to obtain a structural equation model based on generating an instrument of two sub-models of latent factors (service and place) with ten observed variables (items). Results: A questionnaire was developed that relates six observable variables to the latent factor service and four observable variables to the latent factor place which are ten items based on a Likert scale from 1 to 5, obtaining a Cronbach's alpha = 0.901. The mean population satisfaction score was 4.523. The model presented a Root Mean Square Error of Approximation (RMSEA) of 0.026 (0.000-0.098), and standardized beta values greater than 0.2 according to the confirmatory factor analysis. Therefore, the goodness-of-fit of our model is consistent and the instrument of patient satisfaction with the use of drive-thru has been validated. Patient satisfaction had a mean of 4.9 points. Conclusions: This study developed and validated a reliable scale that evaluates satisfaction in a hospital pharmacy drive-thru service during COVID-19 pandemic that can be applied in other Spanish speaking countries. A great percentage of the patients that were evaluated had good satisfaction.

Improving pharmaceutical practice in diabetes care using point-of-care glycated haemoglobin testing in the community pharmacy.

OBJECTIVES: To evaluate the use of point-of-care testing to detect new cases of diabetes mellitus at a Brazilian public community pharmacy. METHODS: This cross-sectional study included individuals without a previous diagnosis of diabetes mellitus who met the criteria for screening according to the Brazilian Diabetes Society, which were identified during their presence at a Brazilian public community pharmacy. The measurements of HbA1c were performed using a Cobas b101 device (Roche Diagnostics) and were categorized according to the following classification established by the Brazilian Society of Diabetes: HbA1c <5.7%, normal; HbA1c between 5.7% and 6.4%, pre-diabetes; and HbA1c >6.4%, new diagnosis of T2DM. KEY FINDINGS: One hundred and eight users met the inclusion criteria. The patients' mean age was 54.4 (± 15.4) years old, ranging from 22 to 80 years old. Eighty (74.1%) participants presented with glycated haemoglobin levels over the standard threshold, of which 58 (72.5%) were in the pre-diabetes range (glycated haemoglobin levels between 5.7% and 6.4%), and 22 (27.5%) had glycated haemoglobin levels >6.4%, which corresponds to a new diagnosis of type 2 diabetes mellitus. CONCLUSIONS: The use of point-of-care glycated haemoglobin testing allowed community pharmacists at a Brazilian public community pharmacy to identify health system users with glycated haemoglobin alterations that corresponded to the pre-diabetes state or a new diagnosis of type 2 diabetes mellitus. This presented a good opportunity to refer these users to diabetes diagnosis and treatment services.

Ensino experiencial na farmácia universitária: um estudo de perspectiva etnográfica na educação / Experiential learning in a university pharmacy: a study adopting the ethnographic approach to education / Enseñanza experiencial en la farmacia universitaria: un estudio de perspectiva etnográfica en la educación

O objetivo deste estudo foi refletir sobre o desafio da formação de identidade profissional do farmacêutico clínico em um contexto de currículo não integrado e em um ambiente tradicional e especializado. Desenvolveu-se uma pesquisa qualitativa orientada pelos pressupostos da perspectiva etnográfica na educação, empregando-se múltiplos métodos de coleta de dados entre abril e julho de 2019. O cenário de ensino experiencial foi uma Farmácia Universitária da região Sul do Brasil. Por meio de uma descrição densa e com uso da reflexividade teórica e intertextual, é apresentada uma narrativa utilizando a voz dos participantes como âncora para dar visibilidade ao processo vivenciado. A ausência de um padrão para o cuidado na profissão farmacêutica, o currículo tradicional e a desarticulação entre teoria e prática constituem desafios para os estudantes de Farmácia legitimarem a prática profissional farmacêutica centrada no usuário.(AU)

The aim of this study was to reflect on the challenge of forming the professional identity of clinical pharmacists in the context of non-integrated curriculums and a traditional specialized environment. We conducted a qualitative study between April and July 2019 guided by the ethnographic approach to education, employing multiple data collection methods. The experiential learning setting was a university pharmacy in the south of Brazil. By means of a thick description and through the use of theoretical and intertextual reflexivity, we present a narrative using the voice of the participants as an anchor to provided visibility to the experienced process. The absence of a standard for the care process in the pharmacy profession, the traditional curriculum, and the lack of connection between theory and practice are challenges facing pharmacy students in legitimizing patient-centered professional practice.(AU)

