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van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1228-1243. [PMID: 38182099 DOI: 10.1016/j.jaip.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs. OBJECTIVE We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU). METHODS We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings. RESULTS Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. CONCLUSIONS Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
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Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Centre Groningen, Groningen, University of Groningen, Groningen, The Netherlands.
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Patino
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Bogdan Muresan
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
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Merks P, Chełstowska B, Religioni U, Neumann-Podczaska A, Krasiński Z, Kobayashi A, Plagens-Rotman K, Drelich E, Fehir-Sola K, Fijałkowski Ł, Baj I, Vaillancourt R, Wieczorowska-Tobis K, Mastalerz-Migas A, Koziol M, Pinkas J, Szymański FM, Hering D. Enhancing Patient Adherence to Newly-Prescribed Medicine for Chronic Diseases: A Comprehensive Review and Cost-Effective Approach to Implementing the New Medicine Service in Community Pharmacies in Poland. Med Sci Monit 2024; 30:e942923. [PMID: 38431771 PMCID: PMC10919058 DOI: 10.12659/msm.942923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
New Medicine Service (NMS) components are an important element to improve patient compliance with medical recommendations. NMS provides support to patients prescribed new medicines, helping them to manage long-term conditions. The purpose of this service is to provide patients with advice, guidelines, and educational materials regarding the use of new medicines to increase patient compliance and therapy safety. The NMS has already been introduced in many European countries. This review aims to identify the benefits and potential barriers to implementing the NMS in community pharmacies and to suggest solutions that would increase its effectiveness. Previous studies have primarily shown that the NMS improves patient compliance with therapy, accelerating the expected effects of the therapy. Pharmacist support during implementation of a new drug therapy substantially increases patient safety. As the experience of numerous countries shows, both pharmacists and patients express positive opinions on this service. Therefore, it seems that NMS should be an indispensable part of pharmaceutical patient care in any healthcare system. This article aims to review the implementation of the New Medicine Service (NMS) for community pharmacists in Poland and the provision of a cost-effective approach to improve patient adherence to newly-prescribed medicine for chronic diseases.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Beata Chełstowska
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | | | - Zbigniew Krasiński
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznań University of Medical Sciences, Poznań, Poland
| | - Adam Kobayashi
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Katarzyna Plagens-Rotman
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland
| | - Ewelina Drelich
- The Polish Pharmacy Practice Research Network (PPPRN), Warsaw, Poland
| | - Katarina Fehir-Sola
- European Association of Employed Community Pharmacists (EPhEU), Vienna, Austria
| | - Łukasz Fijałkowski
- Department of Organic Chemistry, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Regis Vaillancourt
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- The Polish Pharmacy Practice Research Network (PPPRN), Warsaw, Poland
| | | | | | - Mark Koziol
- Pharmacy Defence Association, Birmingham, United Kingdom
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | - Filip M. Szymański
- Department of Civilization Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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Phimarn W, Saramunee K, Leelathanalerk A, Srimongkon P, Chanasopon S, Phumart P, Paktipat P, Babar ZUD. Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020). Int J Clin Pharm 2023; 45:1326-1348. [PMID: 37233864 DOI: 10.1007/s11096-023-01590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/01/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. AIM To conduct a systematic review of literature on economic evaluation of pharmacy services. METHOD Literature (2016-2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost-benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost-benefit analysis (CBA). RESULTS Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). CONCLUSION The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services.
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Affiliation(s)
- Wiraphol Phimarn
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Kritsanee Saramunee
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand.
| | - Areerut Leelathanalerk
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pornchanok Srimongkon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Suratchada Chanasopon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Panumart Phumart
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pawich Paktipat
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
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Naidoo V, Moodley R, Bangalee V, Suleman F. New Medicine Service by Community Pharmacists: An Opportunity to Enhance Universal Health Coverage at a Primary Health Level in South Africa. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221146834. [PMID: 36625010 PMCID: PMC9834920 DOI: 10.1177/00469580221146834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
The implementation of universal health coverage (UHC) in South Africa has focused on promoting equitable health care services to all citizens. In this regard, pharmacists are expected to expand their professional capabilities to promote primary healthcare system functionality. The new medicine service (NMS) has proven to be beneficial in medicine optimization and adherence. The aim of the NMS is to assist and advise patients on their newly diagnosed conditions and to promote the safe and rational use of medicines. This study explores the provision of NMS within the UHC primary healthcare service package and the opportunity for enhancing pharmacist practice. This pilot reports on the implementation of NMS in a low-middle income country. Data was obtained using convenience sampling and an interview-based approach. Findings were evaluated, analyzed, and reported using qualitative techniques. This study was conducted at an independent community pharmacy in Durban, South Africa. Fifty-four patients were successfully enrolled into the program based on the eligibility criteria; 19 patients exited the program before completion. From those that completed the program, 65.71% had no problems detected; rather the program served as a platform to provide information and ensure proper adherence practices, 34.29% of patients experienced problems and were referred back to the prescriber, or pharmacist. After the completion of the program, 54.29% where found to be adherent to their medication, however, 45.71% were found to be non-adherent and were counseled accordingly or referred back to the medical practitioner. This paper highlighted that the implementation of a pharmacist's full scope of practice and services such as the NMS is essential in improving therapeutic outcomes, recognize medicine related problems, and avert unnecessary use of medicines.
