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Viegas R, Guerreiro MP, Duarte-Ramos F, Mendes R, da Costa FA. The role of community pharmacists and pharmacies in physical activity promotion: an interdisciplinary e-Delphi study. Int J Clin Pharm 2024:10.1007/s11096-024-01731-z. [PMID: 38662124 DOI: 10.1007/s11096-024-01731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Physical activity has a key role in the prevention and control of noncommunicable diseases. Community pharmacists are an accessible source to provide brief advice to people on how to be more physically active. Nonetheless, there is a limited understanding of stakeholders' perspectives on their role in promoting physical activity, to inform policy and practice. The present study addresses this gap. AIM To determine consensus from different health professionals on the role of pharmacists and pharmacies in brief physical activity counselling in Portugal. METHOD This cross-sectional study used a two-round e-Delphi panel. The questionnaire was organised into four domains of physical activity promotion and comprised 37 items. Interdisciplinary experts rated their level of agreement using a 5-point Likert scale. Consensus was set at the outset as 75% or more of participants scoring 4 or 5 (consensus "in") or 1 or 2 (consensus "out"). RESULTS Forty-two health professionals involved in promoting physical activity in the ambulatory setting in Portugal were selected through purposive quota sampling. Eighteen out of 37 items were consensual in the first round and five more achieved consensus after the second round (62.2%). Physical activity promotion was seen as the role of all healthcare workforce and pharmacies were considered as suitable spaces for service provision, regardless of remuneration. CONCLUSION This study endorses a set of roles for physical activity promotion in community pharmacy from an interdisciplinary perspective. Consensually established perspectives can inform policy making and practice, streamlining the coordination of pharmacies with the national health service.
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Affiliation(s)
- Ruben Viegas
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Portugal
| | - Filipa Duarte-Ramos
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Filipa Alves da Costa
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
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Mazzilli S, Cocco N, Petri D, Moazen B, Rosello A, D'Arcy J, Plugge E, Baglietto L, Murauer E, Stöver H, Trattonikolas T, Stylianou I, Doltu S, Busmachiu V, Mavrou J, Yiasemi I, Barbiros I, da Costa FA, Meroueh F, Ranieri R, Tavoschi L. Implementation of COVID-19 vaccination services in prison in six European countries: translating emergency intervention into routine life-course vaccination. BMC Public Health 2024; 24:1001. [PMID: 38600540 PMCID: PMC11007954 DOI: 10.1186/s12889-024-18063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/10/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Evidence has shown that the risk of transmission of SARS-CoV-2 is much higher in prisons than in the community. The release of the COVID-19 vaccine and the recommendation by WHO to include prisons among priority settings have led to the inclusion of prisons in national COVID-19 vaccination strategies. Evidence on prison health and healthcare services provision is limited and often focuses on a single country or institution due to the multiple challenges of conducting research in prison settings. The present study was done in the framework of the EU-founded project RISE-Vac. It aimed to analyse the best practices and challenges applied in implementing COVID-19 universal vaccination services during the pandemic to support future expansion of routine life course vaccination services for people living in prison (PLP). METHODS Two online cross-sectional surveys were designed and piloted: survey1 on prison characteristics and (non-COVID-19) immunisation practices; survey2 on the implementation and coverage of COVID-19 vaccination with open-ended questions for thematic analysis. Each RISE-Vac project partner distributed the questionnaire to one or two prisons in their country. Answers were collected from eight European prisons' directors or medical directors between November 2021-May 2022. RESULTS According to our findings, the implementation modalities of COVID-19 vaccination services in the surveyed prisons were effective in improving PLP vaccination coverage. Strategies for optimal management of the vaccination campaign included: periodic time slot for PLP vaccination; new staff recruitment and task shifting; distribution of informational material both to PLP and prison staff. Key challenges included continuity of care after release, immunisation information system, and vaccine hesitancy. CONCLUSIONS To the best of our knowledge, this is the first study describing the implementation of COVID-19 vaccination services in European prisons, suggesting that the expansion of vaccination provision in prison is possible. There is no unique solution that will fit every country but commonalities likely to be important in the design and implementation of future vaccination campaigns targeting PLP emerged. Increased availability of vaccination services in prison is not only possible, but feasible and highly desirable, and can contribute to the reduction of health inequalities.
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Affiliation(s)
- Sara Mazzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - Nicola Cocco
- Infectious Diseases Service, Penitentiary Health System, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Davide Petri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Babak Moazen
- Department of Health and Social Work, Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Federal Republic of Germany
| | | | | | - Emma Plugge
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eva Murauer
- Health Unit of the Villeneuve-les-Maguelone prison, University Hospital Centre Montpellier, Montpellier, France
| | - Heino Stöver
- Department of Health and Social Work, Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Tassos Trattonikolas
- Ministry of Justice and Public Order - Cyprus Prison Department, Nicosia, Cyprus
| | - Iakovos Stylianou
- Ministry of Justice and Public Order - Cyprus Prison Department, Nicosia, Cyprus
| | | | | | | | | | - Irina Barbiros
- National Administration of Penitentiaries, Chișinău, Republic of Moldova
| | | | - Fadi Meroueh
- Health Unit of the Villeneuve-les-Maguelone prison, University Hospital Centre Montpellier, Montpellier, France
| | - Roberto Ranieri
- Infectious Diseases Service, Penitentiary Health System, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Viegas R, Barbosa A, Mendes R, Duarte-Ramos F, Alves da Costa F. Pharmacists' involvement in physical activity promotion in community pharmacy: a systematic review. Eur J Public Health 2024; 34:299-308. [PMID: 38366221 PMCID: PMC10990504 DOI: 10.1093/eurpub/ckae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Physical activity (PA) promotion in healthcare systems is one of the priority areas highlighted by the World Health Organization, which recognizes that progress has been slow largely due to a lack of awareness and investment while requiring a system-based approach. Community pharmacies are one of the health structures that are more easily accessible to populations, thus constituting an ideal venue for developing health promotion activities. This research aimed to describe PA-enabling interventions developed in community pharmacies by pharmacists. METHODS An electronic search was performed in PubMed, Scopus, Web of Science, Cochrane and reference lists of the different papers until June 2023. Studies were eligible if performed in community pharmacies by pharmacists, focused on interventions aimed at increasing PA levels and if at least one PA-specific outcome was measured at two different time points. RESULTS We identified 7076 publications in the initial search, plus 31 records identified through backward citation tracking from relevant studies. After an initial screening, 236 were selected for full-text analysis. Of the 29 selected papers, 10 presented a low risk of bias for the measurement of PA levels. PA outcomes were generally self-reported outcomes where the change in terms of the percentage of individuals considered active or who increased PA because of the intervention. CONCLUSION Several interventions to improve PA through community pharmacies were found although with a high level of heterogeneity and with only few with a low risk of bias. More targeted research that aims to capture PA levels and support the training of healthcare professionals is needed.
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Affiliation(s)
- Ruben Viegas
- iMED, Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Ana Barbosa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Romeu Mendes
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Filipa Duarte-Ramos
- iMED, Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Filipa Alves da Costa
- iMED, Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
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Viegas R, Silva F, Nørgaard LS, Duarte-Ramos F, Mendes R, Alves da Costa F. Physical activity promotion in the community pharmacy: An opportunity for an expanded role? Res Social Adm Pharm 2024; 20:345-352. [PMID: 38129220 DOI: 10.1016/j.sapharm.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Physical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists' role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice. OBJECTIVE The aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion. METHODS In-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion. RESULTS Data saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 - Knowledge, #10 - Memory, Attention and Decision Processes and #13 - Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP. CONCLUSION Community pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.
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Affiliation(s)
- Ruben Viegas
- Faculty of Pharmacy, University of Lisbon - imed, Research Institute for Medicines, Lisboa, Portugal.
| | - Filipa Silva
- Faculty of Sciences and Technology, University of the Algarve, Faro, Portugal
| | - Lotte Stig Nørgaard
- Faculty of Health and Medical Sciences, Department of Pharmacy, University of Copenhagen, Denmark
| | - Filipa Duarte-Ramos
- Faculty of Pharmacy, University of Lisbon - imed, Research Institute for Medicines, Lisboa, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; ACES Douro I - Marão e Douro Norte, Administração Regional de Saúde do Norte, Vila Real, Portugal
| | - Filipa Alves da Costa
- Faculty of Pharmacy, University of Lisbon - imed, Research Institute for Medicines, Lisboa, Portugal
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Oliveira CL, Duarte-Ramos F, Alves da Costa F, Fernandez-Llimos F. Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: a historical cohort study. Int J Clin Pharm 2024:10.1007/s11096-023-01697-4. [PMID: 38315304 DOI: 10.1007/s11096-023-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a multifactorial condition often induced by drugs commonly used in hospitals. Identifying and staging AKI necessitates frequent monitoring of renal function. AIM To assess the impact of real-world hospital practices regarding serum creatinine (SCr) testing on the identification and staging of AKI, and its implications for adjusting drug doses. METHOD A historical cohort study utilizing hospital records from all adult patients admitted between 01/06/2018 and 31/12/2020 was conducted. Patients with no SCr assessment during their stay or those with an SCr at admission ≥ 2 mg/dL were excluded. AKI was determined using two criteria, namely AKIN and KDIGO, considering the time intervals between two SCr tests as outlined in the criteria. Additionally, patients with SCr increases exceeding AKI limits, regardless the time interval, were also identified. The estimated glomerular filtration rate (eGFR) and kinetic eGFR (KeGFR) were calculated. RESULTS During the study period, 17,269 hospitalizations and 62,255 SCr tests were recorded. Among the 17,032 hospitalizations with a length of stay > 48 h, 46.8% experienced periods with no SCr tests performed for more than 48 h. Any stage of AKI was identified in 7.0% of patients and in 9.1% using AKI and KDIGO criteria, respectively. Ignoring time limits in both criteria revealed potential AKI in 1942 patients (11.2%), indicating a potential underdiagnosis of AKI by 37.5% or 19.1%, depending on the criteria used. A total of 76 drugs requiring dose adjustment in patients with eGFR ≤ 50 ml/min were prescribed in 78.5% admissions. These drugs were prescribed in 87.9% of patients potentially underdiagnosed with AKIN and in 88.9% with KDIGO. CONCLUSION There is a need for changes in the established hospital procedures to ensure more frequent testing of SCr levels. Implementing an advanced scope of practice for clinical pharmacists could support these changes.