El objetivo de este estudio fue reflexionar sobre el desafío de la formación de la identidad profesional del farmacéutico clínico en un contexto de currículum no integrado y en un ambiente tradicional y especializado. Se desarrolló una investigación cualitativa orientada por las presuposiciones de la perspectiva etnográfica en la educación, utilizándose múltiples métodos de colecta de datos entre abril y julio de 2019. El escenario de la enseñanza experiencial fue una Farmacia Universitaria de la región sur de Brasil. Por medio de una descripción densa y con el uso de la reflexividad teórica e intertextual se presenta una narrativa que utiliza la voz de los participantes como ancla para dar visibilidad al proceso vivido. La ausencia de un estándar para el proceso de cuidado en la profesión farmacéutica, el currículum tradicional y la desarticulación entre teoría y práctica se constituyen en desafíos para que los estudiantes de Farmacia legitimen la práctica profesional farmacéutica centrada en el usuario.(AU)

Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

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

Global healthcare systems, including the National Health System in Brazil - one of the largest public models in the world -, continue to evolve, as well as populations' health needs, currently shaped on individuals feeling a greater desire to manage their own health. Self-care practices are part of several public policies and clinical guidelines in Brazil including the National Policy on Complementary and Integrative Practices, the National AIDS Control Program, the National Policy for Women's Health, and the Guidelines for Care of People with Chronic Diseases. There are over 100,700 community pharmacies, in the country (89.2% privately owned) employing 234,300 pharmacists, representing an important delivery point for self-care, as they are the first point of access to care for most patients. Self-medication is a common practice in Brazil (prevalence rates of self-medication ranging from 16.1% to 35.0%), especially with non-prescription/over-the-counter medicinal products (65.0%). In fact, these products represent over 25% of volume marketed of medicines, summing revenues of USD 1.9 billion per year. Studies demonstrated a positive budget impact as important savings for the National Health System due to reductions of unnecessary medical appointments and loss of working days. In addition to minor ailments management, other self-care services provided by community pharmacies that are frequently sought by Brazilian citizens (20-25% of cases) are smoking cessation and weight management (costs per service ranging from around USD 5.00-12.00). However, pharmacy services are not yet as fully integrated in Brazil to the same extent as in other countries. Barriers such as standardization of processes (from services' design, implementation, and evaluation in practice), pharmacist remuneration for the provision of services and the amount to be charged for the service are still a matter of controversy. For more rapid and sustainable advances in these practices, communication among various stakeholders, professional practice and healthcare regulations, standardization of services and financing of self-care (both publicly and privately) are urgently needed. This paper provides an overview of some self-care services provided by community pharmacies in Brazil and call attention to the ongoing challenges to move the National Health system forward.

[Design, implementation and evaluation of a service for Medication compliance aids (MCAs) in an institutional Pharmacy in the city of Córdoba]. / Diseño, implantación y evaluación de un servicio de Sistemas Personalizados de Dosificación en una farmacia institucional de la ciudad de Córdoba.

Introduction: The Pharmaceutical Service (PS) for the provision of Medication compliance aids (MCAs) consists of reconditioning and unifying, in a protocolized manner and in multi-compartment devices, the medications used by a patient, ordering them according to their dosage guideline. The objective was to design, implement and evaluate an PS of MCAs in an institutional pharmacy in the city of Córdoba. Methods: Observational, descriptive and longitudinal study. A Standard Operating Procedure (SOP) was developed from for PS of MCAs and applied to a sample of 20 patients. Adherence was analyzed by: tablet count and Morisky-Green test. A validated service satisfaction questionnaire was applied and a cost analysis was performed considering the initial investment and the times involved. Results: A 98.0% adherence was obtained by counting the tablets and by the Morisky-Green test: 5.0% at the start of the service and 55.0% at 3 months. The patients expressed in the satisfaction questionnaire: 90.0% very satisfied and 10.0% satisfied. Regarding the cost analysis, the initial investment was USD 1,670.44. A value of US $ 4.29 was calculated for the first interview, and the monthly cost of preparation ranged from US $ 16.02, for 7-30 weekly takings, to US $ 28.73 for more than 121 takings. Conclusion: It was possible to develop and implement an SOP for the PS of SPD, with significant improvements in adherence. A high degree of patient satisfaction was observed and were obtained minimal operating costs to achieve sustainability.

