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.

Consumer perceptions of using social media for health purposes: Benefits and drawbacks.

Consumers are increasingly using social media to interact with other consumers about health conditions and treatment options. This study aimed to investigate the advantages and disadvantages of using social media for health-related purposes from the consumers' perspectives. Five focus groups with 36 Australian adults with a chronic condition and on medication were conducted, audio-recorded, transcribed verbatim, and thematically analysed. Consumers reported that social media was very convenient, for accessing health-related information and for peer engagement; user-friendly; improved their health knowledge; empowered them; and provided social and emotional support. The disadvantages included information overload, wasting time; negative feelings; doubts about online information credibility; and issues related to online interactions. Despite some disadvantages, health-related use of social media led consumers to feel supported, knowledgeable, and empowered. Consumers' motivation to keep accessing social media for health-related purposes opens up avenues for the delivery of services via social media.

Consumer Health-Related Activities on Social Media: Exploratory Study.

BACKGROUND: Although a number of studies have investigated how consumers use social media for health-related purposes, there is a paucity of studies in the Australian context. OBJECTIVE: This study aimed to explore how Australian consumers used social media for health-related purposes, specifically how they identified social media platforms, which were used, and which health-related activities commonly took place. METHODS: A total of 5 focus groups (n=36 participants), each lasting 60 to 90 minutes, were conducted in the Sydney metropolitan area. The group discussions were audiorecorded and transcribed verbatim. The transcripts were coded line-by-line and thematically analyzed. RESULTS: Participants used general search engines to locate health-related social media platforms. They accessed a wide range of social media on a daily basis, using several electronic devices (in particular, mobile phones). Although privacy was a concern, it did not prevent consumers from fully engaging in social media for health-related purposes. Blogs were used to learn from other people's experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific group discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures such as surgery. No participant reported editing or contributing to Wikipedia or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. Social media allowed consumers to obtain and provide disease and treatment-related information and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (eg, responded to people's questions). CONCLUSIONS: Participants used a wide range of social media for health-related purposes. Medical information exchange (eg, disease and treatment) and social and emotional support were the cornerstones of their online activities. Social media appears to be used as a key tool to support disease self-management.

Do pharmacists use social media for patient care?

Background Social media are frequently used by consumers and healthcare professionals. However, it is not clear how pharmacists use social media as part of their daily professional practice. Objective This study investigated the role social media play in pharmacy practice, particularly in patient care and how pharmacists interact online with patients and laypeople. Setting Face-to-face, telephone, or Skype interviews with practising pharmacists (n = 31) from nine countries. Method In-depth semi-structured interviews; audio-recorded, transcribed verbatim, and thematically analysed. Main outcome measure Two themes related to the use of social media for patient care: social media and pharmacy practice, and pharmacists' online interactions with customers and the public. Results Most participants were community pharmacists. They did not provide individualized services to consumers via social media, despite most of them working in a pharmacy with a Facebook page. No participant "friended" consumers on Facebook as it was perceived to blur the boundary between professional and personal relationships. However, they occasionally provided advice and general health information on social media to friends and followers, and more commonly corrected misleading health information spread on Facebook. Short YouTube videos were used to support patient counselling in community pharmacy. Conclusions Participants recognized the potential social media has for health. However, its use to support patient care and deliver pharmacy services was very incipient. Pharmacists as medicine experts are well equipped to contribute to improvements in social media medicines-related information, learn from consumers' online activities, and design new ways of delivering care to communities and individuals.

Pharmacists' perceptions of professionalism on social networking sites.