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Affiliation(s)
- Catarina Luz Oliveira
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Filipa Duarte-Ramos
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Filipa Alves da Costa
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, -Applied Molecular Biosciences Unit, i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, Universidade of Porto, Porto, Portugal
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Tonin FS, Alves da Costa F, Fernandez-Llimos F. Impact of harm minimization interventions on reducing blood-borne infection transmission and some injecting behaviors among people who inject drugs: an overview and evidence gap mapping. Addict Sci Clin Pract 2024; 19:9. [PMID: 38310293 PMCID: PMC10838443 DOI: 10.1186/s13722-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to synthetize the evidence on the effectiveness of harm minimization interventions on reducing blood-borne infection transmission and injecting behaviors among people who inject drugs (PWID) through a comprehensive overview of systematic reviews and evidence gap mapping. METHODS A systematic review was conducted with searches in PubMed and Scopus to identify systematic reviews assessing the impact of interventions aimed at reducing the harms associated with injectable drug use. The overall characteristics of the studies were extracted and their methodological quality was assessed using AMSTAR-2. An evidence gap map was constructed, highlighting the most frequently reported outcomes by intervention (CRD42023387713). RESULTS Thirty-three systematic reviews were included. Of these, 14 (42.2%) assessed the impact of needle/syringe exchange programs (NSEP) and 11 (33.3%) examined opioid agonist therapy (OAT). These interventions are likely to be associated with reductions of HIV/HCV incidence (10-40% risk reduction for NSEP; 50-60% for OAT) and sharing injecting paraphernalia (50% for NSEP, 25-85% for OAT), particularly when combined (moderate evidence). Behavioral/educational interventions were assessed in 12 reviews (36.4%) with most authors in favor/partially in favor of the use of these approaches (moderate evidence). Take-home naloxone programs and supervised-injection facilities were each assessed in two studies (6.1%), which reported inconclusive results (limited/inconsistent evidence). Most authors reported high levels of heterogeneity and risk of bias. Other interventions and outcomes were inadequately reported. Most systematic reviews presented low or critically low quality. CONCLUSION The evidence is sufficient to support the effectiveness of OAT, NSEP and their combination in reducing blood-borne infection transmission and certain injecting behaviors among PWID. However, evidence of other harm minimizations interventions in different settings and for some outcomes remain insufficient.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Teodoro MI, Mayer A, da Costa Miranda A, Nunes H, da Costa FA, Lourenço A. Real-world effectiveness of aromatase inhibitors and fulvestrant in HR+/HER2- advanced breast cancer: a snapshot of the last two years before conventional use of CDK 4/6 inhibitors in a Portuguese institution. J Pharm Policy Pract 2024; 17:2296551. [PMID: 38250517 PMCID: PMC10798277 DOI: 10.1080/20523211.2023.2296551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background Monotherapy with aromatase inhibitors and fulvestrant were the standard-of-care for hormone receptor-positive (HR+)/human epidermal growth factor receptor-type2 negative (HER2-) advanced breast cancer, before integration of cyclin-dependent kinase 4/6 inhibitors. Effectiveness data is essential for regulatory action, but little is known about real-world use of aromatase inhibitors and fulvestrant. Methods A retrospective cohort study was conducted resorting to data from a cancer registry to identify adult women with HR+/HER- advanced breast cancer exposed to aromatase inhibitors or fulvestrant (31 May 2017-31 March 2019) at the main oncology hospital in Portugal. Cases were updated with follow-up until death or cut-off (31 March 2021) and pseudoanonymized data extracted. Primary outcome was overall survival (OS) and secondary time to treatment failure (TTF), estimated using survival analysis and compared with published trials. Results 192 patients were distributed by subgroups according to the medicine. Letrozole: OS 30.8 (95% confidence interval (CI) 20.6-41.4); TTF 11.2 (95%CI 8.7-13.7). Exemestane: OS 22.1 (95%CI 9.7-34.6); TTF 6.0 (95%CI 4.1-7.8). Fulvestrant: OS 21.6 (95%CI 16.5-26.7); TTF 5.6 (95%CI 4.5-6.6). Conclusions Estimated effectiveness (OS) of letrozole and fulvestrant was, respectively, 3.2-3.5 months lower than reported. The clinical meaning seems uncertain and may be explained a higher proportion of worse prognostic characteristics in patients treated in the real-world.
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Affiliation(s)
- Maria Inês Teodoro
- Unidade de Investigação em Epidemiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
| | - Alexandra Mayer
- Unidade de Investigação em Epidemiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Ana da Costa Miranda
- Unidade de Investigação em Epidemiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Hugo Nunes
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Filipa Alves da Costa
- Unidade de Investigação em Epidemiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
| | - António Lourenço
- Unidade de Investigação em Epidemiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Alves da Costa F, Paulino E, Crisóstomo S. Role of Portuguese community pharmacy and pharmacists in self-care. Explor Res Clin Soc Pharm 2023; 12:100334. [PMID: 37810745 PMCID: PMC10556834 DOI: 10.1016/j.rcsop.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Portugal recognizes the importance of self-care in its policies and has been actively engaging in health literacy and citizen empowerment. The current National Health Plan for the period 2021-2030 clearly mentions the need to "take greater advantage of the network of community pharmacies throughout the national territory, in favour of the health of the community, from the protection and promotion of health, through health literacy, to the prevention and early detection of disease, and the aggravation of chronic disease, among others". There is recognition of the role of pharmacists and community pharmacies. However, more needs to be done to promote intersectoral collaboration, particularly as community pharmacies are private entities but can nonetheless support the public national health service. Community pharmacies assisted many individuals during the pandemic to test suspect cases free of charge. The fight to end AIDS and viral hepatitis is another example where community pharmacies promote self-testing and ensure efficient screening and referral to diagnosis and treatment. Portugal has already moved to reimburse community pharmacies for services with some of them in areas of self-care including COVID-19 testing. Nevertheless, future challenges include making community pharmacies sustainable. Taking into account that community pharmacies are private entities that can supplement the public health service just as any other provider, it is essential to review payment models, referral mechanisms and access and integration of information from other partners in primary and secondary care.
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Affiliation(s)
- Filipa Alves da Costa
- Research Institute for Medicines (iMED), Faculty of Parmacy, University of Lisbon; Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Ema Paulino
- National Association of Pharmacies (Associação Nacional das Farmácias, ANF), Lisboa, Portugal
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Hahn M, Stuhec M, Alves da Costa F. Author Correction: Overview of this issue: "clinical pharmacy impacting mental health delivery and outcomes". Int J Clin Pharm 2023; 45:1497. [PMID: 37947952 DOI: 10.1007/s11096-023-01660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Martina Hahn
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Frankfurt, Germany
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
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Viegas R, Alves da Costa F, Mendes R, Deidda M, McIntosh E, Sansano-Nadal O, Magaña JC, Rothenbacher D, Denkinger M, Caserotti P, Tully MA, Roqué-Figuls M, Giné-Garriga M. Relationship of the SITLESS intervention on medication use in community-dwelling older adults: an exploratory study. Front Public Health 2023; 11:1238842. [PMID: 38035303 PMCID: PMC10687584 DOI: 10.3389/fpubh.2023.1238842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Sedentary behavior (SB) and physical activity (PA) interventions in older adults can improve health outcomes. Problems related with aging include prevalent comorbidity, multiple non-communicable diseases, complaints, and resulting polypharmacy. This manuscript examines the relationship between an intervention aiming at reducing SB on medication patterns. Method This manuscript presents a local sub-analysis of the SITLESS trial data on medication use. SITLESS was an exercise referral scheme (ERS) enhanced by self-management strategies (SMS) to reduce SB in community-dwelling older adults. We analyzed data from the ERS + SMS, ERS and usual care (UC) groups. Patient medication records were available at baseline and at the end of the intervention (4-month period) and were analyzed to explore the effect of SITLESS on medication patterns of use. Result A sample of 75 participants was analyzed, mostly older overweight women with poor body composition scores and mobility limitations. There was a significant reduction of 1.6 medicines (SD = 2.7) in the ERS group (p < 0.01), but not in the UC or ERS + SMS groups. Differences were more evident in medicines used for short periods of time. Conclusion The findings suggest that an exercise-based program enhanced by SMS to reduce SB might influence medication use for acute conditions but there is a need to further investigate effects on long-term medicine use in older adults.
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Affiliation(s)
- Ruben Viegas
- Faculty of Pharmacy, iMED, Research Institute for Medicines, University of Lisbon, Lisbon, Portugal
| | - Filipa Alves da Costa
- Faculty of Pharmacy, iMED, Research Institute for Medicines, University of Lisbon, Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ACES Douro I – Marão e Douro Norte, Administração Regional de Saúde do Norte, Vila Real, Portugal
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Oriol Sansano-Nadal
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- School of Health and Sport Sciences (EUSES), Rovira i Virgili University, Tarragona, Spain
| | - Juan Carlos Magaña
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Michael Denkinger
- Institute for Geriatric Research at Agaplesion Bethesda Clinic and Geriatric Centre, Ulm University Medical Centre, Ulm, Germany
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
| | - Mark A. Tully
- School of Medicine, University of Ulster, Londonderry, United Kingdom
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Faculty of Health Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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Hahn M, Stuhec M, da Costa FA. Overview of this issue: "clinical pharmacy impacting mental health delivery and outcomes". Int J Clin Pharm 2023; 45:1025-1026. [PMID: 37801185 DOI: 10.1007/s11096-023-01654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Martina Hahn
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Frankfurt, Germany
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
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Oerlemans S, Efficace F, Kyriakou C, Freitas AC, Shamieh O, Creutzberg CL, Lehmann J, Petranovic D, Nagele E, Bredart A, Dong D, Scholz CW, Caocci G, Molica S, Griskevicius L, Xochelli A, Kieffer JM, Agelink van Rentergem JA, Alrjoub W, Mueller A, Gomes Da Silva M, Alves da Costa F, Malak S, Cocks K, van de Poll-Franse LV. International validation of two EORTC questionnaires for assessment of health-related quality of life for patients with high-grade non-Hodgkin lymphoma (QLQ-NHL-HG29) and low-grade non-Hodgkin lymphoma (QLQ-NHL-LG20). Cancer 2023; 129:2727-2740. [PMID: 37204189 DOI: 10.1002/cncr.34822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a critical aspect to consider when making treatment decisions for patients with non-Hodgkin-lymphoma (NHL). This international study by the European Organisation for Research and Treatment of Cancer (EORTC) tested the psychometric properties of two newly developed measures for patients with high-grade (HG)- and low-grade (LG)-NHL: the EORTC QLQ-NHL-HG29 and the EORTC QLQ-NHL-LG20 to supplement the core questionnaire (EORTC QLQ-C30). METHODS Overall, 768 patients with HG-NHL (N = 423) and LG-NHL (N = 345) from 12 countries completed the QLQ-C30, QLQ-NHL-HG29/QLQ-NHL-LG20 and a debriefing questionnaire at baseline, and a subset at follow-up for either retest (N = 125/124) or responsiveness to change (RCA; N = 98/49). RESULTS Confirmatory factor analysis showed an acceptable to good fit of the 29 items of the QLQ-NHL-HG29 on its five scales (symptom burden [SB], neuropathy, physical condition/fatigue [PF], emotional impact [EI], and worries about health/functioning [WH]), and of the 20 items of the QLQ-NHL-LG20 on its four scales (SB, PF, EI, and WH). Completion took on average 10 minutes. Test-retest reliability, convergent validity, known-group comparisons, and RCA find satisfactory results of both measures. A total of 31%-78% of patients with HG-NHL and 22%-73% of patients with LG-NHL reported symptoms and/or worries (e.g., tingling in hands/feet, lack of energy, and worries about recurrence). Patients reporting symptoms/worries had substantially lower HRQOL compared to those without. DISCUSSION The use of the EORTC QLQ-NHL-HG29 and QLQ-NHL-LG20 questionnaires in clinical research and practice will provide clinically relevant data to better inform treatment decision-making. PLAIN LANGUAGE SUMMARY The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group developed two questionnaires. These questionnaires measure health-related quality of life. The questionnaires are for patients with high-grade or low-grade non-Hodgkin lymphoma. They are called the EORTC QLQ-NHL-HG29 and QLQ-NHL-LG20. The questionnaires are now internationally validated. This study demonstrates that the questionnaires are reliably and valid, which are important aspects of a questionnaire. The questionnaires can now be used in clinical trials and practice. With the information gathered from the questionnaires, patients and clinicians can better evaluate treatments and discuss the best choice for a patient.