Introducción: El Servicio Profesional Farmacéutico Asistencial (SPFA) de provisión de Sistemas Personalizados de Dosificación (SPD) consiste en reacondicionar y unificar, de manera protocolizada y en dispositivos multicompartimentales, los medicamentos que emplea un paciente, ordenándolos según su pauta posológica. El objetivo fue diseñar, implantar y evaluar un SPFA de SPD en una farmacia institucional de la ciudad de Córdoba. Métodos: Estudio observacional, descriptivo y longitudinal. Se desarrolló de un Procedimiento Normalizado de Trabajo (PNT) para el SPFA de SPD y se aplicó a una muestra de 20 pacientes. Se analizó la adherencia mediante: recuento de comprimidos y test de Morisky-Green. Se aplicó un cuestionario validado de satisfacción del servicio y se realizó un análisis de costos considerando la inversión inicial y los tiempos involucrados. Resultados: Se obtuvo un 98,0% de adherencia por recuento de comprimidos y por Test de Morisky-Green, 5,0% al inicio del servicio y 55,0% a los 3 meses.  Los pacientes expresaron en el cuestionario de satisfacción:  90,0% muy satisfecho y 10,0% satisfecho.  Respecto al análisis de costos, la inversión inicial fue de USD 1.670,44. Se calculó un valor de U$4,29 para la primera entrevista y el costo mensual de preparación, desde USD 16,02 para 7-30 tomas semanales hasta USD 28,73 para más de 121 tomas. Conclusión: Fue posible desarrollar e implantar un PNT para el SPFA de SPD, con mejoras significativas en la adherencia. Se observó un elevado grado de satisfacción del paciente y se obtuvieron los costos operativos mínimos para conseguir su sostenibilidad.

Perception of community pharmacists about the work process of drug dispensing: a cross-sectional survey study.

BACKGROUND: Drug dispensing aims to promote rational medicine use. However, in many countries, the work processes are still not well defined. In this sense, the perception of pharmacists about dispensing practices presents an overview of how the service is being performed in the country and its main challenges. Thus, the purpose of this study was to determine the self-reported work process of Brazilian community pharmacists in relation to drug dispensing, challenges, and strategies for carrying out the service. METHOD: A cross-sectional survey was conducted between May and July 2021, with community pharmacists from all regions of Brazil. Pharmacists were invited to answer a validated, self-administered questionnaire, implemented through Google Forms, containing 33 questions related to the steps of drug dispensing (questions and counseling) and the main challenges and strategies to perform the service. The data were exported to Microsoft Office Excel and SPSS®. Multiple linear regression analysis was used to assess the association between responses and demographic information, with a significance level of less than 5% (p < 0.05). This study was approved by the Research Ethics Committee (number: 4.295.171). RESULTS: A total of 625 community pharmacists responded to the survey. Most pharmacists reported always or frequently performing 17 (54%) of the 31 steps described in the instrument. The steps that pharmacists reported performing more frequently were forming the medication name (n = 569, 91.04%), verifying the completeness and adequacy of the prescription according to current legislation (n = 567, 90.72%) and providing counseling on dosage (n = 549, 87.84%). Documentation was the main step in which pharmacists reported never or rarely performing (n = 424, 67.84%). The results showed that there was a significant influence of the variables of public education institution, age, and postgraduate education on the frequency of dispensing steps (F(3, 621) = 14.884, p < 0.001; R2ajdusted = 0,063). CONCLUSION: This study showed that most pharmacists reported always or frequently asking most of the questions and performing counseling contained in the instrument during drug dispensing. These results can contribute to an understanding of current dispensing practices and generate insights for developing strategies to qualify the service.

Dispensing of psychotropic drugs in the Brazilian capital city before and during the COVID-19 pandemic (2018-2020).

Objective: Evaluate the data on the psychotropic drugs dispensed by private community pharmacies before and during the SARS-CoV-2 pandemic. Methods: This cross-sectional study compared the quarterly and annual consumption of psychotropic drugs per Defined Daily Dose per 1000 inhabitants-day (DHD). Interrupted time series were also constructed to expose changes in the consumption pattern in the periods before and after March 2020. Results: Among the 20 most consumed psychoactive drugs, 12 were antidepressants, for example, escitalopram (DHD 7.996 and 10.626; p < 0.001), and sertraline (DHD 6.321 and 8.484; p < 0.001), in addition to the hypnotic zolpidem (DHD 6.202 and 8.526; p < 0.001). The time series reveals (R 2 value) a variation in drug dispensing, in DHD values, during the pandemic. Conclusion: Despite the higher variance, a significant increase is clearly seen in the consumption trends of psychoactive drugs, particularly antidepressants, consistent with the pandemic's influence on the general population's mental health.

Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil.

BACKGROUND: Medication errors are avoidable occurrences that can assume clinically significant dimensions and impose relevant costs to the health system, especially in the context of antineoplastic therapy. OBJECTIVE: Assess the clinical significance and economic impacts of a clinical pharmaceutical service. This retrospective study consists of an analysis of pharmacy interventions and drug-related problems found in a review of electronic prescriptions referring to antineoplastic therapy of a public teaching tertiary hospital in Brazil. METHOD: Retrospective descriptive study obtained from electronic records of drug-related problems and pharmaceutical interventions related to antineoplastic therapy for oncological and hematological diseases, obtained through the pharmacotherapy review service. The accepted interventions were analyzed for the financial impact generated, evaluating your direct costs. The perception of clinical significance of a random sample of interventions was ascertained by the experts' opinion, using the Delphi method. RESULTS: The most frequent problem was a "lack of information to professionals" (25.06%), "problems as to the frequency and interval of doses" (22.90%), and "medication underdosing" (16.20%). Dose adjustment (31.50%) and clarifications (30.90%) were the most frequent pharmaceutical interventions. In the second round of Delphi, experts rated 77.77% of interventions as extremely significant and very significant. The main drugs reported in the interventions were cyclophosphamide, carboplatin, methotrexate, folinic acid, and monoclonal antibodies. The savings amounted to US$1,193,970.18 and involved mainly bortezomib, dactinomycin, and monoclonal antibodies. CONCLUSION: Clinical pharmacy services contributed to the rational use of medicines presenting clinical significance and avoiding waste of financial resources.

Sources of medicines for hypertension and diabetes in Brazil: results from the National Health Survey / Fontes de medicamentos para hipertensão e diabetes no Brasil: resultados da Pesquisa Nacional de Saúde / Fuentes de medicamentos para la hipertensión y diabetes en Brasil: resultados de la Encuesta Nacional de Salud

This study aims to analyze the sources people over 18 years of age use to obtain medication for the treatment of hypertension and diabetes, according to sociodemographic characteristics from 2013 to 2019. Data from the Brazilian National Health Survey were analyzed. Most individuals with diagnosis and prescription to pharmacological treatment reported obtaining medicines exclusively from one type of source. The percentage of people who acquired hypertension medicine exclusively from public pharmacies decreased, from 24.5% in 2013 to 16.2% in 2019; while there was an increase in those obtaining from the Popular Pharmacy program, from 23.5% to 31.4%; as well as for out-of-pocket payment, which rose from 30.9% to 35.5% The percentage of people who acquired diabetes medication exclusively from public pharmacies increased from 7.4% to 18.6% and with out-of-pocket payment increased from 21.6% to 26.8%, while the percentage of those who acquired from the Popular Pharmacy program decreased from 47.2% to 36.4%. The percentage of those who acquired medication from various sources decreased for both hypertension and diabetes. For men, white, and those with higher education, the source of medication acquisition, for both conditions, was mostly by out-of-pocket payment. The high number of medicine acquisition from public sources represents an advance in Brazil's response to the treatment of these conditions, but reducing regional differences still represents a challenge to be overcome by the healthcare system.

Este estudo buscou analisar as fontes utilizadas por pessoas com mais de 18 anos para obter medicamentos para o tratamento de hipertensão arterial e diabetes de acordo com características sociodemográficas de 2013 a 2019. Foram analisados dados da Pesquisa Nacional de Saúde. A maioria dos indivíduos com diagnóstico e prescrição para tratamento farmacológico relatou a obtenção de medicamentos exclusivamente de um tipo de fonte. O percentual de pessoas que adquiriram medicamentos para hipertensão exclusivamente de farmácias públicas diminuiu de 24,5% em 2013 para 16,2% em 2019. Por outro lado, o percentual daqueles que adquiriram pelo Programa Farmácia Popular aumentou de 23,5% para 31,4% e gastos próprios foram de 30,9% para 35,5%. O percentual de pessoas que adquiriram medicamentos para diabetes exclusivamente de farmácias públicas aumentou de 7,4% para 18,6% e gastos próprios aumentaram de 21,6% para 26,8% enquanto o percentual dos que adquiriram da Farmácia Popular diminuiu de 47,2% para 36,4%. O percentual daqueles que adquiriram medicamentos de diversas fontes diminuiu tanto para hipertensão quanto para diabetes. Homens, pessoas brancas e pessoas com Ensino Superior adquiriram medicamentos para ambas as condições principalmente por gastos próprios. O alto número de aquisições de medicamentos de fontes públicas representa um avanço na resposta do Brasil ao tratamento dessas condições, mas reduzir as diferenças regionais ainda é um desafio a ser superado pelo sistema de saúde.