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Pankov D, Geskovski N, Simonoska Crcarevska M, Glavas Dodov M. Building a draft national strategy for implementation of pharmaceutical care in patients with chronic diseases in Republic of North Macedonia. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Donka Pankov
- Institute of Pharmaceutical Technology, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, RN Macedonia
| | - Nikola Geskovski
- Institute of Pharmaceutical Technology, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, RN Macedonia
| | - Maja Simonoska Crcarevska
- Institute of Pharmaceutical Technology, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, RN Macedonia
| | - Marija Glavas Dodov
- Institute of Pharmaceutical Technology, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, RN Macedonia
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Costa S, Guerreiro J, Teixeira I, Helling DK, Pereira J, Mateus C. Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®). Front Pharmacol 2022; 13:903270. [PMID: 36160402 PMCID: PMC9493118 DOI: 10.3389/fphar.2022.903270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background: There is little experience in the economic evaluation of pharmacy/primary care collaborative health interventions using interprofessional technology-driven communication under real-world conditions. This study aimed to conduct cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care versus usual (fragmented) care alongside a trial. Methods: An economic evaluation was conducted alongside a 6-month pragmatic quasi-experimental controlled trial. Data sources included primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. The target population was adult patients on hypertension and/or lipid-lowering medication. The perspective was societal. We collected patient-level data on resource use to estimate trial costs. Effect outcomes included blood pressure (BP) and quality-adjusted life years (QALYs). Bootstrapping was used to estimate uncertainty around the incremental cost-effectiveness and cost-utility ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability of the intervention being cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. Conclusion: Considering the limitations of the trial which affected effectiveness and economic outcomes, our results are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on methods and strategies that can be used in future economic evaluations of collaborative public health interventions with the potential for reimbursement. Clinical trial registration:https://www.isrctn.com/ISRCTN13410498, identifier ISRCTN13410498
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Affiliation(s)
- Suzete Costa
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), Lisboa, Portugal
- *Correspondence: Suzete Costa, , orcid.org/0000-0002-4521-5473
| | - José Guerreiro
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colorado, United States
| | - João Pereira
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), and Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Bandiera C, Ribaut J, Dima AL, Allemann SS, Molesworth K, Kalumiya K, Käser F, Olson MS, Burnier M, van Boven JFM, Szucs T, Albrecht D, Wilson I, De Geest S, Schneider MP. Swiss Priority Setting on Implementing Medication Adherence Interventions as Part of the European ENABLE COST Action. Int J Public Health 2022; 67:1605204. [PMID: 36032275 PMCID: PMC9411421 DOI: 10.3389/ijph.2022.1605204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Janette Ribaut
- Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Hematology, University Hospital of Basel, Basel, Switzerland
| | - Alexandra L. Dima
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Samuel S. Allemann
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kate Molesworth
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Kabeza Kalumiya
- Patient-as-Partner Project, Geneva University Hospitals, Geneva, Switzerland
| | | | - Melvin Skip Olson
- Real World Data Strategy and Innovation, Novartis Pharma AG, Basel, Switzerland
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Thomas Szucs
- European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Daniel Albrecht
- Federal Department of Home Affairs, Federal Office of Public Health Division, Bern, Switzerland
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Sabina De Geest
- Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- *Correspondence: Sabina De Geest, ; Marie P. Schneider,
| | - Marie P. Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- *Correspondence: Sabina De Geest, ; Marie P. Schneider,
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Wan Rohimi WNLH, Mohd Tahir NA. The cost-effectiveness of different types of educational interventions in type II diabetes mellitus: A systematic review. Front Pharmacol 2022; 13:953341. [PMID: 35935879 PMCID: PMC9355120 DOI: 10.3389/fphar.2022.953341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Aims: Educational interventions are effective to improve peoples’ self-efficacy in managing diabetes complications and lifestyle changes. This systematic review aims to assess and compare various aspects of educational interventions and to provide updated pharmacoeconomics data.Methods: Literature searches were conducted using databases such as EBSCOhost, Ovid, PubMed, Scopus, and Web of Science. Outcomes such as study characteristics, costs, medication adherence, effectiveness and were narratively summarized, and the quality of each article was assessed.Results: A total of 27 studies were retrieved. The types of educational interventions were classified as face-to-face strategy, structured programs, telemedicine health education, a combination approach, and others. All types of educational interventions (N = 24, 89%) were reported to be cost-effective. The cost-effectiveness of the other two studies was considered to be not cost-effective while the outcome of one study could not be determined. The majority of the studies (N = 24, 89%) had moderate-quality evidence whereas thirteen (48%) studies were regarded to provide high-quality economic evaluations.Conclusion: All types of educational interventions are highly likely to be cost-effective. The quality of economic evaluations is moderate but the most cost-effective types of educational interventions could not be determined due to variations in the reporting and methodological conduct of the study. A high-quality approach, preferably utilizing the societal perspective over a long period, should be standardized to conduct economic evaluations for educational interventions in T2DM.Systematic Review Registration: website, identifier registration number.