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Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases Data Centre, Rome, Italy
| | | | - Ana Carolina Freitas
- Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Carien L Creutzberg
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Eva Nagele
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anne Bredart
- Institut Curie, Psycho-Oncology Unit, Paris, France
- Psychopathology and Health Process Laboratory (UR 4057), Paris University, Paris, France
- PSL University, Paris, France
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Stefano Molica
- Azienda Ospedalier Ciaccio, Catanzaro, Italy
- Department of Hematology, Hull University Teaching Hospitals, NHS Trust, Hull, UK
| | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Jacobien M Kieffer
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Waleed Alrjoub
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Anja Mueller
- Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Maria Gomes Da Silva
- Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Filipa Alves da Costa
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie-Hématologie, Saint-Cloud, France
| | - Kim Cocks
- York Trials Unit, University of York, York, UK
- Adelphi Values, Bollington, Cheshire, UK
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Alves da Costa F, Cardoso Borges F, Ramos A, Mayer A, Brito C, Ramos C, Bernardo C, Cossito M, Furtado C, Ferreira AR, Martins-Branco D, da Costa Miranda A, Lourenço A. Effectiveness of palbociclib with aromatase inhibitors for the treatment of advanced breast cancer in an exposure retrospective cohort study: implications for clinical practice. Breast Cancer Res 2023; 25:78. [PMID: 37386484 PMCID: PMC10308630 DOI: 10.1186/s13058-023-01678-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND New drugs for locally advanced or metastatic breast cancer have led to clinical benefits, aside with increasing costs to healthcare systems. The current financing model for health technology assessment (HTA) privileges real-world data. As part of the ongoing HTA, this study aimed to evaluate the effectiveness of palbociclib with aromatase inhibitors (AI) and compare it with the efficacy reported in PALOMA-2. METHODS A population-based retrospective exposure cohort study was conducted including all patients initiating treatment in Portugal with palbociclib under early access use and registered in the National Oncology Registry. The primary outcome was progression free survival (PFS). Secondary outcomes considered included time to palbociclib failure (TPF), overall survival (OS), time to next treatment (TTNT), and proportion of patients discontinuing treatment due to adverse events (AEs). The Kaplan-Meier method was used and median, 1- and 2-year survival rates were computed, with two-sided 95% confidence intervals (95%CI). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for reporting observational studies were used. RESULTS There were 131 patients included. Median follow-up was 28.3 months (IQR: 22.7-35.2) and median duration of treatment was 17.5 months (IQR: 7.8-29.1). Median PFS was 19.5 months (95%CI 14.2-24.2), corresponding to a 1-year PFS rate of 67.9% (95%CI 59.2-75.2) and a 2-year PFS rate of 42.0% (95%CI 33.5-50.3). Sensitivity analysis showed median PFS would increase slightly when excluding those not initiating treatment with the recommended dose, raising to 19.8 months (95%CI 14.4-28.9). By considering only patients meeting PALOMA-2 criteria, we could observe a major difference in treatment outcomes, with a mean PFS of 28.8 months (95%CI 19.4-36.0). TPF was 19.8 months (95%CI 14.2-24.9). Median OS was not reached. Median TTNT was 22.5 months (95%CI 18.0-29.8). A total of 14 patients discontinued palbociclib because of AEs (10.7%). CONCLUSIONS Data suggest palbociclib with AI to have an effectiveness of 28.8 months, when used in patients with overlapping characteristics to those used in PALOMA-2. However, when used outside of these eligibility criteria, namely in patients with less favorable prognosis (e.g., presence of visceral disease), the benefits are inferior, even though still favorable.
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Affiliation(s)
- Filipa Alves da Costa
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
| | - Fábio Cardoso Borges
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Adriana Ramos
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Alexandra Mayer
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Claudia Brito
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Catarina Ramos
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Catarina Bernardo
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Mariane Cossito
- Direção de Avaliação de Tecnologias de Saúde, Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED I.P.), Lisbon, Portugal
| | - Cláudia Furtado
- Direção de Avaliação de Tecnologias de Saúde, Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED I.P.), Lisbon, Portugal
| | - Arlindo R Ferreira
- Unidade de Mama, Centro Clínico Champalimaud, Fundação Champalimaud, Lisbon, Portugal
- Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Diogo Martins-Branco
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Academic Trials Promoting Team, Institute Jules Bordet, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Ana da Costa Miranda
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - António Lourenço
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Alves da Costa F, Ramos A, Bernardo C, Cardoso Borges F, Costa Miranda A. Epidemiological and clinical characterization of a population-based cohort of cutaneous malignant melanoma patients in the South Region of Portugal. Sci Rep 2023; 13:5641. [PMID: 37024631 PMCID: PMC10079850 DOI: 10.1038/s41598-023-32434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
An historical population-based cohort study was conducted aiming to estimate the incidence of cutaneous malignant melanoma in the South Region of Portugal between Jan 2016 and June 2017; to clinically characterize the diagnosed individuals; to describe instituted treatment; and to estimate survival outcomes. Data were extracted from a cancer registry (ROR-Sul) covering 4,800,000 inhabitants (46% of the Portuguese population) and included a total of 789 individuals meeting eligibility criteria. The crude incidence rate (18 months) of melanoma was 13.36/100,000 inhabitants and the Age-Standardized Incidence Rate per 100,000 World population was 9.65/100,000 inhabitants. The most common histological subtypes identified were superficial extension, followed by malignant melanoma and nodular melanoma. Most cases were diagnosed in stage I (50.39%), equally distributed by sex and with a median age of 65 years. During the study period, 174 recurrence events were recorded (23.45%) and recurrence-free survival rate was significantly lower in more advanced stages. Patients had a two-fold risk of recurrence/death when in presence of ulcerated tumors [adjusted hazard ratio (adj HR) = 2.28; 95% confidence interval (CI) 1.40-3.70]. Overall survival rate at 3-years was 80.54% (95% CI 77.58-83.15), higher than previous national reports, and considerably higher for individuals diagnosed at earlier stages (p < 0.001). We have also identified differential survival outcomes in stages II-III explained by the uptake of sentinel lymph node biopsy. The epidemiologic and clinical characteristics of malignant melanoma patients studied are consistent with international literature. The incidence and rates observed suggests additional public health campaigns are needed to modify behaviours of the Portuguese population and thus reduce their risk.
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Affiliation(s)
- Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal.
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Ana Costa Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
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Bernardo C, Tosin MHDS, Almada M, Sampaio R, Oliveira BGRBD, Costa E, Vrijens B, Alves da Costa F. Translation and cross-cultural adaptation of the ABC taxonomy for medication adherence into Portuguese - Updating patients into people. Res Social Adm Pharm 2023; 19:653-659. [PMID: 36621396 DOI: 10.1016/j.sapharm.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Ascertaining Barriers to Compliance (ABC) taxonomy for describing medication adherence was created in 2012, aiming to standardize terms and definitions in research and practice. The taxonomy comprises seven terms and definitions. Originally developed in English, subsequently translated into French and German, is currently being translated to Portuguese, Spanish, Czech, Romanian and Italian, aiming to promote its global use and overcome cultural barriers. OBJECTIVES To cross-culturally translate the ABC taxonomy into Portuguese for Portugal and Brazil. METHODS A systematic literature search was conducted to identify published taxonomy terms and definitions in Portuguese, and to identify panelists in medication adherence. Initial mapping of terms and definitions retrieved was scrutinized by the research team to build an e-survey. The e-survey was piloted and then sent to panelists in both countries seeking consensus using a three-round Delphi method. Consensus was defined as ≥ 85% for round 1 and ≥ 75% for round 2. Terms with agreement <10% were dropped between rounds. In round 3, terms and definitions reaching agreement between 50 and 75% were classified as moderate consensus,>75-95% as consensus and >95% as strong consensus. RESULTS A total of 778 studies were identified and 84 included, enabling the extraction of 154 terms and 32 definitions. In round 1, 164 panelists participated, 115 in round 2 and 99 in the round 3. Consensus was achieved in both countries for all seven terms and definitions, although with varying intensity of agreement. The term "Management of adherence" and the definition of "Discontinuation" obtained moderate consensus in both countries. CONCLUSIONS A unified and unique ABC taxonomy in Portuguese was possible to develop for use in Portugal and in Brazil. Its use will harmonize and standardize the terms and definitions used in clinical practice and research.
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Affiliation(s)
- Catarina Bernardo
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Michelle Hyczy de Siqueira Tosin
- Department of Nursing, Fluminense Federal University. Dr. Celestino 74, Centro, 24020-091, Niterói, RJ, Brazil; Rush University Medical Center. 1620 W Harrison St, 60612, Chicago, IL, United States
| | - Marta Almada
- Faculty of Pharmacy, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - Rute Sampaio
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, R. Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | | | - Elísio Costa
- Faculty of Pharmacy, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal; Research Unit on Applied Molecular Biosciences Faculty of Pharmacy, University of Porto, R. Jorge deViterbo Ferreira 228, 4050-313, Porto, Portugal
| | | | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal; Interdisciplinary Research Center Egas Moniz (CiiEM), University Institute Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal.
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Alves da Costa F, Meyer JC, Dawoud D. Editorial: Women in drugs outcomes research and policies: 2021. Front Pharmacol 2022; 13:1059422. [DOI: 10.3389/fphar.2022.1059422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
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Alves da Costa F, Verschuuren M, Andersen Y, Stürup-Toft S, Lopez-Acuña D, Ferreira-Borges C. The WHO Prison Health Framework: a framework for assessment of prison health system performance. Eur J Public Health 2022; 32:565-570. [PMID: 35373832 PMCID: PMC9341673 DOI: 10.1093/eurpub/ckac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison. METHODS The framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework. RESULTS The framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included. CONCLUSIONS A new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.
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Affiliation(s)
- Filipa Alves da Costa
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Marieke Verschuuren
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Yanina Andersen
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | | | - Daniel Lopez-Acuña
- Department of International Health, Andalusian School of Public Health, Granada, Spain
| | - Carina Ferreira-Borges
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
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Cardoso Borges F, Alves da Costa F, Ramos A, Ramos C, Bernardo C, Brito C, Mayer-da-Silva A, Furtado C, Ferreira AR, Martins-Branco D, Miranda A, Lourenço A. Real-world effectiveness of palbociclib plus fulvestrant in advanced breast cancer: Results from a population-based cohort study. Breast 2022; 62:135-143. [PMID: 35182993 PMCID: PMC8859011 DOI: 10.1016/j.breast.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). Materials and methods We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). Results A total of 210 patients were included. Median age was 58 years (range 29–83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28–9.05) and 2-year rwPFS was 16.65% (95%CI 11.97–22.00). Median rwOS was 24.70 months (95%CI 21.58–29.27), median rwTPF was 7.5 months (95%CI 6.51–9.08) and median rwTTNT was 11.74 months (95%CI 10.33–14.08). Conclusion Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting. Palbociclib plus fulvestrant seems to be an effective therapy for ABC in real-world. Median rwPFS and rwOS were estimated at 7.43 and 24.70 months, respectively. Our data suggest lower effectiveness in real-world than the efficacy reported. Treatment was discontinued due to AEs in 8.09% of patients, suggesting good tolerability. Registries may generate effectiveness data and support clinical and HTA decisions.