Este estudio buscó analizar las fuentes utilizadas por personas mayores de 18 años para obtener medicamentos para el tratamiento de la hipertensión arterial y la diabetes según las características sociodemográficas de 2013 a 2019. Los datos provienen de la Encuesta Nacional de Salud. La mayoría de los individuos con diagnóstico y prescripción de tratamiento farmacológico reportaron obtener los medicamentos exclusivamente de un tipo de fuente. El porcentaje de personas que compraban medicamentos para la hipertensión exclusivamente en farmacias públicas disminuyó del 24,5% en 2013 al 16,2% en 2019. Por otro lado, el porcentaje de quienes lo compraban a través del programa Farmacia Popular aumentó del 23,5% al 31,4% , y el gasto pasó del 30,9% al 35,5%. El porcentaje de personas que compraban medicamentos para la diabetes exclusivamente en farmacias públicas aumentó del 7,4% al 18,6% y el gasto propio aumentó del 21,6% al 26,8%, mientras que el porcentaje de los que compraban en Farmacia Popular descendió del 47,2% al 36,4%. El porcentaje de quienes compraban medicamentos de diferentes fuentes disminuyó tanto para la hipertensión como para la diabetes. Los hombres, los individuos de raza blanca y las personas con educación superior adquirieron medicamentos para ambas afecciones a sus expensas.. El alto número de compras de medicamentos de fuentes públicas es un avance en la respuesta de Brasil al tratamiento de estas condiciones, pero la reducción de las diferencias regionales sigue siendo un desafío para ser superado por el sistema de salud.

Perceptions of Pharmacy students about their competences for professional practice in community pharmacy

Abstract Pharmaceutical education should enable the development of competences for community pharmacy practice, which is an important field for the pharmacist workforce. The aim of this study was to evaluate the competences perceived by pharmacy interns from a Brazilian pharmacy school for community pharmacy practice. This study adopted a combined quantitative and qualitative approach. The study cohort included undergraduate students who undertook internships in community pharmacy in the final year of the pharmacy course. Students responded to an 11-item structured questionnaire according to a five-point Likert scale that included perceptions of their competences for community pharmacy practice. Among the 693 possible answers, 605 (87.3%) agreed that the course promoted the development of competences for professional practice in community pharmacy. Less than 70% of students perceived themselves as prepared to respond to symptoms and provide non-prescription medicines. Qualitative analysis of the comments revealed three themes: the need to improve patient information skills, improve practice as a member of a health care team, and improve dispensing according to legal requirements. These findings may support improvements in undergraduate pharmacy programs, such as the inclusion of experiential learning, active learning methods, interprofessional education, and development of clinical skills.

Mapping community pharmacy services in Brazil: a scoping review

Abstract The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient's health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists' interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists' interventions as well as reporting results and measuring fidelity in future research.

Community pharmacies and pharmacists in Brazil: A missed opportunity.

The Brazilian National Health System (BR-NHS) is one of the largest public health systems in the world. In 2019 Brazil had 114,352 community pharmacies (76.8% private owned), that represent the first point of access to healthcare in Brazil due to their wide distribution. Unfortunately, from the government's point of view, the main expected activity of private and public community pharmacies is related to dispensing medicines and other health products. Public community pharmacies can be part of a healthcare center or be in a separate location, sometimes without the presence of a pharmacist. Pharmacists working in these separated locations do not have access to patients' medical records, and they have difficulty in accessing other members of the patient care team. Pharmacists working in public pharmacies located in healthcare centers may have access to patients' medical records, but pharmacy activities are frequently under other professional's supervision (e.g., nurses). Private pharmacies are usually open 24/7 with the presence of a pharmacist for 8 hours on business days. Private community pharmacies have a very limited integration in the BR-NHS and pharmacists are the third largest healthcare workforce in Brazil with more than 221,000 registered in the Brazilian Federal Pharmacist Association [CFF - Conselho Federal de Farmácia]. A University degree in pharmacy is the only requirement to entry into the profession, without any proficiency exam for maintenance or career progression. The Brazilian pharmacist's annual income is ranked as the 2nd better-paid profession with an annual average income of EUR 5,502.37 (in 2020). Description of clinical activities for pharmacies by the CFF increased in the recent years, however there is still a long way to effectively implement them into practice.