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Bremer S, Henjum S, Sæther EM, Hovland R. Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs. Res Social Adm Pharm 2022; 18:3939-3947. [PMID: 35750567 DOI: 10.1016/j.sapharm.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) lead to substantial morbidity and mortality and increase healthcare costs. Several interventions have been developed to reduce DRPs and improve the outcome of drug therapy. OBJECTIVE To investigate DRPs identified through a pharmacist-led intervention and to assess patient satisfaction with the intervention. METHODS Patients received two pharmacist consultations 1-2 weeks and 3-5 weeks after collecting a new cardiovascular medicine. Information about patient characteristics, beliefs about medicines (BMQ), DRPs, and patient evaluations were collected using questionnaires. RESULTS Pharmacists identified DRPs among 52.4% and 43.1% of the 633 patients at consultation 1 and 2, respectively. Of the DRPs reported in consultation 1, 43.7% were solved at consultation 2. Among patients with side effects, patients who received advice on managing these in consultation 1 where more likely to have solved problems at consultation 2 (61.2% vs. 42.6%, p = 0.008). Female gender, high BMQ concern and the number of new medicines were associated with DRPs. Patients were highly satisfied with the intervention. Predictors of satisfaction were female gender, older age, higher BMQ necessity, face-to-face consultations, longer duration of consultation 1, and solved problems in consultation 2. CONCLUSIONS The results indicate that the pharmacist-led follow-up intervention can aid early identification and solving of DRPs in patients prescribed new cardiovascular drugs. Knowledge of factors associated with DRPs and patients' satisfaction may allow further improvement of the intervention.
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Affiliation(s)
- Sara Bremer
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway.
| | - Solveig Henjum
- Norwegian Pharmacy Association, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
| | | | - Ragnar Hovland
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
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Lynnerup C, Nørreslet M, Graabæk T. Attitudes towards video communication for New Medicine Service at community pharmacies – A qualitative pilot study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100103. [PMID: 35478522 PMCID: PMC9030321 DOI: 10.1016/j.rcsop.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background New Medicine Service (NMS) is a community pharmacy service that can increase adherence among patients with a newly diagnosed chronic disease. NMS must be carried out by a pharmacist, which is a barrier for some pharmacy units with no pharmacist physically present. Video communication might be a way to overcome this barrier. Objective This study aims to explore both patients' and community pharmacy staff's attitudes of video-based NMS in a community pharmacy setting. Methods Semi-structured, telephone interviews were conducted with patients who have participated in video-based NMS. Focus groups with pharmacists who have carried out the video-based NMS and with staff that referred patients to the video-based NMS were conducted at community pharmacies. Thematic inductive analysis was used to analyse the interviews and focus groups. Results In total, 10 patient interviews were conducted, along with one focus group with four pharmacists and one focus group with 10 referring staff. Three main themes emerged during the analysis: (i) Talking to a screen, (ii) content of the NMS, and (iii) tackling the technique. Patients reported that their questions for the pharmacists were the same as if the NMS had been face-to-face. Pharmacists felt that they appeared more professional on video and that non-medical related conversation was reduced compared with ordinary face-to-face NMS. The referring staff either preferred referring to a video-based NMS over an ordinary face-to-face NMS or had no preferences. Conclusions Both patients and pharmacy staff had a positive attitude towards the video-based NMS, the content of the NMS and the performance of the IT-system. The consulting time was reduced for video-based NMS compared to face-to-face NMS, but that did not affect the medical related content of the NMS, which indicates that video-based NMS is possible without compromising the health related content.
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Mishima S, Arakawa N, Bates I, Smith F. Opportunities to demonstrate expertise and job satisfaction of community pharmacists in Japan and England. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2029261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shigeaki Mishima
- School of Pharmacy, University College London, London, UK
- Faculty of Business Administration, Osaka University of Economics, Osaka, Japan
| | - Naoko Arakawa
- School of Pharmacy, University College London, London, UK
- School of Pharmacy, University of Nottingham, University Park, Nottingham, UK
| | - Ian Bates
- School of Pharmacy, University College London, London, UK
| | - Felicity Smith
- School of Pharmacy, University College London, London, UK
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Valverde-Merino MI, Martinez-Martinez F, Garcia-Mochon L, Benrimoj SI, Malet-Larrea A, Perez-Escamilla B, Zarzuelo MJ, Torres-Robles A, Gastelurrutia MA, Varas-Doval R, Peiro Zorrilla T, Garcia-Cardenas V. Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy. Patient Prefer Adherence 2021; 15:2363-2376. [PMID: 34729007 PMCID: PMC8554318 DOI: 10.2147/ppa.s330371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. PURPOSE To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. MATERIALS AND METHODS The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost-utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost-utility ratio (ICUR) was calculated on the total sample of patients. RESULTS A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case, the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost-utility plane. Using a threshold value of €20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. CONCLUSION The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective.