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Affiliation(s)
- Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisbon (FFULisboa), Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Brito
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Alexandra Mayer-da-Silva
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Furtado
- Health Technology Assessment Department, Autoridade Nacional Do Medicamento e Produtos de Saúde (INFARMED), Parque da Saúde de Lisboa, Avenida Do Brasil, 53, 1749-004, Lisboa, Portugal.
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisboa, Portugal.
| | - Diogo Martins-Branco
- Academic Trials Promoting Team, Institute Jules Bordet, Rue Meylemeersch 90, 1070, Bruxelles, Belgium; Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Ana Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - António Lourenço
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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Aguiar JP, Gama Marques J, Leufkens HGM, Alves da Costa F. Healthcare Professionals' Views on the Management of Medication Complexities in the Elderly With Mental Health Disorders: A Cross-Sectional Study. Front Psychiatry 2022; 13:885216. [PMID: 35677869 PMCID: PMC9168079 DOI: 10.3389/fpsyt.2022.885216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many challenges in elderly pharmacotherapy are identified, including the use of Potentially Inappropriate Medications (PIMs) which may increase the odds of adverse events, especially in elderly patients with mental health disorders (e. g., behavioral, and psychological symptoms of dementia-BPSD, schizophrenia, bipolar disorder). However, information on the knowledge and practice of healthcare professionals (HCPs) about this topic is still scarce. METHODS A cross-sectional study was undertaken from July-October 2019. An online questionnaire was specifically designed and validated for this study. We sought HCPs (physicians, pharmacists, and nurses) worldwide, using (a) social media, via Facebook, Twitter, and LinkedIn; and (b) email contacts of the research team (convenience sample). Either way participants were asked to share on their social media or via e-mail the questionnaires with other HCPs (snowballing sample). The survey assessed two main domains: knowledge and practice. Knowledge was evaluated by self-report (perceived knowledge by a 5-item Likert confidence scale) and using three clinical cases, scored between 0 and 30 points (each one rated from 0 to 10 points; real knowledge). Barriers in clinical practice were evaluated using a 5-item Likert scale judging practitioners' opinion. RESULTS A total of 165 questionnaires were collected. HCPs were mainly female (n = 114; 69.1%), with a mean age of 35.3 ± 11.3 years old. Seventy-two percent (n = 118) were pharmacists, 21.1% (n = 35) were physicians, and 7.3% (n = 12) nurses. There was a weak correlation, albeit significant, between perceived and real knowledge (r = 0.199; p = 0.001). The mean score of the clinical vignettes regarding elderly patients with dementia and bipolar disorder were 4.59 ± 4.08 and 4.86 ± 2.97 points, respectively. Most HCPs were classified as having an intermediate knowledge (n = 100; 60.6%) about medication complexities in the elderly with mental disorders. Most HCPs agreed that lack of time (81.6%; n = 138), lack of education and training on elderly pharmacotherapy (72.2%; n = 122), and lack of tools adapted to daily practice (61.8%; n = 105) were the main barriers. CONCLUSIONS Most of the HCPs felt confident to manage medication complexities in elder patients with mental disorders, but only a minority obtained a good score in the knowledge assessment test. The main barriers identified included structural barriers (tools unfit for practice) and process barriers (time).
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Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - João Gama Marques
- Serviço de Psiquiatria Geral e Transcultural, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal.,Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa (FMUL), Lisboa, Portugal
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
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20
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Alves da Costa F, Andersen Y, Ferreira-Borges C. Success in Vaccination Efforts of Vulnerable Populations in the WHO/European Region: Focus on Prisons. Front Public Health 2021; 9:738422. [PMID: 34676195 PMCID: PMC8523909 DOI: 10.3389/fpubh.2021.738422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filipa Alves da Costa
- Alcohol, Illicit Drugs & Prison Health Programme, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Yanina Andersen
- Alcohol, Illicit Drugs & Prison Health Programme, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Carina Ferreira-Borges
- Alcohol, Illicit Drugs & Prison Health Programme, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
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21
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Moura L, Steurbaut S, Salvesen Blix H, Addison B, Rabus S, Mota-Filipe H, Alves da Costa F. A cross-sectional survey to map Clinical Pharmacy Education and Practice in Europe. Int J Clin Pharm 2021; 44:118-126. [PMID: 34498216 DOI: 10.1007/s11096-021-01321-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Background Clinical activities provided by pharmacists are increasing worldwide, including in Europe. However, an overview of clinical pharmacy education and practice is needed. Aim To map clinical pharmacy (CP) education and practice among European countries. Method A cross-sectional web-based survey led by the Education Committee of the European Society of Clinical Pharmacy (ESCP) was conducted. The survey comprised three domains focusing on: undergraduate education, postgraduate education, and practice. A multi-phased validation process was undertaken, attributing levels of evidence according to the number of information sources for each country. Triangulation was used to seek within country consensus. Main outcome measures included the number of hours of education in CP; existence of a specialization in CP and activities delivered in practice. Results Data from 40 European countries were included (response rate 95.2%). Most respondents (86.8%) agreed with the ESCP definition of CP. Almost every country (94.9%) reported CP topics at the undergraduate level [median number = 65 h/semester (IQR: 2.0-5.6)], including practical teaching [median = 30.0% (IQR: 17.0-42.0)]. At postgraduate level, 92.5% of countries reported PhD programmes including CP and 65.0% mentioned the existence of specific CP master/diploma degrees. Continuous professional development (CPD) courses were also reported by 63.9% of respondents. More than half the countries (52.5%; n = 21) recognized CP as an area of specialization, which for 60.0% of participants was applied solely in the hospital setting. Conclusion Although CP is embedded in education and practice in European countries, there is wide variability in education and practice patterns.
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Affiliation(s)
- Laura Moura
- Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Hege Salvesen Blix
- Norwegian Institute of Public Health, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Brian Addison
- School of Pharmacy & Life Sciences, Aberdeen, Scotland
| | - Sule Rabus
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | | | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal, Av. Prof. Gama Pinto, 1649-003.
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22
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Aguiar JP, Gama Marques J, Alves da Costa F. Utility and limitations of a screening tool of older person's prescription among psychiatric elder patients: A comprehensive review. Aging and Health Research 2021. [DOI: 10.1016/j.ahr.2021.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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23
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Paudyal V, Fialová D, Henman MC, Hazen A, Okuyan B, Lutters M, Cadogan C, da Costa FA, Galfrascoli E, Pudritz YM, Rydant S, Acosta-Gómez J. Pharmacists' involvement in COVID-19 vaccination across Europe: a situational analysis of current practice and policy. Int J Clin Pharm 2021; 43:1139-1148. [PMID: 34218402 PMCID: PMC8254632 DOI: 10.1007/s11096-021-01301-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022]
Abstract
One year since the emergence of the COVID-19 pandemic, rapid response measures have been implemented internationally to mitigate the spread of the virus. Following rapid and successful pre-clinical and human trials, several vaccines have been authorised for use across Europe through
the European Medicines Agency and national regulatory authorities. Clinical trials have shown promising results including important reductions in disease severity, hospitalisation and mortality. In order to maximise the public health benefit of available vaccines, there is a pressing need to vaccinate a large proportion of the population. Internationally, this has prompted coordination of existing services at enormous scale, and development and implementation of novel vaccination strategies to ensure maximum inoculation over the shortest possible timeframe. Pharmacists are being promoted as healthcare professionals that enhance roll-out of COVID-19 vaccination programmes. This paper aims to summarise current policy and practice in relation to pharmacists’ involvement in COVID-19 vaccination in 13 countries across Europe.
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Affiliation(s)
- Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Ankie Hazen
- Centre for Pharmacy Postgraduate Education, University of Manchester, Manchester, UK
| | - Betul Okuyan
- Clinical Pharmacy Department, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Monika Lutters
- Clinical Pharmacy, Cantonal Hospital Baden, Baden, Switzerland
- Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - Silas Rydant
- Meduca, Koninklijke Apothekersvereniging Antwerpen (KAVA), Lange Leemstraat 187, 2018, Antwerpen, Belgium
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Abstract
PURPOSE The purpose of this paper is to summarize activities being undertaken by the World Health Organization (WHO) Regional Office for Europe to prevent and control COVID-19 in and beyond prisons, activities specifically designed to increase information sharing and to support Member States, to comment on potential impacts of these initiatives at country-level responses and to underline the need for a rights-based approach to managing the pandemic, including the right to vaccination. DESIGN/METHODOLOGY/APPROACH The Health in Prisons Programme (HIPP) of the WHO Regional Office for Europe worked with partner organizations to review regularly the evidence on best practices in prison health and use it to inform policy recommendations at the global level. HIPP issued overarching guidance and specific tools to support implementation of measures to prevent and control the spread of COVID-19 in prisons and other custodial settings. Moreover, to monitor the emergence of outbreaks, the HIPP developed a minimum data set for countries voluntarily to report COVID-19 cases and identify situations in need of direct support. FINDINGS Since May 2020, the WHO has periodically received data from Member States, leading to the development of country-specific bulletins to support countries and, whenever appropriate, to organize virtual missions to further support ministries and public health bodies responsible for managing COVID-19 in prisons. ORIGINALITY/VALUE The development of a specific set of indicators for prisons enables exploring data in a disaggregated manner. Monitoring response measures developed in prison enables judging their appropriateness to minimize the spread of SARS-CoV2 in prisons and alignment with guidance issued by the WHO.
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Affiliation(s)
- Filipa Alves da Costa
- European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization Regional Office for Europe, Moscow, Russian Federation
| | - Maria Neufeld
- European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization Regional Office for Europe, Moscow, Russian Federation
| | - Mohamed Hamad
- European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization Regional Office for Europe, Moscow, Russian Federation
| | - Eric Carlin
- European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization Regional Office for Europe, Moscow, Russian Federation
| | - Carina Ferreira-Borges
- European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization Regional Office for Europe, Moscow, Russian Federation
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Cardoso R, Guo F, Heisser T, Hackl M, Ihle P, De Schutter H, Van Damme N, Valerianova Z, Atanasov T, Májek O, Mužík J, Nilbert MC, Tybjerg AJ, Innos K, Mägi M, Malila N, Bouvier AM, Bouvier V, Launoy G, Woronoff AS, Cariou M, Robaszkiewicz M, Delafosse P, Poncet F, Katalinic A, Walsh PM, Senore C, Rosso S, Vincerževskienė I, Lemmens VEPP, Elferink MAG, Johannesen TB, Kørner H, Pfeffer F, Bento MJ, Rodrigues J, Alves da Costa F, Miranda A, Zadnik V, Žagar T, Lopez de Munain Marques A, Marcos-Gragera R, Puigdemont M, Galceran J, Carulla M, Chirlaque MD, Ballesta M, Sundquist K, Sundquist J, Weber M, Jordan A, Herrmann C, Mousavi M, Ryzhov A, Hoffmeister M, Brenner H. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol 2021; 22:1002-1013. [PMID: 34048685 DOI: 10.1016/s1470-2045(21)00199-6] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Colorectal cancer screening programmes and uptake vary substantially across Europe. We aimed to compare changes over time in colorectal cancer incidence, mortality, and stage distribution in relation to colorectal cancer screening implementation in European countries. METHODS Data from nearly 3·1 million patients with colorectal cancer diagnosed from 2000 onwards (up to 2016 for most countries) were obtained from 21 European countries, and were used to analyse changes over time in age-standardised colorectal cancer incidence and stage distribution. The WHO mortality database was used to analyse changes over time in age-standardised colorectal cancer mortality over the same period for the 16 countries with nationwide data. Incidence rates were calculated for all sites of the colon and rectum combined, as well as the subsites proximal colon, distal colon, and rectum. Average annual percentage changes (AAPCs) in incidence and mortality were estimated and relevant patterns were descriptively analysed. FINDINGS In countries with long-standing programmes of screening colonoscopy and faecal tests (ie, Austria, the Czech Republic, and Germany), colorectal cancer incidence decreased substantially over time, with AAPCs ranging from -2·5% (95% CI -2·8 to -2·2) to -1·6% (-2·0 to -1·2) in men and from -2·4% (-2·7 to -2·1) to -1·3% (-1·7 to -0·9) in women. In countries where screening programmes were implemented during the study period, age-standardised colorectal cancer incidence either remained stable or increased up to the year screening was implemented. AAPCs for these countries ranged from -0·2% (95% CI -1·4 to 1·0) to 1·5% (1·1 to 1·8) in men and from -0·5% (-1·7 to 0·6) to 1·2% (0·8 to 1·5) in women. Where high screening coverage and uptake were rapidly achieved (ie, Denmark, the Netherlands, and Slovenia), age-standardised incidence rates initially increased but then subsequently decreased. Conversely, colorectal cancer incidence increased in most countries where no large-scale screening programmes were available (eg, Bulgaria, Estonia, Norway, and Ukraine), with AAPCs ranging from 0·3% (95% CI 0·1 to 0·5) to 1·9% (1·2 to 2·6) in men and from 0·6% (0·4 to 0·8) to 1·1% (0·8 to 1·4) in women. The largest decreases in colorectal cancer mortality were seen in countries with long-standing screening programmes. INTERPRETATION We observed divergent trends in colorectal cancer incidence, mortality, and stage distribution across European countries, which appear to be largely explained by different levels of colorectal cancer screening implementation. FUNDING German Cancer Aid (Deutsche Krebshilfe) and the German Federal Ministry of Education and Research.
