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Fraticelli L, Freyssenge J, Promé-Combel E, Agnellet E, Dargaud Y, Chamouard V. Evaluation of the Care Pathway in the Context of the Dispensing of Emicizumab (Hemlibra) in Community Pharmacies in France: Protocol for a Cross-sectional Study Based on the Kirkpatrick Model. JMIR Res Protoc 2023; 12:e43091. [PMID: 36884286 PMCID: PMC10034610 DOI: 10.2196/43091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Commercialized since 2019, emicizumab (Hemlibra) was available only in French hospital pharmacies for prophylaxis of hemophilia A with or without inhibitors. Since June 15, 2021, patients can choose between a hospital and community pharmacy. These changes in the care pathway have important organizational consequences for patients, their relatives, and health professionals. Two training programs are available for community pharmacists: the "HEMOPHAR" training program proposed by the national reference center for hemophilia and the Roche training program proposed by the laboratory that markets the product. OBJECTIVE The PASODOBLEDEMI study aims to evaluate the direct impact of the training programs provided to community pharmacists in the context of the dispensing of emicizumab, and to evaluate patients' satisfaction with their treatment whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy. METHODS We designed a cross-sectional study based on the 4-level Kirkpatrick evaluation model: the immediate reaction of community pharmacists following training (Reaction), the knowledge acquired during the training (Learning), the professional practice of community pharmacists during dispensing of the product (Behavior), and patients' satisfaction related to the treatment whether it is dispensed from a hospital or from a community pharmacy (Results). RESULTS Considering that single outcome measures cannot adequately reflect the complexity of this new organization, the Kirkpatrick evaluation model provides 4 distinct outcomes: the immediate reaction after the HEMOPHAR training program, the level of knowledge acquired after the HEMOPHAR training program, the impact of training on professional practice, and patient satisfaction with access to emicizumab. We developed specialized questionnaires for each of the 4 levels of the Kirkpatrick evaluation model. All community pharmacists involved in dispensing emicizumab, whether they have followed the HEMOPHAR or the Roche training program or neither, were eligible for inclusion. All patients with severe hemophilia A were eligible, irrespective of inhibitor use, age, treatment with emicizumab, and whether they chose dispensation from a community pharmacy or retained dispensation from a hospital pharmacy. CONCLUSIONS The new organization for dispensing emicizumab to patients with hemophilia A in French community pharmacies must be accompanied by optimal safety and quality conditions due to the risk of serious and urgent bleeding situations in the management of rare bleeding diseases. The elaboration of the PASODOBLEDEMI protocol has already a positive impact with the commitment of all health professionals, physicians, hospital and community pharmacists, and the patient community. The results will be disseminated among the French authorities and will enable, if necessary, proposing this access model to other rare diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT05449197, https://clinicaltrials.gov/ct2/show/NCT05449197?term=NCT05449197; ClinicalTrials.gov NCT05450640, https://clinicaltrials.gov/ct2/show/NCT05450640?term=NCT05450640. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43091.
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Affiliation(s)
- Laurie Fraticelli
- Laboratory P2S (Health Systemic Process), UR 4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Julie Freyssenge
- Research on Healthcare Performance RESHAPE, INSERM U1290, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Emilie Promé-Combel
- French Reference Center of Hemophilia and Rare Inherited Bleeding Disorder, Louis Pradel Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Eléonore Agnellet
- Pharmaceutical Unit, Louis Pradel Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Yesim Dargaud
- French Reference Center of Hemophilia and Rare Inherited Bleeding Disorder, Louis Pradel Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Valérie Chamouard
- French Reference Center of Hemophilia and Rare Inherited Bleeding Disorder, Louis Pradel Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Pharmaceutical Unit, Louis Pradel Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
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Valérie C, Laurie F, Julie F, Clément C, Claude N, Carlos EK. PHAREO study: Perceived and observed accessibility to therapeutic drugs used for treating patients with inherited bleeding disorders. J Clin Pharm Ther 2022; 47:1667-1675. [PMID: 35726381 DOI: 10.1111/jcpt.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The dispensing of clotting factor concentrates in hospital pharmacies imposes accessibility constraints on patients and their caregivers, thereby increasing the disease burden. Very few studies have addressed these issues so far in terms of individual perceptions and actual difficulties. The PHAREO study aims to report patient's perception of treatment accessibility and evaluate spatial accessibility. METHODS The PHAREO study is an observational survey based on a questionnaire specifically designed for the study purpose in collaboration with patients' representatives in the second demographic and economic French region. RESULTS AND DISCUSSION We collected 293 responses (participation rate of 64.1%) which show that 89.8% of respondents were either very or rather satisfied with regard to access to treatment. However, respondents reported difficulties in accessing the hospital pharmacy. The data also showed that 79.2% of respondents tended to over-estimate travel time which was reported above their acceptable threshold for 39.2% of them. The main determinants of dissatisfaction were parental burden (OR 2.5 [1.3; 4.8], p = 0.008) and waiting time at the hospital pharmacy (OR 1.5 [1.1;2.0], p = 0.016, per 10 min increase). WHAT IS NEW AND CONCLUSION The PHAREO study provides subjective and objective data regarding satisfaction levels of persons with haemophilia and other coagulation deficiencies, with a high representativeness rate for patients on prophylaxis (87.5%). Both respondents and hospital pharmacists pled for an evolution of the current dispensing circuit to improve access to treatment and reduce the burden for patients. Currently, the community pharmacists are apart from the dispensing circuit. The authors propose improvements in the pathway of care for patients and their caregivers by including the community pharmacists alongside the hospital pharmacists in a centralized coordination scheme.