BACKGROUND: Social networking sites (SNS) are a new venue for communication, and health care professionals, like the general population, are using them extensively. However, their behavior on SNS may influence public perceptions about their professionalism. OBJECTIVE: This study explored how pharmacists separate professional and personal information and activities on SNS, their perceptions of professional behavior on SNS, and opinions on guidelines in this area. METHODS: In-depth, semi-structured interviews were conducted with international practising pharmacists (n = 31) recruited from a range of countries (n = 9). Initially, pharmacists known to the research team were invited, and thereafter, participants were recruited using a snowballing technique. The interviews lasted from 30 to 120 min. All interviews were recorded, transcribed verbatim, and thematically analyzed. RESULTS: A majority of participants mixed professional and personal information and activities on SNS, and about one third adopted a separation strategy where professional information and activities were clearly separated from personal ones (e.g. two different SNS accounts, or one particular SNS for professional use and another platform for personal purposes). Most participants expressed concern over how pharmacists present themselves and behave in SNS when they reported (un)professional behaviors of peers they had observed. Examples of perceived unprofessional behaviors included revealing details of personal life and activities; open complaints about the pharmacy sector, co-workers, physicians, and patients; inappropriate description of pharmacists' roles and activities; and breaches of patient confidentiality. Positive professional behaviors, such as expression of compassion for patients, examples of effective patient management, promotion of pharmacists' role, and correction of misleading health information being spread online were also observed. There was no consensus on having professional social media guidelines. Some preferred SNS to be unregulated while most believed certain guidance was needed to maintain high professional standards in the online environment. CONCLUSIONS: A definitive strategy to separate professional and personal information and activities on SNS was not adopted by most pharmacists. E-professionalism issues could negatively impact on the standing of individual practitioners and the profession. Most agreed that education about SNS use would be beneficial; however, support for guidelines or regulations for pharmacists' use of SNS was not unanimous.

Professional Use of Social Media by Pharmacists: A Qualitative Study.

BACKGROUND: Social media is frequently used by consumers and health care professionals; however, our knowledge about its use in a professional capacity by pharmacists is limited. OBJECTIVE: Our aim was to investigate the professional use of social media by pharmacists. METHODS: In-depth semistructured interviews were conducted with practicing pharmacists (N=31) from nine countries. Interviews were recorded, transcribed verbatim, and thematically analyzed. RESULTS: Wikipedia, YouTube, and Facebook were the main social media platforms used. Professional use of social media included networking with peers, discussion of health and professional topics, accessing and sharing health and professional information, job searching, and professional promotion. Wikipedia was the participants' first choice when seeking information about unfamiliar topics, or topics that were difficult to search for. Very few pharmacy-related contributions to Wikipedia were reported. YouTube, a video-sharing platform, was used for self-education. University lectures, "how-to" footage, and professionally made videos were commonly watched. No professional contribution was made to YouTube. Facebook, a general social networking site, was used for professional networking, promotion of achievements, and job advertisements. It also afforded engagement in professional discussions and information sharing among peers. CONCLUSIONS: Participants used social media in a professional capacity, specifically for accessing and sharing health and professional information among peers. Pharmacists, as medicines experts, should take a leading role in contributing to health information dissemination in these user-friendly virtual environments, to reach not only other health care professionals but also health consumers.

Provision of a Medicines Information Service to Consumers on Facebook: An Australian Case Study.

BACKGROUND: Social networking sites (SNSs) have changed the way people communicate. They may also change the way people seek health advice. OBJECTIVE: This study describes the provision of a medicines information service on Facebook to individual consumers. It aimed to discuss the pros and cons, and inform health and pharmacy stakeholders and researchers about the opportunities and challenges of providing such a service. METHODS: We adopted an exploratory approach using a case study method. RESULTS: NPS MedicineWise, an independent, not-for-profit Australian organization, runs a public question-and-answer service on Facebook, dubbed Pharmacist Hour. Consumers following the organization's Facebook page are invited to post medication-related questions often with a suggested health topic. A wide range of questions and comments are posted related to medication usage. The pharmacist answers the queries, providing evidence-based medicines information and using consumer-friendly language, during the specific 1-hour period. The most popular questions in the past 12 months were related to adverse effects, treatment options for conditions, and drug interactions. The service had a mean number of engagements (defined as a like or share of the Pharmacy Hour post) of 38 (SD 19) people and a mean 5 (SD 3) questions per session. CONCLUSIONS: The Pharmacist Hour Facebook service addresses the medicines information needs of consumers and indirectly promotes other appropriate and relevant NPS MedicineWise products and services to further assist consumers. The service offers a new medium for a quality use of medicines organization committed to promoting awareness about the correct and safe use of medicines in Australia.