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Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Feng Guo
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Thomas Heisser
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | - Petra Ihle
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | | | | | - Zdravka Valerianova
- Bulgarian National Cancer Registry, University Hospital of Oncology, Sofia, Bulgaria
| | - Trajan Atanasov
- Bulgarian National Cancer Registry, University Hospital of Oncology, Sofia, Bulgaria
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Mužík
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mef Christina Nilbert
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Margit Mägi
- Estonian Cancer Registry, National Institute for Health Development, Tallinn, Estonia
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, University Hospital of Dijon, INSERM U1231, French Network of Cancer Registries (FRANCIM), Dijon, France
| | - Véronique Bouvier
- Digestive Tumors Registry of Calvados, University Hospital of Caen, U1086 INSERM UCN-ANTICIPE, French Network of Cancer Registries (FRANCIM), Caen, France
| | - Guy Launoy
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancer, Normandy University, University of Caen Normandy, INSERM-ANTICIPE, Caen, France; Department of Research, University Hospital of Caen, Caen, France
| | - Anne-Sophie Woronoff
- Cancer Registry of Doubs, Centre Hospitalier Régional Universitaire Besançon, Besançon, France
| | - Mélanie Cariou
- Digestive Tumors Registry of Finistère, Centre Hospitalier Régional Universitaire Morvan, French Network of Cancer Registries (FRANCIM), Brest, France
| | - Michel Robaszkiewicz
- Digestive Tumors Registry of Finistère, Centre Hospitalier Régional Universitaire Morvan, French Network of Cancer Registries (FRANCIM), Brest, France
| | - Patricia Delafosse
- Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France
| | - Florence Poncet
- Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France
| | | | | | - Carlo Senore
- University Hospital 'Città della Salute e della Scienza', SSD Epidemiologia Screening-CPO Piemonte, Turin, Italy
| | | | | | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frank Pfeffer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Maria José Bento
- Department of Epidemiology, North Region Cancer Registry of Portugal, Portuguese Oncology Institute of Porto, Porto, Portugal; IPO Porto Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal; Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Jessica Rodrigues
- Department of Epidemiology, North Region Cancer Registry of Portugal, Portuguese Oncology Institute of Porto, Porto, Portugal; IPO Porto Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Filipa Alves da Costa
- Portuguese National Cancer Registry, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Ana Miranda
- Portuguese National Cancer Registry, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Vesna Zadnik
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | - Tina Žagar
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | | | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Montse Puigdemont
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain
| | - Marià Carulla
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain
| | - María-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain; Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain
| | - Monica Ballesta
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Kristina Sundquist
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Jan Sundquist
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Marco Weber
- Cancer Registry Bern-Solothurn, Bern, Switzerland
| | | | - Christian Herrmann
- Cancer Registry of Eastern Switzerland and Liechtenstein, St Gallen, Switzerland; Graubünden and Glarus Cancer Registry, Chur, Switzerland
| | - Mohsen Mousavi
- Cancer Registry of Eastern Switzerland and Liechtenstein, St Gallen, Switzerland; Graubünden and Glarus Cancer Registry, Chur, Switzerland
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine; Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.
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Neufeld M, Alves da Costa F, Ferreira-Borges C. Prisons need to be included in global and national vaccinations effort against COVID-19. Lancet Reg Health Eur 2021; 4:100088. [PMID: 33997833 PMCID: PMC7981462 DOI: 10.1016/j.lanepe.2021.100088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, Dresden, 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health ,33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1
| | - Filipa Alves da Costa
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation.,Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Carina Ferreira-Borges
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
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da Costa FA, Mala-Ladova K, Lee V, Tous S, Papastergiou J, Griffiths D, Chaumais MC, Hersberger KE, Viola R, Paulino E, Lobban T, Neubeck L, Freedman B, Antoniou S. Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study. J Thromb Thrombolysis 2021; 49:606-617. [PMID: 31782043 DOI: 10.1007/s11239-019-02000-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists' success; technology enhanced engagement amongst patients and increased pharmacists' confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal. .,Faculdade de Farmácia, The Research Institute for Medicines (iMED.ULisboa), Universidade de Lisboa, Lisbon, Portugal.
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovského, 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Vivian Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Salvador Tous
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Travessera de Gràcia, 56, 08006, Barcelona, Spain
| | - John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Dale Griffiths
- Westview Pharmacy, 5 Glendale Road, Glen Eden, Auckland, 0602, New Zealand
| | - Marie-Camille Chaumais
- Faculté de Pharmacie, Hôpital Antoine Béclère, Université Paris-Sud, 157, Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Pharmazentrum, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Reka Viola
- Faculty of Pharmacy, University of Szeged, Zrínyi u. 9, Szeged, 6720, Hungary
| | - Ema Paulino
- Farmácia Nuno Álvares, Avenida D. Nuno Álvares Pereira, 39-C, Almada, Portugal
| | - Trudie Lobban
- Atrial Fibrillation Association (AF Assoc)/ Arrhythmia Alliance (A-A), AF Association, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire, OX7 5SR, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthil Campus, Sighthill Court, Edinburgh, EH11 4BN, Scotland, UK
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney, John Hopkins Dr, Camperdown NSW, Sydney, 2006, Australia
| | - Sotiris Antoniou
- Barts Health NHS Trust, UCL Partners, 9 Prescot Street Aldgate, London, E1 8PR, UK
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Aguiar J, Ribeiro M, Pedro AR, Martins AP, da Costa FA. Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study. Int J Clin Pharm 2020; 43:629-636. [PMID: 33104948 DOI: 10.1007/s11096-020-01174-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although much is known about cardiovascular patients' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.
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Affiliation(s)
- João Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Manuel Ribeiro
- Environmental and Natural Resources Center (CERENA), University of Lisbon, Higher Technical Institute, Lisbon, Portugal
| | - Ana Rita Pedro
- National School of Public Health, Nova University of Lisbon, Research Group in Health Policy and Administration, Lisbon, Portugal
| | | | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal. .,Interdisciplinary Research Center Egas Moniz (CiiEM), University Institute Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal.
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Tavoschi L, Monarca R, Giuliani R, Saponaro A, Petrella S, Ranieri R, Alves da Costa F, Ferreira-Borges C, Montanari L. Prevention and Control of COVID-19 in Italian Prisons: Stringent Measures and Unintended Consequences. Front Public Health 2020; 8:559135. [PMID: 33042953 PMCID: PMC7527433 DOI: 10.3389/fpubh.2020.559135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/14/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Monarca
- Health Without Barriers, The European Federation for Prison Health, Viterbo, Italy.,Department of Infectious Diseases, Viterbo Local Health Unit, Viterbo, Italy
| | - Ruggero Giuliani
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milan, Italy
| | | | - Stefano Petrella
- Penitentiary Health System, Modena Local Health Unit, Modena, Italy
| | - Roberto Ranieri
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milan, Italy
| | - Filipa Alves da Costa
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russia
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russia
| | - Linda Montanari
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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Alves da Costa F. Today the pharmacy world lost a leader in pharmaceutical care. Int J Clin Pharm 2020; 42:976-978. [PMID: 32865677 DOI: 10.1007/s11096-020-01119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Murteira R, Borges FC, Mendes GP, Ramos C, Ramos A, Soares P, Furtado C, Miranda A, da Costa FA. Real-world effectiveness of pembrolizumab in previously treated non-small cell lung cancer: A population-based cohort study. Pharmacoepidemiol Drug Saf 2020; 29:1295-1302. [PMID: 32844487 DOI: 10.1002/pds.5091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Immunotherapy is promising for lung cancer treatment, although at significant financial impact. The aim of this study was to evaluate the effectiveness and the efficacy-effectiveness gap of pembrolizumab in previously treated non-small cell lung cancer (NSCLC). METHODS A population-based ambispective cohort study was conducted. Cases of interest were identified through the National Cancer Registry database and additional data sources. Patients aged ≥18 years, diagnosed with NSCLC and exposed to pembrolizumab, between 23 June 2016 and 31 October 2018, as second or later lines of treatment for advanced disease were included. Patients were followed-up until death or cut-off date (30 April 2019). Primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS), event-free survival (EFS), and adverse events (AEs) leading to treatment discontinuation. The efficacy-effectiveness gap was evaluated comparing results with clinical trial data. RESULTS A total of 181 patients were included. Median age was 63 years (range 33-94); 74.6% were male. Median treatment duration was 5.6 months (interquartile range: 1.4-10.4) and, at cut-off date, treatment had been discontinued in 141 patients, mainly due to disease progression. Median OS was 13.0 months (95% confidence interval [CI] 9.3-15.9) and 1-year OS was 53.1% (95% CI 45.2%-60.3%). Median PFS was 5.6 months (95% CI 4.6-7.2), median EFS was 4.7 months (95% CI 3.2-6.0), and treatment was discontinued due to AE in 8.3% of cases (n = 15). The efficacy-effectiveness gap seems to favor pembrolizumab use in clinical practice. CONCLUSION Real-world data suggest the performance of pembrolizumab to reflect the clinical trial outcomes in previously treated NSCLC.