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Affiliation(s)
- Chamouard Valérie
- Centre de Référence de l'Hémophilie et autres déficits constitutionnels en protéines de la coagulation, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France.,Service pharmaceutique, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France
| | - Fraticelli Laurie
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Laboratoire Parcours Santé Systémique (P2S) UR 4129, Université de Lyon 1, Lyon, France
| | - Freyssenge Julie
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Research On Healthcare Performance (RESHAPE), INSERM, Lyon, France
| | - Claustre Clément
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France
| | - Négrier Claude
- Centre de Référence de l'Hémophilie et autres déficits constitutionnels en protéines de la coagulation, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France
| | - El Khoury Carlos
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Clinical Research Unit, Médipôle Hôpital Mutualiste, Villeurbanne, France
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Fernandes BD, Foppa AA, Almeida PHRF, Lakhani A, Lima TDM. Application and utility of geographic information systems in pharmacy specific health research: A scoping review. Res Social Adm Pharm 2021; 18:3263-3271. [PMID: 34836813 DOI: 10.1016/j.sapharm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. OBJECTIVES The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. METHODS During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. RESULTS After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables. CONCLUSIONS GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.
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Affiliation(s)
- Brígida Dias Fernandes
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo (UFES), Avenida Marechal Campos, 1468, Bonfim, Vitória, Espirito Santo, 29047105, Brazil.
| | - Aline Aparecida Foppa
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Ali Lakhani
- School of Psychology and Public Health, La Trobe University, 360 Collins St, Melbourne, Victoria, Australia, 3000; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia, 4131.
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro (UFRRJ), Brazil.
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Beny K, du Sartz de Vigneulles B, Chamouard V, Guilloux R, Gay V, Negrier C, Dussart C. Patients' Perception of the Impact of Innovation on Hemophilia Care Management Organization: A Qualitative Study Protocol (INNOVHEMO Study). Patient Prefer Adherence 2021; 15:1807-1815. [PMID: 34434044 PMCID: PMC8380624 DOI: 10.2147/ppa.s322531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND New therapies provide a favorable evolution in the care management of persons with hemophilia. However, the impact of these new therapies on patient care organization remains to be determined. A qualitative study will be implemented to analyze patients' perception regarding the impact of innovation on the organization of their care management. Secondary objectives will include refining specific factors related to persons with hemophilia (barriers or facilitators, especially the place of treatment) to consider within an organizational impact analysis. PATIENTS AND METHODS Semi-structured individual interviews will be conducted via videoconferencing or by phone by two researchers using an interview guide. Participants will be recruited from the Rhône-Alpes region, in France. Physicians from two hemophilia treatment centers will identify eligible patients. Moreover, a call for volunteers will be launched by the Rhône-Alpes committee of the French hemophilia association. Interviews will be conducted with adult patients, adolescent patients or parents of a minor with hemophilia regularly treated prophylactically or on demand. Data analysis will be performed with NVivo® software. Each interview will be analyzed by two researchers using an inductive content analytic method. DISCUSSION The INNOVHEMO study is an original study analyzing the way patients perceive the impact of an innovation on their care management organization. The resulting patient-specific factors, identified as barriers or facilitators, will need to be integrated into a more comprehensive analysis of the impact of innovation on care management organization.
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Affiliation(s)
- Karen Beny
- EA 4129 Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, Lyon, France
- Central Pharmacy, Hospices Civils de Lyon, Lyon, France
- Correspondence: Karen Beny Central Pharmacy, Hospices Civils de Lyon, 57 rue Francisque Darcieux, CS 60004, 69563 Saint Genis Laval Cedex, Lyon, FranceTel +33 4 78 86 66 92Fax +33 4 72 67 88 74 Email
| | | | - Valerie Chamouard
- Reference center on hemophilia and other constitutional hemorrhagic diseases, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
- Pharmacy, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Ronald Guilloux
- Laboratory S2HEP, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Valérie Gay
- Hemophilia Care Center, Centre hospitalier Métropole Savoie, Chambéry, France
| | - Claude Negrier
- Reference center on hemophilia and other constitutional hemorrhagic diseases, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Claude Dussart
- EA 4129 Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, Lyon, France
- Central Pharmacy, Hospices Civils de Lyon, Lyon, France
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