Análise da produção científica sobre os serviços farmacêuticos comunitários no enfrentamento da pandemia pelo coronavírus / Analysis of scientific production on community pharmaceutical services in confronting the coronavirus pandemic

RESUMO Esta revisão buscou sintetizar as práticas em serviços farmacêuticos relacionadas ao gerenciamento e às atividades clínicas em distintos contextos para a prevenção e a assistência durante a epidemia da Covid-19. Trata-se de uma revisão da literatura sobre políticas públicas de saúde para a reorganização da assistência farmacêutica em países atingidos pela Covid-19 realizada nas bases de dados Web of Science, Science Direct e Biblioteca Virtual em Saúde. Foram selecionados 9 artigos, sendo todos publicados em 2020. Destes, 90% foram publicados pelo periódico 'Research in Social an Administrative Pharmacy' e tiveram como local de realização de estudo países de três continentes. Foram relatadas e debatidas experiências sobre a atuação do profissional farmacêutico e o papel da farmácia comunitária no contexto da pandemia da Covid-19, e sobre a reorganização destes serviços, evidenciadas no contexto de crise, tanto no que tange à oferta de serviços quanto ao próprio espraiamento da doença. O modelo adotado pelos países para o enfrentamento da Covid-19, no âmbito dos serviços farmacêuticos comunitários, baseou-se em atividades para a garantia da qualidade e logística de insumos e medicamentos, triagem e monitoramento de pacientes, acompanhamento farmacoterapêutico, educação em saúde e informações sobre o uso de medicamentos.

ABSTRACT This review sought to synthesize the practices in pharmaceutical services related to management and clinical activities in different contexts for prevention and assistance during the Covid-19 epidemic. This is a review of the literature on public health policies for the reorganization of pharmaceutical assistance in countries affected by Covid-19 carried out in the Web of Science, Science Direct and Virtual Health Library databases. 9 articles were selected, all published in 2020. Of these, 90% of the articles were published by the journal 'Research in Social an Administrative Pharmacy' and had countries of three continents as study sites. Experiences about the performance of the pharmaceutical professional and the role of the community pharmacy in the context of the Covid-19 pandemic, and about the reorganization of these services, evidenced in the context of crisis, were reported and debated, both with regard to the provision of services and the spread of the disease itself. The model adopted by countries to confront Covid-19, within the scope of community pharmaceutical services, was based on activities for quality assurance and logistics of supplies and medicines, screening and monitoring of patients, pharmacotherapeutic accompaniment, health education and information on medication use.

Teaching and Learning Pharmacy Services: A Teaching Method for Developing Competencies for Patient-Centered Care Through Experiential Learning in a Real Workplace.

INTRODUCTION: Considering the transformation process that has been occurring in pharmacy education and the urgent need to address social health needs, proposals of teaching methods for the development of competences and skills in patient-centered care have become an issue worth discussing. The study describes and discusses the method that has been used for developing of these competencies through experiential learning in a university pharmacy in Brazil. EDUCATIONAL ACTIVITY: The Teaching and Learning of Pharmacy Services (TLPS) method encompasses 2 components: theoretical-reflexive one (developing protocols covering the patient care process) and practical-reflexive one (using the protocols with real patients). TLPS connects the 2 components in a way to enable students to acquire and apply theoretical knowledge for a comprehensive assessment of the patients' needs and understand how clinical reasoning and decision-making take place. The assessment process is performed, by the supervisor, which evaluates the behaviors necessary for good professional performance. DISCUSSION: The active learning methodologies have been effectively used in the classroom as a way to stimulate critical thinking, problem-solving, and clinical reasoning. However, experiential learning is considered a central point in the learning process and essential for knowledge building. Thus, the method herein described is shown as an innovative tool to promote self-learning, consolidation and interrelation of the acquired knowledge, easier identification of patients' needs, normalization of behaviors, and improvement in the quality of care.

Implementation of clinical pharmacy services using problematization with Maguerez Arc: A quasi-experimental before-after study.