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Affiliation(s)
- Rodrigo Murteira
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Fábio Cardoso Borges
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Gonçalo Pinto Mendes
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Catarina Ramos
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Adriana Ramos
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Patrícia Soares
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal.,Statistics & Epidemiology, National School of Public Health, Lisbon, Portugal
| | - Cláudia Furtado
- Health Technology Assessment Department, National Authority of Medicines and Health Products (INFARMED), Lisbon, Portugal
| | - Ana Miranda
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal
| | - Filipa Alves da Costa
- National Cancer Registry (RON), Portuguese Institute of Oncology of Lisbon Francisco Gentil (IPOLFG), Lisbon, Portugal.,Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Alves da Costa F, Lee V, Leite SN, Murillo MD, Menge T, Antoniou S. Pharmacists reinventing their roles to effectively respond to COVID-19: a global report from the international pharmacists for anticoagulation care taskforce (iPACT). J Pharm Policy Pract 2020; 13:12. [PMID: 32509312 PMCID: PMC7246962 DOI: 10.1186/s40545-020-00216-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
SARS-CoV2 is dramatically impacting the global population. Worldwide, pharmacists are changing their roles and being increasingly recognized for their role as essential service providers. This commentary provides some examples collected from Asia, Europe, the Americas and Africa, ranging from essential services to meet human rights basic needs, extended generalist services developed to ensure continuity of care and supply of essential medicines to the development of differentiated extended responsibilities in emergency care. All examples were collected using a network of pharmacists from 27 countries, representing various areas of pharmacy practice, education and research and outreaching to include patient advocates. Selected services illustrate good practice, capability to adapt and contribution to universal health coverage. Above all, it demonstrates the commitment and innovation of the pharmaceutical workforce in the fight against COVID-19.
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Affiliation(s)
- Filipa Alves da Costa
- Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | - Vivian Lee
- The Chinese University of Hong Kong, Central Ave, Shatin, Hong Kong
| | - Silvana Nair Leite
- Federal University of Santa Catarina, R. Eng. Agronômico Andrei Cristian Ferreira, s/n - Trindade, Florianópolis, SC 88040-900 Brazil
| | - Maria Dolores Murillo
- Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC), Paseo de las Delicias 31, 28045 Madrid, Spain
| | - Tom Menge
- Kenyatta National Hospital, Hospital Rd, Nairobi, Kenya
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Aguiar JP, Alves da Costa F, Egberts T, Leufkens H, Souverein P. The association between receptor binding affinity and metabolic side effect profile of antipsychotics and major cardio- and cerebrovascular events: A case/non-case study using VigiBase. Eur Neuropsychopharmacol 2020; 35:30-38. [PMID: 32409260 DOI: 10.1016/j.euroneuro.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
Antipsychotics (APs) have been associated with major adverse cardio- and cerebrovascular events (MACCE), but the underlying mechanisms are unclear. Our aim was to elucidate the association between APs, stratified for receptor affinity and metabolic side effects (MSE), in the reporting of MACCE. A case/non-case study was conducted using data from the WHO global Individual Case Safety Report (ICSR) database, VigiBase, among all reports associated with an AP. Cases were ICSRs of MACCE, while non-cases were all other adverse drug reactions (ADRs). APs were classified by AP group, the degree of receptor affinity for adrenergic, dopaminergic, muscarinic, histaminic, and serotoninergic receptors and by MSE profile. The strength of the association was estimated with logistic regression and expressed as crude and adjusted reporting odds ratios (RORadj.) with corresponding 95% confidence intervals (95%CIs). We identified 4987 reports of MACCE and 328,907 reports of other ADRs. Atypical APs (RORadj. 2.46; 95%CI 2.20-2.74) were significantly associated with the reporting of MACCE compared to typical ones. APs with high affinity for Adrenergic alfa-1 (RORadj. 2.98; 95%CI 1.93-4.59), Histaminic H1 (RORadj. 2.31; 95%CI 1.98-2.68), Muscarinic M1 (RORadj. 1.87; 95%CI 1.74-2.01), and Serotoninergic 5-HT2A (RORadj. 3.19; 95%CI 2.07-4.92) were associated with a higher risk of reporting of MACCE compared to low affinity. APs with higher-risk of MSE were associated with higher risk of reporting of MACCE (RORadj. 1.88; 95%CI 1.73-2.05) compared to the lower-risk. APs with high affinity for Adrenergic alfa-1, Histaminic H1, Muscarinic M1, and Serotoninergic 5-HT2A receptors and with high-risk of MSE may explain the occurrence of those events.
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Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa Portugal.
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (ISCSEM), Caparica, Portugal
| | - Toine Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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Alves da Costa F, Rydant S, Antoniou S. The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT). J Eval Clin Pract 2020; 26:670-681. [PMID: 31994273 DOI: 10.1111/jep.13316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration. METHODS It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions. We developed a conceptual framework highlighting seven critical phases in the patient pathway and for each of those listed some of the initiatives identified by our experts worldwide. RESULTS Existing pharmacists' interventions in each of these phases have been identified globally. Various examples in the area of prevention and self-management were found to exist for long; the contribution for early detection and subsequently to timely diagnosis were also quite clear; integration of care was perhaps one of the areas needing greater development, although interventions in secondary care were also quite common. Tertiary care and end of life interventions were found to often be left for other healthcare professionals. CONCLUSION On the basis of the findings, we can argue that much has been done but globally consider that pharmacists are still an untapped resource potentially useful for improved patient care.
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Affiliation(s)
- Filipa Alves da Costa
- Centre for Interdisciplinary Research Egas Moniz (CiiEM), University Institute Egas Moniz, Campus Universitário, Caparica, Portugal.,Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Silas Rydant
- Meduca, Royal Pharmacist Association of Antwerp (KAVA), Antwerp, Belgium
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Health NHS Trust, UCL Partners, London, UK
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Alves da Costa F, Martins AP, Veiga F, Ramalhinho I, Sousa Lobo JM, Rodrigues L, Granadeiro L, Castro M, Barata P, Gomes P, Seabra V, Caramona MM. Development of a Platform to Align Education and Practice: Bridging Academia and the Profession in Portugal. Pharmacy (Basel) 2020; 8:pharmacy8010011. [PMID: 31963380 PMCID: PMC7151656 DOI: 10.3390/pharmacy8010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/29/2022] Open
Abstract
Limited fitness for practice may result from a mismatch between education and practice. Aiming to meet the common interests of academics and practitioners, the Portuguese Pharmaceutical Society (PPS) developed the Education and Practice Platform (EPP). The EPP includes one representative from each pharmacy faculty, and all Councils of Speciality Boards of Practice. Brainstorming with involved parties enabled sharing of interests, concerns and identifying a common path. Aims, mission, vision and values were set. The EPP’s mission is to: act as an enabler to foster the quality and adequacy of education through sharing best practices, ultimately leading to facilitate professional integration, and to foster quality development in teaching practices with recognition for autonomy in freedom to teach and to learn. Its vision is an alignment of education and practice with the PPS’ statutes to ensure validation of the competences defined for each practice area, and compliance with international guidance. Key performance indicators (KPIs) were set. Activities developed include the creation of a national forum to discuss education and practice, development of workshops on teaching methods and pharmacy internships, enhanced representation in international events and response to global and national requests. Ongoing work focuses on the creation of a common training framework in hospital and community pharmacy practice adapted to Portugal. The EPP is a worldwide case study, encouraging the development of discussion contributing to an open climate of sharing best practices, indirectly leading to foster a better alignment between education and practice. Many of these results are so far intangible in scientific terms but worth describing.
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Affiliation(s)
- Filipa Alves da Costa
- Ordem dos Farmacêuticos, Rua da Sociedade Farmacêutica, 18, 1169-075 Lisboa, Portugal; (A.P.M.); (M.M.C.)
- Correspondence: ; Tel.: +351-213191399
| | - Ana Paula Martins
- Ordem dos Farmacêuticos, Rua da Sociedade Farmacêutica, 18, 1169-075 Lisboa, Portugal; (A.P.M.); (M.M.C.)
| | - Francisco Veiga
- Faculdade de Farmácia da Universidade de Coimbra, Polo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Isabel Ramalhinho
- Faculdade de Ciências e Tecnologia da Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal;
| | - José Manuel Sousa Lobo
- Faculdade de Farmácia da Universidade do Porto, Edifício 3, Piso 3. Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
| | - Luís Rodrigues
- Escola de Ciências e Tecnologia da Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal;
| | - Luiza Granadeiro
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal;
| | - Matilde Castro
- Faculdade de Farmácia da Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003 Lisboa, Portugal;
| | - Pedro Barata
- Faculdade de Ciências da Saúde da Universidade Fernando Pessoa, Rua Carlos da Maia, 296 4200-150 Porto, Portugal;
| | - Perpétua Gomes
- Instituto Universitário Egas Moniz, Campus Universitário, Quinta da Granja Monte de Caparica, 2829-511 Caparica, Portugal;
| | - Vítor Seabra
- Instituto Universitário de Ciências da Saúde, Rua Central de Gandra, 1317, 4585-116 Gandra, Portugal;
| | - Maria Margarida Caramona
- Ordem dos Farmacêuticos, Rua da Sociedade Farmacêutica, 18, 1169-075 Lisboa, Portugal; (A.P.M.); (M.M.C.)
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Aguiar JP, Bernardo C, Gama Marques J, Leufkens H, Alves da Costa F. Identification of a Set of Patient-Related Features to Foster Safe Prescribing of Specific Antipsychotics in the Elderly With Dementia. Front Psychiatry 2020; 11:604201. [PMID: 33192746 PMCID: PMC7661963 DOI: 10.3389/fpsyt.2020.604201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Antipsychotics (APs) are widely used to manage behavioral and psychiatric symptoms in dementia, although with a variety of adverse drug reactions. Therefore, it is important to know which patient-related features should be considered to foster a safe prescribing of these medications. Objectives: To compile and validate a set of patient-related features (PRFs) to foster safe prescribing of specific APs in the elderly with dementia; and to evaluate the feasibility of using them in clinical practice by analyzing the exhaustiveness of medical records. Method: A rapid literature review was the starting point, where PRFs were identified through a search in PubMed combined with information from the Summary of Product Characteristics (SmPCs). In the next step, a two-round e-Delphi survey was undertaken, where a total of 450 participants were invited by e-mail, including prescribers and specialists in benefit-risk assessment. Finally, a cross-sectional study was undertaken, where 100 patients were randomly extracted from the psychiatric hospital database. Outcomes were defined as the assessment of the clinical relevance and feasibility of the PRFs, and the level of exhaustiveness of these features in medical records. Data analysis was performed using univariate statistics (IBM SPSS v.23.0). Results: A total of 92 experts participated in the e-Delphi. Forty-seven PRFs obtained consensus, where 12 were applicable to haloperidol, 14 to olanzapine/risperidone, 13 to quetiapine, and 8 to aripiprazole. Age, comorbidities, and co-medications were rated as important features regardless of the prescribed drug. All PRFs were rated as always or frequently available and, if not, they were easy or partially easy to obtain. Age, comorbidities, and co-medications were always available in the medical records, whereas cognitive status (between 41.4 and 78.8%) or hepatic function (between 17.2 and 30.4%) presented a low-level of exhaustiveness. Conclusions: Even though a high number of PRFs were rated as clinically relevant, some of them were identified as frequently missing from medical records. This may suggest that medical records should be complemented with other sources (e.g., nursing and pharmacy records) to ensure a safe prescribing of APs.