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Affiliation(s)
| | | | - Leticia Garcia-Mochon
- Department of Management of Health Services and Professionals, Andalusian School of Public Health, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Amaia Malet-Larrea
- Medicines Information Centre, Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastian, Spain
| | | | | | | | | | - Raquel Varas-Doval
- Pharmaceutical Care Services Department, General Pharmaceutical Council of Spain, Madrid, Spain
| | - Tamara Peiro Zorrilla
- Pharmaceutical Care Services Department, General Pharmaceutical Council of Spain, Madrid, Spain
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Abdennadher M, Saxena A, Pavlova MK. Evaluation and Management of First-Time Seizure in Adults. Semin Neurol 2021; 41:477-482. [PMID: 34619775 DOI: 10.1055/s-0041-1735143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
First seizures are often perceived as devastating events by patients and their families due to the fear of having a life-long disease. One in 10 people experiences one or more seizures during their lifetime, while 1 in 26 people develops epilepsy. Acute symptomatic seizures are often related to a provoking factor or an acute brain insult and typically do not recur. Careful history and clinical examination should guide clinicians' management plans. Electroencephalography and brain imaging, preferably with epilepsy-specific magnetic resonance imaging, may help characterize both etiology and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision to prescribe drugs depends on individual risk factors for seizure recurrence and possible complications from seizures, which should be discussed with the patient. Counseling about driving and lifestyle modifications should be provided early, often at the first seizure encounter.
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Affiliation(s)
- Myriam Abdennadher
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Aneeta Saxena
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Milena K Pavlova
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
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Naidoo V, Suleman F, Bangalee V. Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study. PLoS One 2021; 16:e0257348. [PMID: 34555058 PMCID: PMC8459985 DOI: 10.1371/journal.pone.0257348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. OBJECTIVES To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. METHODS Community pharmacists' across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. RESULTS Six hundred and sixty-four pharmacists' responded to the online survey. Seventy-five percent of pharmacists' reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. CONCLUSIONS This study provides baseline data for policy makers on pharmacists' readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.
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Affiliation(s)
- Vivian Naidoo
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
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Janjua S, Pike KC, Carr R, Coles A, Fortescue R, Batavia M. Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2021; 9:CD013381. [PMID: 34496032 PMCID: PMC8425588 DOI: 10.1002/14651858.cd013381.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic lung condition characterised by persistent respiratory symptoms and limited lung airflow, dyspnoea and recurrent exacerbations. Suboptimal therapy or non-adherence may result in limited effectiveness of pharmacological treatments and subsequently poor health outcomes. OBJECTIVES To determine the efficacy and safety of interventions intended to improve adherence to single or combined pharmacological treatments compared with usual care or interventions that are not intended to improve adherence in people with COPD. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register, CENTRAL, MEDLINE and Embase (search date 1 May 2020). We also searched web-based clinical trial registers. SELECTION CRITERIA RCTs included adults with COPD diagnosed by established criteria (e.g. Global Initiative for Obstructive Lung Disease). Interventions included change to pharmacological treatment regimens, adherence aids, education, behavioural or psychological interventions (e.g. cognitive behavioural therapy), communication or follow-up by a health professional (e.g. telephone, text message or face-to-face), multi-component interventions, and interventions to improve inhaler technique. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Working in pairs, four review authors independently selected trials for inclusion, extracted data and assessed risk of bias. We assessed confidence in the evidence for each primary outcome using GRADE. Primary outcomes were adherence, quality of life and hospital service utilisation. Adherence measures included the Adherence among Patients with Chronic Disease questionnaire (APCD). Quality of life measures included the St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ). MAIN RESULTS We included 14 trials (2191 participants) in the analysis with follow-up ranging from six to 52 weeks. Age ranged from 54 to 75 years, and COPD severity ranged from mild to very severe. Trials were conducted in the USA, Spain, Germany, Japan, Jordan, Northern Ireland, Iran, South Korea, China and Belgium. Risk of bias was high due to lack of blinding. Evidence certainty was downgraded due to imprecision and small participant numbers. Single component interventions Six studies (55 to 212 participants) reported single component interventions including changes to pharmacological treatment (different roflumilast doses or different inhaler types), adherence aids (Bluetooth inhaler reminder device), educational (comprehensive verbal instruction), behavioural or psychological (motivational interview). Change in dose of roflumilast may result in little to no difference in adherence (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.22 to 1.99; studies = 1, participants = 55; low certainty). A Bluetooth inhaler reminder device did not improve adherence, but comprehensive verbal instruction from a health professional did improve mean adherence (prescription refills) (mean difference (MD) 1.00, 95% CI 0.46 