The use of social media in pharmacy practice and education.

BACKGROUND: Social media is becoming increasingly ubiquitous. It has significant potential as a health communication and educational tool, and may provide a medium for the delivery of health-related services. OBJECTIVES: This systematic review aimed to investigate the use of social media in professional pharmacy practice and pharmacy education, and includes an evaluation of the research designs utilized. METHODS: Medline, Embase, PubMed, IPA, and CINAHL databases were broadly searched for peer-reviewed research studies about pharmacy and social media (SM). The search was restricted to years 2000 to June 2013, with no other restrictions applied. Key words used were within three concept areas: "social media" and "pharmacist or student" and "pharmacy." RESULTS: Twenty-four studies met the inclusion criteria. SM was broadly addressed as a general concept in 3 of the 24 studies. The other 21 studies investigated/used specific SM tools. Fourteen of those addressed social networking sites (SNS), four wikis, two blogs, and one Twitter. The studies' foci were to describe SM use (n = 17 studies) by pharmacist, pharmacy educators, and pharmacy students and investigate usage related topics (such as e-professionalism and student-educator boundary issues); or the use of SM as an educational tool in pharmacy education (n = 7). Pharmacy students were the subject of 12 studies, pharmacists of six, and faculty members and administrators of four. Survey methods were used in 17 studies, alone or with an additional method; focus groups were used in two; interviews in one; and direct observation of social media activity in seven. Results showed that SM in general and SNS in particular were used mainly for personal reasons. Wikis, Facebook, and Twitter were used as educational tools in pharmacy education with positive feedback from students. CONCLUSION: Research investigating the use of SM in the practice of pharmacy is growing; however, it is predominantly descriptive in nature with no controlled studies identified. Although some studies have used SM to deliver and enhance pharmaceutical education, none have focused on the delivery of pharmacy services through SM.

Tacrolimus (FK506) reduces hippocampal damage but fails to prevent learning and memory deficits after transient, global cerebral ischemia in rats.

Transient, global cerebral ischemia (TGCI) leads to hippocampal damage and disruption of spatial learning and memory. The immunosuppressant, tacrolimus (FK506), prevents TGCI-induced hippocampal neurodegeneration, but its effectiveness in promoting the recovery of learning and memory performance after TGCI has been little investigated. Here, we use a confined version of the aversive, non-food rewarded radial maze to evaluate further the effects of FK506 on TGCI-induced learning and memory deficits. In the first experiment, rats were rendered ischemic (15 min 4-VO) and 20 days later were tested for acquisition of the radial maze task over 15 consecutive days (post-operative training). In the second experiment, naive rats were trained for 10 days and subjected to TGCI (pre-operative training); retention of task performance was assessed on days 31, 35 and 39 post-ischemia. Acquisition and retention performances were expressed as a) latency to find a goal box, b) number of reference memory errors, and c) number of working memory errors. Data are presented both across daily training sessions (15 days, 3-day blocks) and as a total value (summed over the 15 days). Histological examination was performed on the day after behavioral testing. In both experiments, FK506 (1.0 mg/kg) was given i.v. at the beginning of reperfusion, followed by doses applied intraperitoneally (i.p.) 6, 24, 48 and 72 h post-ischemia. TGCI markedly disrupted both acquisition and retention performance (p<0.0001-0.05). Treatment with FK506 did not prevent the TGCI-induced acquisition and retention deficits, independently of whether performances were quantified 'daily' or as a 'total' value. In contrast, FK506 reduced hippocampal damage significantly compared to the vehicle alone (p<0.001-0.05). We conclude that the present study did not confirm our earlier behavioral data, and suggest that FK506 is not effective in treating the behavioral outcomes of TGCI, despite its efficacy in reducing CA1, hippocampal damage. However, further studies including other behavioral tasks and more extensive neurohistological analysis, are needed to better elucidate the effectiveness of FK506 in promoting functional recovery in models of transient, global cerebral ischemia.