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Affiliation(s)
- João Pedro Aguiar
- Faculdade de Farmácia, Research Institute for Medicines (iMED.ULisboa), Universidade de Lisboa, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - Catarina Bernardo
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - João Gama Marques
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisbon, Portugal.,Faculdade de Medicina, Clínica Universitária de Psiquiatria e Psicologia Médica, Universidade de Lisboa (FMUL), Lisbon, Portugal
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Filipa Alves da Costa
- Faculdade de Farmácia, Research Institute for Medicines (iMED.ULisboa), Universidade de Lisboa, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
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da Costa FA, da Costa Miranda A. Using cancer registries to supplement clinical trial data and inform regulatory decision. Pharmacoepidemiol Drug Saf 2019; 29:1319-1321. [PMID: 31788909 DOI: 10.1002/pds.4931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/04/2023]
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Cunha S, Antunes E, Antoniou S, Tiago S, Relvas R, Fernandez-Llimós F, Alves da Costa F. Raising awareness and early detection of atrial fibrillation, an experience resorting to mobile technology centred on informed individuals. Res Social Adm Pharm 2019; 16:787-792. [PMID: 31473110 DOI: 10.1016/j.sapharm.2019.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/10/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a cardiac arrhythmia responsible for one third of ischemic strokes. Early detection of AF plays an important role in preventing embolic stroke. OBJECTIVES This study aimed to test the feasibility of an awareness event including opportunistic screening for atrial fibrillation; and to test the reliability of the innovative portable electrocardiogram (ECG) device used. METHODS An awareness campaign was held during two weeks, where individuals consenting to participate in a pharmacist-led detection event, received a manual pulse check, were clinically evaluated and subject to a single-lead electrocardiogram using AliveCor Kardia® mobile. ECGs highlighted as possible AF were confirmed by the cardiologist and those signalled with abnormalities in cardiac rhythm were referred to their physician. Data were collected in a password protected application and analyzed using SPSS, v.24. The Kardia® mobile's sensitivity and specificity was tested against the standard 12-lead ECG. RESULTS The awareness event involved 223 individuals, among which 205 were screened. Mean age was 66 years (SD = 15) and hypertension was the most frequently reported (n = 107; 52.2%). Mean CHAD2DS2- VASc score was 3 (SD = 1.8). Cardiac irregularities were identified in 45 individuals, 14 confirmed to be new cases of AF (6.8%) by the cardiologist. The sensitivity and specificity were 90.9% and 97.4%. CONCLUSION Data suggests this device to be potentially useful for opportunistic early detection of AF, provided interprofessional collaboration is guaranteed so that suspect cases are adequately managed and in a timely way. Fourteen new cases of AF were identified in the population studied, suggesting the pharmacist working in a multiprofessional context, may have had an important role in preventing potential ischemic-related strokes with this initiative. All healthcare professionals involved in the patient pathway should play a more active role in contributing to better health outcomes, particularly within primary care.
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Affiliation(s)
- Sara Cunha
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal.
| | - Eduardo Antunes
- Serviço de Cardiologia, Hospital Santa Marta, EPE; Rua de Santa Marta, 1169-024, Lisboa, Portugal.
| | - Sotiris Antoniou
- Barts Health NHS Trust, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, United Kingdom.
| | - Sália Tiago
- Farmácia Sália, Praça do Bocage 98-99, Setúbal, Setúbal (S.Julião, N. Sra. da Anunciada e Sta. Ma da Graça), 2900-276, Setúbal, Portugal.
| | - Rui Relvas
- Residência Sénior Egas Moniz, Avenida D. Manuel Martins, n.° 4. Maçã - Sampaio, 2970-585, Sesimbra, Portugal.
| | - Fernando Fernandez-Llimós
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia da Universidade de Lisboa (FFUL), Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal; Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia da Universidade de Lisboa (FFUL), Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
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Aguiar JP, Heitor Costa L, Alves da Costa F, Leufkens HG, Martins AP. Identification of potentially inappropriate medications with risk of major adverse cardiac and cerebrovascular events among elderly patients in ambulatory setting and long-term care facilities. Clin Interv Aging 2019; 14:535-547. [PMID: 30880934 PMCID: PMC6404669 DOI: 10.2147/cia.s192252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Cardiovascular diseases (CVDs) are extremely common among the elderly, but information on the use of potentially inappropriate medications (PIMs) with cardiovascular risk is scarce. We aimed to determine the prevalence of PIMs with risk of cardiac and cerebrovascular adverse events (CCVAEs), including major adverse cardiac and cerebrovascular events (MACCE). Patients and methods A cross-sectional study was performed using a convenience sample from four long-term care facilities and one community pharmacy in Portugal. Patients were included if they were aged 65 or older and presented at least one type of medication in their medical and pharmacotherapeutic records from 2015 until December 2017. The main outcome was defined as the presence of PIMs with risk of MACCE and was assessed by applying a PIM-MACCE list that was developed from a previous study. All medications included in this list were assessed for their availability in Portugal. Results A total of 680 patients were included. Of those, 428 (63%) were female with a mean age of 78.4±8.1 years. Four-hundred and four (59.4%) patients were taking medications associated with CCVAEs risk (mean =1.7±1.0 drugs/patient), including 264 patients (38.8%) who used drugs with MACCE risk (mean =1.4±0.8 drugs/patient). Fifty percent of patients with a previous history of CVD (n=521) were taking PIMs with risk of CCVAEs, including 30.0% with risk of MACCE. Conclusion Our findings show that 50% of patients with previous history of CVD were taking drugs with risk of CCAVEs and 30% with risk of MACCE. More tailored tools for the management of drug therapy in elderly patients with CVD are of major importance in clinical practice.
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Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal,
| | - Luís Heitor Costa
- Serviço de Medicina Interna, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal.,Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Hubert Gm Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ana Paula Martins
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal,
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Aguiar JP, Brito AM, Martins AP, Leufkens HGM, Alves da Costa F. Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing. J Clin Pharm Ther 2019; 44:349-360. [DOI: 10.1111/jcpt.12811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/25/2023]
Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia Universidade de Lisboa Lisboa Portugal
| | - Ana Mafalda Brito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM) Instituto Universitário Egas Moniz Caparica Portugal
| | - Ana Paula Martins
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia Universidade de Lisboa Lisboa Portugal
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical PharmacyUtrecht Institute for Pharmaceutical SciencesUtrecht University Utrecht the Netherlands
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM) Instituto Universitário Egas Moniz Caparica Portugal
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Brito AM, Simões AM, Alcobia A, Alves da Costa F. Optimising patient safety using pharmaceutical intervention in domiciliary hospitalization. Int J Clin Pharm 2018; 39:980-984. [PMID: 28840436 DOI: 10.1007/s11096-017-0512-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction The domiciliary hospitalization unit (DHU) is an innovative model of care provision, where hospital care is transferred to the patients' home. However, this shift adds a care transition layer to the process, which may increase the probability of medication errors to occur. Method A pharmacist has been integrated into the DHU team to improve medication use. We developed an observational study documenting his intervention for 6 months. Information about the patient's drug therapy before admission, during hospitalization and after hospital discharge were gathered, enabling comparison of possible discrepancies that may happen during care transitions. The pharmacist evaluated the appropriateness, necessity, effectiveness, and safety of medication and intervened when deemed appropriate. Conclusions Data suggests that a pharmacist involved in the DHU may have a positive impact on medication use. Medication review and reconciliation are examples of pharmaceutical interventions that may lead to increased effectiveness and patient safety.
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Affiliation(s)
- Ana Mafalda Brito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário. Quinta da Granja. Monte da Caparica, 2829-551, Caparica, Portugal.
| | - Ana Margarida Simões
- Hospital Garcia de Orta (HGO), EPE Av. Torrado da Silva, 2801-951, Almada, Portugal
| | - Armando Alcobia
- Hospital Garcia de Orta (HGO), EPE Av. Torrado da Silva, 2801-951, Almada, Portugal
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário. Quinta da Granja. Monte da Caparica, 2829-551, Caparica, Portugal.,Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica, 18, 1169-075, Lisbon, Portugal
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Aguiar JP, Cardoso Borges F, Murteira R, Ramos C, Gouveia E, Passos MJ, Miranda A, da Costa FA. Using a cancer registry to capture signals of adverse events following immune and targeted therapy for melanoma. Int J Clin Pharm 2018; 40:852-861. [PMID: 29860707 DOI: 10.1007/s11096-018-0665-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
Background Toxicity of oncology treatments in real-life patients is frequently disregarded and hence underreported. Objective To characterize adverse events (AEs) of immunotherapy and targeted therapy reported in patients with locally advanced or metastatic melanoma. Setting District Hospital for Cancer treatment (Instituto Português de Oncologia de Lisboa Francisco Gentil). Method A retrospective cohort of melanoma patients was established, comprising adult patients diagnosed with malignant melanoma treated with immunotherapy or targeted therapy. Exposure was characterized by nature, time and intensity of exposure. To account for different exposure periods, person-time was used as unit of analysis. Main outcomes measure Occurrence of AEs. Results Data from 111 patients included in the cohort indicates the majority received immunotherapy regimens (CTLA-4, anti-PD-1 and combination therapy; (n = 70; 63.1%), among which anti-PD-1 were the predominant treatment. Pembrolizumab was the most frequently prescribed drug (n = 30; 45.7%). Three hundred and seventy-one AEs were extracted. The incidence of AEs was lower in the anti-PD-1 mAc group (54 AEs per 1000 person.months) and the number of AEs/patient was also lower (3.1 ± 2.0). Grade 3 to 4 AEs occurred in 15.3% (n = 17) of the cohort, being more common in the targeted therapy group. Forty-two (11.6%) of the extracted AEs were not described in the Summary of Product Characteristics of the drugs under study. Conclusion This study suggests various known and unknown AEs of immunotherapy and targeted therapy may be identified using the Cancer Registry database. These events should be considered as signals worth further investigation for assessment of causality as the underreporting of AEs in cancer may have potential implications for the patient's quality of life.
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Affiliation(s)
- João P Aguiar
- iMED.ULisboa - Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal
| | - Fábio Cardoso Borges
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Rodrigo Murteira
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Catarina Ramos
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Emanuel Gouveia
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Maria José Passos
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Ana Miranda
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal
| | - Filipa Alves da Costa
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisbon, Portugal. .,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal.
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Papastergiou J, Kheir N, Ladova K, Rydant S, De Rango F, Antoniou S, Viola R, Murillo MD, Steurbaut S, da Costa FA. Correction to: Pharmacists' confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm 2018; 40:202. [PMID: 29322471 DOI: 10.1007/s11096-017-0586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the original publication of this article, the article note has been missed and published online.
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Affiliation(s)
- John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M4J 1L2, Canada.,School of Pharmacy, University of Waterloo, 755 Danforth Avenue, Toronto, ON, M4J 1L2, Canada
| | - Nadir Kheir
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Katerina Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05, Hradec Kralove, Czech Republic
| | - Silas Rydant
- Pharmaceutical Care Division (Meduca), Royal Pharmacists Association of Antwerp (KAVA), Lange Leemstraat 187, 2018, Antwerpen, Belgium
| | - Fabio De Rango
- Shoppers Drug Mart 1271, 2501 Third Line, Oakville, ON, L6M 5A9, Canada
| | - Sotiris Antoniou
- Barts Health Centre; Barts Health NHS Trust, London, UK.,UCL Partners, London, UK
| | - Reka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikrautca 8, Szeged, 6724, Hungary
| | - Maria Dolores Murillo
- Farmacia Fernández Vega C.B., C/Par nº 26 Urbanización Club de Golf. Alcalá de Guadaira, Sevilla, 41500, Spain
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology & Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829‑551, Caparica, Portugal. .,Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica, 18, 1169‑075, Lisbon, Portugal.