to 1.54). Motivational interview improved mean adherence scores on the APCD scale (MD 22.22, 95% CI 8.42 to 36.02). Use of a single inhaler compared to two separate inhalers may have little to no impact on quality of life (SGRQ; MD 0.80, 95% CI -3.12 to 4.72; very low certainty). A Bluetooth inhaler monitoring device may provide a small improvement in quality of life on the CCQ (MD 0.40, 95% CI 0.07 to 0.73; very low certainty). Single inhaler use may have little to no impact on the number of people admitted to hospital compared to two separate inhalers (OR 1.47, 95% CI 0.75 to 2.90; very low certainty). Single component interventions may have little to no impact on the number of people expereincing adverse events (very low certainty evidence from studies of a change in pharmacotherapy or use of adherence aids). A change in pharmacotherapy may have little to no impact on exacerbations or deaths (very low certainty). Multi-component interventions Eight studies (30 to 734 participants) reported multi-component interventions including tailored care package that included adherence support as a key component or included inhaler technique as a component. A multi-component intervention may result in more people adhering to pharmacotherapy compared to control at 40.5 weeks (risk ratio (RR) 1.37, 95% CI 1.18 to 1.59; studies = 4, participants = 446; I2 = 0%; low certainty). There may be little to no impact on quality of life (SGRQ, Chronic Respiratory Disease Questionnaire, CAT) (studies = 3; low to very low certainty). Multi-component interventions may help to reduce the number of people admitted to hospital for any cause (OR 0.37, 95% CI 0.22 to 0.63; studies = 2, participants = 877; low certainty), or COPD-related hospitalisations (OR 0.15, 95% CI 0.07 to 0.34; studies = 2, participants = 220; moderate certainty). There may be a small benefit on people experiencing severe exacerbations. There may be little to no effect on adverse events, serious adverse events or deaths, but events were infrequently reported and were rare (low to very certainty). AUTHORS' CONCLUSIONS Single component interventions (e.g. education or motivational interviewing provided by a health professional) can help to improve adherence to pharmacotherapy (low to very low certainty). There were slight improvements in quality of life with a Bluetooth inhaler device, but evidence is from one study and very low certainty. Change to pharmacotherapy (e.g. single inhaler instead of two, or different doses of roflumilast) has little impact on hospitalisations or exacerbations (very low certainty). There is no difference in people experiencing adverse events (all-cause or COPD-related), or deaths (very low certainty). Multi-component interventions may improve adherence with education, motivational or behavioural components delivered by health professionals (low certainty). There is little to no impact on quality of life (low to very low certainty). They may help reduce the number of people admitted to hospital overall (specifically pharmacist-led approaches) (low certainty), and fewer people may have COPD-related hospital admissions (moderately certainty). There may be a small reduction in people experiencing severe exacerbations, but evidence is from one study (low certainty). Limited evidence found no difference in people experiencing adverse events, serious adverse events or deaths (low to very low certainty). The evidence presented should be interpreted with caution. Larger studies with more intervention types, especially single interventions, are needed. It is unclear which specific COPD subgroups would benefit, therefore discussions between health professionals and patients may help to determine whether they will help to improve health outcomes.
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Affiliation(s)
- Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | | | - Robin Carr
- 28 Beaumont Street Medical Practice, Oxford, UK
| | - Andy Coles
- COPD Patient Advisory Group, St George's, University of London, London, UK
| | - Rebecca Fortescue
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Mitchell Batavia
- Steinhardt School of Culture, Education and Human Development, Department of Physical Therapy, New York University, New York, NY, USA
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Leporatti L, Levaggi R, Montefiori M. Beyond price: the effects of non-financial barriers on access to drugs and health outcomes. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:519-529. [PMID: 33629208 DOI: 10.1007/s10198-021-01270-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We study the impact of the pharmacy dispensing channel (as a proxy for access to drugs) on the drug purchases, health outcomes, and health care utilization (emergency room visits or hospitalizations) of chronically ill patients in Liguria, Italy, in 2017. METHODS We use the coarsened exact matching algorithm to compare the health outcomes for a treated group of patients living in a local health authority (LHA) where drug distribution through community pharmacies was restricted. These patients were matched to a control group of patients living in other LHAs, where drugs were also dispensed through a broad network of community pharmacies. We exploit a unique administrative dataset with information on the socio-demographic characteristics and health care services utilization of Ligurian patients with chronic cardiovascular and respiratory ailments. We restrict our analysis to patients 65 years of age or older who were admitted to hospitals from 2013 to 2016 with either a principal or secondary diagnosis connected to chronic cardiovascular and respiratory diseases. RESULTS Reduced access to drugs leads to lowered drug consumption, a higher probability of adverse health outcomes including mortality, and a higher consumption of medical services in terms of hospitalizations and emergency room visits. These effects increase with patients' age. CONCLUSION The pharmacy dispensing channel significantly affects drug consumption and acts as a proxy for adherence among chronically ill patients. Thus, health outcomes and health care utilization should be carefully evaluated when comparing the costs of alternative dispensing channels.