Sustained neuroprotection and facilitation of behavioral recovery by the Ginkgo biloba extract, EGb 761, after transient forebrain ischemia in rats.

The effects of the Ginkgo biloba extract, EGb 761, on ischemia-induced learning/memory impairments and hippocampal damage were evaluated in a non-food motivated, aversive radial maze task (AvRM). Rats were subjected to 15 min transient, global cerebral ischemia (TGCI). In the first experiment, rats were rendered ischemic, and 23 days later were tested for acquisition performance (post-operative training). In a second experiment, rats were trained for 10 days and then subjected to ischemia (pre-operative training); the retention of cognition performance was assessed on days 31, 35 and 39 after ischemia. Acquisition and retention performances were expressed by (a) latency to find a goal box, (b) number of reference memory errors, and (c) number of working memory errors. EGb 761 (50 or 150 mg/kg) was given orally, starting before ischemia and continuing for up to 3 days after ischemia. TGCI markedly disrupted both acquisition and retention performance (p < 0.001-0.05). EGb 761 (150 mg/kg) completely reversed acquisition impairment as measured by the parameters 'latency' and 'number of reference errors' when performance was examined across sessions (p < 0.01-0.05). The total number of reference errors was also completely abolished by EGb 761 (150 mg/kg). However, EGb 761 did not statistically reduce the effects of TGCI on the parameter 'working memory errors' (across session and total). At 50 mg/kg, EGb 761 did not affect ischemia-induced acquisition impairment at all. The retention deficit caused by ischemia was not statistically reduced by EGb 761 (150 mg/kg), whatever examined across session or as total. EGb 761 reduced the extent of hippocampal CA1 cell loss (p < 0.01-0.001), an effect sustained at least up to 40 days after ischemia. These findings show that EGb 761 is effective in reducing, at least partially, both the cognitive impairments and hippocampal damage after TGCI in rats, and suggest that its effect on behavioral recovery may be dissociated from the neuroprotective effect on the hippocampus. The present results also validate the AvRM as an alternative, reliable behavioral test to assess the effects of drugs on behavioral recovery after ischemic brain damage.

The Ginkgo biloba extract, EGb 761, fails to reduce brain infarct size in rats after transient, middle cerebral artery occlusion in conditions of unprevented, ischemia-induced fever.

There is much biochemical evidence, but very few studies in animal models of stroke in vivo, to suggest that Ginkgo biloba (EGb 761) may offer neuroprotection against regional, ischemic brain damage; additional investigations are needed to ensure future clinical trials. This study reports the effects of EGb 761 given acutely or chronically before ischemia. Rats were subjected to middle cerebral artery occlusion (MCAO) for 2 h and the brain infarct size was assessed 24 h later. Dipyrone (100 mg/kg, i.p.) was injected 30 min before ischemia, and 2.5 and 5.5 h after ischemia, to reduce ischemia-induced fever. EGb 761 (Tebonin) was given acutely (200 mg/kg, p.o., 60 min before ischemia) or chronically (100 mg/kg, p.o., once daily, for 14 days before ischemia). Acute or chronic treatment with EGb 761, either alone or in combination with dipyrone, did not reduce the infarct size compared with saline alone (p > 0.05). Dipyrone failed to prevent ischemia-induced fever during the intra-ischemic period (p > 0.05 vs saline; p < 0.001 vs sham). In the reperfusion phase, dipyrone reduced fever to normothermic levels in the group treated acutely with EGb 761 (p < 0.01 vs saline, p > 0.05 vs sham) but not after chronic EGb 761 (p < 0.01 vs sham), indicating possible pharmacokinetic interaction. In conclusion, within the context of unprevented, ischemia-induced fever, the present results demonstrate that EGb 761 has no significant effect on brain infarct size.