RATIONALE, AIMS, AND OBJECTIVES: The growth of clinical pharmacy services (CPS) has positively impacted clinical, economic, and humanistic health outcomes. However, detailed studies on the process of implementing CPS in healthcare systems are incipient. Thus, the present study aimed to evaluate the CPS implementation in certain public health units in a metropolis in northeast Brazil. METHODS: A quasi-experimental before-and-after study was carried out in Recife City, from July 2015 to March 2016. The study was carried out using the Methodology of Problematization with Maguerez Arc and was divided into: initial evaluation (before), planning, interventions, and preliminary evaluation (after). The participants were pharmacists, patients, health professionals, and local health managers. Descriptive statistics were used to report data. The statistical significance of the comparison between variables was evaluated using the Wilcoxon test (95% CI; P ≤ .05). RESULTS: Initial evaluation: Identified incipient CPS, a lack of structure and work process of pharmacists. Planning: Sixteen brainstorming meetings were held with the different actors resulting in a strategic plan. INTERVENTION: Twenty-two political-administrative meetings were held with managers and health teams and 768 hours of theoretical and practical training with mentoring for pharmacists. Preliminary evaluation: Structure indicators presented a statistically significant difference, differently from the process indicators. Pharmacists attended 842 patients and performed 1465 pharmaceutical consultations in 6 months. Regarding the outcome indicators, it was possible to identify changes in the clinical status of the most prevalent diseases among those patients who attended three pharmaceutical consultations. CONCLUSIONS: It was possible to evaluate the CPS implementation in certain public health units in a metropolis in Brazil, through the Methodology of Problematization with Maguerez Arc. This methodology may be part of models for future implementations of CPS in health systems.

Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses.

OBJECTIVE: To map the clinical pharmacy services conducted in Brazil, their characteristics, outcomes, and process measures in general population, as well as the assessment of the clinical impact on people with cardiometabolic diseases (cardiovascular diseases and metabolic diseases). METHODS: A systematic scoping review and meta-analysis were conducted. The electronic searches were re-run in March 2020. To the clinical impact assessment, meta-analyses of cardiometabolic outcomes (i.e., change of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total cholesterol, glycated hemoglobin (HbA1c), fasting glycemia, LDL-, and HDL-cholesterol) were led. The risk of bias was assessed with the Cochrane Collaboration tools. RESULTS: 71 studies were identified (7,402 patients), being the majority quasi-experimental studies (n=41) and published by research groups of Southeast Brazil (n=33). Medication therapy management (n=62) was the most frequent clinical pharmacy service, performed on outpatient setting (n=45), with adults or elderly people (n=58) with hypertension (n=18) or diabetes (n=10). Process measures (n=58) (e.g. resolution of drug related-problem) were widely used as indicator, followed by clinical (n=44) (e.g. change in SBP), humanistic (n=12) (e.g. change in quality-of-life score assessed by Short-Form 36 Health Survey Questionnaire), and economic outcomes (n=3) (incremental cost-effectiveness ratio for reduction in HbA1c). Regarding the assessment of clinical impact of the services, 20 studies were included in meta-analyses, showing improvement in most cardiometabolic outcomes when considered individual studies. However, the evidence presents high risk of bias, high heterogeneity (median 67-90%) and imprecision, contributing to wide prediction intervals and low reliability. CONCLUSIONS: A predominance of studies on cardiometabolic diseases, process measures, and clinical outcomes were identified. Considering the assessment of the clinical impact of clinical pharmacy services in cardiometabolic diseases, an improvement in most cardiometabolic outcomes was showed, however, with low confidence and wide prediction interval. Therefore, development of larger studies with low risk of bias and major homogeneity is necessary for a better comprehension of clinical pharmacy service characteristics, benefits, and the population groups most benefited.

Primary health care policy and vision for community pharmacy and pharmacists in Colombia.

