Prevention, education and counselling: the worldwide role of the community pharmacist as an epidemiological sentinel of headaches

Triptans utilization in Italian population: A real-life study in community pharmacies

The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.

Pharmaceutical care for patients with headache

INTRODUCTION

Headache cephalalgia is the condition in which individuals feel pain in different parts of the head. It is one of the most common disorders believed to be amenable to self-treatment. The pharmacist can provide significant support to patients.

Community pharmacists’ routine provision of drug-related problem-reduction services

Objectives

The present study aimed to assess the degree of the provision of services for drug-related problems (DRPs) and the factors affecting provision within the community pharmacy setting in Irbid, a large city in Northern Jordan.

Methods

A cross-sectional survey was developed and administered to community pharmacists in Irbid, Jordan during the period from January to May 2017. The survey is composed of background and practice characteristics, services provided routinely by the community pharmacists to address DRPs, and barriers and facilitators for DRP-reduction services. A summated score quantifying the degree of DRP-reduction service provision was calculated, which included overall scores and scores for the different scales and domains. Statistical analysis included descriptive statistics and a multivariate linear regression model for factors associated with the high provision of DRP-reduction service.

Results

Two hundred community pharmacists out of 210 pharmacists approached completed the surveys yielding a response rate of 95.2%. The most frequent DRPs encountered within the routine practice in the community pharmacy were economic aspects (76.0%). The mean total score relating to different DRP-reduction services was 32.9 (58.8%) out of 56 as the maximum possible score. It was estimated that 28.2% of the responding pharmacists provided the service overall (scored more than 50% of the scale). For the assessment, intervention, and referral dimensions, similar percentages of providers of the services were achieved: 59.7%, 61.9%, and 49.0%, respectively. Lower rates of providers were achieved on the documentation scale (12.9%). The lack of recognition of the pharmacist role by physicians was the most commonly reported barrier to effective DRP-reduction services among community pharmacists (78.9%). The ability to receive external guidance was indicated by the majority of surveyed pharmacists (94.5%) as a potential facilitator to DRP-reduction services in this study. Predictors associated with high total scores were the presence of medical records for the patients in the pharmacy, patients contact the pharmacy using email, a high satisfaction in professional relationships with physicians, and pharmacists’ age.

Conclusion

Even though community pharmacists in this study have been shown to deliver certain activities to address DRPs to a high degree, the overall rate of DRPs services was suboptimal. Community pharmacists reported several barriers that should be taken into consideration to facilitate the role of community pharmacists in providing adequate DRP reduction services to patients.

Chronic headache patients' health behavior and health service use 12 months after interdisciplinary treatment - what do they keep in their daily routines?

Background

We do not yet know whether or the extent to which multimodal therapy changes the health behaviors and health service use of chronic headache patients in the long term. Associations are expected between pain symptoms and pain management abilities for patients who are categorized as successfully treated and those who remain unchanged.

Methods

Routine longitudinal data of an enrolment period of five years from 101 headache patients treated with a two-week, full-day, semi-inpatient multimodal pain therapy at the Interdisciplinary Pain Center of the University Clinic Erlangen were available when therapy began and 12 months after treatment. To investigate long-term changes in health behavior and health service use as well as their associations with the outcome “reduction in pain days,” we used descriptive and inferential statistics (i.e., binary logistic regression).

Results

Patients who underwent interdisciplinary treatment showed statistically significant changes in their health behavior in five areas. Twelve months after treatment, we found a significantly higher frequency of engagement in athletic sports (p < .001) as well as increases in the use of relaxation techniques (p < .001), TENS devices for relaxation purposes (p = .008), psychological coping strategies (p < .001), and mindfulness-based techniques for dealing with pain (p < .001). 52.8% of the sample reported a reduction in the number of pain days 12 months after treatment. Binary logistic regression (χ² (12) = 21.419; p = .045; R² = .255) revealed that a reduction in pain days 12 months after treatment was positively associated with regular physical activity in the form of muscle strengthening and stretching (athletic sports) (p = .012).

Conclusion

Chronic headache patients acquired long-term skills from an interdisciplinary treatment concerning the use of relaxation techniques, the use of psychological coping strategies, and physical activity in the form of athletic exercise. Of those, regular athletic exercise was positively associated with a smaller number of pain days in the long term. Thus, a physical activity module should be an element of interdisciplinary treatment for chronic headache patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02646-w.

The Quality of Counseling for Headache OTC Medications in German Community Pharmacies Using a Simulated Patient Approach: Are There Differences between Self-Purchase and Purchase for a Third Party?

Background

In Germany—as worldwide—headache is one of the most frequent causes of self-medication. The dispensing of over-the-counter (OTC) medications may only be carried out by community pharmacies (CPs). In doing so, CPs have to ensure “adequate” counseling, for both self-purchase and purchase for a third party, which also occurs in everyday pharmacy practice. The aim of this study was to evaluate the quality of counseling for headache OTC medications in German CPs and, as the first study worldwide, to analyze whether and to what extent there are differences in counseling between self-purchase and purchase for a third party.

Methods

A cross-sectional study was carried out using the covert simulated patient methodology (SPM) in all 42 CPs in the German big city Potsdam. With the help of 8 trained simulated patients (SPs), each CP was visited four times by a different SP. The SPs simulated in each CP two scenarios two times with the demand for an OTC medication against headache, which differed only in whether the demand was for themselves or for their boyfriend/girlfriend.

Results

All 168 planned pharmacy visits (84 visits per scenario) were successfully carried out. Overall, the median counseling score was 3.0 out of 9 points (interquartile range [IQR 2.0]). There were no significant differences between the two scenarios (Wilcoxon signed-rank test; p=0.495, r = 0.053). In a multivariate binary logistic regression analysis, the counseling level and the different scenarios were not significantly associated (adjusted odds ratio [AOR] = 1.635, 95% CI = 0.673–3.972, p=0.278).

Conclusions

Due to the partly considerable deficits in counseling of German CPs, policy-makers and the regional chambers of pharmacists are called upon to take appropriate measures to improve the quality of counseling. It is positive that no differences in counseling between self-purchase and purchase for a third party were found, but further verifying studies with a modified methodology are recommended.