Permanent, 3-stage, 4-vessel occlusion as a model of chronic and progressive brain hypoperfusion in rats: a neurohistological and behavioral analysis.

Permanent, 3-stage, 4-vessel occlusion (4-VO) was evaluated as a practicable model of progressive, cerebral hypoperfusion in rats, resulting in quantifiable, reproducible, neuronal damage within a time interval shorter than that described in the 2-VO model. The effect of permanent and graded 4-VO on cognition was also evaluated using the newly developed, aversive radial maze. The vertebral arteries (VA) plus the common carotid arteries (CCA) or internal carotid arteries (ICA) were progressively and permanently occluded, following different experimental sequences (CCA--> VA; VA-->CCA-->CCA or VA-->ICA-->ICA) with inter-stage intervals ranging from 1 to 4 weeks. Only two of four groups subjected to 2-stage 4-VO (CCA-->VA) showed modest reduction in the number of normal-appearing CA1 pyramidal cells, despite the significant treatment effect (p < 0.001-0.01 versus sham). A high rate of mortality (63.8%) was associated with 2-stage 4-VO. More pronounced and consistent neuronal damage occurred 8 weeks after 3-stage 4-VO, following the sequence VA --> CCA --> CCA (p < 0.001). One month after this schedule, profound, persistent cognitive impairment was demonstrated in the aversive radial maze (p < 0.01-0.0001). This behavioral effect was not manifested when the ICA, rather than the CCA, were occluded, despite the presence of significant, although less severe, hippocampal lesioning. The mortality rate was significantly reduced when 3-stage 4-VO was used (p < 0.0001). These consistent, histological and behavioral effects, combined with a low mortality rate, suggest that permanent, 3-stage 4-VO may represent a reliable animal model of chronic, progressive, cerebral hypoperfusion.

Effect of tacrolimus (FK506) on ischemia-induced brain damage and memory dysfunction in rats.

The behavioral and neurohistological protective effects of tacrolimus (FK506) were examined in rats subjected to 15-min global forebrain ischemia. Learning and memory performance were evaluated in an aversive, non-food-motivated, eight-arm radial maze. In one experiment, naive rats were rendered ischemic, and 15 days later they were tested for acquisition of a spatial task (postoperative training). In a complementary experiment, rats were trained for 8 days and then subjected to ischemia (preoperative training); 15 days later (on Day 24 of testing) they were retested for retention of cognition. FK506 (1.0 mg/kg) was given intravenously at the beginning of reperfusion, followed by doses applied intraperitoneally 6, 24, 48 and 72 h postischemia. Behavioral performance was expressed by latency to find the goal box, and number of errors. Ischemia did not affect acquisition performance. In contrast, retention of cognition was markedly impaired by ischemia, particularly working memory (P<.05-.001). This ischemia-induced, retrograde amnesia was significantly reduced by FK506 compared to vehicle alone on Day 24, as measured by latency and working memory errors (P<.025). A neuroprotective effect of FK506 was also seen on working memory, when postischemic performance was compared to that prior to ischemia (P>.05, Day 24 vs. Day 8, paired samples), in contrast to the significant, retrograde amnesia found in the ischemic, vehicle-treated group (P<.01). FK506 also significantly reduced the extent of hippocampal CA1 cell loss; however, this effect did not correlate with behavior. The present results suggest that the histological, neuroprotective effect of FK506 may be accompanied by a reduction in cognitive impairment, as assessed in a novel, non-food-motivated, eight-arm radial maze after transient, global, cerebral ischemia in rats.