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Affiliation(s)
- Lucia Leporatti
- Department of Economics and Business Studies, University of Genoa, Via Vivaldi 5, 16126, Genoa, Italy
| | - Rosella Levaggi
- Department of Economics and Management, University of Brescia, Via San Faustino 74b, 25122, Brescia, Italy
| | - Marcello Montefiori
- Department of Economics and Business Studies, University of Genoa, Via Vivaldi 5, 16126, Genoa, Italy.
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Nabergoj Makovec U, Locatelli I, Kos M. Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial. BMC Health Serv Res 2021; 21:266. [PMID: 33752647 PMCID: PMC7986462 DOI: 10.1186/s12913-021-06223-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/28/2021] [Indexed: 02/08/2023] Open
Abstract
Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06223-8.
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Affiliation(s)
- Urška Nabergoj Makovec
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Igor Locatelli
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Mitja Kos
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia.
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Rathbone AP, Jamie K, Todd A, Husband A. A qualitative study exploring the lived experience of medication use in different disease states: Linking experiences of disease symptoms to medication adherence. J Clin Pharm Ther 2020; 46:352-362. [PMID: 33151549 DOI: 10.1111/jcpt.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN Medication non-adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high-mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control. OBJECTIVE To explore patients' lived experiences of medication adherence. METHODS Participants were recruited from community pharmacies and general practices. Forty-one semi-structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications. RESULTS Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short-term episodes of non-adherence were unlikely to lead to negative health outcomes but may result in negative social consequences. DISCUSSION The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications. WHAT IS NEW There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short-term episodes of non-adherence were normalized by healthcare professionals. CONCLUSION Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence.
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Affiliation(s)
- Adam Pattison Rathbone
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
| | | | - Adam Todd
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
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Real JP, Rossetti CA, Vargas AM, Jimenez‐Kairuz A, Robledo JA. Hypercholesterolaemia screening: proposal for development of a new professional pharmaceutical service. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Pablo Real
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA) CONICET Córdoba Argentina
- Programa de Servicios En Farmacias Comunitarias (PROSERFARM) de la Facultad de Ciencias Químicas Universidad Nacional de Córdoba Córdoba Argentina
| | - Cristian Alan Rossetti
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
| | - Aylen Magali Vargas
- Inter‐Agency Program for Health Prevention and Education (Programa Interinstitucional de Prevención y Educación en Salud, PIPES) Jovita, Córdoba Argentina
| | - Alvaro Jimenez‐Kairuz
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA) CONICET Córdoba Argentina
| | - Jorge Alberto Robledo
- Inter‐Agency Program for Health Prevention and Education (Programa Interinstitucional de Prevención y Educación en Salud, PIPES) Jovita, Córdoba Argentina
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Stewart D, Whittlesea C, Dhital R, Newbould L, McCambridge J. Community pharmacist led medication reviews in the UK: A scoping review of the medicines use review and the new medicine service literatures. Res Social Adm Pharm 2020; 16:111-122. [DOI: 10.1016/j.sapharm.2019.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
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Franklin BD, Abel G, Shojania KG. Medication non-adherence: an overlooked target for quality improvement interventions. BMJ Qual Saf 2019; 29:271-273. [DOI: 10.1136/bmjqs-2019-009984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/24/2023]
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Sanyal C, Husereau DR. Community-Based Services by Pharmacists: A Systematic Review of Cost-Utility Analyses. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1450-1457. [PMID: 31806202 DOI: 10.1016/j.jval.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To conduct a systematic review of cost-utility studies of community-based services provided by pharmacists and to examine their reporting and methodological quality. METHODS A comprehensive literature search was performed in February 2019 using a replicable search strategy in bibliographic databases MEDLINE, EMBASE, and the NHS Economic Evaluations Database from their inception onwards. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed reporting and methodological quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists. RESULTS Twenty studies were included in this review, representing the healthcare systems of the United Kingdom, Spain, France, The Netherlands, Belgium, Italy, Canada, the United States of America, and Brazil. Descriptions of the context in which the studies were done, justification of data sources on patient and process outcomes, choices of model, and generalizability of study findings were often inadequately reported. Seven studies (35%) were deemed of high methodological quality, 11 studies (55%) of fair quality, and 2 studies (10%) of poor quality. In addition, various methodological issues related to the randomized controlled trials and observational studies used to generate effectiveness estimates were identified. CONCLUSIONS In view of the lack of standardized definitions of expanded services, heterogeneity in study objectives, settings, comparators, methodology, outcomes, and the variable quality of these studies, the value of these services (in terms of costs) compared with quality-adjusted survival remains inconclusive.