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Papastergiou J, Kheir N, Ladova K, Rydant S, De Rango F, Antoniou S, Viola R, Murillo MD, Steurbaut S, da Costa FA. Pharmacists' confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm 2017; 39:1282-1290. [PMID: 29139019 PMCID: PMC5694509 DOI: 10.1007/s11096-017-0551-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/21/2017] [Indexed: 02/07/2023]
Abstract
Background Guidelines on the management of orally anticoagulated patients are continuously evolving, leading to an increased need for pharmacists to be fully integrated in care provision. Objective To identify self-reported gaps in confidence among practicing pharmacists in the area of anticoagulation. Setting Pharmacists in different work settings in different countries. Method Cross-sectional international survey from October 2015 till November 2016 among pharmacists working in different settings to assess their level of confidence when delivering anticoagulants as well as to identify possible educational needs regarding this medication class. Validation of the survey was ensured. Results Responses from 4212 pharmacists originating from 18 countries were obtained. Pharmacists' level of confidence was significantly higher (p < 0.001) when advising patients on vitamin K antagonists (VKAs) versus non-vitamin K antagonists (NOACs). In general, hospital pharmacists displayed higher confidence levels compared to community pharmacists when advising patients on anticoagulation (p < 0.001). Two distinct patterns of confidence levels emerged relating to basic and advanced pharmaceutical care. Confidence levels when providing advanced pharmaceutical care were significantly higher for Oceania and lower for South America (p < 0.005). Conclusions Pharmacists felt more confident in supporting patients receiving VKAs compared to the more recently introduced NOACs. With the increasing use of NOACs and the risks pertaining to anticoagulation therapy, it is essential to invest in education for pharmacists to address their knowledge gaps enabling them to confidently support patients receiving oral anticoagulants.
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Affiliation(s)
- John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M4J 1L2, Canada
- School of Pharmacy, University of Waterloo, 755 Danforth Avenue, Toronto, ON, M4J 1L2, Canada
| | - Nadir Kheir
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Katerina Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05, Hradec Kralove, Czech Republic
| | - Silas Rydant
- Pharmaceutical Care Division (Meduca), Royal Pharmacists Association of Antwerp (KAVA), Lange Leemstraat 187, 2018, Antwerpen, Belgium
| | - Fabio De Rango
- Shoppers Drug Mart 1271, 2501 Third Line, Oakville, ON, L6M 5A9, Canada
| | - Sotiris Antoniou
- Barts Health Centre; Barts Health NHS Trust, London, UK
- UCL Partners, London, UK
| | - Reka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikrautca 8, Szeged, 6724, Hungary
| | - Maria Dolores Murillo
- Farmacia Fernández Vega C.B., C/Par nº 26 Urbanización Club de Golf. Alcalá de Guadaira, Sevilla, 41500, Spain
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology& Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal.
- Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica, 18, 1169-075, Lisboa, Portugal.
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Hamedi N, da Costa FA, Horne R, Levitan M, Begley A, Antoniou S. How prepared are pharmacists to support atrial fibrillation patients in adhering to newly prescribed oral anticoagulants? Int J Clin Pharm 2017; 39:1273-1281. [DOI: 10.1007/s11096-017-0529-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
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da Costa FA, Ribeiro MC, Braga S, Carvalho E, Francisco F, Miranda AC, Moreira A, Fallowfield L. Sexual Dysfunction in Breast Cancer Survivors: Cross-Cultural Adaptation of the Sexual Activity Questionnaire for Use in Portugal. ACTA MEDICA PORT 2016; 29:533-541. [PMID: 28060691 DOI: 10.20344/amp.7389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/26/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The increasing survivor population of breast cancer has shifted research and practice interests into the impacts of the disease and treatment in quality of life aspects. The lack of tools available in Portuguese to objectively evaluate sexual function led to the development of this study, which aimed to cross-culturally adapt and validate the Sexual Activity Questionnaire for use in Portugal. MATERIAL AND METHODS The questionnaire was translated and back-translated, refined following face-to-face interviews with seven breast cancer survivors, and then self-administered by a larger sample at baseline and a fortnight later to test validity and reliability. RESULTS Following cognitive debriefing (n = 7), minor changes were made and the Sexual Activity Questionnaire was then tested with 134 breast cancer survivors. A 3-factor structure explained 75.5% of the variance, comprising the Pleasure, Habit and Discomfort scales, all yielding good internal consistency (Cronbach's α > 0.70). Concurrent validity with the FACt-An and the BCPT checklist was good (Spearman's r > 0.65; p-value < 0.001) and reliability acceptable (Cohen's k > 0.444). The Sexual Activity Questionnaire allowed the identification of 23.9% of sexually inactive women, for whom the main reasons were lack of interest or motivation and not having a partner. DISCUSSION Patient-reported outcomes led to a more comprehensive and improved approach to cancer, tackling areas previously abandoned. Future research should focus on the validation of this scale in samples with different characteristics and even in the overall population to enable generalizability of the findings. CONCLUSION The adapted Sexual Activity Questionnaire is a valid tool for assessing sexual function in breast cancer survivors in Portugal.
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Affiliation(s)
- Filipa Alves da Costa
- Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal. Centro de Investigação Interdisciplinar Egas Moniz. Costa da Caparica. Portugal
| | - Manuel Castro Ribeiro
- Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal; Centro de Recursos Naturais e Ambiente. Instituto Superior Técnico. Universidade de Lisboa. Lisboa. Portugal
| | - Sofia Braga
- Serviço de Oncologia Médica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Elisabete Carvalho
- Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Fátima Francisco
- Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Ana Costa Miranda
- Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - António Moreira
- Serviço de Oncologia Médica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal; Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Lesley Fallowfield
- Unit of Psycho Oncology. Sussex Health Outcomes Research & Education in Cancer (SHORE-C). Brighton & Sussex Medical School. University of Sussex. Sussex. United Kingdom
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da Costa FA, Periquito C, Carneiro MC, Oliveira P, Fernandes AI, Cavaco-Silva P. Potentially inappropriate medications in a sample of Portuguese nursing home residents: Does the choice of screening tools matter? Int J Clin Pharm 2016; 38:1103-11. [PMID: 27343120 DOI: 10.1007/s11096-016-0337-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Background Potentially inappropriate medications (PIMs) are often found in high proportion among the elderly population. The STOPP criteria have been suggested to detect more PIMs in European elderly than the Beers criteria. Objective This study aimed to determine the prevalence of PIMs and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents. Setting Four elderly facilities in mainland Portugal Method A descriptive cross-sectional study was used. Elderly polypharmacy patients were included in the study and their medication (registered in patient clinical records) analysed using the Beers (2012 original version and 2008 version adapted to Portugal), STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria. Data were analysed using univariate and bivariate descriptive statistics, considering a confidence interval of 95 %. MAIN OUTCOME MEASURES Prevalence of PIMs and PPOs. Results The sample included 161 individuals, with a mean age of 84.7 years (SD = 6.35), 68.9 % being female. A total of 807 PIMs and 90 PPOs were identified through the application of the three set of criteria. The prevalence of PIMs using the most recent version of the Beers criteria was 85.1 and 42.1 % for independent and dependent of diagnosis, respectively. The Portuguese adaptation of this same tool indicated a lower prevalence of PIMs, 60.3 and 16.7 %, respectively. The prevalence of PIMs using the STOPP criteria was 75.4 %, whilst the prevalence of PPOs, using START, was 42.9 %. There were significant differences in the mean number of PIMs detected depending on the tool used. (p < 0.001). Conclusions The application of the studied criteria in an elderly sample enabled the identification of a notable amount of PIMs and PPOs, indicating there is room for improving the quality of care. The variation in prevalence indicates careful choice of the tool is a prerequisite for engaging in medication review. Using START/STOPP criteria enabled a more holistic approach to the quality of prescribing in the elderly, highlighting low levels of cardiovascular risk prevention and abuse of psychotropic drugs, aside with system failures largely preventable by electronic prescribing and alert generation.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal. .,Epidemiology Department (ROR-Sul), Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. .,Pharmaceutical Society (OF), Rua da Sociedade Farmacêutica 18, 1169-075, Lisboa, Portugal.
| | - Catarina Periquito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Maria Clara Carneiro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Pedro Oliveira
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Ana Isabel Fernandes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Patrícia Cavaco-Silva
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
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da Costa FA, Silvestre L, Periquito C, Carneiro C, Oliveira P, Fernandes AI, Cavaco-Silva P. Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists' Interventions to Improve Safety and Effectiveness of Medicines. Drugs Real World Outcomes 2016; 3:89-97. [PMID: 27747806 PMCID: PMC4819488 DOI: 10.1007/s40801-016-0061-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Currently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities. OBJECTIVES The objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist's intervention. METHODS An exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist's recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes. RESULTS The initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness-DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe-DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness-DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001). CONCLUSION A pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
- Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Rua Professor Lima Basto, 1099–023 Lisboa, Portugal
- ISCSEM, Campus Universitário, Quinta da Granja Monte de Caparica, 2829–511 Caparica, Portugal
| | - Luísa Silvestre
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Catarina Periquito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Clara Carneiro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Pedro Oliveira
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
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da Costa FA, Guerreiro JP, de Melo MN, Miranda ADC, Martins AP, Garçāo J, Madureira B. Effect of reminder cards on compliance with antihypertensive medication. International Journal of Pharmacy Practice 2010. [DOI: 10.1211/ijpp.13.3.0006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
Poor compliance to antihypertensive medications has been identified as a primary cause of uncontrolled blood pressure (BP), with consequent increases in hypertension-related morbidity and mortality. Therefore, any measure known to improve compliance should be encouraged. This study assessed the impact of reminder cards on compliance to antihypertensive therapy.
Method
A field trial was undertaken in pharmacies located in the districts of Lisbon and Porto. Eligible participants comprised those aged 30–74 years, prescribed an angiotensin-converting enzyme inhibitor (ACEI) in monotherapy, and taken on a once-daily regimen. Patients were allocated to control group (CG) or intervention group (IG), the latter being provided with a reminder card, an alarm-type device due to remind the patient of the time to take his medication. Patients were monitored monthly during 3 months for compliance and blood pressure control.
Key findings
Seventy-one patients participated in the study (intervention: 35; control group: 36). Compliance was similar between the groups in the first 2 months of follow-up (97.1% IG vs 94.9% CG at first follow-up and 97.5% IG vs 94.2% CG at second follow-up) and higher in the intervention group at the end of the study (97.3% IG vs 87.3% CG; P = 0.011). There were no mean blood pressure differences between compliant and non-compliant subjects at the end of the study (P value for differences in systolic BP (Psyst) = 0.580; and P value for differences in diastolic BP (Pdlast) = 0.175).
Conclusion
This small-scale study indicates a possible positive impact on patients' compliance resulting from the use of reminder cards. However, this needs confirming in larger scale studies with longer monitoring periods.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - José Pedro Guerreiro
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Magda Nunes de Melo
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Ana da Costa Miranda
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Ana Paula Martins
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - José Garçāo
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Brenda Madureira
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
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Costa FAD, Guerreiro JP, Duggan C. Análisis de la calidad de vida relacionada con la diabetes (ADDQoL) para Portugal: exploración de la validez y la fiabilidad. Pharm Pract (Granada) 2006. [DOI: 10.4321/s1885-642x2006000300004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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