Colombia is a decentralized republic with a population of 50 million, constituted by 32 departments (territorial units) and 1,204 municipalities. The health system provides universal coverage and equal access to health care services to 95% of the population. Primary health care is seen as a practical approach that guarantees the health and well-being of whole-of-society. The National Pharmaceutical Policy (NPP, 2012) goal is "to develop strategies that enable the Colombian population equitable access to effective medicines, through quality pharmaceutical services (PS)". There are 4,351 providers certified to deliver PS: 3,699 (85%) ambulatory and 652 (15%) hospital care. The goals for PS are: a) promoting healthy lifestyles; b) preventing risk factors arising from medication errors; c) promoting rational use of medicines; and d) implementing Pharmaceutical Care. There are a number of ways that ambulatory patients access medications: through intermediary private companies, public and private hospitals pharmacies, and retail establishments (drugstores and pharmacies). Intermediary private companies are similar to Pharmaceutical Benefits Management in the U.S. health system, and act as intermediaries between health insurers, pharmaceutical laboratories, and patients. Pharmacists are being employed by these companies and in health insurance companies managing, auditing and delivering rational use of medicines programs. In 2014 there were approximately 20,000 pharmacies and drugstores, (private establishments) where a significant number of prescription-only medicines are sold without medical prescription. Colombian laws allow personal without pharmacy education to be a "director" in these establishments, so the training and education of persons working in drugstores and pharmacies is an important challenge. There about 8,000 registered pharmaceutical chemists with 25% to 30% working in patient care. Since the 90´s, there are more favorable conditions for pharmacist's participation and contribution to health system and patient's health outcome. These environmental facilitators include: a) laws and regulations regarding pharmaceutical services (2005-2007), b) establishment of a NPP (2012), and c) opportunities associated with the consolidation of private health management companies providing health services with an interest in pharmaceutical services (since 1995). Finally, telepharmacy, comprehensive care routes for pharmaceutical services, and further strengthen of postgraduate training in pharmacy practice are future strategies to improve the pharmacy profession in Colombia. They provide an opportunity to influence the recognition and value of the pharmacist as the health care professional.

Rol del farmacéutico en la atención integral de pacientes con hepatitis C: revisión sistemática / The role of pharmacists in the comprehensive care of patients with hepatitis C: a systematic review

Resumen Objetivo: identificar y caracterizar las acciones/intervenciones realizadas desde los servicios farmacéuticos en el abordaje de pacientes con hepatitis C y proponer una vía clínica para la gestión de la enfermedad que incluya la participación del farmacéutico. Método: revisión sistemática en PubMed y EMBASE empleando los términos "Hepatitis C", "Pharmaceutical Services", "Community Pharmacy Services", y "Pharmacies"; artículos publicados hasta el 31 de marzo de 2019, cuyo tema central fueran las actividades realizadas por los servicios farmacéuticos en la atención a pacientes con hepatitis C. Se recopiló información sobre la actividad realizada, responsable, si la intervención era individual o colectiva y el entorno de aplicación. Las actividades se agruparon en promoción y prevención, gestión administrativa, atención farmacéutica, investigación y otros servicios de apoyo. De acuerdo con esto, se propuso una vía clínica para el manejo de la hepatitis C con participación del farmacéutico. Resultados: se incluyeron 60 artículos, principalmente de estudios descriptivos. La mayoría de las publicaciones reportó intervenciones realizadas en Estados Unidos y España. Se identificó la participación del personal farmacéutico en cada una de las etapas del proceso de atención, que incluye la provisión de servicios de reducción del daño, tamizaje del virus de la hepatitis C, vinculación de los pacientes al tratamiento, prescripción de medicamentos y órdenes de laboratorio. Conclusiones: se identifican y caracterizan las acciones/intervenciones realizadas desde el servicio farmacéutico para el manejo de la hepatitis C y se propone una vía clínica en la que se integran los servicios profesionales farmacéuticos a las demás actividades de la atención del paciente.

Abstract Objective: To identify and characterize the actions/interventions carried out by pharmaceutical services to approach patients with Hepatitis C and propose a clinical pathway for managing the disease that involves pharmacists. Methodology: A systematic review was conducted in PubMed and EMBASE using the terms "Hepatitis C," "Pharmaceutical Services," "Community Pharmacy Services," and "Pharmacies." Articles published until March 31, 2019, whose central topic was the activities carried out by the pharmaceutical services in the care of patients with Hepatitis C, were included. Information on the activity performed, the person in charge, whether the intervention was individual or collective, and the implementation environment was collected. The activities were grouped into promotion and prevention, administrative management, pharmaceutical care, research, and other support services. Based on the above, a clinical pathway for the management of Hepatitis C involving pharmacists was proposed. Results: Sixty articles were included, mainly descriptive studies. Most publications reported interventions in the United States and Spain. Pharmaceutical staff involvement was identified at each stage of the care process, including the provision of harm reduction services, Hepatitis C virus screening, enrolling patients to treatment, medication prescription, and laboratory orders. Conclusions: The actions/interventions carried out by the pharmaceutical service for Hepatitis C management were identified and characterized. A clinical pathway has been proposed to integrate professional pharmaceutical services with other patient care activities.