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Affiliation(s)
| | - Donald R Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Elliott RA, Boyd MJ, Tanajewski L, Barber N, Gkountouras G, Avery AJ, Mehta R, Davies JE, Salema NE, Craig C, Latif A, Waring J, Chuter A. 'New Medicine Service': supporting adherence in people starting a new medication for a long-term condition: 26-week follow-up of a pragmatic randomised controlled trial. BMJ Qual Saf 2019; 29:286-295. [PMID: 31732700 PMCID: PMC7146933 DOI: 10.1136/bmjqs-2018-009177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022]
Abstract
Objective To examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks. Methods Pragmatic patient-level parallel randomised controlled trial in 46 English community pharmacies. 504 participants aged ≥14, identified in the pharmacy when presenting a prescription for a new medicine for predefined long-term conditions, randomised to receive NMS (n=251) or normal practice (n=253) (NMS intervention: 2 consultations 1 and 2 weeks after prescription presentation). Adherence assessed through patient self-report at 26-week follow-up. Intention-to-treat analysis employed. National Health Service (NHS) costs calculated. Disease-specific Markov models estimating impact of non-adherence combined with clinical trial data to calculate costs per extra quality-adjusted life-year (QALY; NHS England perspective). Results Unadjusted analysis: of 327 patients still taking the initial medicine, 97/170 (57.1%) and 103/157 (65.6%) (p=0.113) patients were adherent in normal practice and NMS arms, respectively. Adjusted intention-to-treat analysis: adherence OR 1.50 (95% CI 0.93 to 2.44, p=0.095), in favour of NMS. There was a non-significant reduction in 26-week NHS costs for NMS: −£104 (95% CI −£37 to £257, p=0.168) per patient. NMS generated a mean of 0.04 (95% CI −0.01 to 0.13) more QALYs per patient, with mean reduction in lifetime cost of −£113.9 (−1159.4, 683.7). The incremental cost-effectiveness ratio was −£2758/QALY (2.5% and 97.5%: −38 739.5, 34 024.2. NMS has an 89% probability of cost-effectiveness at a willingness to pay of £20 000 per QALY. Conclusions At 26-week follow-up, NMS was unable to demonstrate a statistically significant increase in adherence or reduction in NHS costs, which may be attributable to patient attrition from the study. Long-term economic evaluation suggested NMS may deliver better patient outcomes and reduced overall healthcare costs than normal practice, but uncertainty around this finding is high. Trial registration number NCT01635361, ISRCTN23560818, ISRCTN23560818, UKCRN12494.
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Affiliation(s)
- Rachel Ann Elliott
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, University of Nottingham School of Pharmacy, Nottingham, UK
| | | | - Nick Barber
- School of Pharmacy, UCL School of Pharmacy, London, UK
| | - Georgios Gkountouras
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Rajnikant Mehta
- School of Medicine and Dentistry, University of Birmingham, Birmingham, UK
| | | | | | | | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- School of Pharmacy, 68 Brighton Cottages, Haywards Heath, UK
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Dawoud DM, Haines A, Wonderling D, Ashe J, Hill J, Varia M, Dyer P, Bion J. Cost Effectiveness of Advanced Pharmacy Services Provided in the Community and Primary Care Settings: A Systematic Review. PHARMACOECONOMICS 2019; 37:1241-1260. [PMID: 31179514 DOI: 10.1007/s40273-019-00814-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pharmacists working in community and primary care are increasingly developing advanced skills to provide enhanced services, particularly in dealing with minor acute illness. These services can potentially free-up primary care physicians' time; however, it is not clear whether they are sufficiently cost effective to be recommended for wider provision in the UK. OBJECTIVE The aim of this study was to review published economic evaluations of enhanced pharmacy services in the community and primary care settings. METHODS We undertook a systematic review of economic evaluations of enhanced pharmacy services to inform NICE guidelines for emergency and acute care. The review protocol was developed and agreed with the guideline committee. The National Health Service Economic Evaluation Database, Health Technology Assessment Database, Health Economic Evaluations Database, MEDLINE and EMBASE were searched in December 2016 and the search was updated in March 2018. Studies were assessed for applicability and methodological quality using the NICE Economic Evaluation Checklist. RESULTS Of 3124 records, 13 studies published in 14 papers were included. The studies were conducted in the UK, Spain, The Netherlands, Australia, Italy and Canada. Settings included community pharmacies, primary care/general practice surgeries and patients' homes. Most of the studies were assessed as partially applicable with potentially serious limitations. Services provided in community and primary care settings were found to be either dominant or cost effective, at a £20,000 per quality-adjusted life-year threshold, compared with usual care. Those delivered in the patient's home were not found to be cost effective. CONCLUSIONS Advanced pharmacy services appear to be cost effective when delivered in community and primary care settings, but not in domiciliary settings. Expansion in the provision of these services in community and primary care can be recommended for wider implementation.
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Affiliation(s)
- Dalia M Dawoud
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo, Egypt.
| | - Alexander Haines
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - David Wonderling
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Joanna Ashe
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Jennifer Hill
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Mihir Varia
- NHS Herts Valleys Clinical Commissioning Group, Hertfordshire, UK
| | - Philip Dyer
- Diabetes, Endocrinology and Acute Internal Medicine, Diabetes Centre, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Julian Bion
- Intensive Care Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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25
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Banks I, Weller D, Ungan M, Selby P, Aapro M, Beishon M, Bolt M, Bonanno F, Champeix C, Dégi C, Eneqvist LJ, Kazmierska J, Kolacinska A, Malas S, Moine S, Pavlic DR, Price R, Walter F, Wyld L. ECCO Essential Requirements for Quality Cancer Care: Primary care. Crit Rev Oncol Hematol 2019; 142:187-199. [PMID: 31445441 DOI: 10.1016/j.critrevonc.2019.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.
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Affiliation(s)
- Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum
| | - David Weller
- World Organization of Family Doctors (WONCA Europe); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mehmet Ungan
- World Organization of Family Doctors (WONCA Europe); Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Matti Aapro
- European Cancer Organisation (ECCO); Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Marije Bolt
- Council of Occupational Therapists for European Countries (COTEC)
| | - Fiona Bonanno
- European Society of Oncology Pharmacy (ESOP); Sir Anthony Mamo Oncology Centre, Malta
| | | | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Lisa Jelf Eneqvist
- European Oncology Nursing Society (EONS); Regional Cancercenter Stockholm-Gotland, Sweden
| | - Joanna Kazmierska
- European Society of Radiotherapy and Oncology (ESTRO); Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland
| | - Agnieszka Kolacinska
- European Society of Surgical Oncology (ESSO); Department of Head and Neck Cancer Surgery and Surgical Oncology, Medical University of Lodz, Lodz, Poland
| | - Simon Malas
- Association of European Cancer Leagues (ECL); Oncology Clinic, Limassol General Hospital, Limassol, Cyprus
| | - Sébastien Moine
- European Association of Palliative Care (EAPC); Education and Health Practices Laboratory, University of Paris, France
| | | | | | - Fiona Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Lynda Wyld
- European Society of Breast Cancer Specialists (EUSOMA); Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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26
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Costa S, Horta MR, Santos R, Mendes Z, Jacinto I, Guerreiro J, Cary M, Miranda A, Helling DK, Martins AP. Diabetes policies and pharmacy-based diabetes interventions in Portugal: a comprehensive review. J Pharm Policy Pract 2019; 12:5. [PMID: 30937173 PMCID: PMC6427867 DOI: 10.1186/s40545-019-0166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacy-based interventions are complex public health endeavors which include, but are not restricted to, the conventional medication supply role. In diabetes, such interventions may improve patients' outcomes. The aim of this study was to review relevant policies and research developed in Portugal directed at pharmacy-based diabetes interventions, and to inform future policies, practice and research in collaborative practice with primary care. RESEARCH METHOD An exploratory review of diabetes legislation and policy papers, as well as a comprehensive review in Embase, MEDLINE (via Ovid and PubMed), Google Scholar, and grey literature until November 2017 was performed. RESULTS Sixteen policy papers and 10 studies were included in the analysis. Positive evidence from pharmacy interventions was retrieved concerning screening individuals at risk, screening uncontrolled patients, managing diabetes, and supporting self-monitoring. CONCLUSIONS Some consistency in favorable findings, but also room for improvements in health policies, intervention design and research methods, were observed.
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Affiliation(s)
- Suzete Costa
- USFarmácia® Collaborative Care Project, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Rute Horta
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Rita Santos
- Post-Graduate School of Health & Management (EPGSG), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Isabel Jacinto
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, IPO Lisboa, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Dennis K. Helling
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 8189 East 5th Avenue, Denver, CO 80230 USA
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
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27
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Latif A, Waring J, Watmough D, Boyd MJ, Elliott RA. 'I expected just to walk in, get my tablets and then walk out': on framing new community pharmacy services in the English healthcare system. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1019-1036. [PMID: 29671885 DOI: 10.1111/1467-9566.12739] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, University of Nottingham, UK
| | | | - Deborah Watmough
- Division of Pharmacy Practice and Policy, University of Nottingham, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, University of Nottingham, UK
| | - Rachel A Elliott
- Manchester Centre for Health Economics, University of Manchester, UK
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Sutton M, Garfield-Birkbeck S, Martin G, Meacock R, Morris S, Sculpher M, Street A, Watson SI, Lilford RJ. Economic analysis of service and delivery interventions in health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
There are well-developed guidelines for economic evaluation of clearly defined clinical interventions, but no such guidelines for economic analysis of service interventions. Distinctive challenges for analysis of service interventions include diffuse effects, wider system impacts, and variability in implementation, costs and effects. Cost-effectiveness evidence is as important for service interventions as for clinical interventions. There is also an important role for wider forms of economic analysis to increase our general understanding of context, processes and behaviours in the care system. Methods exist to estimate the cost-effectiveness of service interventions before and after introduction, to measure patient and professional preferences, to reflect the value of resources used by service interventions, and to capture wider system effects, but these are not widely applied. Future priorities for economic analysis should be to produce cost-effectiveness evidence and to increase our understanding of how service interventions affect, and are affected by, the care system.
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Affiliation(s)
- Matt Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Steph Garfield-Birkbeck
- National Institute for Health Research Evaluation Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Graham Martin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rachel Meacock
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics, London, UK
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